Physical Therapists in the WNBA (an update)

The 2021 WNBA Season is under way and the Seattle Storm is off to a great 4-1 start.  Every year, I look forward to seeing opponent staff members I've gotten to know over many years working around the league when they come to town. With last year's season being held in an isolated Wubble (WNBA + Bubble) in Florida, it has been a long time since I've seen some really awesome colleagues and I can't wait to catch up with them.  This also gives me the chance to see how the WNBA is growing and I often wonder if the opportunities for women in Professional Sports Medicine are improving.  

In May 2019, I wrote this blog post which looked at teams having physical therapists in the WNBA compared to the NBA.  At that time, based on team rosters and Google searching, I was able to find only three (out of 12) WNBA teams with physical therapists - the Atlanta Dream had Jess Cohen, a dual credentialed ATC/PT who is now with the Portland Trailblazers (YAY WOMEN IN THE NBA!), Emily Wert with the Minnesota Lynx and the Mayo Clinic, and myself with Seattle. In the NBA at that time, 14/30 teams had PTs on their rosters, many of them dual credentialed (licensed in physical therapy in addition to another area of practice - common in sports are athletic trainers (ATC) or strength and conditioning coaches (CSCS)).  At that time, 3 WNBA teams did not list their Head Athletic Trainers on their team rosters and most did not list team physicians. 

I recently came across this May 2021 (August 2020 online) publication "Gender disparity among NBA and WNBA team physicians," which got me thinking it was time to research for an updated post to see what has changed. The article summarized an October 2019 Google Search for team physicians over the past 10 years in each league, identifying 125 NBA Team Physicians (122 male, 3 female) and 28 WNBA Team Physicians (20 male, 8 female) and also considered the geographical location for these providers. The Northeast Region had the most female providers, but the disparity remained.  The paper cited a previous publication for finding the following:

"In professional sports, O’Reilly et al. demonstrated that 28 of 420 (6.7%) current team physicians were women. Of the 420 physicians included in this study, 224 (53.3%) were orthopedic surgeons. Among those, 14 of 224 (6.3%) were women. The authors also noted that the greatest proportion of female physicians among professional sports leagues was in the Women’s National Basketball Association (WNBA), with 11 female physicians out of 34 (32.4%) as opposed to 3 of 158 (1.9%), 7 of 117 (6.3%), and 11 of 139 (7.9%) team physicians in the National Football League (NFL), National Basketball Association (NBA), and Major League Baseball (MLB) respectively."

I'm pleased to report progress across the WNBA!  In today's search, I started with checking all the team rosters, front office pages, and then went to Google.  I also used LinkedIn to confirm names when it was hard to tell if the findings were current. I can now report that only two WNBA teams do not list a Head Athletic Trainer. Google easily found the Dallas Wing's ATC (Branay Hicks), but the Indiana Fever search came up empty - except their job posting looking to fill the position in April 2021.  It would be unfair of me to ignore that the season is 1 month in and that with COVID challenges and last year in a bubble, a little grace for delayed website updating should be permitted.  

Storm Head Athletic Trainer Caroline Durocher (far left)

Additionally, when specifically looking at ATCs, PTs, and Strength and Conditioning Coaches, the gender spread is now much more women with 18 females and 4 males identified around the league among these three jobs and only two teams have male athletic trainers in the league, now.  (This assumes the Indiana Fever Athletic Trainer is a man, which has historically been true and appeared to be the case when I last watched some clips of their games.) It brings me great joy to see the Seattle Storm with a Head Athletic Trainer, Strength Coach, and Physical Therapist (in addition to massage therapist and acupuncturist and additional providers) who are all women.  Also, big news release today, the Seattle Storm return to a female Head Coach with Noelle Quinn taking charge following the retirement of Dan Hughes.  Moving even further than gender, the number of non-white athletic trainers has also increased and the diversity in that group is noticeable, which is even better!

The biggest difference I've found is the increase in physical therapists around the league. The Las Vegas Aces lead the pack with a dual credentialed PT/ATC (Michelle Anumba) as well as a PT who is also a Certified Strength and Conditioning Coach (CSCS) (Chelsea Ortega).  While I'm trying to help elevate women in sports medicine, Chelsea has a company called "Clinic to Field" which offers a 20+ hours continuing education course, "Comprehensive Management of Sports-Related Concussion" approved for PTs and ATCs.  The Phoenix Mercury also have a PT/CSCS on their staff, Derrick Nillissen.  I think this transition, though slow, is going to be the best thing for the athletes.  Athletic Trainers and Physical Therapists do very different work.  To have the knowledge and skills of both on team staffs can only help improve athletic performance.  

I tried to find the current team physicians, too, but most WNBA teams don't have those listed.  My search was unable to find providers for several teams, but some teams list many.  If the count I found is accurate, I found 12 WNBA team physicians who are male and 5 who are female.  The New York Liberty, who partners with the Hospital for Special Surgery, highlighted their team physician group best.  To be fair - no healthcare provider joins a team medical staff for recognition, so the fact that their names are absent isn't that surprising.  But because these teams create platforms, it seems like one potential way to elevate women in sports medicine from a league who is already doing so much to elevate women in so many different spaces. 

How about progress in the NBA sports medicine staffs? When I looked in 2019, I was able to identify 6 women among the medical providers in the NBA through both their Athletic Trainer and Strength Coaches Associations.  This time around, again from the NBATA and NBSCA listings, I found even more!  From the Athletic Trainer's Group - there were 19 dual credentialed ATC/PT providers and there were 12 women ATCs.  From the Strength and Conditioning Association there were 3 women, bringing the total up to 22 women working in the NBA's sports medicine departments!  This ignores massage therapists, chiropractors, dieticians, dentists, acupuncturists, and many other providers.  This time around, we've got two women with dual designations in the WNBA and NBA with both Chalisa Fonza and Sarah Walls covering the Washington Mystics and Washington Wizards.  Of course, this is all based on what's currently posted on the internet - so it could be outdated-  but it's still better than 2019 which makes me happy.  

Unfortunately, the medical staffs around the WNBA continue to be miniscule in comparison to the NBA. It's hard to compare the numbers because there are so many more teams, but the NBATA has 82 athletic trainers listed for 30 teams.  The WNBA has 12 for 12 teams. And the WNBA providers are still not permitted to participate in the organizations for the NBA's sports medicine providers, which just means we have less access to basketball-related resources and research and knowledge sharing, though the WNBA athletic trainers have also made gains in that area by collectively gathering without their own organization.

I continue to hope that eventually the WNBA will have more providers and will be able to organize league-wide like the big men's leagues all do.  Every year I get a handful of emails and messages from college students asking me how I got to work in the WNBA, and I can see that the interest and aspirations are only getting stronger as the league gains more and more popularity.  I'll continue to try to find ways to help the league, but for now, let's take a moment to be grateful that progress is occurring and be excited for all the women in sports medicine across the WNBA and NBA.

Physical Therapists in the WNBA

The 2019 WNBA Season is finally here!  Earlier this week, the WNBA announced their new Commissioner, Cathy Engelbert, CEO of Deloitte, after a search that began in October.  You can read about that here. She's coming into the WNBA at a time when the league and players' union are negotiating the collective bargaining agreement as well as a time when women's sports are on the rise.  Since the WNBA is the longest running women's professional sports league, they have a sizeable platform which comes with responsibility and opportunity.  The choice to use the title of "Commissioner" rather than President, which has been the historical title of the WNBA's highest leader, is, I'm sure, purposeful. Thanks to Wikipedia: "A commissioner is a person who has been given an official charge to do something."  Most men's professional sports leagues in the USA are directed by commissioners - Adam Silver in the NBA, Roger Goodell in the NFL, Rob Manfred in MLB... there are more.  Cathy Engelbert will be the first WNBA Commissioner, and while I can't really find a source that defines the difference between a Commissioner and a President, this choice makes her appear to be at the same level of Adam Silver rather than the previous title that made all WNBA Presidents look like they were a step below the NBA Commissioner.  Whether or not she reports to Adam Silver, I like the way this looks. 

Photo: Steven Yee

Also this week, the Seattle Storm played their two 2019 pre-season with games against the Phoenix Mercury and Los Angeles Sparks.  I love pre-season games because it gives all the recent college graduates who are trying out for teams the opportunity to play WNBA basketball.  The college game may look the same as the WNBA to some people when you're watching on TV, but truly, they differ.  The size, strength, and speed of these athletes - who are truly the elitest of the elite - just can't be matched by the college teams.  Both are excellent to watch, in my opinion, but they're different. Also, sometimes I forget in the off-season how big Brittney Griner really is... but then you see her on the court and remember.  SO BIG. Wikipedia says 6' 9" and 205 pounds... but basically she's a brick wall on the basketball court.

I also look forward to pre-season games to see how the staff gets into their game day routines.  Just like the players on the roster change and each person has to find their role among that list, the staff evolves and each person's roles may change from season to season.  With new medical staff on board this year, this was the first opportunity for us to all work a game together and see how everyone fits and what roles we will all play.  And every year since I started with the Seattle Storm, I've wondered how many physical therapists are on WNBA staffs this season, and what role do they play?  But this was the first year that I wondered how this compares to the NBA?  So... I did a search, and this is what I found:

In the WNBA - there are only two teams out of the twelve in the league that list physical therapists among their staff.  The Atlanta Dream have a Head Athletic Trainer who is also a physical therapist and the Seattle Storm have me on their list.  In addition, the Seattle Storm Head Athletic Trainer is also a physical therapist.  So 16% of WNBA teams list a physical therapist on their staff list and my google searching suggests that Minnesota may also has a dedicated team physical therapist, though she's not listed on their staff directory, but if we count her in the mix, it makes 25% of teams.  This number seems insanely low - but even more concerning to me was that there were three teams who don't even have a Head Athletic Trainer listed on their website!  We're in-season and it is required that all teams must have one. This concerns me because it gives the impression that the sports medicine personnel are not an essential part of the organization. While teams obviously do not have to announce who they are using, every NBA team has their athletic trainer listed. I realize the season is just starting and getting websites updated is time consuming so maybe the sites haven't been updated for this season. 

Let's assume that the WNBA team websites would be at least as frequently updated as the NBA lists.  Where I had to search extensively in the WNBA to see if teams even have sports medicine personnel at all, the NBA makes it pretty easy to search because they have professional organizations for their athletic trainers and strength and conditioning coaches.  The NBA Athletic Trainers Association (NBATA) and NBA Strength Coaches Association (NBSCA) list members from each team. I first went through all the NBATA members which showed that fourteen NBA teams (46%) have physical therapists on staff, most of whom are dual-licensed athletic trainers and physical therapists, and that about half of the teams had a head athletic trainer along with two more assistant athletic trainers.  Then I went through the strength and conditioning coaches association and found a few more teams, but some of these were duplicates with the NBATA because it looks like physical therapists are allowed to be in both. 

And then I did a google search and found that every single team in the NBA has an affiliated physical therapist.  100%.  Many of the teams that did not list them in their staff directories are clinic owners that consult for the team and likely aren't listed in their staff directory for this reason.  This might be happening a little in the WNBA, but more likely, injured WNBA players are not seeing someone designated to their team and with training specifically corresponding to training high level athletes.  I strongly believe that every team should have a physical therapist, but also realize that this would be a financially complicated situation.  Athletes of this caliber don't just show up in every neighborhood PT clinic every day, and most clinics aren't equipped with heavy enough equipment to adequatlely rehab people this strong!  Overwhelmingly, the medical staff lists in the NBA are much longer than those in the WNBA despite having rosters that are only 3 players larger than in the WNBA.  I suspect that there will be more and more physical therapists moving into professional sports in the upcoming few years as more athletic trainers pursue the dual degree designation.

Some interesting findings during my google searching: at least two NBA strength and conditioning coaches were previously strength coaches for the Seattle Storm.  There were at least six women listed among the NBA's High Performance positions.  For example, the San Antonio Spurs Director of Rehabilitation is a female physical therapist.  And finally, there were at least two graduates from the University of Connecticut working in the NBA, which is just another testament to the level of education the kinesiology department there offers.

I am hopeful that the new appointment of Commissioner Cathy Engelbert will also improve the medical staff opportunities around the WNBA.  The NBATA and NBSCA regulations do not allow WNBA medical providers to join them, but they offer really awesome continuing education opportunities, improved ability to collect data and publish research related to injuries and training, more opportunities for league-wide sponsorships, and shared resources that ultimately improve the safety and health of the league as a whole.  The NHL, NFL, and MLB also have similar groups, but the WNBA does not. Yet.  It's not because the providers in the WNBA have not tried to start their own organization.  They have.  And continue to do so.  As the WNBA moves forward with their negotiations looking towards better pay, better travel arrangements, better living accommodations, and a more realistic livelihood - I hope that their healthcare options might also be considered and that this component is taken seriously.   My best day working for the Storm is when no players are injured and nobody needs any care - but regardless of injury status, there's always room for players to gain strength and improve their performance.  Here's to a healthy 2019 WNBA season!

Wishing Stewie a Speedy Recovery!

My heart hurts to write this week’s blog post. 

A few days ago, WNBA Most Valuable Player – and Seattle Storm superstar – and former University of Connecticut standout – and all-around philanthropic and kind person - Breanna Stewart - ruptured her Achilles tendon playing basketball overseas.  Since my social media feeds are filled with a combination of women’s basketball gurus and physical therapists/strength and conditioning coaches, there were A LOT of posts on my feed about her injury and the political implications of it.  If you're not squeamish, you can watch this video of her injury:

breanna stewart landed on brittney griners foot during the euroleague title game and looked in serious pain

not clear if it was ankle or knee but she was helped off the floor and put no weight on it pic.twitter.com/AO8ecTLtgJ

— dynamo kursk fan account (@WEREONLIVE) April 14, 2019

(Note: she injures the other leg - not the one that lands on Brittney Griner.  And it has now been publically announced that she has ruptured her Achilles on multiple news outlets, by the Seattle Storm, and by Breanna Stewart herself.)

So many people have focused on the fact that her income in the WNBA requires her to play overseas and that if the pay scale was more equitable to what the NBA players make she wouldn’t need to play overseas for more income (meaning WNBA players should earn the same percentage of league income as NBA players – not that they would have equal salaries to the men). I get it. I understand the value of that conversation.  I understand many of the challenges the WNBA faces limiting their ability to increase the salaries of their players.  I should also mention that I serve as the Seattle Storm team physical therapist, a role I have served in a volunteer capacity for the past four seasons.  I would have taken a pay cut to make it so Stewie could have avoided this injury, because in my professional opinion, it's the worst, but alas, I have no funds to defer to even share with her.  Instead of looking at the political implications for the WNBA players and their finances, I’m going to look at her injury from the physical therapist perspective to share why this injury means she's not going to be seen in a Storm jersey this season. 

Just a few days ago, Dr. Tim Hewett at the Mayo Clinic posted this video of an Achilles tendon rupture. 

How does a Human Achilles Tendon Rupture ...? Here's how ... check it out @MayoClinic Materials & Structural Testing Core @mayoclinicsport ! pic.twitter.com/qM9ZoXJ2Oq

— Tim Hewett (@Hewett1Tim) September 22, 2017

In real-time, it happens much faster with a high force while the foot is plantarflexed (toes below the heel, as occurs when jumping off the ground) and is generally described as feeling like you were shot in the back of your heel.  The video of Stewie's injury certainly looks like it matches the usual description.  When I wrote my thesis for PT School, a survey of WNBA and NCAA (Former) Big East Women's Basketball Players, only two people playing in the WNBA had recovered from Achilles Tendon Ruptures.  That's good news because it shows that people recover from this severe injury which is so much less common in elite athletes than the ACL tear we more frequently see.

Some additional elite-level women's basketball players who returned from Achilles tendon ruptures (I'm sure not an exhaustive list):
1) Nykesha Sales who tore hers in her senior year at UConn in 1998 and then returned to play nine WNBA seasons including six WNBA All Star Game appearances
2) Tamika Catchings - who tore hers in the 2007 WNBA playoffs and returned to play for the Indiana Fever in 2008 as well as in the 2008 Olympic Games
3) Liz Cambage - tore in the Australia vs USA exhibition game leading up to the World Championships in 2014 and ultimately returned to her national team and WNBA
4) Riquna Williams - ruptured abroad in Dubai in 2016 and returned to play for the LA Sparks
5) Brittany Boyd - tore hers in 2017 and returned to the New York Liberty
6) Chiney Ogumwike tore her Achilles in 2016 in China and returned to the Connecticut Sun Lineup in 2018
7) And of course, there are NBA players too.  Kobe Bryant tore his Achilles and made it back to the NBA, for about 1.5 more seasons.  Fellow Uconn Husky Rudy Gay (weird - he's the 3rd Husky on this list!) made it back with decreased minutes.   DeMarcus Cousins tore his last summer and a whole article was written on all the players who had injured their Achilles tendon and how many had made it back to the NBA.  The odds were ok... not great... but none of those dudes were Stewie.

For rehabilitation from a surgery, there are often protocols used by physical therapists as guidelines to progress someone recovering from an injury.  Protocols are helpful ways to communicate between a surgeon and a physical therapist because the surgeon was actually able to see the extent of damage done and how complicated the repair or procedure was.  So, for someone who is young and healthy like Breanna Stewart, her protocol may allow for a faster progression than perhaps the 65 year old dentist I rehabbed from an Achilles repair two years ago because her tissue quality should be better than his.  If, however, Stewie had been having aches and pains in her Achilles for years prior to this injury and her tendon quality was not in good shape, it's possible the surgeon would recommend a slower return to activities because of the health of the materials he was working with.  Regardless, there are standard healing times for different types of tissues that will need to be followed.

Numerous protocols exist online as guidelines to rehab from an Achilles Tendon Repair, but truthfully, they should all take into account the basic properties of healing and the input of the surgeon based on their findings.  For example, this protocol from the University of Wisconsin has the START of running (in a straight line) at 4 months post surgery.  That does not mean jumping, cutting, hopping on one foot, turn around jumpers, or doing any sort of awesome acrobatics that Breanna Stewart customarily performs in basketball games.

This protocol from Mass General Hospital starts with two weeks in a cast, then about twelve more weeks in a walking boot, before transitioning to a shoe.  Then, it allows for start of run/walk intervals at about five months post op with jumping and sport activities from six to eight months after surgery.  There's quite a bit of variability between these programs - but in my experience, nobody is getting back to sports, especially at an elite level like Stewie, in less than six months.  Tendon just needs that much time to heel and an annoyingly slow progression  in loading it to get back to previous level of activity.

Stewie posted a few things on social media heading into surgery today.  I'm sure she knows the road ahead is long, but that she's got a lot of good things on her side, most notably her age and support system.  That and she's a fighter.  Wishing Stewie a speedy recovery and can't wait to see her on the Storm Sidelines this season as she works her way back to the court for 2020.

UConn and the Storm: Me, Breanna Stewart, Kaleena Mosqueda-Lewis, Coach Auriemma, Sue Bird, Coach Dailey

To Dynamic Valgus - Or Not to Dynamic Valgus? That is the Question

Ann Strother

I was recently watching a Medbridge video on knee injuries when this image appeared on the screen.  HEY!  That's Ann Strother!  Hey girl!  A UConn Women's Basketball star overlapping with two of my years there as team manager, professional basketball player in the WNBA for a few teams while I was working for the Connecticut Sun, on my list for top 10 most beautiful three-point shots, and for sure one of the kindest people on Planet Earth - I was so excited to see her on the screen - except that it was with regard to knee injuries. 

The video was discussing her inverted "V" position called knee valgus which, according to several research articles (like this 2005 paper, and this 2003 paper, and this 2018 paper) may be one of many factors that increase risk of ACL injury in female athletes.  Medbridge had used this image demonstrating her continuing to exhibit this "faulty pattern" after already having had torn and rehabilitated from tearing her ACL. Ann tore her ACL during her sopomore year of high school.  Despite the injury, she was the 2002 Gatorade High School Basketball Player of the Year (her high school senior year) before heading to UConn where she was ultimately a two-time NCAA National Champion.

Kevin Durant

Anyways - seeing her on my computer made me think back to a few weeks earlier when I headed to California to see the Golden State Warriors play against the Los Angeles Lakers only for LeBron James to be out for the night.  I wrote about that here, but while watching the game, I observed that same knee posture repeatedly demonstrated by Kevin Durant of the Golden State Warriors.  See how he's standing at the free throw line about to shoot with his knees almost touching and his feet wider than his shoulders?  He does this a lot.  It's the same position.  While sitting at the game, I snapped this shot and sent it to all my favorite physical therapists and my current student in the clinic... because this knee position is repeatedly considered to be a big problem.

So... is it really a problem?  According to a lot of research, as I've previously mentioned, yes it is because of it's increased risk for injury.  But... is it a problem for Kevin Durant?  Should we be correcting this position in all of our patients who exhibit it?  Is it still a problem for Ann Strother, who I'm pretty sure is not currently playing basketball... but is still running around chasing after her two young children?  What I'm saying is - does every person who shows up in the PT clinic with this presentation need to have it "corrected" or do only some of them need to change it?  Or should we not be correcting it at all?  ACL injury prevention programs constantly work to strengthen the body to prevent exhibiting this type of movement and in PT school we're trained to squat "perfectly" without showing this pattern.  I'm constantly telling my patients to keep their knees out...but half of the time I'm wondering if it really matters. This is the movement pattern I see DAILY in my patients at Seattle Children's Hospital, most frequently in teenage girls who have knee pain, but certainly in boys and in all ages and with varying conditions.  I can tell you from experience that changing the squat position so that they don't do this inverted V is usually much less painful in many of these patients.  I can't tell you that training them to move without the V will prevent them from having an injury later on in life.

So what do we do about it?  As Robert Frost says, "Two roads diverged in a wood..." There appear to be different approaches to dealing with this presentation.  On the one hand, you can work to strengthen and reinforce a more "sturdy" pattern with the knees more straight above the feet rather than angled inward.  Glute strengthening, squatting, and training "proper" jump and landing form tend to be the typical components of a rehab program that works on this pathway.  Repeatedly trying to target a better posture and moving away from this dynamic valgus presentation is a common treatment approach. 

But Kevin Durant is paid about $30 Million per year... do you think he's going to let me change his free throw shot form?  Or anyone on his sports medicine staff for that manner?  Is he actually stable in this position?  Does he train in this position?   So the other option, that some people are now advocating for, is to train into these "suboptimal" positions on purpose.  There are recommendations to purposefully train ankle mobility and control into the position that is common for ankle sprains, particularly in those patients who have already sprained an ankle.  the thought process here seems to be that you can purposefully move into these patterns and try to develop control there so that you're less likely to injure yourself if you end up in that position.  In my search for literature on this approach, I came up empty-handed for scientific papers.  I know that when I injured my ankle years ago, putting it into the position of injury was painful and I wouldn't want to put myself there... years later I still don't purposefully do that motion... but if I play sports and accidentally end up there, I could see how I might be risking injury because I haven't trained my body to tolerate the position.  I did find some non-scientific articles that suggest doing this approach, like this one that discusses the idea of purposefully training into the movement patterns that you were injured in.  There are some people that suggest that if you don't train the injury pattern, you won't be resilient enough if life or your sport puts you into that position and you'll suffer another injury. 

And so...to dynamic valgus or not to dynamic valgus... that is the question. I'm here to tell you that I don't know the answer.  There's not enough evidence to support one way or the other - though there is definitely evidence showing that this position increases risk of injury - so the two approaches both suggest we need to be able to either avoid the position or control the position - not just ignore that position.  I think it might be a combination of both approaches.  I'm certainly not about to go give my patients who squat with dynamic valgus heavy load and have them repeatedly use that pattern - because that seems harmful, and as I've already written - we should Do No Harm.  But I'm also not afraid to consider putting people into and out of positions like this inverted V to see what they tolerate and show them that the human body can do some fascinating things.  What do you all think?

Basketball Bucket List

Sometimes I write about basketball.  This is one of those times.

Do you ever write a list of things to do for the day, and then when you realize you've completed something that wasn't on the list, so you add it on to feel like you've achieved more tasks?

I have a bucket list....places I'd love to go, people I hope to meet, events I'd like to attend, even some personal accomplishments I'm striving to achieve.  I started the list the day after I met Michael Jordan because I realized that meeting Michael Jordan would have been on a list if I already had one.  Like when I go about my day running errands and then realize I did my laundry but it had never been on the list!  I wrote the list in 2009, but added things on there I had already accomplished, because they would have definitely been on my bucket list if I had written it sooner.

Michael Jordan

Michael Jordan played in the NBA from 1984 (the year I was born) until 1993, then again from 1995-1998, and then from 2001-2003 (the year I graduated from High School).  I started watching UConn Women's Basketball in the 1990's and definitely was not watching the NBA while MJ was playing.

Sometimes events transpire that make it impossible for me to check off an item on my bucket list.  For example - I never had the opportunity to meet Pat Summitt, legendary women's basketball coach at the University of Tennessee.  When I was in college, I disliked her for what she represented and for the rivalry between our teams, but as a fan of women's basketball, I now appreciate that she made significant contributions to women's basketball that have allowed me to experience many incredible opportunities.  Knowing I'll never meet her is a big disappointment.  Watching Michael Jordan play NBA basketball is another thing I'll never achieve. Bucket list failures. Never to be checked off the list.

I don't want this to happen with other trailblazers and superstars in the basketball world.  I want to meet so many people and watch many others play in person. My first NBA game was in Boston and I remember seeing Ray Allen and Kevin Garnett and Paul Pierce plaing together and dunking.  Kevin Garnett had always been portrayed like a bit of an animal - and his energy came across even bigger than that at the Boston Garden. They were SO big. SO athletic. SO much higher up in the air. And, in the moments when they made an amazing play, the world seemed to slow down for a few seconds.  But those were just moments.

It was on my bucket list to watch Kobe Bryant play.  I bought tickets to the Lakers @ Nuggets game while I was on clinical rotation in Denver on March 7, 2014.  He did not arrive with the team and was announced to be out for the rest of the season with a knee injury. I'm pretty sure he had a tibial plateau fracture.  It made me really sad to miss that opportunity because, just like taking a photo of the mountains - the scale is changed when you look at things through a screen.  I needed to see him in person.  He retired from basketball and I'll never get to see it.

This past weekend, I headed to Oakland, CA for the Golden State Warriors versus the Los Angeles Lakers.  If I couldn't see Kobe, at least I could see LeBron James in action. He's the greatest of my time.  But LeBron didn't play this past weekend. Bucket list fail. Again.

LeBron was taking the night off for "load management."  The Storm Strength and Conditioning Coach who was with me for the game said to me, "Well, LeBron's old, so that might start happening a lot more, now."  Excuse me, WE are not old!  His glory days are not yet over.  I'm not crossing it off my bucket list yet because it can still happen, but I feel like I've had three basketball bucket list fails. I was disappointed that I missed a chance to see one of the greatest men's basketball players of all time playing live, but I loved the reason they used.  As a phyical therapist, all I really do is load management.

My favorite thing about LeBron James, beyond the fact that he's an amazing basketball player, is that his birthdate is December 30, 1984.  Two days after my own. So, really, the only differences between me and LeBron James are two days and a few dollars.  Nothing else. Ha!

It hurts too much when you run, but you can tolerate walking?  There's a load you can manage.  A ten pound bicep curl hurts but five pounds doesn't?  We've identified a load you can use.  "Shin splints" from ramping up your training volume too quickly for a marathon?  Improper load management could be to blame. If you had to define what physical therapists do in two words, I think it would be appropriate to say, we "manage load."

So... while I'm bummed that LeBron didn't play, and I don't know that I'll ever get the chance to see him again, I'm glad to know that the Lakers are at least using terminology that makes sense from a rehabilitation perspective. 

Enough of the bucket list fails. I've also had bucket list successes.  The basketball bucket list includes a ton of women's basketball opportunities and must-see/must-meet experiences, and that's where my heart truly lies.  Also, this week (February 6, 2019) was National Girls and Women in Sports Day.  This is a special day that gives a chance to pay tribute to the women in sports who have helped paved the road to allow for more opportunities for girls and women in sports today.  I've previously written posts here and here about women in sports and am so grateful to those who have paved the way.

Attending a UConn National Championship win in person would also have been on my bucket list, except I wrote the list after having that chance.  My freshman year of college, the team won, but I wasn't traveling with the team.  I had attended the National Championship in 2006 when the University of Maryland - with current Seattle Storm power forward Crystal Langhorne - beat Duke University in Boston. It was incredibly fun, especially because I've always loved the Maryland Terrapins and was so close to going there myself - but it wasn't my team.  So when a group of us were able to attend the 2009 National Championship in St. Louis, MO when UConn beat Louisville, it checked off a box on my future list.

The NBA has been around much longer than the WNBA, so where I didn't have the chance to see the pioneers of the NBA, it's an entirely different story for the WNBA. I saw Rebecca Lobo play live basketball. And Lisa Leslie.  And Tina Thompson.  And Katie Smith.  And Sheryl Swoopes.  And Katie Douglas. And Becky Hammon.  And Nykesha Sales.  And Kara Lawson.  And Tamika Catchings. And Lindsay Whalen.  The pioneers of the WNBA.  In most of those cases, I didn't just get to watch them play some exceptional basketball, I also met them, occasionally had meals with them, traveled the world with a few of them, and got to learn about basketball and how the women's basketball world works.  The game that they play is the same game the men are playing.  But the women's basketball world is not the same as the men's basketball world, and having an appreciation for how hard these athletes are working year-round is inspiring to me.

There are still basketball related items to check off my list.  I'm working on those.  If given the choice to watch the Golden State Warriors versus the Los Angeles Lakers, including a healthy LeBron James - or the Seattle Storm versus the Phoenix Mercury of the WNBA... I'd pick the WNBA game EVERY SINGLE TIME.  If you haven't been to a game, the season is coming.  Reach out and let me know when you want to go.  Add it to your bucket list.  Let's make it happen.

Women in Sports in the News!

I have several blog posts that I have started drafting that are in skeleton form.  Ideas pop into my head while I'm doing my continuing education work or reading things online that I think I'll want to learn more about in the future and I start up a draft for later.  I had plans for this week's blog because I just finished reading a book I really enjoyed... and then I hopped onto my Twitter and Facebook accounts and saw two really awesome articles about some amazing women in sports.  Change of plans! This week we're looking at some real trailblazers.

First: this awesome video from Gatorade Performance Partners about the Female Athletic Trainers serving in the NFL. Maybe someday, it won't matter that we identify them as females... but for now, this is important!  I came upon this post because the Head Team Physician and Orthopedic Surgeon for the Connecticut Sun, Dr. Katherine Coyner, tweeted it.  I recently connected with her and have been following her work at the University of Connecticut Health Center and with the Connecticut Sun from afar.  (To my knowledge, there are four WNBA teams that have head physicians who are women, two of which are orthopedic surgeons.  The Minnesota Lynx operate with surgeon Dr. Nancy Cummings, the New York Liberty work with Dr. Lisa Callahan, and the Phoenix Mercury work with Dr. Amy Jo Overlin.  These women are trailblazers and their career paths are inspiring!)  Back to the video... there are six female athletic trainers in the NFL out of 145.  But more than 50% of athletic trainers are females and more than half of the current students in athletic training programs are also females (according to the clip).  I'm sure these ATCs don't all want to work in the NFL - or potentially any of the professional men's sports... but opportunities for women in professional sports are limited.   Check it out!


I saw this video first thing this morning while I was perusing my social media over breakfast.  I then went to work... treated some kiddos at Seattle Children's Hospital... and came home to find this post:

<--Jenny Boucek, former Seattle Storm Head Coach, now Assistant to the Coaching Staff/Special Projects with the Dallas Mavericks

I first met Coach Jenny Boucek when I was an undergraduate at UConn and she came to watch practice before an upcoming WNBA draft.  I remember asking her if she wanted to draft a team manager... I already knew where I wanted to go after college.  We had a nice chat and our paths crossed numerous times over the years.  I loved that she was the Head Coach when I first came to Seattle to serve as the Storm Physical Therapist.  She's a wonderful person.  And now she's navigating uncharted waters as a pregnant coaching staff member for an NBA Team!  I can't wait to hear more about how her story unfolds, but this first article about her job prospects from a few NBA teams gives me hope. I truly believe that with ANY job... it should only matter that the best candidate is hired.  Based on this, it looks like employers are now starting to join in that belief and cross the gender boundaries that were so much more rigid in the past. Way to go, Mark Cuban.

Both of these news clips brought me joy.  The opportunities for women are growing right in front of my eyes, particularly in sports - and not just in women's sports.  We can still do better - but let's enjoy these moments and then get to work on making more progress.  This upcoming weekend is the WNBA All Star Game and I can't wait to watch while I'm on a quick visit home to the East Coast! 

Any other inspiring stories you've come across and want to share!?  Post a comment... and consider following the blog!

ACL Injuries No Longer a Career - Ender

This post originally appeared on the TD Athletes Edge blog on January 24, 2018 - my first guest post!  Special thanks to Tim DiFrancesco for the invitation and the learning opportunity.  

When it comes to scientific research, anecdotal evidence is lowest on the hierarchy of resources.  As a clinician, it is vital to review higher levels of evidence, but sometimes it’s impossible to ignore what you witness.  There are numerous publications reporting higher incidence of ACL injury in females compared to males, and there are also studies that outline the outcomes to these athletes.

When I was the manager for the Cheshire High School (Connecticut - GO RAMS!) Girls’ Basketball Team, my friend tore her ACL going for a breakaway layup and landing in a heap on the floor.  A few years later, as a team manager for UConn Women’s Basketball (Go Huskies!), I was standing three feet away from a player when she changed directions during a drill and dropped to the floor with a yelp…torn ACL. After an ankle sprain you're back to playing in a week or two… but with these injuries mean you're out for almost a year. 

Rosemary Ragle was the Athletic Trainer for UConn Women’s Basketball for 18 seasons.  She was kind enough to share with me that in her tenure, 6 athletes (average of 1 every 3 seasons) tore their ACL and she also treated several others, at least 6 more, who had the injury prior to arriving on campus needing rehab.  Of the six that were injured at UConn, all of them returned to the team roster and most moved on to play professionally. 

James Doran, the current Men’s Basketball Athletic Trainer at UConn has been there for 12 seasons.  He confirmed what I had read in this Hartford Courant Article that he had worked with two athletes (average of 1 every six seasons) who tore their ACL in a Husky jersey. AJ Price, later played eight years in the NBA and Terry Larrier is currently the team’s 2nd leading scorer.

After UConn, I spent four seasons with the Connecticut Sun WNBA team.  During that time, four Sun players (average 1 per season) tore their ACL either in a Sun jersey or while playing overseas.  All four recovered and played again at an elite level including one winning a 2016 Olympic Medal.  I asked Tim DiFrancesco how many Lakers guys had torn their ACL in his six seasons in the NBA: Zero! Basically – there’s a boatload of anecdotal evidence with a small sample size that demonstrates females are injured more often than males. At the end of the day, though, most of these injured athletes ultimately made it back to their previous level of competition.

My graduate research studied lower extremity injuries in the WNBA and (former) Big East Conference Women's Basketball Teams. Previous studies showed that ACL injury was uncommon: 3-5% of basketball players, but that was because it was looking at how many athletes were injured in a season.  From that perspective, sure, it's rare to tear an ACL. But my research looked at a large sample of women’s basketball players (246) over their whole career and showed that almost 25% of these athletes had experienced the injury, some of them multiple times.  25% doesn't sound so rare to me. These athletes were all currently playing in Division I College Basketball or in the WNBA at the time of their participation having overcome an ACL injury. 

To my knowledge, a study of this type has never been conducted in the NBA, but based on this 2006 article, the WNBA experiences more ACL tears than the NBA. A CBS Sports7 report from 2013 outlined that in each NBA season, up to 5 players (out of 491 roster spots) tear an ACL which is about 1% of all the players in the league. At that time, this was an increase to previous NBA seasons. If a set of teammates don't both experience the injury, 25 teams out of 30 will go through the season unharmed. I wish I had the access and approval to do my study in the NBA to see how many of these guys have ever torn their ACL in their whole career – and then made it back.  My suspicion is significantly less players have been injured in the NBA than in the 25% in the WNBA, and the majority have made it back to playing.

Twenty years ago, and sometimes still today, an ACL tear was considered a career-ending injury. It’s still devastating because of the time lost from sports and school for the injured athletes, lost work time for parents, costs, extensive rehabilitation, pain and potential long term physical and mental consequences.  Though it is easy to see the gender disparity, these injured athletes mostly return to basketball and are able to excel at a high level of competition.  Why these outcomes have improved is largely speculative, but since we started out anecdotally, why not suggest reasons for the improvement?

Perhaps surgical techniques such as physeal sparing in the youth population and the trend towards more bone-patellar tendon-bone grafts over hamstring grafts or allografts is a contributor to better outcomes.  When there is not additional internal derangement to the meniscus, it is likely that more accelerated protocols for early range of motion and weight bearing in rehabilitation are getting these athletes back into shape quicker.  There is research on return to sport protocols which have improved the process of assessing injured athletes to make sure they’re ready for return, hopefully preventing recurrence of injury.  There have been studies examining mechanical faults during ACL injuries as well as muscular imbalances that increase risk of injury which can be treated by physical therapy.  The development of more ACL Injury Prevention programs has been increasing and groups are working hard to get them disbursed that this may be improving outcomes.

Why does any of this matter?  It matters because even though these injured athletes make it back to their sports, there are a large percentage of them that could be preventable.  There is now ample research showing that ACL injury prevention programs reduce the risk of injury.  Newly released in January 2018 is the National Athletic Trainer’s Association Position Statement on ACL Injury Prevention which is the most up-to-date data on evaluating the levels of evidence that support the importance of participation in these programs.  It outlines that participation in an ACL injury prevention program can reduce the risk of ACL injury 52-61% but it can also reduce risk of other injuries, too. If your child, particularly middle-school or high-school aged is participating in a sport, ask their coaches if they’re doing a program with their team.  If they’re not, have your child independently examined by a physical therapist, a skilled strength and conditioning team such as at TD Athletes Edge, or consider some of the following resources which may be helpful:

1) Seattle Pediatric Sports Medicine ACL Injury Prevention Program: http://seattlepediatricsportsmedicine.com/injury-prevention/injury-prevention-warm-up-program/injury-prevention-routine/

2) FIFA 11 ACL Injury Prevention Program: https://www.kort.com/uploadedFiles/KORT/Content/Services/Sports_Medicine/Concussion_Management/FIFA-the-11-Booklet.pdf

3) Cincinnati’s Sportsmetrics ACL Injury Prevention Program: http://sportsmetrics.org/

4) As a parent or coach, watching an ACL Injury Prevention Program and trying to implement it with your child/team is not enough.  A skilled clinician should be implementing it or checking the movement patterns.  This is imperative.  Ask a local physical therapist or skilled strength coach to watch your child’s movement to assess their risk for injury and to develop a program tailored to their needs to decrease their risk.

References 

1)      Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: Summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–319. PubMed

2)      Deitch JR, Starkey C, Walters SL, Moseley JB. Injury risk in professional basketball players. A comparison of women’s national basketball association and national basketball association athletes. Am J Sports Med. 2006;34(7):1077–1083. PubMed doi:10.1177/0363546505285383 7. https://www.ncbi.nlm.nih.gov/pubmed/16493173

3)      Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, et al. Non-contact ACL injuries in female athletes: An international Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394–412. PubMed doi:10.1136/bjsm.2008.048934 http://bjsm.bmj.com/content/42/6/394

4)      Gordon AI, DiStefano LJ, Denegar CR, Ragle RB, Norman JR. College and Professional Women’s Basketball Players’ Lower Extremity Injuries: A Survey of Career Incidence. IJATT. 19:5 (22-35). September 2014.  http://journals.humankinetics.com/doi/pdf/10.1123/ijatt.2014-0020

5)      Padua DA, DiStefano LJ, Hewett TE, Garrett WE, Marshall SW, Golden GM, Shultz, SJ, Sigward SM, National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. Journal of Athletic Training. 2018; 53(1).

6)      Hartford Courant Article: Dom Amore. UConn Men’s Insider: Doran is a trainer with patience, but too many patients. January 31, 2017.  Accessed January 9, 2018. http://www.courant.com/sports/uconn-mens-basketball/hc-uconn-men-insider-james-doran-0201-20170130-story.html

7)      CBS Sports Article: Ken Berger. ACL Injuries Once Were Rare Occurrences in the NBA But No More: October 4, 2013. Accessed January 12, 2018. https://www.cbssports.com/nba/news/acl-injuries-once-were-rare-occurrences-in-nba-but-no-more/