Working with Pro Athletes is Not Enough to Make You an Expert; Yet Another Surgery for Brandon Roy!

Was his career really over? With chronic knee pain and seven surgeries later, Brandon Roy is still fighting for his playing career. (Wire image)

To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.

Brandon Roy was once regarded as one of the most prolific guards in the NBA.  With excellent lateral explosiveness and sleek moves to the basket, the All-Star guard was poised to go down as one of the greatest in NBA history.  Just before the start of the 2011 NBA season, Brandon Roy announced his retirement from playing professional basketball.

Unfortunately, Brandon Roy has been a victim of the system. The system is present in basketball, football, and baseball, and all sports at the professional and youth levels. The system is a part of a culture that we have seen all to often shorten or ruin the careers of some of sports greatest athletes.  Many athletes go on to to achieve success in spite of this system and culture.

The system and culture I am referring to is related to the treatment and care of athletes, and most importantly in Brandon’s case, care of sports or athletic injuries.  In the world of sports, injured athletes are viewed as unable to help the team and often times a distraction.  Many coaches, knowingly and unknowingly, relegate the mental state of injured players to the bottom of the depth chart as well as their bodies once an athlete is injured.  Some athletes are so dedicated to their return that they will push themselves hard to get back on the court or the field even when their bodies show signs that they are not ready.  Brandon Roy is one of those athletes who will do whatever it takes to get back on the court.

Beset with chronic injuries to his left knee, Brandon wore one knee brace or sleeve while playing in Portland. (Getty images)

Some successful athletes seek advice outside of their immediate medical team. After seven surgical procedures, Brandon Roy did just that and all I can say is… Good for Brandon!  Public perception is that if a medical group, team of doctors, physical therapists, athletic trainer works with a professional sports team they must be the best. If a pro team trust multimillion dollar athletes with a medical expert, the average person believes that medical group must be good enough for them.  Unfortunately, that’s just not true.  In today’s world, some professional teams hire based on cost.  Others hire or obtain a team based upon a close personal relationship. The buddy system is always at play especially in America.

In 1994, I sat in one of my graduate school classes at the University of Northern Colorado wondering what was the next step I would take towards achieving my goals.  After a few weeks of contemplating my future I sat down with my grad school adviser, Dr. David Stotlar. A well respected administrator around the country in sports, Dr. Stotlar served as one of the pioneers in the emerging field of Sports Marketing. The UNC program was one of only five universities in the country at the time offering a Master’s degree in the field of Sports Marketing and Administration.  I asked the following question:

What happens in the interview process for a job with a professional sports team after I complete my master’s, if I am down to one of the final two candidates for a job? There I would sit with a Master’s Degree in Sports Business, a Degree in Kinesiology, and experience as a former athlete.  Candidate number two, happens to be the workout or drinking buddy of the General Manager’s son and also plays golf periodically with the decision maker.  I asked, “Who would get the job?”  Dr. Stotlar replied, “Well Zig, unfortunately for you, the job is likely to go to the buddy of the GM’s son. ”

At that point I set out to work on relationships and building a reputation of doing quality work. My efforts lead to friendships with numerous professional athletes including Charles Barkley, Michael Jordan and many others.  i worked hard to open the doors to numerous opportunities in professional sports. I’ve been blessed to have been able to work with some of the greatest athletes in the world.  But that alone does not make even me anymore of an expert than the recent college graduate. What makes any person better in their field and in life is their experiences and how they learn from them.  Working with some of the greatest athletes in the world in multiple sports has forced me to think outside of the box and evaluate each athlete and their goals or conditions on an individual basis, regardless of whether or not they played the same sport or suffered the same injuries as others with who I had worked.

All too often that happens today, especially in professional sports. After all, just take a simple look at how often coaches are recycled from team to team.  NBA coaches move from one team to another. When a head coach gets a new job, he brings in his entire staff of good friends, brothers, and associates whom they trust.  A coach can bring in their entire system to their new team.  Assistant coaches, strength coaches, even athletic trainers sometimes change jobs based on the buddy system  Once in the system, the less effective at their jobs begin to work the system to ensure their longetivity in the event the coach who brought them in moves on.  If a staff has been there for a while even through poor job performance something else is keeping them on staff. Most of the time, that something is relationships.

The bad news is for the new team is that If a coach’s entire system didn’t work in one program, its not likely to work in another  The smart members of that new staff recognize the writing on the wall from the last job and start working relationships the moment they walk in the door.  The culture of professional basketball is unlike any other professional sport.  In football, coaches bring in experts and specialists on offense and pair them with experts on defense and other areas crucial to the entire team’s success.  In basketball, an offensive guru, often gets a job and fills crucial coaching roster spots with more offensive gurus to help implement their system. Professional sports team positions are filled with coaches and administrators who were fired as a group from one place and move as a group to coach a whole new team.  Coach’s mistakenly bring all the problems they had in one organization over to their new teams. Why do they do this?  Loyalty, comfort, and control.

Professional sports are highly political and and a close fraternity. Once you are in, you could be in for life. Even if you are not the best in your field. Once you are out of the system you may be out temporarily or permanently depending upon your persistence and actual value to a team or player.  You can be kicked out of the fraternity sometimes based on the simple fact that you challenged the system, even if you are one of the best at what you do. This is the buddy system at its finest.  Unfortunately, this buddy system isn’t just happening with coaches on the bench, it happens with experts who care for the athletes.

And that is not the best way to determine the best care for multimillion dollar athletes.

Sometimes a handshake is all it takes to become a part of any professional or collegiate sports medicine or strenght and conditioning teams. Others pay for the rights (sponsorships) or accept less pay for treating players. Any money not paid for services is made up by the publicity from the association with a professional team.

It’s definitely not the best way to provide care for youth athletes. This buddy system affects youth sports too, as parents race their kids to the lines building in the offices of the team doctors for professional and collegiate sports teams in their area.  Often, you hear parents boast about getting their kid in to the see the team doctor for XXXX professional or collegiate teams.

Often times, they boast right after their 14 year old has completed an unnecessary surgical procedure when all they might have needed was rest and proper body development.  they won’t even know this procedure was unnecessary for years to come.  This trickle down affect is causing many youth athletes to now begin to suffer repeat injuries. This system is broken and won’t be fixed until athletes take control of their own medical care.

An athlete with repeat injuries is often labeled negatively as injury prone or high risk.  Once an athlete is labeled as have high risk of injury or injury prone, they can be blackballed or see their career placed in jeopardy as a result of what has nothing to do with them as a person.  Injuries to a player like Brandon Roy are not treated them same. And this credit can be given solely to Brandon himself.  He is given the benefit of the doubt and ample consideration because of his talent and excellent character.  Brandon Roy is a great person.  As a result of his character and personality, people root for him.  I root for Brandon Roy, Greg Oden, Derrick Rose, and even Kobe Bryant (I’m a Bull’s fan remember) especially when it comes to their health. Every player deserve a better healthcare system.  A system where they can have open access to the best health care available and believe or not, they currently do not.  Some programs obviously get better care than others as they hire medical staffs that are on the cutting edge or at least open minded.  Brandon Roy deserves a chance to get healthy and stay healthy.

Less than a year ago, Brandon Roy was headed for retirement and probably a career in coaching basketball.  After what I am sure was careful consideration and weighing his options, Brandon took the steps he believed necessary to get back on the court.  It is reported that Brandon underwent PRP (platelet rich plasma) injections similar to those reportedly undergone by Kobe Bryant, Greg Oden and others in an effort to help aid in the recovery and repair of damaged or deficient tissue.

I can imagine Brandon felt great in the days and weeks following the procedure.  As a result of how good he felt and a testament to his own personal work ethic, Brandon Roy was able to return to the NBA after many had given his career up for dead.  Brandon Roy proved many doubters wrong.  I for one was excited about his comeback.  After all,  one of my earlier writings predicted that Brandon Roy could and would play again!

Unfortunately for Brandon, his road to recovery is not quite complete. I was not surprised when I awoke on November 19 to reports that Brandon Roy would undergo an arthroscopic procedure on his knee.  After seven procedures on his left knee, this surgery was to Brandon’s right knee.  This is concerning to me and should be to his medical team in Minnesota as Brandon has now started to experience “compensatory pain and injury to what has previously been a healthy body part.  (Remember Greg Oden in 2008/2009: Oden Rupture Patella Tendon in healthy left knee as a result of compensating for multiple previous surgeries on his right knee. Oden first began to experience signs of patella tendonitis in the left knee months prior to the left knee injury.  In my opinion, someone addressed the patella tendonitis as a symptom, not a compensation injury).

In Minnesota Brnadon Roy can be seen wearing two compession sleeves knees sleeves. This can be done as a result injury or pain to both knees or as a preventative measure. (Getty Images)

A compensation injury occurs when either consciously or subconsciously a person unloads a previously injured area to avoid pain, discomfort, or re-injury.  Typically, an athlete who suffers an injury to the left knee shifts that stress to the other leg. (This involves repeated injuries in the case of Brandon Roy)  Think about this, when an injury occurs the first response from the brain is to protect the area from further pain or injury. This can be notice by the athele who injures one leg and hops off the field or court on the other leg. The athlete is so focused on being in control of their body and showing that they aren’t helpless that they use one leg instead of two to go from point A to point B.  Crowds often applaud this effort. But in reality it can be seen as a foreshadowing of things to come.

While surgery is a way doctors help repair specific damage, surgery can still be considered an intentional injury to some tissue in an effort to repair a more important injury.  Immediately after surgery, an athlete is unable to utilized the newly repaired leg for some limited amount of time.

What’s next for Brandon?  Well unfortunately I predict another injury to Brandon’s left knee immediately following this surgery. Brandon’s healthy right knee has now forced all the stress back to his chronically injured left knee and upon return to the court if not before, Brandon will begin to experience more pain and discomfort in his left knee.  If he shifts that stress immediately back to his right knee, Brandon could suffer cartilage damage, an MCL (medial collateral ligament) tear, or an ACL (anterior cruciate ligament ) tear or Patella tendon issues on the right knee.  Because of Brandon’s history I would put my money on the right knee suffering a more acute injury but he may begin to experience more pain on his left knee before he even gets a chance to get back on he court.

Compensation injuries are difficult to deal with and become chronic injuries almost instantly unless the root cause of the problem has been address. A word of advice to Brandon:

  1. Eliminate surgery as an option unless there is structural damage.
  2. Identify the root cause of your issues and stop settling for the quick fix.
  3. Hire someone who can pay attention to detail of how you perform each exercise during rehab and strength training.

I have no personal desire to hold Brandon’s hand through recovery from this or any surgery. But will readily offer my advice to him and his staff on what is contributing to his injuries. I require a lot from any athlete I work with emotionally and psychologically but most importantly, I require support from the people around the athlete.  They are the ones who are with the athlete every day and should be able to see impending issues.  Until Brandon stops experimenting with procedures, surgeries and other quick fixes, his injuries are destined to repeat themselves of migrate to other parts of his body.  Brandon Roy can get back on the court and stay on the court but he has to select better people to help him achieve his goal.

If there is one thing the last year has taught me personally, it’s that your career can be affected by the people you put around you and the decisions they make.  My professional and personal life was affected by the actions of others whom I brought onto my team almost five years ago.  I accept that responsibility that I allowed them to turn me into a victim. But no one can be a victim forever. Brandon Roy’s life is currently being affected by people on his team who may not have intentions of harming him but they are doing just that. Brandon has become a victim allowing just about anything that might help his injury recovery to drive his thoughts and procedures.  Get to the root cause of your injuries Brandon. Take control back Brandon! It’s not easy, but I did it and so can you!

Zig Ziegler is a sports kinesiologist and professional sports consultant.  To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.

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Greg Oden to play in 2012-13 NBA season? It is possible! Heres how…

What a crazy last 12  months in the NBA.  Brandon Roy is coming back! When I wrote about Brandon Roy coming back from retirement in April,  some readers responded in disbelief.  “He’s got bone on bone,” they said.  “I must have been on drugs”, one commenter said.  “No credibility”, and so on.   Well this is not an I told you so follow up, but more about how Greg Oden can get there too.  (Blog coming soon about Brandon Roy’s chances of staying healthy: stay tuned).

After a whirlwind last 6 months or so, Greg Oden was released and gave a lengthy interview discussing his career and life with Mark Titus of Grantland.  According to published reports, Greg also began a rigorous rehab and conditioning program to help get his body right.  In addition, Greg also reportedly underwent a surgical procedure to help reduce pain in his knee.

The reason you’re here is to find out if and how it might be possible for Greg Oden to make a return as well.  I am a fan of Greg as a person and want to see him on the court and achieve his basketball dreams.

My biggest motivation for writing about Greg Oden and other athletes issues is to bring light to the fact that proper treatment of the ‘root cause of any injury is an  essential component to helping prevent athletes and anyone from suffering from an injury long term’.   What traditionally has been referred to as proper treatment has had only short term benefits to the patient.  Traditionally, professionals in the industry treat the symptom.  If you treat the symptom (pain or injury), yes you can get back in the game quickly.  But the long term affects can be devastating and cut short any athlete’s career.

Recently, someone asked what I thought would have happened had Michael Jordan been drafted in Portland instead of Sam Bowie (whose career was hampered by chronic foot injuries)?  The answer is who knows and who really cares.

The bigger question is what would we be saying about Michael Jordan if he had not recovered from injuries suffered to his feet early in his career.  Three games into the 1985-86 season, Jordan went down with a broken bone in his left foot and was sidelined for 64 games before returning in mid-March.

The answer is that Air Jordan might have been reduced to a fraction of what he is today.  According to his teammates and those who played against him, Michael Jordan (whom I first met in 1994) worked harder than any other player in the game on and off the court.  In many ways, his work ethic overshadowed any treatments or training programs prescribed for him  As a result, any trainer who worked with Jordan would have become a name in the industry because he was Michael Jordan. Had that same trainer worked with Sam Bowie, we have no idea how Bowie ‘s body would have responded.  It is impossible to treat the two players with similar injuries with the same treatment because their body types and injury/training histories are different.

Oh by the way, many people forget or don’t know that Sam Bowie played in the NBA until 1995, he just didn’t play the way he was expected to based upon being drafted Number 1 overall ahead of the greatest player of all time.

Now back to Greg Oden so I can tie this all together.  A proven surgical procedure undergone by hardworking Kobe Bryant (who works as hard as Jordan on his fitness level) to eliminate pain only fixes part of the problem: the pain goes away. That is a good thing because the pain prevented Greg from being able to workout efficiently.   Additional benefits to the procedure Greg underwent earlier this year include reduced inflammation and possibly accelerated healing in the areas of his body affected by all of his surgical procedures.  Based upon the sheer number of surgeries Greg has undergone, his body has probably built up a considerable amount of scar tissue and some nerve damage may have occurred as well.  The procedure could potentially help with both.  This is very positive for Greg’s comeback.  But it is still not enough.

I hope Greg’s rehab and training program has focused on his weaknesses.  As I’ve stated previously, Greg moves inefficiently because of weaknesses in his body that have caused injuries.  Here are a few areas that were weak on Greg in 2008 and as evidenced by the repeated procedures in 2009, 2010, 2011, and 2012, possibly still affecting him today: glutes, hamstrings, quads, hip flexors, hip extensors, hip rotators (internal and external), peroneals, gastrocs, soleus, abs,anterior and posterior tibialis, and more–mostly on the right side.  The left side indicated signs of significant fatigue and overuse.  So Greg’s left side needed then and probably still does need a break, relaxation.

The Number One area Greg Oden needs to improve….his feet!!!

Greg Oden laces up the shoes on his size 18 shoes into a rigid botttom, Nike shoe. Oden’s shoes also contain at least a heel lift, which also places stress on the front of his right knee. The lift could contribute significantly to meniscus injuries. immobile feet and a heel lift. No wonder Oden has meniscus and patella issues.

In particular, Greg needs to improve  his right “foot flexion” strength.  Can Greg grip things with his feet?  As crazy as it may sound to the novice reader, it is a necessary part of efficient biomechanics and Kinesiology.  As you’re reading this, take off your shoe and you’ll see what I mean.  Place a towel flat on the floor and grip or pick it up with your foot (one foot at a time for 50 reps- hold each rep for 2 seconds).  Try it and see how your foot feels.  Some of you won’t make it to 25 before your foot cramps.  If you’re right handed do the exercise with your right foot. Lefty’s just the opposite.

The feet are the single most neglected part of any training program.  Less than one percent (1%) of all trainers or physical therapist include true foot exercises in the daily or even weekly training programs for their athletes.  Now big manly types will say working out your feet is not important. Give them big strong massive biceps and they’ll take that guy. But let’s get real, we are seeing more injuries to knees, achilles, and other parts of the body related to weak feet.

We assume that because we are on our feet that they are functioning correctly, but that is not true. And no all of you you barefoot running enthusiasts, that is not enough either. Barefoot running only affects where the impact occurs not function of the feet. That’s a whole blog series I have set for October.

Here’s an indicator of whether or not you need to train your foot flexion or gripping:  Do you wear flip flops? If so, you are overworking the top of your foot and ankle (dorsiflexion and toe extension). In my research for this post, I watched a youtube video promoting toe extension exercises for dancers. It is honestly the worst and most unnecessary exercise ever, unless you’ve suffered an injury that keeps you from wearing flip flops.  Don’t get me wrong, some people will need it but 9 out of 10 would be negatively impacted by it.

Greg Oden and just about every other basketball player in the world needs the opposite.   These athletes need to work on gripping things with their feet. Why do I say this? It’s because the shoes worn by basketball players prevents their foot and ankle from functioning properly.  The solid rigid surface, the ankle taping…this prevents the ankle and foot from doing what it does naturally.  So yes, Greg Oden has a weak right foot.  In addition, he has a weak right lower leg complex: gastrocs/soleus.

This weak right foot contributes to his weak right lower leg, which contributes to his weaker right hamstrings, glutes, quadriceps, and other areas of his right leg.  These weaknesses cause Greg to over use his left side which is what contributed to Greg Oden’s left patella injury in 2009.  So if Greg Oden wants to come back in 2012-13, he’ll need to work hard, but he’ll also need to work on the right areas of his body.   Most importantly, Greg should absolutely under no conditions perform the same number of sets and reps or stretches on his right side in comparison to his left.  Greg’s injury history alone is an indicator that one side was damaged more than the other, so why do the same things on both? And yes, all of this was a part of the “controversial report” given to the Portland Trailblazers in 2008 and again in 2009 when contacted for a copy by Tom Penn.  Emotionally, another major injury would probably end his career. I would hate to see this because I had a chance to have an impact on his career longevity.

I guess we can say that two chronically, injured players for one team might be playing in the NBA for other teams after being let go due to those alleged career ending injuries.   And isn’t it amazing that one of them could win a championship (if he ends up in Miami and they win again). Shocking!  I’m just saying… somebody other than me thinks these two guys are still worth it and can be fixed.

The bottom line is just because you read it on the internet or someone makes a statement about it does not mean that it’s true.  Apparently one shoe has already dropped as Brandon Roy has signed with a new NBA team.  Another shoe will drop when Greg Oden is signed before the start of the season and returns to the NBA.  I’m pretty sure someone will sign Greg  next season.  And at worst, Greg can hang on for another 5 years or so going from team to team and make millions.  I hope he works hard on the root cause of his injuries and not just the injury itself.  Ask the question of your therapists, Greg.  And make sure you get a real answer not just one to pacify you.

The only other question left for me to answer here is, “What’s my motivation?”

Well, it is truly to see Greg Oden and many other injured athletes back on the court or in the game.  If Greg’s serious about a return, he should have a copy of his old report if he does not already have one.  But also, he should get a new one. Oh and if he does call to request one, no one will never hear about it from me until long after he returned to the court.   After all, you didn’t know about his previous tests as I kept that confidential not because I had to but because I wanted to keep it quiet.  At anytime, I could have promoted my relationship with the Blazers or any athlete or team as many others in the field do.  Having a famous clientele doesn’t make you an expert.   Actually having a positive impact on them or sharing valuable information for their benefit is what makes me and others in the profession feel great about waking up every day to go to work.

Until Greg was let go, I was a background guy.  That means when an athlete or team came to me, I stayed in the background. This is not about attention for me, it’s about bringing light to a dark situation. I want Greg Oden’s flame to shine.  Let the candle burn Greg.   Next week, I’ll detail Greg’s number 2-5  most important exercises to guarantee his long term health. Oh by the way, NBA teams, a guy with a tight back (back problems) can be fixed and is still worth a top draft pick. hint hint.

Zig Ziegler, The Sports Kinesiologist can be followed on Twitter @zigsports.

Derrick Rose Update: Career in Jeopardy…Why Rose will never be the same!

To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.

While Derrick Rose was tearing his ACL, I spent the morning conducting a 3D-Biomechanics Assessment on future projected Top Five NBA draft pick Shabazz Muhammad.  While there are no guarantees the UCLA bound senior at Las Vegas’s Bishop Gorman High School will escape future knee injuries, the move will provide Muhammad with exercises targeting any weaknesses or imbalances in his body. The results are in the hands of Muhammad along with his current and future trainers at UCLA.

I appreciate the your coming out to do the tests on me,” said Shabazz.  “I will do what I can to improve.”  In addition, to the biomechanics assessment to identify his risk of injury, Shabazz, also was able to benefit from a fine tuning of his pelvis position during shooting free throws. Already with a free throw shooting percentage around 85%, after the adjustment to his pelvis, Shabazz stated, “I already feel myself shooting straighter.”

The subtle techniques changes will become permanent as Shabazz follows the strength and conditioning exercises and stretches recommended specifically for his body.  But most importantly, Shabazz and other young players can significantly reduce the risk of overuse and compensatory injuries related to muscle imbalances.

For Derrick Rose, it’s not too late to help improve his ability to recover from his recent ACL tear.  His recent injuries (prior to the ACL tear) were warning signs that something was about to go dreadfully wrong.  It’s like ignoring the check engine or oil light in the car.  Sure we can keep driving; check the oil and probably notice that we are low on oil (adding more), but eventually the symptom turns into a major problem.  The light was an indicator that maybe we had an oil leak?  I’m just guessing here but I’ve seen enough simple symptoms turn into major problems.

As for Rose, Oden, and others, to help us all understand the risks of rehab and recovery, let’s first gain a better understanding of the injury itself.

A tear to the anterior cruciate ligament (ACL) in the knee usually occurs in one of two ways: 1) hyperextension of the knee 2) rotation of the knee.  Both causes contribute to ACL tears while bearing more weight on the knee than supporting muscles can bear. If either motion is too great, an ACL tear or meniscus tear (at a minimum) can occur. This type of non-contact injury usually occurs while the athlete is attempting to change directions.  (There are other ways for injuries to occur but these are the two most common methods for non-contact related ACL/Meniscus tears).

Rose suffered a torn ACL while landing and attempting to RE-accelerate or change directions during his trademark “jump stop” power move.  In my opinion, the injury occurred during the transition phase of the move where Rose was in between stopping and starting (changing directions). At the point in the game when the injury occurred, Rose’s body (which had spent the past two months compensating for injuries below the knee) was experiencing in-game fatigue.  His ACL tear could have happened in the first minute or the last minute, however, because of his history.

Rose is and has always been a player who relies on his explosive leaping ability, quickness, and all around athletic ability. He has been labeled a fearless player who plays with reckless abandon.  That all changed with a little over one minute to play in game one of the 2012 playoffs against the Philadelphia 76ers.

How will this affect Rose going forward?

In the future, when Rose moves to his right, he will be able to play aggressively. However, stopping or changing directions while moving to the right will be extremely challenging.  As Rose attempts to change directions while moving to the right, the inside of the left knee must assist in deceleration.  If the left leg does not absorb its appropriate share of the workload during this deceleration, one of two things is bound to happen: 1) re-injury to the left knee or 2) new injury to the right knee.

As Rose attempts to move to the left, the outside of the left knee absorbs the majority of the workload while moving in that direction. This creates less of a challenge for Rose in the future because of the nature of the injury.  Stopping or changing directions for Rose when moving left should be considerably easier for Rose to do as the inside of his right knee will bear the majority of the load in deceleration.  The act of actually pushing off is primarily the responsibility of the outside of his left leg.  As a result, Rose will be able to change directions when moving left, but may subconsciously rely more on his right leg.

In my description above, Rose will be forced to overuse his right leg considerably, resulting in a higher risk of injury to the right leg from foot to hip.  We may see Rose tear his right ACL or retear his left, develop Patella tendonitis in the right knee, or suffer an injury to the right hip,or foot (which was supported by muscles already weaker than those in his left leg).

The biggest concern for Rose is the fact that Rose’s injury is an injury related to rotational stability of his left knee.  The ACL attaches to the inside of the lateral aspect of his femur (thigh bone) and the lateral aspect of the medial portion of the tibia (lower leg).  In stabilizing the knee, the ACL resists rotation. In Rose’s case, his lower leg internally rotated and could not stabilize before his femur began to externally rotate.  The rotated out of sequence and in opposite directions.

The most neglected part of ACL surgery and rehab is the rotational stability of the knee.  During surgery, the bones of the upper and lower leg are not typically rotated back into their normal position prior to the injury.  The new ACL is attached typically with the two segments in the posture they moved to when the injury occurred.

As for rehab, we constantly hear “experts” in the field of medicine and rehab referring to the quadriceps and hamstring muscles as the most important to ACL recovery. But we are rehabbing only part of the knee’s stabilizing muscle groups.

Why is it that no one discusses the extremely important segment of the body below the knee with muscles that cross the knee and assist in the stability of the knee?  It’s because the protocols have become watered down and we only look at the primary muscles that flex or extend the knee.  Apparently, experts in the field of rehab and medicine have forgotten that the lower leg muscles assist in stabilizing and supporting healthy knee function. Yes, I’m referring the entire muscle group of the lower leg.

The Gastrocnemius/Soleus complex (typically referred to as the calf muscles) is the single most important muscle group to target when recovering from ACL surgery, the quads and hamstrings are important but no more important than the lower leg muscle group.  Yet, only a minimal portion rehab is dedicated to targeting the lower leg.  The Anterior and Posterior Tibialis, and mobility of the peroneals are extremely important to complete recovery.

In addressing this area to aid in recovery, Rose’s therapist must pay attention to the rotation of the knee, by manually assisting the repositioning the tibia/femur posture. In doing so, they can return his knee to its pre-injury “joint posture”. If this happens, Rose can return quickly and achieve near pre-injury levels, reducing his risk of re-occurrence.

If you ask anyone who has ever undergone ACL or meniscus rehab (Greg Oden, Brandon Roy, Terrell Owens, myself (8 times), and the list goes on and on) no one will say that they spent a good deal of rehab time working on developing the lower leg muscles. For Derrick Rose and others to recover completely from ACL or other knee injuries, more emphasis must be placed on the lower leg.  If not, Rose will become an out of control player (unable to stop to change directions) or suffer repeated injuries to his knees and be out of the game before he’s 26 years old.  Keep in mind that rehab type exercises for Rose will need to become a part of his regular training program to ensure that his “fixes” are permanent and to keep him from suffering chronic knee, hip, foot, and other injuries.  As a Bulls fan, I’m pulling hard for Derrick Rose, but I have my concerns.

As a Sports Kinesiologist specializing in human movement, I’m pulling for experts in our field to open their eyes and close their protocols. Address every athlete individually, not the injury.  The injury is just a symptom that something went wrong.  And in the case of Derrick Rose, Greg Oden, Brandon Roy and others, something went wrong repeatedly and will continue to do so, unless the root cause of the injury is address. Let’s hope Shabazz Muhammad and other young players bound for the NBA can benefit from the changes in the sports, fitness, and medical injury early enough to stop the trend in accepting injuries as part of the game.  Many injuries can be prevented but we have to take steps to make this a reality.

Zig Ziegler, The Sports Kinesiologist, provides feedback on injuries to A-List athletes in an effort to help educate athletes and parents on the prevention of injuries.  Be sure to check out other stories here about Greg Oden, Brandon Roy, Mark Sanchez, Tiger Woods, and more.  Follow Zig on twitter @zig_ziegler.

We Can’t Just Keep Cutting on Athletes…

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Where does the force go when it starts to build up in a joint? If the body does not redistribute the forces appropriately, an injury will occur.

We can’t just keep cutting on athletes or anyone else for that matter. Every time an athlete undergoes a procedure to fix one problem, another issue is likely to pop up. This statement should be considered 100% true unless procedures are put in place during rehabilitation or prehab to address the actual, root cause of the problem.  These new issues can lead to other injuries, which are termed  “compensation injuries”, may be noticed during the rehab or upon return to sports participation.  This should be done only by an athletic trainer, therapist or physician trained to look for such compensations, rather than guessing at the potential compensations.

“When an athlete suffers an injury that requires surgery, he must absolutely undergo the recommended surgery to repair the damage,” said Dr. Stephen Shoemaker of Torrey Pines Orthopaedic Medical Group in La Jolla, California. “However, it’s the rehab that now becomes the most important part of the process to ensure the athlete recovers from the procedure.”

This is the key to return to sports activity.  In addition to rehab of the injured area, protocols should now be put in place to address the compensation patterns the athlete will develop immediately following the injury and subsequent surgery.

In some cases, the injury may be caused by contact. Such an injury typically may the easiest to recover from physically, but may require more to overcome the psychological trauma associated with the contact.  However, non-contact injuries are usually an indication of an inability of the person suffering the injury to absorb the forces properly.  This type of injury may be the most difficult to fully recover from as the contributing factors are lead by inefficiencies of the person’s body which may go undetected during rehab.

To help gain a clear picture of what is being said here, we must understand a couple factors.  There are several types of forces at play in any given activity. For this writing, we will just refer to them  as : 1) action forces, which we’ll define as the forces which are imparted upon a body part (muscle, bone ,or joint).  Action forces are trying to escape the muscle, joint or bone (segment) during motion in multiple movement planes and directions.  The other force to be mindful of is 2) Reaction force, which is the force the the body exerts to attempt to control those forces trying to escape the body part (bone, muscle, or joint).

The athlete’s muscles must exert reaction forces by activating the muscles of the body affected as the action forces are at work escaping the body. If the athlete’s muscles are unable to properly control and redirect the action and reaction forces, an injury occurs.  In the case of an athlete who suffers a non-contact knee injury, the action forces absorbed by the knee were too powerful (or in some cases the forces moved too quickly) for the muscle to react and protect the joint.  At this point injury occurs.

Example: Forces imparted upon and exerted by the human body are much like the forces we feel in a car in going around a turn or when stopping.  If we go too fast around a turn or don’t press on the brakes appropriately, the force may be too much for a driver to redirect the vehicle. A crash or failure to stop is likely to occur.

Much like the driver of a car, an athlete must redirect the forces or injury will occur.  The severity of the injury depends largely on the amount and type of forces and the person’s ability to react efficiently to control them.

If the injury is to the ligaments of the knee, the muscles typically failed to respond in time or the force was too great to absorb efficiently. As a result, the ligaments of the joint were left to fend off those forces but failed.  Ligaments are not capable of withstanding extreme forces and just like a rubber band will snap when stretched past their limits. In addition, this can cause a simultaneous injury inside the joint to the meniscus (cartilage).  In some cases, the ligaments will stretch but not tear.  In the case of an injury inside joint to the meniscus, but not the ligaments, the friction forces (linear or rotational) may have caused damage.   This typically occurs when the ligaments themselves have more laxity or flexibility or the direction of the force was greater than the maximum flexibility of the ligaments in that direction.

The human body is the greatest machine known to man.  It is a great compensator for forces acting upon it and often, through human efforts (reaction), redirects the body to reduce the impact of forces. The body will always find a way to do the “task” we ask it to perform as long as the physical strength and flexibility required to perform the task is present. This means that if we ask the body to jump using both legs equally, the body will perform the task with weight distributed as evenly as the body is capable of while absorbing and disbursing the forces as the body sees fit (compensation).

In a recent post, I discussed Greg Oden’s injuries and the results of my findings after conducting a 3D-biomechanics evaluation of his walking, running, squatting, and jumping motion.  The data obtained when analyzed alone shows that Greg had developed significant compensations to address his body’s inability to absorb forces appropriately in both of his legs.  Greg Oden can be the great player he once was in college and dominate professional basketball.  This can be done with much less rehab than he has already undergone and possibly no further surgical procedures. (This decision for additional surgery is left to the athlete and experts in soft tissue repair and evaluation).

It’s apparent by the history of multiple injuries suffered and surgical procedures, that Greg has muscles in certain areas of his body that fail to contract on time or possess enough strength to absorb and distribute the forces appropriately throughout his body.  In kinesiology and biomechanics, first and foremost, we must evaluate the sequence of forces as they move through the body.  In walking, running, and jumping, the first joint to store and release energy is the big toe on each foot. If an athlete is jumping using both legs, they must begin to squat which transfers vertical energy downward towards the ground (through the feet).  Once that energy reaches the ground, it begins to release upwards along the same path on which it was delivered to the ground.  If the path downward was flawed because of muscle imbalances, weaknesses, or neuropathy (disruption of the nerve signal), the muscles and joints are overloaded and an injury may occur.

In the case of Greg Oden’s patella tendon related injury, the forces of gravity were attempting to return his 7 ft tall, 270 pound body to the ground during landing following a leap in the air.  On the way to landing, Greg’s muscle imbalance is likely to have caused an overload of the muscles and joints along the way. This improper absorption of forces caused the injury.   As a result of his own imbalances, Greg was a ticking time bomb.

Once on the court, his patella injury would be considered a freak accident by the casual observer and fans. At which point, Greg may be labeled injury prone (due to his history of injuries) or God only knows what other names fans and the media would label him.  However, because Greg has had years to develop the compensations for weaknesses related to previous injuries, it was destined to happen unless those weaknesses and imbalances were addressed. To diffuse the bomb, recovery efforts could take as little as 4 weeks to 12 weeks, putting Greg back in action provided no other surgeries are needed to repair damage already done to his body.  However, if surgery is taken as an action to repair the damage and alleviate the pain or discomfort he is suffering without addressing the true weaknesses, the recovery period is guaranteed to be significantly longer.

Non-contact injuries are an indication of the inability to properly act and react, causing a build up of forces incapable of being overcome with physical effort. The upward bound or shear forces will escape in any fraction of 360 degrees (in all directions) of motion surrounding each body segment (bone and muscles) and joint the forces must pass through.

Most of us agree that an epidemic exists in our country with respect to the growing problem of childhood and adult obesity, however, another epidemic is at work as well. The epidemic I speak of us is the growth of injuries in sports: both chronic and acute. Despite the existence of fitness training, sports performance, and sports rehab facilities popping up faster than fast food franchises, injuries are still growing, and most are repetitive injuries.

Chronic injuries occur because we are so quick to dismiss our health related issues. If our car starts to make noises or smell funny, we take it into the mechanic. If we wait too long, the problem gets worse and other problems surface.  When it comes to our body, we are very quick to ignore the signs and symptoms which enables the problem to worsen. In ignoring the problem, we typically shift the stress to other parts of our body until we can no longer get around it.

I was fortunate enough to conduct the entire rehab program for a 14 year- old high school female basketball player who suffered bi-lateral (right and left knee) ACL injuries within 9 months of each other.  I started her rehab following her second ACL tear. That athlete and many others were able to avoid future injuries because we addressed the muscle imbalances and root causes of the injuries.  The most neglected part of her prior rehab was  rotational instability above and below the joint.  At the moment, rotational instability following knee surgery is not address at all in rehab.   But in reality, rotational instability must be addressed early in rehab along with more emphasis placed on the strength and proprioception of her lower leg and feet (not just the quadriceps and hamstrings muscles).

That 14 year-old girl is now a two months shy of her 18th birthday and just completed her senior season of high school basketball with no further occurrence of injury in any part of her body. While the level of play is not the same as professional sports, the demands on the body of a high school athlete are relative to their physical development, as are the demands of a professional athlete.  (This is just one example.).

It’s time for a new standard of care for taking care of our bodies.  All of those who work with athletes and everyday people should work to obtain objective measurements and strive for physical balance and symmetry.  In “data” we trust not “speculation and guesswork”.  Every fitness trainer, coach, or physical therapist should rely on their eyes first and then call upon experience second to evaluate what they saw.  We must apply the principles of human movement to rehab focusing on how the body performs the exercise not just the completion of the exercise.  At this point, we should implement customized rehab programs based on the athlete instead of current protocols which are based solely on recovering from the surgical procedure or the injury.

Everyone has an opinion but we need to eliminate the guesswork.  As an industry, all professional who work with people in sports performance, rehab, and medicine need check our opinions at the door and do what’s best for the athlete rather than trying to keep our our jobs.  “Do no harm” is the first objective.  However, harm is done unintentionally to the athlete if standardized protocols for rehab continue to be the standard of care for injuries.

There are a lot of experts who may disagree with my posts and I welcome their feedback. I will gladly post any rebuttal or response to any post on this blog provided they are done in a tasteful and respectful manner. I reserve the right to reject comments and posts that contain profanity, are personal attacks, or lack foundation.  All opinions are welcome just remember that youth athletes, parents, and others view my blogs. So I welcome and encourage respectful debate and comment.