I Asked a Doctor About Jayson Tatum’s Injury. Here’s What It Means for the Celtics.

We've spoke a lot about Jayson Tatum since his injury, so I drafted in an expert to give us a better understanding.

“Will Jayson Tatum be back this season?”

You’ve heard it. I’ve heard it. At this point, it feels like we’ve all answered it at least once per day for the past 10 months.

And it’s always followed by the sequel: Should he come back this season?

The truth is, most of us don’t actually know. We have opinions. Strong ones. But for 99% of us, those opinions are based on fandom and armchair medical analysis.

Over the past few weeks, it’s felt like a Tatum return is getting closer. We’ve all seen the March 1st debate following the NBA’s decision to move the Celtics/Sixers game into a prime time slot.

With that in mind, I thought now would be an ideal time to speak with a medical expert.

Earlier today, I spoke with Dr. Abhinav Gautam of Nuoro Wellness to discuss Tatum’s injury, the risks associated with a potential return, and whether waiting until next season really does provide genuine upside.

Why Gautam, I hear you ask…

“I’ve been fortunate over the last several years to have worked with, you know, some of the top athletes in the world from a variety of different sports,” Gautam said when I asked him to cite his credentials at the top of the interview. “I’m excited now that we have our clinic called Nuoro Wellness, and our main investor there is Todd Boehly: he’s one of the owners of Chelsea Football Club, LA Lakers and the LA Dodgers.”

I thought the best approach would be to start at the very beginning. And in Tatum’s case, that meant asking how beneficial it was to get him into surgery within 24 hours of suffering his torn Achilles.

“The main antagonist or enemy to maximal human performance as it relates to injury is scar tissue formation,” Gautam said. “And the body is this divine intelligent being. It’s this magical system that’s actually capable of self-healing. Now, the problem is that certain types of injuries, the body can’t heal itself in a way that would be, let’s say, regenerative.”

“So then it heals in the only way it knows how to, which is by creating scar tissue. There’s been a trend now in orthopedics where you’re trying to operate on people as quickly as you can to minimize that distortion of anatomy. And minimize the scar tissue that’s forming immediately.”

From my layman’s understand of what Gautam is saying…Operating on Tatum quickly likely limited the amount of scar tissue that would form, and thus, not only sped up the recovery time, but also gave him a better chance of recovering closer to his pre-injury self.

“It’s never going to be 100% back to normal,” Gautam said when explaining the issues with a torn Achilles.

My next aim was to try to ascertain what areas Tatum may still be focusing on in his rehabilitation. We’re not talking about it from a basketball standpoint, but rather a physiological one.

“In terms of sports readiness for the NBA specifically, it’s his multi-directional deceleration to then reacceleration. And then looking at how is his single-leg landing mechanics. Then there’s fatigue-proofing. Because he may be able to do that for three or four reps, but under the bright lights and the pressures of a game, you don’t want him to be fatigued in the fourth quarter. So a simple way of thinking about it is that they’re not going to just be checking for strength, but they’re going to be checking for whether the whole elastic system¹ is back. The data suggests that players typically return 10 to 11 months after surgical repair.”

Interestingly, Gautam touched on something that we’ve also deliberated over in this newsletter for the past few months: the importance of Tatum learning to trust his body. Or, more specifically, the mental hurdles that can come from such a traumatic injury.

“One thing I can tell you, and maybe you’ve had injuries yourself, is whenever you get injured, once you’ve healed and once you’ve been cleared, the biggest component, then I found in taking care of a lot of these men and women, is the psychological component, right? So very difficult to play free if you’re massively concerned about injuring your leg in basketball,” he said.

“Your mind is not going to get in that flow state. And flow state for any of us is when you just zone out, you know, like nothing else matters and you just kind of become completely 1000 % present in whatever it is you’re doing. And it’s hard to be present in anything that you’re doing when you’re in pain or you have doubts about your, your health.”

Unfortunately for Tatum, clearing that mental hurdle will only happen once he’s back on the court. I don’t think it’s something you can work through in practice — not totally, at least. He needs to drive the lane against a fully committed defense. Jostle for a rebound against a physical forward or big. Set or navigate a hard screen.

All of these occur countless times during a game scenario. In practice, the entire team will be aware of his rehab, and they’re not going to want to derail him.

The problem is, derailing is a potential risk. Whenever you’re coming back from injury, there’s always the chance of getting hurt or having complications arise. And of course, those risks become more of a concern if Tatum returns to the rotation too early.

“What are the risks of him returning too early? So that could be a re-rupture, which is rare, but it would obviously be catastrophic,” Gautam said. “There could be persistent tendinopathy, which basically means inflammation or irritation of the tendon from underprepared load tolerance, meaning you kind of come back too soon, and now you’re overexerting yourself, and now the tendon is like inflamed, and now you’ve taken several steps backwards.”

“You can have secondary injuries. So that could be from a hamstring, a hip, a knee, or that could be the other leg. And then also there’s like a potential performance ceiling that’s been reduced, meaning he doesn’t return to the same level that he was because the elasticity hasn’t fully been restored. So basically, like the biggest risk to coming back too early isn’t just the Achilles, but it’s the compensation injuries that happen if the system isn’t ready.”

Let’s be real, though — the Celtics have an elite medical staff. They will be aware of all these potential issues and have likely been structuring Tatum’s rehab to avoid them as best as possible. After all, it isn’t the first Achilles injury in NBA history. Kevin Durant provided a blueprint.

When speaking with Dr. Gautam, I asked about potential Achilles-strengthening work Tatum is doing and could continue to do for the foreseeable future.

“It’s probably a reasonable thought to think that he’s been doing red light therapy on the Achilles. He’s probably been doing maybe even what’s called PEMF, right? Which is pulsed electromagnetic frequency, which basically oscillates magnets on off, on off, on off. And that’s been shown to rapidly or to substantially improve healing from bone fractures to even soft tissue injuries. Because it’s increasing blood flow, it’s increasing the lymphatic flow, it’s increasing cellular nutrition. So it’s... he’s probably doing all these things. Like he’s probably getting therapy multiple times a day, right? Cold plunging…everything, like myofascial scraping².”

We’ve all seen the work Tatum has been putting in — or at least, what he and the team have allowed us to see. But when speaking with Gautam, the enormity of Tatum’s injury really became apparent.

It’s hard to believe there will be an easy answer on when/if he should return this season, especially now we’ve been clued in on the actual risks of coming back too soon.

“The risk of rushing things too soon is not to be understated.”

Still, I’m choosing to trust in Boston’s medical staff, and the experience of those Tatum is surrounded by. I can’t imagine risking a top-5 player in the world by bringing him back too early, even if the Celtics are defying expectations this year.

“Look, he’s in Boston,” Guatam said. “There are a lot of great doctors around there in the Harvard system. I’m sure he’s getting the best care he can. There’s no reason. They’re number two, at least last I looked. I think they’re second in the East. You can say that they’re doing pretty well without him. Obviously, they’d be much better with him, you know, but like if you’re both the organization and the player, like why would you risk returning too soon”

Will Tatum return this season? Probably. Should he? That's not our call, and after speaking with Gautam, it's clearer than ever that we don’t know what we don’t know.

Now, this isn’t me saying he shouldn’t come back. It’s me saying that the medical professionals involved will undoubtedly have the final say, and from there, it’s all about the psychological factors, which is something we can’t speculate on, because we haven’t seen him in action…yet.

1. Dr. Guatam explained the ‘elastic system in detail…

“That elastic load sharing starts at the plantar fascia, which originates under the foot. And then this is going up through the calf and into what’s called the posterior chain. So a way of thinking about this is that the Achilles is the cable, but the fascia is the tensioning system that helps distribute the force and restore the spring.”

2. “Myofascial scraping…So where they’re taking that kind of metal tool, and they’re scraping along that surgical site because they’re trying to smooth out that tissue. I guess to use my napkin… If it’s supposed to look like this, like a flat sheet, you know, but now there’s like crumples in it, it’s going to be less efficient and that distortion in the anatomy it can increase the risk of tearing it again, can make it less strong right less elastic etc.” — Scraping the surgical site to smooth out the soft tissue.