Unless you are hiding underneath a rock, you are aware that Kobe Bryant suffered an achilles tear. Since this blog post doesn’t hype any product or anyone I realize it will be privately emailed instead of tweeted. I am very disappointed with the media and the responses from different medical professionals. The Lakers this year have been decimated from injuries and much of it is happenstance. What is one going to do to prepare an athlete for a torn labrum by physical contact? Not much. On the other hand, when someone says one can’t do anything about achilles tears I disagree as the research says differently. Some athletes are going to be genetically predisposed to the injury by numerous factors, and it’s up to both medical and performance staff to help guide coaches to make better decisions. I am not criticizing the organization as I don’t have the inside information, but when I hear bad luck I then have to ask what is the role of the performance and medical team? Blow on the dice for good luck? I do believe in randomness, nearly everyone does. How far does randomness go? It’s convenient to say freak injury all the time, but sometimes a strange and weird injury will arise, often from unlikely factors. Instead of lumping all injuries to a convenient pool of bad luck, let’s look at the factors here.
What we do know about achilles tears in the NBA is that they are not a death sentence to one’s career, but they are close to it. Research on it tells us that one person a year looses the achilles lottery and most come back to play less productive. Roughly 40% never come back. Not quite a coin flip but those that come back are shadows of themselves. The achilles is a strong tendon, and I have used it as an indicator of a warm-up because it’s not vascular and it’s my marker when the bird is cooked. Are some athletes more predisposed to achilles problems biomechanically? Yes. Does that render the career doomed? No. The problem is that many factors go into injuries, but to say that they are freak is a lousy term to toss around. Why not rare and multifaceted? Since something is rare, doesn’t mean it’s spontaneous or without a rough etiology. For example some medical algorithms look at anatomical factors, biomechanics, biochemistry, medical imaging, and player load to seek risk. Most of the best medical algorithm development is not inside sports organizations but with online and international betting! When I was in Europe I visited one group that had an entire floor dedicated to servers to manage data for just soccer. Unfortunately the Lakers organization is crippled by the NBA contracts with private coaches and outsourced medical professionals. This is why I would never want to be a strength coach for a professional team.
The dirty secret in the NBA is that many stars have their own guys doing medical and training and teams allow it. Does anyone think this is the ideal situation? Perhaps that is the direction. Just have emergency medicine (trauma) available and have the internal staff do the day to day operations and allow athletes to bring in their own guys and adjust the contracts. Not making the contracts guaranteed and having those that work internally only guaranteed could be a solution. If any tampering is found by another coach the contract is void but it’s bound to happen. This will make physiological monitoring by the team and some of the other collections very similar to spying. Athletes overreaching from a light week could trigger a dashboard to indicate freelancing with a trainer and that would be very messy.
When something like this happens, everybody wants to know why and there’s not always a reason why. If you look at our season, it’s been a nightmare, longtime trainer Gary Vitti said after Lakers practice Saturday. We had a player come in with a surgery, which was Dwight Howard. Then we had Steve Nash break his leg. Then we had Steve Blake have an abdominal surgery. Then we had Jordan Hill with a hip surgery. Then we had Metta (World Peace) with a knee surgery. We also had Dwight with a (torn) labrum in his shoulder. Antawn Jamison will have surgery after the season is over on his wrist. So, when you try to look at the whys, it’s bad luck.
With a list like this, it looks more like a war memorial than an injury list. My response is not to judge the results only, because some randomness occurs so the process is just as important. If one does all the checklists and is prepared to fly and the plane goes down, at least one did all of the known steps to prevent a crash. Some say it’s better to be lucky than good, but I don’t think one can scale luck over time. What can NBA teams do in the future to reduce the challenges. Here are some ideas of what can be done, what should and will be done is another story.
TTG- Tensiomyography typo? Nope. The same company is providing some interesting solutions to analyze joints, not just muscle. I think teams should screen all players during their movement evaluations with TMG and TTG to get baseline. Since changes are not overnight except for super therapy gurus that work magic in minutes, testing two more times during the year shouldn’t be a big deal. The product is Senstension and like TMG, people are starting to talk.
Elastography- Are tendons getting better or worse? Other medical scanning can be done to see thickening or near invasive histological changes in key areas such as the patella tendon, ankle ligaments, and achilles. Coupled with TMG and TTG you can see the slope or decline in materials inside from the current state of leg function and readiness.
Pressure Mapping- With Dr. Butler speaking at the BSMPG are we going to see more teams invest into objective data? I hope so. This is my biggest pet peeve. Therapists are relying on exercises and manual therapy to solve all problems. While I think manual therapy and exercises help restore function, proper shoe selection and micro adjustments to insole is highly needed. Millimeters. Some will point out that orthotics don’t work with everyone. They are right. Some will say that pressure mapping doesn’t cure everyone. I complete agree. My argument is how is one evaluating the effectiveness of treatment? Do whatever works, but lack of pain because they are shooting up or popping pills is not evidence of proprioceptive exercises and the cuboid adjustments everyone is doing. Did the Black Snake Heel Whip help the Black Mamba after his ankle sprain earlier?
If one is doing all of the above and something still happens, at least one exhausted their resources and known available approaches. It’s better to know that you addressed it rather than just blowing on the dice and hoping it doesn’t happen to you. At the professional level an injury like this will destroy a team, and one should at least invest into options that are know to help. The NBA culture is hard and we have players rapping about ice tea at KFC on youtube, bringing guns to clubs, and passing out on planes and arriving in the wrong city. Time will tell what happens in the future.