The ice is thinner than you think

Part 2 in a TrueHoop series about preventing NBA injuries


PART 1: Mushy bones and everything

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In the last few days, a few people have pointed out that the season just started. Players can’t be tired yet. Surely load management is for tired people, and surely that comes later, right?

Not so fast. Clearly, I don’t think every injury is the result of overwork. Sometimes an enormous man like Aron Baynes lands on Stephen Curry’s wrist and that’s that.

On the other hand, we’ve seen Curry slither past defenders like Baynes a zillion times. This time, he was a hair off. A little slow in his reaction. It happens. It could be random.

But no one can say for certain that it was. Curry played Sunday night in Oklahoma City, then flew to New Orleans. He played Monday night in New Orleans, then he flew to the Bay Area and lost his balance on Wednesday in San Francisco. There’s no way he had a week of good sleep.

  • Research shows that even a small amount of bad sleep can result in the response times of a legally drunk person

  • At the moment he broke his hand, Curry had missed six of his seven 3s against the Suns. Maybe if he’d hit a couple more, he would have done a very Steph thing and used his dribble to create the space to launch a 3. There is research showing players shoot better after good sleep. There’s also research that, like drunk people, tired people take more risks. Whatever the reason, he made a risky choice this time.

  • Muscles perform differently when short of sleep. In tests, for instance, tired people can’t lift as much weight or perform the same workouts. Soft tissue, like muscles, is the first line of defense against skeletal injuries. It’s not out of the question to say that if Steph had the same collision on a different, better-rested night, his muscles may have been a little readier to protect him.

Whatever the mechanism, bad sleep absolutely increases injury rates

What do you think is the worst injury in NBA history? Which is the one that makes you throw up in your mouth a little?

Reverse engineer that crisis—whatever YouTube moment of Shaun Livingston, Paul George, Jusuf Nurkic, or DeMarcus Cousins that you’re picturing. Call in experts from many different disciplines and ask, “What can we do to reduce the chances of this ever happening again?” I can save you some time and money on those experts: There won’t be evidence to suggest a magic supplement, app, or technology. But rest will matter. Just as car accidents are reduced with campaigns to drive sober, basketball accidents can be reduced with campaigns to play rested, ready, and fresh.

Fatigue causes injuries. And everyone knows what fatigue is, right? 

Not really. It turns out, fatigue is surprisingly tricky to define. You feel great at the start of a thing, and then after a while, you feel like you’d rather stop. That means you are short of … something. It could be any number of things, though. Sleep is one of the possibilities. So are blood levels of iron, sodium, and potassium. Alex Hutchinson wrote a book called Endure, and found that fatigue can have many causes:

  • Exhausted or weak muscles—say from a hard workout yesterday—can keep you from your best.

  • If you’re slowing down near the end of a contest it’s quite possibly oxygen that you’re lacking.

  • Pain can keep you from explosive athleticism. 

  • Heat exhaustion, dehydration, and a shortage of fuel can shred your athletic potential.

If you did all kinds of testing in NBA locker rooms as players prepare for games, you might find examples of all of the above. But there’s one particular way of demonstrating readiness and injury resilience that is especially worth exploring, because it’s fascinating, visually rich, encapsulates a lot of the above, has some scientific rigor, just makes sense, and, interestingly, shows immense promise as a predictive tool: biomechanics. The measurable physics of how you move. It’s important, weird, and new. 

The best place to start is with the story of a kid in California who did something a little arrogant in football practice. 

The quiet, hilly town of Cloverdale is where California looks a lot like Oregon—evergreen-swathed ridges, here and there a winery, people returning from ambitious hikes or canoeing trips. But really it's a day trip up 101 from the Golden Gate Bridge. The bleeding north edge of California's Sonoma County. 

That's where star receiver and free safety Marcus Elliott-Woody (he'd later drop the second half of his hyphenated name) committed a sin of arrogance on his 17th birthday. It was 1982. He seemed to have it all: pro-athlete speed and size, enlightened parents who wanted him to become whatever he chose, a girlfriend who still causes him to use a wistful tone, and a football coach who organized the offense around getting him the ball.

"I’d just done this drill with this kid, it was like a one-on-one tackling drill," he remembers. "I juked him really hard. He was a big kid. He was bigger than me.” Marcus is about 6-2, 185. “But I juked him really hard, he kind of grabbed the air."

That might have been enough. But the drill wasn't done. Telling the next part decades later, Elliott wiggles on his bistro stool; some part of his brain remains in a tackling drill in Cloverdale. Palms up, he sways right, then left, and says, "I made like a shimmy-shimmy and went straight through him. Just like straight through him."

It would have been a normal football play. Even an outstanding one. But the big kid fell in a terrible way. He crumpled not to the grass, nor to Elliott's muscle-protected thigh, but somewhere in between.

"He ended up at my knee level."

The first problem: the falling teammate's shoulder "pushed in" Elliott's right knee. As in, bent it the wrong direction. But more importantly, the hyperextension and weight pinned Elliott in place. "I didn’t fall down," he says. "I was just standing there with the ball." 

Around four o’clock on that beautiful afternoon, Elliott’s football career ended.  

"He started rotating ... I heard things popping. I still, I don’t think about it, obviously, but I remember exactly how it sounded." There are four major ligaments in the knee. “Pop, pop, pop, pop.”

One of the most mobile children on the planet was then frozen at home for much of his senior year. Within a week, his coach had found another player to throw the ball to—one of Elliott's best friends. Before too long, Elliott's girlfriend was dating that guy. 

"All of it sucked," he recalls. A doctor now, Elliott uses diagnostic words precisely. "Depression" describes his senior year. "You feel like you’re kind of the center of the universe, and then you step off and the world keeps turning exactly like it did before. Your world’s completely changed, and nobody else’s has. That’s really super isolating."

For months his thoughts were mournful. "These things that I define myself by, things that I was committed to, are all gone. And it was empty."

Thankfully, as time passed, his perspective shifted. "Somehow when I came out of it, it was looking at the same thing, this whiteboard that was empty, and saying wow, that’s also endless potential. I can go anywhere! And I got excited about that."

"People trivialize it, and it’s certainly cliche to say I’m better for it, but I really am, there’s no doubt. I worked so much harder, I was so much clearer about where I was going."

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Fascinated with the human body, Elliott told friends he wanted to work with health and human performance. He convinced his parents to get him a subscription to the journal Medicine & Science in Sport & Exercise. He was intent on making sure that what happened to him didn’t happen to other people. Elliott became the kind of diligent student who starts at U.C. Santa Barbara, transfers to Harvard, and gets the grades to get into almost any medical school on the planet. 

When lifeguarding in San Clemente, he bought a 1976 lime green Westfalia camper with a pop top. “What’s cooler than that?” he asks. It cost $1,600, and he lived in it as he drove all over the West as one of America’s finest triathletes. “I took it everywhere,” he says. “It tickles me, van life. I’m telling you, that’s good living. Good, simple living.”

Elliott remembers interviewing for Johns Hopkins Medical School. The interviewer listened as Elliott explained his mission to use science to get the most out of athletes. Then the renowned cardiac surgeon sighed, leaned forward, and explained that Johns Hopkins was in the business of training the finest doctors in the world, not personal trainers.

That's about when the walls began to shake. Literally. They were on the 18th floor of a Los Angeles high-rise, and this was a very real earthquake. A lot of people might think they were about to die. But in a characteristic Elliott moment, he looked at the whole thing through a lens of neat-o science and engineering. "These high-rises are designed to sway, to cope with earthquakes,” he says, sounding a little delighted. “And you could see across the way into one office, then a different one, then the first one again."

Elliott did not go to Johns Hopkins. He went to Harvard Medical School.

To Elliott, Harvard Medical School represented a huge opportunity and a low-grade personal crisis: the daily grind. "When I was in college I studied pretty hard. But I was pretty efficient too," he remembers. "I knew when I hit diminishing returns. And so I’d do endurance sports. I’d always go work out or get away when I started getting diminishing returns. I didn’t stay up all night. I didn’t do that. I just stayed nice and steady. I think I got into Harvard Medical School studying quite a bit less than most people." 

"When I got to medical school one of the most depressing things was that it didn’t matter how efficient you were. You were going to show up and round at five-thirty, and you were going to leave at seven o’clock when the resident, or the doctor you were shadowing, left. ... That’s just how it’s going to be. My motto was ‘be efficient, and then go play.’ Go feed your spirit. And so that was super hard."

Elliott lived with three other medical students across from the Brookline Reservoir, a few miles from campus. There were hijinx. They would sometimes jump in the reservoir in the dead of winter, “like a polar bear thing,” as one roommate remembers it. There was a time they couldn’t all fit in a taxi, so Elliott crawled into the trunk and rode in the dark. 

But mostly, in all weather, they fed their spirits with bicycle riding.

Losken points out that before medical school, Elliott had done some modeling, in addition to triathlons. When he was new at medical school, Elliott would ride with a goal to look good. Another roommate, Dave, had been a Navy Seal, and rode through the snow in what Losken calls “a Pee Wee Herman bike.” It fed a gritty ethic, where they just didn’t care what everyone else at Harvard thought. 

“It just became our thing,” remembers Albert Losken, an Elliott roommate who is now a plastic surgeon in Atlanta. “We’d ride our bikes in the snow or the rain. And when we got to the courtyard at Harvard, they’d be waiting for us and we’d just scream like yeeeeeee-haw!” They hid doctor clothes under whatever winter gear, and felt a tad like superheroes when they tore off their outer layers. They still ride bikes together when they can.

When he had long days in the hospital Elliott was supposed to wear a tie, but he would break that rule as much as possible. In scrubs, he could turn any found 45-minutes into a workout, doing things like bounding up the hospital stairwell. 

I wonder, “didn’t that make you all sweaty?” Elliott says, “yeah,” seeming not to have considered this before. “I guess it did.”

“Did you ride on the Charles?” I ask, small-talking about the tourist-ready footpaths flanking Boston’s famous river.

“Yes," replies Elliott, taking the question in a more literal and badass way. "When it was frozen enough.” He has three children now, and so quickly adds that he doesn’t think it was smart to ride on a frozen river. 

Elliott remembers crashing hard on the frozen Charles. As he lay there, shaking off the crash, he noticed that some of the snow had cleared off the surface of the ice. He could see “leaves and things” floating by, under the ice, only a few inches from his head. The ice wasn’t nearly as thick as he’d thought. 

So you get the hell out, right?

Not so fast, it turns out. Elliott remembers lying there and … “I did some calculations.” 

Like a physics-class problem: If Elliott weighs 180ish and his bike is maybe 30 and the ice is two-and-a-half inches thick then it can probably hold together with X amount of force. 

Losken remembers the moment. “I think we calculated the speed of the water in the river, too. Because if you fell in, it would suck you downstream so you couldn’t be rescued.”

Eventually some of the most brilliant students on the planet reached a conclusion: “I remember thinking,” says Elliott, “that’s not where you want to be.”

To most of us, you prevent injury simply by not exploring the frozen Charles. Elliott is far more renegade than that. But at the same time, once he got there, he was dorky enough to calculate the actual physics of the thing. 

Tortured though the metaphor may be, it’s not a bad approximation for what he has done with ankles, knees, and hips. He has not stuck to the footpath. He has explored, and over time, sorted out how forces move around in there. 

He didn’t like medical school, but he became an M.D. and read stacks of “studies as high as your hip.” What he learned was that the way a lot of elite athletes were managed was out of step with the science.

It’s a fun little story that feels like it matters, coming from someone who, Losken says, even then was determined to change injury prevention: “He already knew what he wanted to do. He was a trainer who wanted to bring medical science to the profession. He didn’t do an internship or a residency. He wanted to put ‘M.D.’ after his name to give it some force and credibility. He was on a mission.” 

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On TrueHoop later this week: David Thorpe has a suggestion for players guarding James Harden.