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!

Greg Oden? Brandon Roy?: What!?! What Happened?

Greg Oden has been cut by the Portland Trailblazers due to chronic knee problems.  Brandon Roy announced his retirement in 2011 prior to the start of the season, citing “degenerative knees” as the major contributing factor in his decision.   Something is going dreadfully wrong in the Northwest! And it’s not the athletes’ fault.

This is the Greg Oden drafted by the Trailblazers!

In the August of 2008, I received a call from then Portland Trailblazer’s assistant General Manager Tom Penn.  “I heard about your services and want to know if you have an interest in conducting your biomechanics assessment on Greg Oden?” was how he started the conversation.  I replied, “Of course, what did you have in mind?”

According to Tom, they had just been given the ok for Greg to start practicing basketball.  After about an hour of conversation about what types of tests I would perform, Tom and I decided now would be as good a time as any. Well, it turns out Greg Oden was in LA filming an episode of a television show and if I could get there before he left it would be an ideal time to test Greg. So I packed up my biomechanics equipment and headed for LA.

When I arrived at the Mondrian Hotel in Beverly Hills, the hotel staff directed me to their exercise facility where I began to set up my equipment. Greg arrived shortly after I did and we immediately got started on the first of six (6) motion analysis-based biomechanics assessments I would conduct on him that day.  At the time, we called the assessment motion DNA testing.  The concept is based on the idea that no two people move the same way.  Every person’s motion is as unique to them as their fingerprint or DNA.  What affects the efficiency of their motion DNA is their physical strengths, weakness, injuries, habits, limitations, and more…regardless of whether their physical history is positive or negative.  It all affects how each person moves.

In Greg’s case, his history was affected by his height and injury history, as well as the training and rehab he’d undergone since his first day of playing sports.  At the time of his assessment, Greg was coming off micro-fracture surgery to repair torn cartilage in his right knee which cut his rookie season short before it started.  The procedure and coinciding rehabilitation program forced Greg to miss his entire rookie season.  According to team physicians and the medical staff, Greg was recovered and approved to return to the court for practices and “game like” situations.  Greg’s biomechanics assessment told a different story.

Test 1- I hooked up 2 inertia-based motion tracking sensors just above Greg’s knees. The assessment was designed to measure the symmetry of motion between Greg’s left and right legs to determine any differences which might lead to setbacks unless targeted with deficiency specific exercises.  The sensors measure the rotation, adduction/abduction, and flexion/extension of each leg above and below the knee.  In addition to the crucial range of motion-related data, the sensor also allowed me to look at the timing, tempo, and coordination of each leg during normal straight ahead walking and running.

Greg was given two walking tests at 3mph with a 5% incline and 4 running tests at other varying speeds of 6 mph, 7 mph, and 8 mph . Greg’s results showed an alarming disparity in the range of motion (ROM) between his legs with his right leg showing significant weaknesses above and below the knee.  Greg’s left knee showed increasingly large signs of fatigue and overuse resulting from compensations for the weaknesses and physical limitations of his right leg.

Test #2

For biomechanics testing #2, I placed 8 motion tracking sensors all over Greg’s legs, arms, hips and torso.  Each of these sensors would be give us valuable information about how Greg’s entire body responded to stresses and muscle imbalances.  Greg was asked to do simple moves including a functional movement screen referred to as an Overhead Squat (body weight only) and a single and triple vertical leap test.  The 3D-Motion Capture assessment confirmed the imbalances identified by his gait analysis and then some.

The following is an excerpt from his report delivered to and reviewed with the Portland Trailblazers medical staff.

From Greg Oden’s Report of Findings August 25, 2008:

Excerpt #1

Oden’s Right knee appears to have recovered from the surgery. Data indicates the ability to bear weight almost normally in the right leg’s Quadriceps and Hamstring muscles. However, a deeper look at the data indicates that Oden’s normal gait patterns have altered to compensate for weaknesses in his right lower leg.  And as a result, does not distribute weight appropriately throughout the entire right leg. To compensate for the original injury and lower leg weaknesses, Oden has started to bear at times as much as 144% of his weight on the left leg (Ex.: during running trial at 7.0mph for 15 seconds, ROM 10.8 degrees extension L compared to 4.4 degrees of extension R). To compensate, Oden’s right leg excessively internally rotates during extension (push off) at lower speeds. While at higher rates of speed excessively abducts and externally rotates indicating circumduction of the right leg. This action can lead to hip pain on the right side, lower back pain/injury and opposite side knee pain as rotational forces cause the opposite knee to twist and as a result may cause the quadriceps muscles to overload to resist the rotation. This could be the cause of the left leg Patella Tendonitis.

Excerpt #2

When asked to jump, Oden proceeded to bear more weight evenly during take off, but landed with over 30% more weight on his left leg, demonstrating a conscious or subconscious lack of use of the right knee. The overloaded landing can cause significant stress and fatigue to the left quadriceps/patella tendon.

After reviewing the report with the Trailblazers medical staff, I came to several conclusions.  The problem might not be Greg.  I learned from the medical staff that they were already working on some of the exercises and drills which I was recommending for Greg. My response was simple…Greg’s ability to do any of the exercises correctly without hands on assistance was hampered by his own weaknesses.  Greg needed (as do many people undergoing rehab) one-on-one attention to detail as he performed each exercise.  For example: If the goal is to increase the strength in the weakest parts of Greg’s right leg, the more complex the exercise, the more he was able to compensate and work around actually isolating the weak muscles.  Greg needed someone to watch over each rep and exercise carefully to make sure he was doing each exercise correctly until all of  the muscles being targeted were able to contract on autopilot.  Surgery causes damage to nerves which take time to regenerate, affecting the way a person performs an exercise.   This is nearly impossible in a team setting and requires private one-on-one therapy with a therapist who understands how each segment of the body is supposed to move.

From Greg Oden’s Report of Findings September 24, 2008:

Based upon the analysis, our recommendation is the following:

  •  Increase Overall Hamstring Strength
  •  Increase R hamstring and Glute Strength
  •  Improve R leg explosiveness
  •  Increase L Gastroc, Soleus, Glute, Hamstring and Quad Flexibility
  • Consider a more efficient shoe designed to lift the entire foot to improve normal leg stride.

In Greg’s case, every exercise or target area needing improvement on his list required slow, yet focused repetitions.  If Greg was asked to walk, run, squat or jump, he placed more of the load on his left leg than his weaker right leg.  I informed the medical staff that this overload would put Greg at risk for a major acute injury to his left leg.   Greg’s imbalance was so distinct that I even advised that staff that if he didn’t improve the weaknesses in the short-term and continue some of the rehab-like exercises for the entire season, his career could be at risk.

Career in Jeopardy after suffering a fractured patella.

And you can believe it or not, but the medical staff laughed off my recommendations. In fact, we spent nearly two hours at dinner with the medical staff questioning my results and looking for reasons to discredit the results rather than search for solutions to keep the team’s multimillion dollar athlete on the court.  At one point, one member of the medical staff informed me that Greg suffered from a true anatomical leg length shortness on the right side.  As a result of that diagnosis, Greg had been prescribed, by physicians, to wear a heel lift in his right shoe.  Well doc, I hate to be the one to tell you again, but the heel lift actually increases the load and the amount of anterior/posterior shear (forward/backward sliding) on Greg’s right knee, contributing to his need to undergo several micro-fracture surgeries.

The results of Greg’s biomechanics assessments created doubt in my mind about the leg length claims. However, I suggested an alternative to a heel lift if they truly believed that a shorter right leg was a contributing factor to his knee injuries.  The solution, for an athlete with Greg’s height and leg length, an entire shoe lift (orthopedic shoe on the right side) would reduce the sheer forces in the joint and keep Greg healthy while he continued the rehab.

You can imagine the laughter that filled the restaurant from the table.  “No one wears a shoe lift,” one staffer replied.  “That’s crazy. Where would we get one?”  To which I replied, “Hey Nike is Greg’s shoe sponsor and they are right down the street. I’m sure they could customize a shoe lift for one of their star athletes if it keeps him healthy.”  To my knowledge, no shoe lift was ordered for Greg.

Despite the medical staff’s objections to further testing, Assistant General Manager Tom Penn was sold on the results and wanted the entire team tested.  Over the next two weeks, we scheduled a visit to Portland to test the entire team at the start of the preseason.  Testing, of  those players not in camp or available at the time for biomechanics testing during my visit to Portland, would be completed during a practice session in Los Angeles prior to a preseason game with the Clippers.

After completing testing of the entire team (in Portland and LA) and a retest of Greg Oden in Portland, I was astonished at the results of the athletes on the Trailblazer teams. While some athletes demonstrated more biomechanical efficiency than others.  The results of several athletes stood out:  Greg Oden, Brandon Roy, and Joel Pryzbilla. Each of their results showed imbalances, which if gone untreated, would lead to long-term, career threatening, chronic knee issues among other random supposedly unrelated injuries.

Well you may not recall but in 2009, Joel Pryzbilla and Greg Oden both suffered patella or patella tendon injuries . The reports submitted to the team and its medical staff both specifically identified significant amounts of stress on each player’s patella tendon and knee joints as a result of compensating for opposite leg weaknesses and physical limitations.  From 2008 through 2012, all three players had each undergone at least one surgery each (that we know of).  Oden has had at least three major surgeries since 2008, and Brandon Roy is retired after undergoing at least three procedures since 2008.

Neither player consistently contributed significantly to the team as a result of the physical condition of their bodies.  Based upon my assessments back in 2008 and the marginal access I have had to follow their histories, each player’s the risk of each injury could have been significantly reduced or prevented all together.  So I say this to Greg , Brandon, Joel, and every other professional athlete…get a second opinion outside of the team. Take control of your body and your career.  Over the past two years, I have written about the risks of injuries associated with biomechanical deficiencies.

Pryzbilla in pain after a ruptured patella tendon.

Strong egos and lack of information are catching up to athletes and changing if not ending careers in all sports.  Nicolas Batum, Pryzbilla, Travis Outlaw, among other Trailblazers, all missed significant time since their initial biomechanics assessments from 2008-2009 due to injuries which could have been prevented and were pointed out in their reports to the team’s medical staff.  Brandon Roy was forced into retirement because he was not given proper care for his injuries. Greg Oden’s career is at risk for the same reasons.  Both players could still get back on the court and yes, Brandon Roy’s “degenerative knees” can be healthy and he could play for 5-10 more years with the proper treatment.

Brandon Roy following a preventable tear to his meniscus.

The solution: more testing to obtain more objective information is the only way to insure the investment professional teams make in athletes.  Tom Penn should be applauded as an assistant general manager for trying to make a positive impact on the health of the team.  Instead, shortly after 2008, Tom was not rehired and currently works as an analyst for ESPN.  Sure another Greg Oden and maybe even another Brandon Roy will come along for Portland. In the future, athletes like Greg and Brandon will be labeled injury-prone or a bad risk (as they have been since the beginning of sports). The risk is not the investment in the athlete, its the investment in the care they get from the team which drafts or trades for them. 

The Sports Kinesiologist’s Advice:

Wake up professional athletes as well as the agents and teams who care for them.

Mr. Paul Allen, this is your team and your investment is at risk! If you continue to do the same thing and get the same results…. I believe it is considered  the definition of insanity?

Athletes: Know your body, know yourself, and ask questions (even if if means getting an opinion outside of your team’s medical staff.  This is your career!

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!