As Shams Charania of ESPN recently reported, LeBron James is set to miss the opening game of the season for the first time in his storied 23-year career with sciatica.
Coach JJ Reddick has left LeBron’s
timeline open-ended and said “he has his own his own timeline.” Some of that is part and parcel with sciatica and some of that comes with the territory with LeBron injuries as he and his longtime trainer Mike Mancias are extremely in tune with his body and rehabilitation process.
Charania — who shares a very good relationship with James’ representation at Klutch — reported that James will be taking his time with the injury, potentially eyeing the middle of November for his return. Further, Charania reported that the injury occurred in August during basketball-related activities and LeBron had to ramp down significantly since then.
To get a better sense of the injury, let’s take a closer look at what sciatica actually is.
Medically, sciatica is a bit of a catch-all term. I typically use quotations on it because there are so many things that get categorized under the umbrella of “sciatica”. Pain near your back? That’s sciatica. Pain near your hip or butt? Good ole sciatica. Pain down the leg? Must be the sciatica acting up!
The term comes from the sciatic nerve, which emerges from the spine and travels down the leg and has numerous branches along the way.
When the nerve becomes irritated — often due to compression and impingement — it can cause symptoms. True sciatic nerve pain is a burning, stinging, almost electrical-shock-like pain that typifies nerve injuries.
In LeBron’s case, prior to the team stating he was dealing with sciatica, he was said to be dealing with “nerve irritation in the glute” which refers to the gluteal muscles that make up the hip and lower back. Multiple nerves innervate these muscles.
With that information, we know LeBron is likely dealing with irritation that is higher up the chain. If LeBron is truly dealing with sciatic nerve pain and not just a catch-all term, that could be a good sign because typically the worse that sciatic pain gets, the farther it travels down the leg (distal) vs. being closer to the back area (proximal).
The challenging part with nerve pain is that it can be quite erratic and sensitive, which can make it difficult to establish a routine and rehab plan of care that doesn’t aggravate it more. That’s doubly the case when dealing with nerve pain originating in the lower back for elite basketball players like LeBron because the sport involves so much load on the spine, whether that’s twisting, angling, side-bending, bending forward and backward, taking contact and so on.
Mirroring what LeBron has already done, you first have to ramp down activity and then gradually and methodically ramp back up while assessing symptoms on a day-to-day basis and slowly edging into higher intensities. It’s very difficult to put a timeline on that and James is going to be even more conservative and methodical near the start of the season so it doesn’t become something that plagues him for the entire season, which is 100% the right move. I’d fully expect a minutes restriction as he gets back on the court, not only to see how the injury reacts but also to build his fitness.
This is new territory for James in terms of missing the opening games of a season, but it’s yet another physical and mental challenge for a player who has overcome every single one thrown his way thus far. You can trust that LeBron, Mike Mancias and the rest of his team are attacking this like only LeBron can.
Dr. Rajpal Brar, DPT has a doctorate in physical therapy from Northern Arizona University, and runs his own in-person and online sports medicine and performance business, 3CB Performance, in West LA and Valencia, CA and combines his movement expertise and fitness training background to rehab & train elite athletes.
He also works at a hospital — giving him experience with patients in the immediate healthcare setting and neurological patients (post stroke, post brain injury) — and has been practicing for over 5 years. Brar is additionally training at UCLA’s mindful awareness research center (MARC), has a background in youth basketball coaching and analyzes the Lakers from a medical and skills perspective for Silver Screen and Roll and on his own YouTube Channel. You can follow him on Twitter at @3cbPerformance, on Instagram, and on his weekly Substack 3CB Quick HIITS.
