Coaching an NBA team is a demanding and difficult job, on and off the court. The physical challenges include travel, standing for long periods of time, moving around the court during practice and dodging players on the sidelines. For Mike D'Antoni, the new coach of the Los Angeles Lakers, the degree of difficulty is even greater, since he recently underwent a total knee replacement (arthroplasty).
According to reports, coach D'Antoni had his surgery early in November, a few days before he was hired on November 11th. He was medically cleared to coach on November 12th; however, he didn't stand courtside until the 20th. In the interim, he performed rehab and watched games from the locker room. (Find out how to prevent knee injuries.)
A former player, D'Antoni is of average age for the knee procedure. He also appears to be in generally good health. In a typical setting, this would bode well for his recovery. However, his quick return to a full-time job that is somewhat dangerous puts him in a risky position for his recovery.
During a total knee replacement, part of the quadriceps and the patellar tendon are cut, and the end of the femur and tibia are sawed off. A molded-titanium prosthesis is hammered into the marrow to replace the joint. The patella (kneecap) is replaced as well.
I am over-simplifying it, but the surgery is as rough as it sounds. The surgeon creates controlled fractures to prepare the joint for new parts. Needless to say, it's no fun for the patient.
Most people hold off having this surgery as long as they can. Recovery takes four weeks at best but typically lasts three months. Patients often experience pain, swelling (for up to a year), stiffness, weakness, difficulty walking and a risk of infection or blood clots.
Rehab starts immediately after surgery. Patients actually need assistance to walk on the first day. At the beginning, a walker is recommended and the patient can gradually progress to a cane. Defying the odds, D'Antoni was seen walking on the practice court.
It is of utmost importance for rehab to start early to ensure proper restoration of range of motion. Most doctors recommend using a C.P.M. (continuous passive motion) machine for six to eight hours per day after surgery. This would only be possible for D'Antoni if he had a 30-hour day.
Swelling is always difficult to manage due to the intense nature of this surgery and the structure of the knee joint. It's essential to ice and elevate the knee early on to limit swelling; however, the demands of coaching make this very difficult.
The high risk of blood clots is also a major health concern. Standing on the court and sitting on an airplane only compound the problem. To counter this, many doctors recommend that patients wear compression stockings to increase circulation and prevent clotting. (Learn other ways to reduce inflammation.)
Restoring independence and returning to normal life are the primary goals of rehab. Many people struggle with simple activities like getting out of bed; and if the right leg is affected, driving a car is nearly impossible at first. It seems like Coach D'Antoni has made remarkable progress in this regard. Although standing on the sidelines and walking on the practice court are not the whole story, it's safe to say he is well ahead of the game.
The biggest concern for D'Antoni is his safety during games. Involved in the action on the sideline, a coach is at risk of a collision if he can't move quickly. D'Antoni is doing much of his work from a chair to take some stress off his knee and stay out of harm's way. When asked about his safety, D'Antoni told reporters, "I'm too psyched up and too ready to go. I'll get through this; it's no big deal."
It is no small feat to meld personalities into a team and implement a new system, but to do it so soon after major surgery may be as impressive an achievement as taking the Lakers back to the playoffs.