Responses to Comments and Questions on Oden, Roy, and Pryzbilla; Plus Concussions and other injuries

Over the past few days, thousands of people have visited my blog and posted questions or comments. Some of the great questions and comments I have received are from twitter: @zigsports.  All of the comments are appreciated.  Every comment provides me with a learning opportunity.  I am re-posting some of those comments below.

Most of the comments and confusion seems to center around biomechanics or my qualifications to make recommendations.   Please keep in mind that while I use 3D motion capture to conduct a biomechanics assessment, my primary focus is the evaluation of the efficiency of Human Movement or Kinesiology.  The more efficient the movement, the more evenly stress is distributed throughout the body.  As for my experience, a degree in Kinesiology from Western State College of Colorado is the foundation for my methods of working with people. Over the years (18 years of experience working with thousands of “unique” athletes), I have been asked “my opinion” about athlete’s throwing motions, swings, running mechanics, etc..  While on occasion, I have offered my opinion, I prefer to provide my objective interpretation of data rather than offering my subjective opinion.  When I offer an objective interpretation of data, it is much stronger than my opinion.  It’s like asking me to read a tape measure to tell you how far a person traveled versus glancing at the distance and providing a guess.

Earlier this year, an associate of mine who is a medical doctor informed me of a study at the University of California-Davis, which has invalidated the use of goniometers in evaluating joint range of motion.  Medical practitioners (physicians, physician assistants, physical therapists, athletic trainers, chiropractors, and nurse practitioners) use a goniometer to document initial and subsequent range of motion in a joint to evaluate progress.   The reason the study invalidated the use of goniometers is because it showed that practitioners rarely achieved the exact same measurement on the same subject as other practitioners.  This means when that using a subjective tool like a goniometer, 10 out of 10 medical professionals will not measure your knee flexion at 90 degrees using the same goniometer.  So your true progress may be in question.

Consider the evaluations I perform on athletes as a way to document progress with more accuracy a repeatable methodology… A computerized goniometer that can measure joint range of motion while performing any activity, which is repeatable. This is unlike a goniometer which only allows for single joint measurement in a fixed position.

In 2010, i was asked to give my opinion on the throwing mechanics of Mark Sanchez of the New York Jet’s.  In a rare occasion, I did so on this blog and the story was retold in an article by the reporter on his BLOG.  What I wrote was my opinion, no matter how accurate it may or may not have been.   It was still just my opinion based on an evaluation of videos of Sanchez’s in game and practice throwing motions. My experience in comparing and reviewing data and watching human movement have given me an edge in evaluating the potential effects of injuries (known and unknown to the casual observer).

With Greg and his teammates, I interpreted data.  Basically, its like putting down a tape measure and asking 10 people to look at a certain spot on the ground and record the number on the tape measure at that spot indicating the distance from the starting point.  The chances of all 10 people recording the same number are a lot higher than if you ask those same 10 people to guess at how far away from them the spot is from the starting point without using a tape measure.  I am the person who prefers to use the tape measure to validate my opinion or what I thought I saw.

Human movement, especially sports skills, happen way to fast for even the trained eye to see all that is happening, even if you know where to start your review.  Depending upon how significant the abnormality in their motion, the more difficult the visual evaluation becomes to the observer.  Manual evaluations are limited as well.  Primarily, in a manual evaluation, the medical practitioner will palpate (feel around) the injured area feeling for abnormalities.  The thorough examiner may also manually take the injured joint or area through passive range of motion testing.  During both manual evaluations by “expert” medical professionals, time is spent asking the injured person how it feels when they “do this” or “do that”  The injured area may be more or less painful to the person at that point in the position, invalidating the manual assessment.

We’ve all been there, when asked how does it feel?  “Feels fine now doc, is our typical response once the healing process has begun around the symptom. “I feel ready to go” is what we might say as the injured area has significantly healed. Then we get up and limp away.  Where is the accuracy in this if it is the standard evaluation (which I too learned during athletic training classes at Western State)?  Unfortunately, I experienced more of these evaluations due to my participation in sports than I would have wanted as an athlete.

Objective information is the key to preventing injuries and improving performance.    This is not a response to comments from the Portland Trailblazers management.  A response to those comments could come next week.   Thanks for reading.  Here are those comments I told you about earlier. Just a few here and as always, more to come…@zigsports

COMMENT from carrite April 13, 2012 >>Brandon Roy’s “degenerative knees” can be healthy and he could play for 5-10 more years with the proper treatment. I’m reminded of Eric Idle in “The Meaning of Life” obliviously asking about his leg that a tiger has bitten off, “So it will just grow back again, will it?” The only way Brandon Roy is gonna play 5 to 10 more years in the NBA is if one believes in the Magical Meniscus Fairy that brings cartilage to good boys and girls who cross their fingers and believes hard enough…

RESPONSE: zigsports April 16, 2012 That fairy you speak of came to visit me personally in 1997 as a part of my 8th knee surgery and delivered healthy cartilage to my knee which remains intact today nearly 15 years later (After suffering 2 two ACL reconstructions within 12 months and six surgical procedures to remove torn cartilage). A meniscus transplant is another option. However, if corrections are not made to the body to reduce the stress, that meniscus will be damaged as well. So be careful what you wish for my friend. We live in an age where science and medicine provide us with many options.   point of Interest: Brandon may have done damage to the lining of the the bones in his knee which may make him ineligible for the procedure (only a surgeon can determine if he is eligible). However, if he is a candidate, he could play again as I previously stated. But if he does not address his body’s issues which cause him to place stress on the interior of the joint, that procedure may fail.

COMMENT: In general do NBA teams embrace your work? Did you say it’s used in Phoenix? Specifically (because it’s a team I am a fan of), what response if any have you gotten from the Dallas Mavericks to this sort of physical evaluation of players?

In general there is a fear that if we look closely at athletes true physical attributes under the microscope of motion capture, we may do more harm than good. As a result, the industry chooses to ignore it as a whole. Unfortunately, no, the Mavericks have not been significantly exposed to it.   Teams who have been exposed include the New York Knicks (2008 draft pick Danillo Gallinari and a few other players were tested during the 2008 NBA Summer League. Interestingly enough, two days after we gave the results to the Knicks staff indicating excessive stress in Danillo’s back, he suffered a low back injury which affected him most of the 2008-2009 season. He has not been retested.   Yao Ming is another athlete,  I would love to evaluate.  In my opinion, he too should still be playing professional basketball, but I have no idea the extent of damage to his feet and ankles. But I am pretty sure that it is related to imbalances and improper absorption of his body weight from left to right.

COMMENT: What has Joel Przybilla done correctly to get back on the court?

According to his report, Joel actually suffered an injury to the leg we identified as weaker. So his rehab actually forced him to strengthen the leg I indicated he needed to improve. Unfortunately, it was after the injury and subsequent surgery. As a result, he missed time on the court while doing what I suggested (inadvertently). As a result of that rehab, he has been able to come back and continue to play.

In Greg’s case, his patella injury should be considered an overuse injury to his previously healthy leg. But the root cause of his knee problems are more than likely still present as he awaits being healthy enough to be operated on again.  And unfortunately, if the causes are not addressed, another procedure is likely to be required to his knees, left Achilles tendon, or right hip at some point in the future.

I also received a question about my mantra: 100% of all injuries and sports performances are affected by motion…either too much or not enough.

Tej Sahota@boatical   @ZigSports 100% of all injuries are related to motion is a bogus statement. non articulating bone injury? fractures? dislocations?

RESPONSE:  “NEW”  Hi Tej,  non-articulating joints, fractures and dislocations are conditions or injuries caused in the same way as any other injury.  These conditions become present when caused by some activity which places stress on a part of the body causing function of the affected area to fail.

Even a concussion (which is another condition) is related to motion. A concussion occurs when impact causes forces related to the impact unable to properly absorbed and distributed by the body (not just the head) causing movement inside the head whereby the brain itself is displaced impacting the inside of the head. This impact inside the head damages the brain and interrupts normal brain activity, possibly causing minor to severe bruising.  Now this is not the medical definition of a concussion but its meant for the average person to be able to understand what I’m saying  (sometimes we get too complicated).  A football player can get hit in the chest by another player making a tackle.  If the tackled player fails to absorb the force properly a concussion can occur as the head impacts the ground a greater amount of speed and force in a whipping action.  The injury could have occurred in the neck, back, almost anywhere else in the body depending on the direction of the impact and how the energy traveled along the spine when combined with the persons strength and ability to resist the force.  As energy from the impact is absorbed by the body it has to go somewhere.  The better prepared the body, the better force is dissipated throughout the body. A fracture and non-articulating joint may be similar in cause but not exactly the same as a concussion.  Both are caused by something else.  In the cause of a non-articulating joint, it may also be caused an interruption of nerve function as well.

As for a dislocation, this is an injury purely related to motion, strength, and flexibility.  My first surgery was to repair a shoulder dislocation. As a freshman at Oklahoma State University on full athletic scholarship on the track and field team, I dislocated my shoulder playing intramural football. I fumbled a ball, reached out and grabbed it as others piled on, causing the injury.  The shoulder dislocated  31 additional times from September 1987 until I finally had surgery in August of 1988 (I later transferred and graduated with a degree in Kinesiology from Western State College in Gunnison,Colorado).

Today, my shoulder is strong because of the imbalances I’ve learned about and how they affect my body.  Incidentally, the limited range of motion of my left shoulder contributed to a naturally shortened range of motion in my right leg while running. The two sides have to work together for me to be able to hurdle or run period.  It is believed that an injured left shoulder can contribute to acute leg injures on the right leg.  In addition, it may contribute to overuse injuries on the left leg and right low back.  The body is connected!  A toe injury can cause neck pain, not by the injury itself.  The neck pain could be caused by the way we limp after the toe injury.

Are we going to continue to treat the symptoms?  Most importantly are we going to only evaluate the symptoms?  I say NO!  So the next time you’re at the doctor for back pain or some other muscle/joint related issue. Ask more questions.

Want to keep up with the latest in sports and fitness injury prevention plus tips on how to reduce your own personal injury experiences?  Follow me on twitter @zigsports!

Advertisements

6 thoughts on “Responses to Comments and Questions on Oden, Roy, and Pryzbilla; Plus Concussions and other injuries

  1. I can’t wait to see your blog about Derrick Rose’s recent injury, and even Iman Shumpert of the Knicks. Both players rely on athleticism and the world is really shocked right now! Keep it coming! Not many doubters about the “German” technology that athletes, such as Kobe, gets over the summer and that Bynum is planning too as well. If the research and technology is available in order to prevent these type of injuries, I hope you get the attention you deserve and it reduces the amount of injuries someday in the future.

  2. Mr Ziegler, I am a Bulls fan from Chicago and have watched Bulls management/coaching bring Derrick Rose back from injuries too quickly only to see Rose suffer re-injury immediately upon his return. Three times in this month of April alone re-injury (compensatory injury) has occurred.

    You are invited to visit a blog of Bulls fans who are discussing Rose’s numerous injuries this season. http://www.chicagonow.com/chicago-bulls-confidential. Links to your Greg Oden article have been posted here, along with a Sports Illustrated article about Phoenix Suns trainer Aaron Nelson. We would welcome any input or comments you may have.

    • Your request is full-filled. See the latest article on D. Rose. I too am a Bulls fan and have watched silently and unfortunately the inevitable has happened. So sad.

  3. Great stuff. I appreciate the objectivity which you strive to achieve.

    It is sad but not at all surprising that the Portland medical staff laughed off your results. There is simply too much alternative/hoslistic quack voodoo out there, and as a result, physicians such as myself keep the threshold on our bullshit radars quite low. That being said, in my limited opinion, orthopods are likely the most ignorant specialty in terms of embracing an honest and objective, replicable approach to guiding treatment (especially of the back). They are great at stabilizing fractures and other mundane work and if I awake in an emergency room I’d be relieved to see one, but let’s be real– most orthopods would fail any intro college level mechanics/biomechanics class. It’s just not integrated into their training

    • Thank you doc for your honest comment. My simple goal is to add objectivity to our treatment programs. There are way too many opinions and everybody has one. Unfortunately, it’s the patient who suffers. I would never pretend to practice surgery, yet most surgeons quickly in fact, make it a part of their treatment to control the rehab, when they should get out of the way. I did an interesting interview for our show an Ortho in LaJolla, CA who said, his specialty is surgery….Once he sews them up, the rest is up to the PT and Rehab. Very refreshing for him to admit. He does however have a background in motion capture and biomechanics, but knows its not his area of expertise.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s