2017 Offseason

On Nikola Pekovic’s Injury History

With Summer League and the exciting portion of free agency behind us, I figured now would be as good a time as any to dive into the injury history of one of Timberwolves’ fans most beloved players: Nikola Pekovic. Pekovic’s history is extensive and complex and I attempt to highlight just that.

Built like the real-world incarnation of the Incredible Hulk with the off-court personality of a happy-go-lucky child, Nikola Pekovic was an utter joy to watch. Though he was never the most skilled big man on the court or even in the NBA, he used his unique physical traits to grind opposing centers into a fine powder in the low post and the offensive boards. His broad shoulders, mountainous muscles, and surprisingly deft feet were often just too much for defenders to contain over the course of the 25-30 minutes Pek (as he was affectionately known by fans and teammates) was on the court.

Though his cartoonish size and features always received the most press during his fleeting time in Minnesota, it was his swift feet that made him not only playable but allowed him to succeed and granted him the ability get through defenders with a dizzying array of post moves.

It was his feet, not just his muscles, that allowed him to go from an unknown late first round draft pick to a capable starter in the NBA.

However, it was those same feet, the feet that were such an unexpected advantage for a man as hulking as he, that ultimately turned out to be his worst enemy.

The injury issues began early during Pekovic’s career and they seemingly never went away. Of the 574 games the Wolves played over his seven-year career, Pekovic missed a whopping 278, or 48.4%. Below is a comprehensive list of his injuries:

Nikola Pekovic Injury History
Year Injury Games Missed
2010-11 Sprained Ankle 13
2010-11 Illness 1
2010-11 Strained Hip 2
2011-12 Strained Adductor 2
2011-12 Sore Foot 2
2011-12 Sore Ankle 1
2011-12 Bone Spurs – Ankle 7
2012-13 Sprained Ankle 3
2012-13 Thigh Contusion 5
2012-13 Abdominal Strain 8
2012-13 Calf Contusion 3
2013-14 Right Ankle Bursitis 28
2014-15 Right Ankle Bursitis Pain 31
2014-15 Right Ankle Pain 11
2014-15 Right Achilles’ Debridement and Repair 9
2015-16 Right Achilles’ Debridement and Repair Cont. 35
2015-16 Right Achilles’ Debridement and Repair Cont. 35
2016-17 Recurring Right Achilles’ Pain 82

Injuries, even one’s that seem straightforward like an ankle sprain, are typically rather complex and rarely can be explained in a simple fashion, particularly those that are more chronic in nature. For example (and to keep the conversation on ankles): why are some players fine when they roll their ankle, while others suffer a grade III anterior talofibular ligament sprain that requires surgery and significant physical rehabilitation? I’m not sure anyone can say with 100% certainty. At a certain point, a certain degree of luck as well as individual variance in body structure come into account. Everybody’s body is constructed slightly differently, so the difference between someone being injury prone or not may come down to something as specific as the genetic code the programs the amount of type one collagen (the substance that ligaments and tendons are primarily comprised of) in the ligaments of their ankle.

However, we can turn our attention to biomechanics and, more specifically, forces, to get an idea of how much stress is placed on the body during activity, which often plays a role injury occurrence.

Biomechanics is simply defined as “the mechanics of biological and especially muscular activity” and is extensively studied in sports medicine professions, such as physical therapy, athletic training, and chiropractics. To make a long, rather complex story short: improper biomechanics during an activity (I’ll use the simple act of jumping straight up and down as an example in a second) can cause increased forces on the body’s joints, which can lead to injury occurrence; if the body is unable to compensate for the forces placed on it, something must give, and that often manifests as a ruptured ligament, tendon, muscle, or bone in an acute injury or degradation of the same structures in injuries that are chronic.

It would be difficult to say with 100% certainty whether or not Pekovic’s injuries (specifically those of his ankle) were caused by poor biomechanics without looking at his medical charts as well as conducting an in-depth biomechanical analysis (both of which I am, obviously, unable to do). But, to get an idea of the sheer amount of force that his ankles experienced during the simple activity of jumping straight up and then landing (like during a rebound or after a shot; the more technical name for this is a ground reaction force), a study conducted by Daniel Cleather and his team and published in the research journal Clinical Biomechanics found that the ankle is subjected to a force 8.9-10 times the person’s body weight during the activities of jumping/landing and cleaning/jerking. To put that into context, with Pekovic weighing in at 307 pounds, according to Basketball Reference, his ankles experienced between 2,732-3,070 pounds of force with every jump and landing. It isn’t difficult to imagine how the simple act of jumping may have taken its toll on Pekovic’s ankles over time.

There is one specific condition that may have contributed to Pekovic’s injury history, though admittedly this is based much more on conjecture: Chronic Ankle Instability. Chronic Ankle Instability is the chronic structural and neurological condition in which the ankle is more susceptible (or perceived as more susceptible by the individual) for inversion ankle sprains. Inversion ankle sprains, the most common type of ankle sprain and of which Pekovic suffered many, are notorious for prolonged symptoms and reoccurrence rate, with some studies suggesting a re-injury rate as high as 80%. Chronic Ankle Instability is relatively common after an acute ankle sprain and for all we know, Pekovic’s first ankle sprain in 2010-11 may not have actually been his first (though there’s really no way to know for sure) meaning it’s not impossible that he already had Chronic Ankle Instability prior to joining the NBA (again, there is some conjecture here, to a level that makes me a little uncomfortable, to be honest).

The key finding of a study conducted by Matthew Hoch and his team is that people who suffer from Chronic Ankle Instability have decreased ankle dorsiflexion range of motion (if you’re sitting, point your toes to the ceiling while keeping your heel on the floor; that action is dorsiflexion). This lack of motion increases the amount of force placed on the ankle, knee, and hip joints during jumping and landing activities, which, as previously noted, was already rather high for Pekovic.

It is also interesting to note that at the end of his career Pekovic suffered from Achilles’ tendon issues, which ultimately lead to his retirement. Near the end of the 2014-15 season, Pekovic underwent an Achilles’ debridement and repair procedure that he never really recovered from (despite appearing in 12 games the next season). According to Arlington Orthopedic Associates, the goal of this surgery, which occurs when less than 50% of the Achilles’ has been damaged, “is to remove the damaged part of the tendon…[and to repair the remaining tendon] with sutures or stitches.” The typical recovery timeline for this type of surgery is in the 9-15 month range.

Achilles’ tendon length contributes to available dorsiflexion range of motion, so it is possible (again, conjecture) that Pekovic’s were “short” and dysfunctional (this is known as tendinosis when it is chronic, but is most often [erroneously] referred to as tendonitis), which may have been a result of and/or a contributing factor to his potential Chronic Ankle Instability. However, there is limited research available in the literature that indicates a direct link between Chronic Ankle Instability and Achilles’ tendinosis.

But what caused his Achilles’ tendinosis? I don’t know if we can say for sure. As previously mentioned, tendinosis injuries are chronic in nature and can arise for a variety of reasons including but not limited to: repetitive use (or “overuse”), muscle strength and/or length imbalances up and/or down the chain, neurological influence, prior injury, etc.

I think you can now appreciate just how complex Pekovic’s extensive injury history is.

In the end, Nikola Pekovic’s body betrayed him, most likely for a variety of reasons, however, nothing can be said for certain. Perhaps that’s why his injury struggles are particularly sad. Pekovic was a talented player and, for all intents and purposes, a great guy, but all we are left to do is guess as to why his ankles fell apart; we (and he) don’t get the…satisfaction?…of being able to point to one specific, career ending injury. It’s all just very unfortunate.

Here’s to Pek being able to find success and live a happy life after basketball. For all he’s been through, he deserves it.

Share this because Rubio would pass this along:
Tagged , , , , ,

2 thoughts on “On Nikola Pekovic’s Injury History

  1. Easy to understand the frustration which PEK must have and must feel. A sport at which he was very good – which he enjoyed – which brought him a hefty income, and betrayed by chronic foot/ankle problems. I had a short 8 week basketball career – a “big” for high school freshman, I rolled an ankle – walked home a mile after practice – couldn’t get up from the supper table, and was on crutches for weeks afterwards. Had I been any good, it would have been sad, but it also ended my football play after one more season. Thankfully it hasn’t bothered for many years since I gave up softball – normal walking/hiking/daily activities are not a problem. Wishing PEK all the best – hope he can still enjoy his hunting/fishing/normal activities.

    1. How these ankle injuries can turn into debilitating, chronic issues is probably a confounding mix of genetics and bad luck, in my opinion. Or maybe I have extremely good luck. Whereas jmndodge is waylaid from one ankle roll (a total bummer), I’ve rolled my ankles at least a hundred times (between pickup games landing on someone else’s foot and finding gopher holes while trail running) without missing more than two or three days. All I’ve ever needed is ice twice a day. It probably helps that I’m closer to 130 pounds than 307, but I’ve also seen people with worse ankle rolls keep going without missing a beat. Seems like a total crapshoot.

Leave a Reply