[Woj] Howard to get second opinion on knee, could miss extended time

Interesting take. In others words, unless someone is being deceptive here, the MRI showed "only" edema, but no structural damage which would most likely result in season ending knee surgery. If that is the case, is the infamous bone on bone fiction more than fact?

I am getting optimistic here, but at the same time, I do not have to be driving with blinders on.

 

Dwight Howard needs this he needs to rest well. I hope he rest until March because that is where the Rockets really need him the most.

 

Doesn't 2nd opinion usually mean that the first one was a surgery?

I just hope he's ready by the playoffs, he can rest 'till April, if he needs to

 

thanks . can you work for the rockets

 

Thanks for the insight, best of luck on match.

Also, what is your top choice atm?

 

One of the reasons the Rockets did better than expected when Howard was out earlier, is that, this season, Harden's jump in both defense and offense, made him the pivot around which the team rotates.

A second opinion is usually a euphemism for "looking for different (more hopeful) options/alternatives." The first episode of extended knee issues for Howard, was when we began to realize there was more going on. Once he used the phrase "bone on bone," everyone's ears should have perked up. It was also the way he said it, in a soft, quiet voice. If you listen to his voice when he speaks about the knee since then, it is always with a sort of tentative, unsureness, in his voice -- almost an apprehension of a possible worst. I'm not saying the sky is falling, but the further along this goes, the more it seems to confirm that he realized he had a real nagging knee issue that he learned, at some point in the diagnosis, was bone on bone. That isn't a trivial statement or realization. What I don't understand is how the condition wasn't already well characterized from the first episode, when detailed diagnostics were done. If it can be easily managed, as some sports therapists say, the management should have been ongoing since then, with due attention to limited minutes when needed, etc. Howard supposedly worked on strengthening the thigh muscles, etc. to help keep the knee in better position to withstand the rigors of jumping up and down on it, in his comeback after that diagnosis.

It does present a pause for reflection because of the timing, with the trade deadline approaching. That limited window will more than anything, force an assessment of the status of Howard's injury. The mention of Asik might seem hopeful on first thought, but not really on second. It would be no different that when he was here before. Unless he had the starting job for good, he would end up wanting to be somewhere else again. Plus, he definitely is not the second option offensively. With the way the Rockets have played this season, even Howard couldn't be labeled a firm second option.

I don't think the Rockets should look to trade for a center before the deadline, or look to sign someone not currently playing. Who is there to replace the defensive presence of Howard (when healthy)? Asik? As good as he is, he doesn't have the speed of Howard. Others here might be able to suggest someone serviceable, but then, we do, now, have some pretty good shot blockers -- not necessarily true rim protectors, as in "Howard," but shot-blockers, nonetheless. Not to mention the fact of needing, to then, integrate a new player into the rotation, see how well he works within the offense, make any necessary adjustments to accommodate the change, and possibly alter positives they have worked to develop. The Rockets have had so many rotations this season. They are just now beginning to settle on rotations that don't have big letdowns offensively or defensively. Do they want to chance going backwards in the depth chart? I would never say never, though. Sometimes rabbits can seem to be pulled out of hats.

The recollection of Hayes gives some hope that it is possible to compete without an elite center. It could be argued, this year in particular, the offense of Harden has dictated, more than anything, the flow of the offense. Passing into the post, assuming a dominating center, isn't necessarily more effective in getting open shots for other teammates than the alternative of a perimeter player who demands a double-team. When the post gets double-teamed, it packs the paint; when the perimeter gets double-teamed, it helps alter the spacing in the paint. Then, proper cutting/passing offers opportunities for scoring. Just don't make the silly, dumb passes that the Rockets sometimes do.

There are at least 3 players now -- Brewer, Smith, and Ariza -- who can be used to advantage this way. Smith can be posted, but can also cut to the basket well from the perimeter. All could improve a bit on finishing at the rim. The reverse, where Harden is the cutter has been a good way to attack the defenses against him. D-Mo is still the best choice for trying to score on a pass into the post. And his defense is quite good. Not the same as a Howard, but good.

It may seem counter-intuitive to start Dorsey in Howard's absence, but as mentioned, the offense, as currently running (and quite effectively against most teams), doesn't depend on scoring from the post in the same way. When scoring is wanted from the post, D-Mo is good and Smith is getting more comfortable. When Howard is the center, his resume applies a certain pressure to make sure he gets his touches. Utilizing D-Mo is more for balance; like a running game in football. A subtle difference. It is true that teams will not feel a need to defense Dorsey as a post threat, off a pass from the perimeter, but he has been fairly serviceable on passes from a cutting teammate going to the basket. And he tends to dunk in that situation. His "analytics" were enough for Morey to give him a 2-year contract. That wasn't just a whimsical act. Starting Capela would be whimsical... or forced.

I suppose it is possible that he was considered unlikely to play extended minutes, but still... 2 years? Morey has made mistakes and admitted them; i.e., "... let everyone down defensively." But, so far, Dorsey's play has been solid within the context of what is expected of him. He is solid at rebounding, and has kept key possessions alive in recent games. The biggest concern is his tendency to get into foul trouble. Being so thin at the position, he really needs to work on that. Of course, D-Mo can get into foul trouble easily, too. They both need to be keenly aware of their importance of not getting fouls so early. The rotation then gets constricted.

I think we all hope for the best scenario; that Howard's knee can recover with rest and be managed with measured minutes and that he will be available for play sooner rather than later -- for sure come playoff time. But in case that doesn't work out, with the return of Jones, the current rotation may end up being the best scenario under the circumstances -- AND the given of everyone playing the role that is expected of them, 100%, when on the floor.

 

I think you may not have been following this very closely. We already knew he's been in pain, since Nov, possibly even pre season. If he had been fine all this time and just had discomfort and edema recently, then it's much easier to expect a quick turnaround, but a knee injury that hasn't healed in 3-4 months?

The odd part is that they let him play so much. The staff could have screwed up, but Dwight could have also not been very upfront with them and tried to suck it up. I'm leaning towards the latter.

 

Sounds like you know your stuff. If this is the case, sounds like it's not terrible. We can definitely manage without Dwight for that long. Heck...we even thrived without him for a month earlier this season.

 

Where is Dalehbert or whatever his name was. You know, the center that "occasionally" played for the Rockets. He can be good when he wants to.

 

So is an MRI a reliable tool to detect if he is, in fact, bone on bone in the knee? How visible is cartilage in the joint when looking at an MRI?

 

Due to Hippa rules, we will never get to see the actual MRI radiologist report, let alone MRI images. It would definitely relieve (or not) a lot of the anxiety here, because no reputable medical professional would suggest surgical intervention without structural damage. Unless I am wrong by a mile, edema is just superficial fluid accumulation that results in swelling of a body part.

The clearest and fairly common example of edema is calf edema, seen in the elderly and obese population. Calf edema is superficial and likely caused due to venous in suffice (valves do not close properly).

I hope that is the case with Dwight, but without seen the actual report, we can't be sure.

 

Dave, I am not an MRI guy, but I know a lot about ultrasound. My limited understanding is that unless the MRI images are inconclusive, it is one of the best modalities to see structural damages. On a world athlete like Howard, it should be clear as the day if there is any cartilage left.

 

Great post! Thanks!!!

 

It would be hysterical, though, with random CF medical experts pointing at things in the MRI image and screaming that the sky is falling. :grin:

 

Edit edit edit. Urgh....

 

It was completely inaccurate in my case. However, the "cartilage" I had was from microfracture surgery and I guess it doesn't show up well on MRIs. MRIs are not a perfect imaging tool, but they are helpful. The best way to figure out what is going on is thru an incision and scoping the knee so the doctor can actually see the joint.

 

Haha... I know, but wouldn't you be more relieved if edema was essentially the only significant abnormality shown on that report? I know I would. Then the second question would be what caused knee edema in the first place?

 

I quoted you by accident. I meant to quote The Rock MVP...but I appreciate the answer. repped

 

Agreed. My hope is that his knee simply has the same healing powers are Omer Asik's leg when Omer wants to be traded. Maybe Dwight banged knees and never 100% rested it so it has never healed.

Remember the birthday video with Dwight running from Cisco at full sprint through the halls of Toyota Center? It didn't look like something a guy who is supposed to be resting his knee should be doing.

I'm grasping here.

 

Unless Dwight goes and pulls an Arian Foster on us, that is. My uneducated guess is that the Rockets staff are saying, "Whelp, you've got some fluid in there. Nothing is torn, and we don't know why the fluid hasn't gone away yet." Which is the reason why they're obtaining a second opinion now. Anytime something doesn't get better, you want to get a second opinion just as a reflex. Doesn't matter what the first doctor said.