153841688 Nowitzki Misses Game Trying To Avoid Surgery

Dallas Mavericks forward Dirk Nowitzki watches his teammates during the NBA friendly basketball match against FC Barcelona Regal on October 9, 2012 at the Palau Sant Jordi in Barcelona. (credit: JOSEP LAGO/AFP/Getty Images)

DALLAS (CBSDFW.COM) – “I’m doing everything I can to avoid surgery,”  Dirk Nowitzki announced late Monday after sitting out the Dallas Mavericks’ preseason home-opening win over Houston. “I guess that’s obvious that I really don’t want it done now.”

Dirk’s desire to not miss games is admirable, though some wisdom – and continued swelling in the knee – suggests he is delaying the inevitable.

Dirk Nowitzki declined to speak before the 123-104 preseason victory and declined to play in the game as well. Why? That troublesome swelling has returned to his right knee.

“I’m doing everything I can not to have surgery,” Nowitzki said, stressing his wish to be “conservative.” “I guess that’s obvious that I really don’t want it done now. If I want to do it, I would love to do it after the season, get through the season somehow.”

Frankly, though, this is the second Dallas Mavericks training camp in a row Dirk’s endured a sore right knee. Last year — maybe in part due to Nowitzki not coming into camp in prime shape — it took nearly two months to get fully healthy.

After openly discussing how great his legs felt entering training camp, it is a bit surprising to see Nowitzki miss a second preseason exhibition with a knee issue. The team is calling the injury a “right knee effusion,” meaning an abnormal amount of fluid has surrounded the joint.

Part of Dirk’s greatness has always been his durability. … and that is illustrated in his desire to avoid missing games even now. He has been able to overcome numerous ankle sprains throughout his career but it’s the occasional knee injury that has cost him the most games. The most infamous knee injury likely came during the 2003 Western Conference Finals against the Spurs.

Nowitzki suffered a sprained left knee in Game 3 and would not play again in the series. He managed to avoid any other problems until the championship season of 2010-2011 when he sprained his right knee during a December game against the Thunder. He would go on to miss nine consecutive games before returning to the lineup. The knee held up for the remainder of the season and throughout Dallas’s playoff run.

However, after a lockout extended summer and a rushed training camp, the right knee flared up just one month into season. He took time off, missing four games, as he got the swelling under control and reconditioned his body.

But now this.

Dirk and the team have two options at this point, conservative treatment or surgery.

Let’s start with some good news. The conservative approach has worked in the past for Nowitzki,  and it could once again. His previous successes are the result of multiple factors, largely Nowitzki’s commitment to conditioning and the Casey Smith-led Mavs medical staff. It is likely that the hours Nowitzki put in at the gym, performing all the unusual exercises concocted by Holger Geschwindner have increased his flexibility and strength, decreasing his inherent injury risk while preparing his 7-foot frame for the grind of an NBA season. Nowitzki entered the season with improved strength in his legs that should give him an edge in recovery from this particular flare-up.

Furthermore, Smith will be able to aid Nowitzki with state-of-the-art treatment and an educated eye for biomechanics. As DallasBasketball.com’s Jeff Stotts (himself a certified trainer) points out, Smith holds multiple certification from the National Academy of Sports Medicine that are designed to help assess things like muscle imbalances or muscle deficiencies that may be contributing to the problem. If the root of the problem is not internal, Smith and his staff can isolate the issue and work with Nowitzki to correct it.

Minor arthroscopic knee surgery is generally warranted when small pieces of cartilage, tissue, or meniscus are the cause of the chronic swelling and the only way to guarantee the problem subsides is removal. In the procedure tiny incisions are made in the knee to allow surgical instruments, roughly the size of a pencil, into the area to examine and clean up the structures of the knee.

Recovery from the procedure would depend on the extent of the damage in the knee. If nothing is found, a patient can return in a week. Generally, the procedure requires between four to six weeks of recovery.
“I guess a normal guy would be three to six weeks,” Nowitzki said. “I’m usually a fast-recover guy, but you never know.”

There are worst-case scenarios, one doctor tells us tonight, where damage that was never revealed in an MRI shows up during the scope … but that is viewed as highly unlikely.

“The swelling came back three or four times now,” Dirk reported Monday. “That’s obviously not good news. If it’s going to keep swelling up on me, then that’s obviously not the way to go through an 82-game season and hopefully a long playoff run.”

And so Nowitzki waits a little longer and hopes a little more … with rest and ice, and time in the pool and on the eliptical machine … and a desire to delay the seemingly inevitable.

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