Fantasy Basketball: Injury updates on Al Horford, Kristaps Porzingis, and Kawhi Leonard

Jeff Stotts runs, focusing on sports injuries. He will provide short- and long-term updates on various injuries around the league.   

Al Horford (concussion)

The Celtics' big man was on a roll before a concussion sent him to the sidelines. He did not play in Boston's win over the Lakers on Wednesday and will have to progress through the league's mandated concussion protocol, a multi-step procedure in which the injured individual must complete a series of assessments.

The first step requires a player to be completely symptom-free at rest. Symptoms associated with concussions can vary but often include headache, nausea, and sensitivity to light. Once the symptoms have dissipated, the injured player must pass a neurocognitive test, most likely the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test.

The test is carried out a computer and analyzes the individual's current status through an assortment of neuropsychological tests, including memory recall, shape and color recognition, and matching. The results are then compared to a set of baseline data gathered on each athlete prior to the start of the season. The affected athlete must have their ImPACT scores return to their initial baseline numbers before progressing to the next phase of the protocol.

Next, an athlete must remain symptom free following a gradual increase of activity. The progression starts with a simple exercise like riding a stationary bike before advancing to basketball-related activities and ultimately non-contact team drills.

Once the player has completed these steps, Dr. Jeffrey Kutcher, the Director of the NBA's Concussion Program, will be contacted to provide the final clearance for return to play. The time needed to complete the process varies from player to player.

Horford has history working against him, as this isn't his first concussion. The former-All-Star missed nine games during his first season in Boston with a concussion. This prior injury presents a problem because the effects of concussions are cumulative, meaning Horford is more likely to exhibit more significant and longer-lasting symptoms. Fantasy owners waiting for Horford's return will simply have to remain patient and monitor his progress throughout the protocol. He has been upgraded to questionable for Friday's game, so there are definitely some positive signs here.

Kristaps Porzingis

The Unicorn missed his first game of the season recently with two different ailments. One of the injuries, a sprained left ankle, appears mild and shouldn't have any long-lasting effects. However his other problem, bursitis in his right elbow, has a chance a lingering throughout the season.

Bursa are fluid-filled sacs located throughout the body that act like ball bearings in the body, reducing friction within joints. They are commonly found between bone and muscle tissue. Bursa sacs are vulnerable to injury following a direct blow, especially in the elbow and knee. Following impact, the bursa can swell leading to pain and functional limitation. In some extreme cases the sac can rupture, causing the synovial fluid inside to leak out. These areas are infrequently drained unless the swelling is significant or an infection develops. Instead, treatment generally consists of anti-inflammatory medication, compression, and other modalities like ice and ultrasound.

Porzingis has already admitted the bursitis is a chronic condition and suggested he will address the problem directly in the offseason. For now, it appears he will attempt to play through the associated symptoms and potentially protect the area with additional padding. The fantasy-friendly big man is simply too good to bench, but understand he comes with an elevated level of injury risk.

Kevin Durant

The Finals MVP missed Golden State's win over Minnesota earlier in the week with a left thigh contusion. While a bruised thigh doesn't sound particularly serious, damage to the one of the muscles of the quadriceps muscle group can be very painful and limiting. Furthermore, some thigh contusions can develop into a more serious condition known as myositis ossificans. If a player rushes back to the court or receives improper treatment, tiny, bone-like calcifications may develop within the damaged tissue of the muscle. Durant should be fine moving forward but it wouldn't be surprising if he misses another game or two.

LeBron James

James has been on a tear to start the year despite lingering soreness in his left ankle. He initially sprained the joint in the early days of training camp and missed a majority of Cleveland's preseason action. He tweaked the ankle in a loss to the Rockets Thursday as well, but expects to play in the Cavaliers' next contest. James has become synonymous with sustained health and it's not by accident. His workout and approach to healthy living is well-documented. His hard work is evident in his total minutes played for the past eight seasons. However, this doesn't mean James is immune to injury. He's sprained ankles, strained his lower back and calf, and battled several mild illnesses along the way. Still, James' continued dedication to his body has allowed him to miss minimal time and fantasy owners should expect the former MVP to remain a top fantasy option.

Kawhi Leonard

The Spurs' All-Star forward continues to progress at a slow pace and is expected to miss a few more weeks. Leonard is battling a lingering quadriceps tendinopathy and has not responded to treatment as well as the team had hoped.  He is making improvements but the issue is moving slower than anticipated. Leonard's injury is a chronic condition that needs substantial time to appropriately address.  Fantasy owners who invested in Leonard are understandably frustrated, but keep in mind that games missed up front should help ensure his long-term health. Ideally, Leonard would be back in late-November and remain available for the remainder of the season.

Jayson Tatum

The rookie did not play in the second half of Boston's win over the Lakers due to soreness in his right ankle. Imaging performed on the joint failed to uncover any significant bone or ligaments damage, but Tatum remains questionable for the team's next outing. The results of the evaluation are encouraging, but it's important to remember that soreness is a symptom of an underlying issue. Until the root of the problem is addressed, look for Tatum to remain limited. Look for Jaylen Brown, Marcus Morris, and Marcus Smart to see extended action if Tatum is unable to suit up.

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