An early look on what DeMarcus Cousins’ recovery could entail

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Just like he did nearly 15 months ago, DeMarcus Cousins presumably feels frustrated and anxious for three different reasons.

He suffered yet another injury that will likely wipe out his hopes to enjoy an entire NBA postseason for the first time in his career. He faces another potentially lengthy rehab. And he enters a possibly depressed free agency market amid questions marks about his durability.

Good news for Cousins: he did not aggravate the surgically repaired left Achilles tendon that had sidelined him for nearly a year. Bad news for Cousins: the Warriors diagnosed him with a torn left quadriceps muscle. That makes it “unlikely” Cousins will return for the Warriors’ presumably long playoff run, according to a league source.

“It’s so easy to reinjure this kind of injury if you come back too soon,” said Dr. James Gladstone, the Chief of Sports Medicine at The Mount Sinai Health System. “So I would imagine they would be pretty careful about it. I’m pretty sure they would put him through the routine before they send him back onto the court.”

Gladstone said those words without having access to Cousins’ medical records. Dr. Rick Celebrini, the Warriors’ director of sports medicine and performance, has consulted with Cousins after taking an MRI on Tuesday morning.  Gladstone has experience, however, with handling quadricep injuries with patients. So does Dr. Taylor Dunphy, an orthopedic surgeon and sports medicine specialist with Hoag Orthopedic Institute in Irvine Ca.

The Warriors did not outline the specific severity of Cousins’ quadricep muscle injury. But he suffered at least a Grade 2 tear since a Grade 1 is considered a mild strain. Dunphy said it generally takes at least six weeks to recover from a Grade 2 tear, as opposed to two weeks with a Grade 1 strain.

According to that timeline, it is technically possible Cousins could return shortly during part of the Warriors’ presumed appearance in the NBA Finals. That begins on May 30, which is about six weeks from now. The Finals will end as late as June 16. Gladstone added, though, a recovery can take as long as three months depending on the level of pain.

Either way, Cousins could have experienced a much more severe injury. Last season, Kawhi Leonard missed all but nine games with the San Antonio Spurs last season because of right quadriceps tendinopathy, which is the weakening of a tendon that leads to a rupture. Since Cousins has a tear in his quadricep muscle as opposed to a tendon, he is not expected to have surgery.

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Cousins tore his left quadriceps muscle with only 8:09 left in the first quarter of the Warriors’ eventual Game 2 loss to the Clippers on Monday that tied the first-round series, 1-1. Cousins chased a looseball after deflecting a pass from Clippers forward Danilo Gallinari. As he picked up the ball, Cousins’ left leg buckled. After falling to the ground, Cousins grabbed his left thigh immediately.

After standing up on his own, Cousins rejected offers for help off the court. Instead, Cousins limped to the locker room. That marked the end of an incomplete playoff appearance that entailed two points and two reobunds through four minutes in Game 2 He had hoped to rectify his Game 1 performance in which he had nine points on only 4-of-12 shooting and six fouls.

Naturally, that only sparks questions on if Cousins’ non-contact injury relates to his surgically repaired left Achilles tendon. Medical experts said that players can become vulnerable to the so-called “kinetic chain” in which another body part overcompensates.

Dunphy dismissed that concern as “speculation.” Cousins returned in just under a year, which falls in line with a conservative timetable for most injuries. The Warriors considered it important for Cousins not to accelerate his rehab for two reasons. The Warriors had already won two consecutive NBA titles with four All-Stars in Stephen Curry, Kevin Durant, Klay Thompson and Draymond Green. The Warriors wanted to maximize Cousins’ odds for a full and productive recovery.

“If recovered fully and rehabbed fully, it’s not often related,” Gladstone said. “If your mechanics are off, it’s a whole different story.”

Nonetheless, Cousins faces another rehab with uncertainty ahead. The Warriors said that Cousins “will begin rehabilitation immediately.” They did not offer details on what that recovery entails. Typically, Dunphy and Gladstone said physical therapy on a torn quadriceps muscles involves a combination of icing, entails icing, stretching, muscle tissue treatment and strengthening exercises. Those could include squats, leg presses, pool work or running on a weight-bearing treadmill.

Dunphy added some patients take a platelet-rich-plasma injection (PRP), which is a non-invasive procedure that involves drawing the patient’s blood, spinning it into a centrifuge and reinjecting it into the affected area. It is not immediately clear if Cousins to undergo that procedure.

Regardless, Cousins encounters yet another lengthy recovery, leading to questions on if he can maintain status as one of the NBA’s elite centers.

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