Alert! Hot off the Presses! Physical Therapists working in Sports... Athletic Trainers... Strength and Conditioning Coaches... High School Basketball Coaches... Female Athlete Parents... Orthopedic Surgeons... WNBA Colleagues... Basketball Fans... Any one else who is interested in learning something today... Check this one out.
Presenting at Seattle Children's Sports Symposium
A new paper was published (April 16, 2020) in Arthroscopy, Sports Medicine, and Rehabilitation entitled "Injury in the WNBA from 2015-2019." You can find the paper here. I jumped for joy to see this new release when it was in my inbox this morning. Gotta love alerts that know what I'm interested in. In case you don't know, women's basketball player injuries was the topic of my PT School Thesis paper, "College and Professional Women's Basketball Players' Lower Extremity Injuries: A Survey of Career Incidence" which you can read here. In November 2019, I
had the opportunity to present on this topic to the Sports Medicine Department at Seattle Children's Hospital, updating my findings and making it more applicable to our department's work in pediatric sports medicine. This topic is on my mind constantly, and since WNBA Physicals were supposed to be this week, now postponed until the coronavirus battle is under control, I'm thrilled to have basketball on my mind. A new publication five years after my own with some similar findings from an entirely different approach was both gratifying and validating and this paper could not have come at a better time.
The new paper, written by Orthopedic Surgeons at the University of Chicago summarized injuries in the WNBA between 2015 and 2019 which were compiled from publicly accessible websites. Interestingly, the findings were similar to my research with regard to ankle sprains being the most common injury and both papers explore ACL Injuries. My study only looked at lower body injuries so it did not examine concussions, but this recent paper did and I've previously written about the WNBA Concussion Protocol here.
Here's why this paper is important, in my opinion.
PubMed is a search engine for research papers, kind of like Google, only your search will bring scientific information. A PubMed Search conducted today, April 20th, for "WNBA AND Basketball" will give you EIGHT results. In comparison, A PubMed Search for "NBA AND Basketball" will give you 120. This new paper doesn't appear in that search. Neither does mine. I'm not sure what you need to do for PubMed to determine you're worthy, but it's apparent that the topic isn't a common one found in this search engine. PubMed is where I go first when I want to find research on a specific topic that impacts my patients.
So how about a different search engine like Google Scholar. There "WNBA and Basketball" has 5,120 (94 results since 2020), including this new paper and my own, and "NBA and Basketball has 55,000 (1140 since 2020). Obviously I did not screen every title to see if they actually refer to basketball and the NBA which is why I wrote the search this way, but it's SO EASY to see the discrepancy. In my opinion, a new publication looking at the WNBA is a HUGE win for the WNBA.
The papers that are found on the Google Scholar search are on all sorts of topics. There are publications about injuries, like the ones I'm talking about and, as a physical therapist, which I find most interesting. But there are papers about basketball, about female athletes, about gender differences from various perspectives including pay and spectator attitudes, differences between draft selection and playing times, sexuality, fan experiences, race, television time, and the list goes on.
The battle to improve opportunities for women in sports continues. The battle for pay equity, though improved with the new WNBA Players Association negotiations for their collective bargaining agreement, continues. The battle for sports media to increase awareness of women's competitions and to increase support of elite female athletes continues. And this week, the battle for increased awareness of injury data - which ultimately can help contribute to injury prevention strategies, continues, but with a step forward. I tip my hat to you, University of Chicago Orthopedics.
Hope you're all hanging in there, enjoying being at home as much as you can, staying safe, washing your hands and faces. Is your mental health ok? Have you gotten any fresh air? I know that might be hard for some people. It has been over a month since my last blog post, but that was certainly not for lack of trying. I've started to write several times in the past few weeks but the Coronavirus Pandemic has actually left me speechless. (Shocking, I know.) I can't go to my usual coffee shop where I like to write and life has been turned upside-down, just like I'm sure it has been for anyone reading this. I'm not a scientist and won't pretend to know anything about the virus itself. I've never been more aware of how much I touch my own face - and even still I probably don't notice it more than half of the time. I'm not on the front lines fighting this, so don't let the masked image later in this post fool you. I'm spending most of my time in isolation at home when I'm not in the clinic with occasional stops at the grocery store as needed. Writing a blog post hasn't been on my priority list because I couldn't decide what to write about in the shadow of a global pandemic. As a writer friend recently told me, sometimes you just need to sit and write, let it flow, and see what happens.
Writing is an outlet for me. I use it to help organize my thoughts and relieve stresses. It offers an opportunity to be creative, use different areas of my brain, share ideas, highlight things I'm learning, and to show support for causes that matter to me. At a time when I'm also not seeing my usual collection of mental health providers and also not going to the gym, the sudden and total removal of so many outlets has been a big deal. It helps to know that everyone else is in the same boat. Nobody else is going to the gym. We're all working out in our laundry rooms with whatever we have at home or going for walks in the neighborhood. I've heard of people doing lots of different crafts, trying out meditation apps, yoga in the home, new types of exercise, and some people are buying pets in order to find novel coping methods. You're not alone...we're in this together!
So I'm writing today. Without having any planned direction or goals. I've seen a post going around on Facebook that people want to remember what was happening because this is going to be a historical event. My parents remember when JFK was assassinated and my friends and I all remember where we were on 9-11. This will be another memorable event for so many people... and nobody will forget where they were because we've all been on our couches for three weeks already! So this is not my usual blog-writing approach. Welcome to my stream of consciousness. My apologies for being scatterbrained.
At the beginning, I thought this was challenging because I felt trapped with nowhere to go. My family is far away. I was still seeing patients early on and didn't want to risk getting anyone sick. The first week I saw friends who had already started working from home, but then it seemed wrong for me to be around them. Once I got into a rhythm, particularly with regular afternoon FaceTime gatherings, things started to improve. The hardest moments have been worrying about my friends who work on the front lines, concerns about my parents and not being able to help them, and realizing that the Final Four was not going to occur. This weekend should have been the Women's Basketball National Championship - often referred to as my favorite holiday. Several of my friends here in Seattle have been connived into outings at random bars around the city to watch games with me. I'm more than happy to treat my friends to some nachos if it means company to watch the Huskies. The NCAA College Basketball Season was so suddenly aborted after the best year of competition EVER. I don't think it quite hit me until all the replays from previous championships started popping up on social media and I realized how much sports can bring people together, how many years of my life I've spent watching basketball games, and how serious this pandemic really is. You'd think being told to wear goggles, masks, and gloves to treat my few remaining patients would have been sufficient. If you've never worn them - those things are hot, sticky, and make your glasses fog up!
So now that I've rambled on, I guess I should find some sort of purpose for taking your time. All I can come up with is gratitude. On Wednesday, March 18th, I went into my clinic to call my patients and cancel their scheduled appointments. That was sad, but a few days later, I started to really miss what I do. I have fortunately had a few days in the office to treat high priority patients and each time I've seen a patient, I've felt life being restored to my body, air returning back to my lungs, energy surging, and the return of my dimply smile. Endless gratitude reflecting on how my career has unfolded to this point where I have the world's best coworkers all collectively waiting to restore our previous routines.
I'm grateful for the small businesses in my local community who have been able to transition their usual operations to help support everyone at this time. I've enjoyed some really good take-out meals in the past 18 days at home and highly recommend supporting your small local businesses that are trying to survive. I'm grateful for all the people on the front lines - healthcare workers, front desk workers, environmental services cleaning crews, demand flow services, and leadership - in my office and throughout the country and the world who are taking care of so many sick people. I'm grateful for books, the fact that I had too many out from the library when this all started that I'm slowly working my way through, and also audiobook downloads available from the library, and Netflix and Amazon having rentals to watch movies.
I'm grateful for all the different electronic user interfaces that have made it possible for me to have face-to-face conversations with so many people. Between FaceTime, Facebook Messenger, Skype, WebEx, Zoom, Google Hangouts, and HouseParty - it really isn't hard to connect, but those virtual gatherings don't quite feel the same. There were a few days last week where I bounced from call to call catching up with old friends, seeing how family members are doing, and trying to find that missing sense of connection. Today my extended family gathered on Zoom in preparation for Passover to begin on Wednesday. Check that out! People in 20 different homes in at least 10 different states ranging between Washington, Connecticut, Florida, Ohio, Oklahoma, California, and Washington, D.C.
I'm worried for my friends who are working to save lives. They have families and kids of their own and are at extremely high risk. I wish I could do more to help them, to help sick people, I guess just to help anybody. The most any of us can really do right now is to stay at home and prevent further spread of the virus. I'm very hopeful that when this all ends, there will be improvements made to how we operate as a country and as a healthcare system. Let's hope this wraps up in time for everyone to enjoy summer. Let's hope this doesn't destroy families financially, or in any other ways. Let's hope we can resume travel soon. Let's hope everyone stays healthy and safe. And let's hope we can have a massive celebration together on the other side. Let me know if there's anything I can do to help you out. We're all in this together.
Yesterday was Game 3 of the WNBA Finals. If you're not familiar with this league, the Finals are a best-of-five series which means you need to win three games (out of five) to be crowned champion. Last year, the Seattle Storm swept the Washington Mystics 3-0. It was glorious! Right now, the Washington Mystics are 2-1 ahead of the Connecticut Sun, with Game 4 being held tomorrow night at Mohegan Sun Arena in Connecticut.
Why is this important to me? First, as the physical therapist for the Seattle Storm, I wish the Storm were playing in the Finals and that I was there to watch. I love basketball and this really is some of the best basketball you can watch. Haven't been to a WNBA game? What are you waiting for?!?! Second, despite being dedicated to the team I work with, I'm also a supporter of the league as a whole and have a long history with the teams currently competing. The current Head Athletic Trainer for the Sun, Rosemary Ragle, was the UConn Women's Basketball Athletic Trainer while I was in college - and also worked with me on my Grad School thesis. The current Washington Mystics Head Coach, Mike Thibault, hired me to work for the Connecticut Sun when I was graduating from UConn in 2007. I worked for him - and the Sun - for four seasons before PT School. Their assistant coaches include his son, Eric Thibault, and former UConn and Connecticut Sun standout and Olympic Gold Medalist Asjha Jones who were both with the Sun when I worked there. I can't possibly root for one team over the other - though I have a lot more Connecticut Sun t-shirts in my closet than Mystics attire.
So I'm following the WNBA Finals, watching teams compete for the highest position in Women's Basketball - perhaps falling only behind the glory of an Olympic Gold Medal or World Championship - and the headlines are riddled with descriptions of injuries these players are experiencing.
Like these tweets:
Alyssa Thomas has a torn labrum in BOTH of her shoulders.
Elena Delle Donne plays through injury to move Mystics one win from WNBA title
Washington beat Connecticut Sun 91-81, lead series 2-1
League MVP has a herniated disk pinching nerve in her back
Associated Press
Shares
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Elena Delle Donne drives the ball to the basket during Sunday’s game. Photograph: David Butler II/USA Today Sports"Elena Delle Donne put forth a gutsy effort, playing through a back injury, and Washington beat the Connecticut Sun 94-81 on Sunday to move within a victory of winning the franchise’s first title. The league’s MVP has a herniated disk that is pinching a nerve in her back and was questionable to play in Game 3. She finished with 13 points, hitting five of her six shots and played 26 minutes."
I can't help but thinking - what message does this send to the fans, particularly the young ones? Is this helpful? What does it all mean, anyways?
First and foremost, a disclaimer. I am not working with either of these athletes. I do not know what care they are receiving - but I would bet it's excellent from my years interacting with both organizations. I care about the health practices around the WNBA and have been trying to help improve their standards for several years - so from the research I've done, I can say with confidence that it is highly likely that these basketball players are being well taken care of.
Additionally, I absolutely 100% believe that the above-mentioned athletes with injuries are experiencing pain. I read one account that said that Elena Delle Donne could not sit down because it was too painful, so the medical staff and coaching staff had devised a plan to bring her into their locker room when she was subbed out of the game to keep her moving and stretching and to avoid extended periods of sitting time. This sounds like EXCELLENT collaboration between a medical and coaching staff and is something other teams should take notice of! (The Storm is good at this, too, in my opinion!) If an athlete is reporting pain, I believe that they have it. All pain is real. Pain is a personal experience that is influenced by many things. But pain is also a protector and it doesn't necessarily mean these athletes can't be playing. Here are my thoughts with what I've read and, more importantly, some thoughts on comments from fans who have opinions on the matter.
1) There are HUGE numbers of people with imaging showing torn labrums in their shoulders and disc herniations that DO NOT have pain.This paper discusses the labrum tears and found that 55-72% of people without shoulder pain had a labrum tear. (The population was a little older than Alyssa Thomas, aged 45-60, but she is an overhead athlete so this presentation for her is not really that surprising). Want something more specific to athletes? This blog post from fellow UConn Graduate and well-known strength and conditioning coach with Major League Baseball players, Eric Cressey, presented the research on the same topic. He quotes: "Miniaci et al. found that 79% of asymptomatic professional pitchers (28/40) had "abnormal labrum" features and noted that "magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of 'nonclinical' findings."This paper looked at a large sample (3110 subjects) without back pain and found on MRI that 30% of 20-year-olds have disc herniations and that the number increases over time. This is why sometimes people have surgery but it does nothing to correct their pain... because the MRI findings and the surgical correction does not always fit with the pain.
2) These are elite level athletes so it concerns me when I read that suggest they're "skipping surgery and playing through pain." Tissue damage DOES NOT correlate with pain, so unless ESPNw was given reports from the teams stating that they had pre-participation MRIs that were normal and then started having pain the correlated with tissue damage (which goes against a lot of the evidence) a surgery may not even come close to fixing these problems. Another way of looking at this is - why does their body adapt to present with the MRI findings that they have. For example (hypothetically) is Alyssa Thomas' upper back too stiff for her to get her arms all the way overhead to shoot and rebound? Because if that's happening, she's effectively cranking on her labrum to get her arms over head and then a shoulder surgery may fix her labrum, but it doesn't actually fix the initial cause of the problem. She'll still have a stiff upper back, so it'll only be a matter of time until the labrum is reinjured unless the real underlying cause is addressed. Why does everyone want people to rush straight to surgery, anyways? That's painful! As a physical therapist, my number one goal is to help athletes avoid having any surgery at all. Sure - if it's necessary, such as in the case of Breanna Stewart having an entirely ruptured Achilles tendon, we're talking about something different. But what if we just let these athletes recover after a grueling season (next week!).
3) Can we acknowledge the additional stressors of playing in the WNBA Championships? It is well known that emotional stress contributes to our experience of pain. Elena Delle Donne was injured during Game 2 of the WNBA Finals. Anybody else ever get injured at work and need to finish the shift or wake up with a super stiff neck or spasm in their low back and still have to go to their job the next day? She has a job to do and it's far more in the spotlight than most people's work. She'll get her symptoms managed and her pain will likely have a bigger impact on her job than on many other peoples' jobs, but she'll also participate in the conversation of whether or not she plays. Or at least she'll have her agent do it. Someone will be advocating on behalf of these players to protect their health.
Many of the comments online were about how she was forced to play. We don't really know that! Any chance these commenters considered that she chose to play once the medical providers told her she would be allowed to? The reality of this situation is that in less than one week the WNBA season ends, the physical and emotional stresses of the season will be reduced, and a period of relative rest (which means they don't just curl up in a ball in bed) can begin. What if they have some injuries, but they're also sleep deprived with elevated cortisol levels from their increased stress, not eating as healthy as usual with their family entourage visiting for the Finals and wanting to eat out? It's so much more complicated than just "an MRI showed some damage." There will be time to stay away from the basketball court coming soon, time to reduce the amount of stress on their bodies and their minds with decreased physical activity including, less jumping, decreased torsion and load on injured anatomy, maybe some extra napping, some gentle swimming or yoga, and globally allowing the nervous system to calm down. The Playoffs are three straight weeks of sympathetic Fight or Flight Mode... how about a nice parasympathetic Thanksgiving style dinner that puts you into rest and digest recovery mode? Maybe we'll see that no surgeries will be needed for any of them!
4) There are definitely circumstances where an injury to an athlete means they should not play their sport because it puts them at risk for further injury. For example, after experiencing a concussion, it is dangerous to the athlete's health to compete before all symptoms have entirely resolved. For example, if an athlete has a broken bone, not only could it be extremely painful to compete, but the athlete is at much worse damage with a subsequent injury. For example, if an athlete cannot control their bowel or bladder or they have muscle weakness or numbness/tingling into their legs or arms - these can suggest a much bigger problem with the spinal cord.
But there are many circumstances where an injury to an athlete means they will have pain while they do the things they love, but they may be OK to play with certain precautions. For example, someone who recently sprained their ankle may be able to play while wearing an ankle brace. The brace can protect from further injury while they are completing their healing. For example, in many states it is approved for someone wearing a cast with a broken bone to pad the cast and play sports anyways. The cast will protect the injured athlete from worse injury and the padding protects opponents from being hurt. A torn labrum of the shoulder may be associated with a lot of pain for Alyssa Thomas, but is she at risk for any sort of red flag event by playing through it? No. And, without knowing the details of Elena Delle Donne's injury, I suspect she's experiencing a lot of back pain without the neurological symptoms into her legs that suggest spinal cord problems and that her medical team has determined it is safe to be playing. She would not be on the court otherwise.
At the end of the day, tomorrow night could be the final game of the 2019 WNBA Season. If it is, the Mystics go home with a Championship. If not, they will play one more game. I personally want to see all the best players on the court at the top of their performance. So I'll send up some prayers for these two incredible athletes and role models and to all the other WNBA players currently having pain. And I'll be rooting for the Sun and Mystics medical providers who will soon get a nice rest break, too.
Long before sunrise on the morning of Thursday, September 12, 2019, I boarded a sleepy airplane lightly coated in the typical Pacific Northwest mist heading towards a career-enhancing expedition. After a brief pit stop in Denver, I continued on to Cincinnati airport, weirdly located across the Ohio River in Northern Kentucky. Upon arrival at the CVG baggage claim I met two physical therapists who I would spend the next eleven days learning and observing various topics related to sports physical therapy. Rebecca Troulliet from North Oaks Health System in Louisiana and Patrick Barber from University of Rochester in New York joined me for the American Academy of Sports Physical Therapy (AASPT, formerly known as the Sports Section) Traveling Fellowship. Sponsored by Kevin Wilk, LightForce and DJO Global/DonJoy. We spent about three days each at University of Cincinnati, Mayo Clinic locations in Minneapolis and Rochester, Minnesota, and The Ohio State University. What does it mean to be a Fellow? According to Wikipedia, "a fellowship is a group of people who work together to pursue mutual knowledge or practice." Though each of us had individual purposes for participation, we are all physical therapists working with athletes and we were all looking for growth in our careers. Through observation and lecture attendance with more seasoned clinicians, we had exposure to different techniques and clinical approaches than our usual day-to-day experiences. Now that I've returned to my usual swing of things and seeing my patients at Seattle Children's Hospital, I'm taking this opportunity to reflect on the experience and share why I chose to pursue this Fellowship along with some highlights from our trip. First: Why did I want to complete a Fellowship? In May 2014, when I was completing PT School at the University of Connecticut, my career aspirations were to serve as a team physical therapist in the WNBA. I had previously worked in a non-medical capacity for the Connecticut Sun for four seasons, but elevating to this new type of position as a new grad PT didn't seem remotely feasible. Beyond the fact that I was a new clinician, WNBA teams didn't have physical therapists, then, so this goal seemed unrealistic. (Most teams still don't, which I wrote about here) I thought my fastest route to working with professional female athletes was to advance my education from PT School through a Sports PT Residency Program. In 2014 there were about twenty of those programs nation-wide, mostly offering one or two slots. I applied to three, including Ohio State, but was not successful in securing a position. Now there are almost fifty SCS Residency programs with so many more opportunities nationwide! To search Residency programs in any PT Specialty area, click here. Fortunately, physical therapists have an alternative route to obtaining board certification and specialization in sports physical therapy that does not require participation in a residency program. You can find the requirements to do so here. As I pursued the alternative route, I also landed a role with the Seattle Storm, and in March 2019 completed my Board Certification Exam. In our cohort, Pat also took his exam in March following completion of the University of Rochester Residency program and Becca is currently working through the alternative route requirements to specialize in the future. So because I did not complete a residency program but did pursue specialization, I felt like I lacked some of the mentorship and on-field hours that a residency would have provided, and this fellowship filled some of that gap. Second: What was the Fellowship like? Each location was very different from the others which helped us gain a broad spectrum of the possible roles and responsibilities for a sports physical therapist.
Fellows and PT staff @Cincinnati
At the University of Cincinnati, we were hosted by Bob Mangine and Tim Machan and primarily spent our time in their athletic training room with them and on the sideline. We had the chance to watch game-time coverage, led by Head Athletic Trainer Aaron Himmler and had a sit-down discussion with their concussion program and vision training expert, neuroscientist Dr. Joe Clark. We attended lectures on a variety of topics by members of their staff including wearable technology, use of the ACL-Return to Sport Index Outcome Measure, Neuroplasticity, Prevention of Catastrophic Injuries, and and we each presented our own lectures. My presentation examined the Impact of Fear Avoidance on Return to Sport, Becca discussed Sudden Cardiac Death and Pat outlined Upper Extremity Return to Sport Tests.
With Timberwolves Robby Sikka and Matt Duhamel
After exploring Cincinnati, the three of us packed our bags to head to Minneapolis for the first half of our visit to the Mayo Clinic. Our host in Minnesota was Corey Kunzer who is the coordinator of the Mayo Residency program. The clinic in Minneapolis serves the community as well as having partnerships with the Minnesota Lynx (WNBA), Minnesota Timberwolves (NBA), and Minnesota Twins (MLB). Only days before our arrival, the Seattle Storm had knocked the Lynx out of the WNBA playoffs so I felt a little like I was in enemy territory, but I was glad to finally meet Emily Beyer, Lynx Team Physical Therapist as well as Matt Duhamel, Team Physical Therapist/Director of Athletic Therapy for the Timberwolves and Jeff Lahti, PT for the Twins. We also met Robby Sikka, Timberwolves VP of Basketball Performance and Technology who uses wearable technology with the basketball players to improve their on-court performance. Their basketball facilities are fantastic and, according to their staff is considered to be the best training site in the NBA. They have practice basketball courts with athletic training rooms and locker rooms for the teams right next to the medical clinics where they have physical therapists, orthopedic surgeons, physicians, athletic trainers, and other specialties who can thoroughly care for the athletes alongside the general public. Can you imagine being at your PT session and rehabbing alongside (Lynx superstar) Sylvia Fowles or (Timberwolf and UConn great) Shabazz Napier?! The Mayo providers collaborate with the team providers in their biomechanics lab which includes force plates and multiple angles of cameras for jump-testing and movement assessment as well as for recommendations for optimal care. It was a really interesting arrangement for sports medicine for all levels of athlete.
Diagnostic Imaging with Dr. Jay Smith @ Mayo
Then we drove down to Rochester, MN, home of the original Mayo Clinic. Founded in 1889, the Mayo Clinic is basically the entire town of Rochester and the area is spotted with old historical buildings that contain the most beautiful old libraries and intricate marble ceilings that tell the history of medicine in the US along with more contemporary constructions housing the huge variety of specialties that the Mayo Clinic houses. We learned about Diagnostic Ultrasound from expert Dr. Jay Smith were taken to the Mayo Clinic Biomechanics lab which houses the machine used by Dr. Tim Hewett to extensively study ACL injury, and participated in a golf biomechanics lab.
Coach Tamika (Williams) Jeter @ OSU
After Minnesota we headed to Columbus, Ohio, home of The Ohio State University Buckeyes. Our host, John Dewitt took us on a tour of their athletics and training facilities where I ran into former UConn and Connecticut Sun basketball player Tamika Williams for a quick reunion. We attended a discussion on articular cartilage surgical procedures presented by Caroline Brunst and a lecture presented by Dr. Ken Yeager on Building Resiliency observed the nationally recognized Ohio State Marching Band rehearse, attended the marching band Skull Session pep rally and another football game. We had the chance to meet many of the Ohio State Physical Therapy Residents studying in a wide variety of specialties including performing arts, oncology, sports, orthopedics, women's health, and neurology. And I got to see some of my Ohio family living nearby, which was the cherry on top of a really awesome collection of learning experiences.
Fellows with John DeWitt @The Ohio State University
I can't recommend this Fellowship highly enough, and would be happy to connect with anyone considering application for future participation. I'm sure that if you asked Pat and Becca, they would select different portions of our trip as their highlights or what was most impactful based on the differences between our patient populations and professional goals, but I'm so glad I was able to share this impactful experience with them. Thank you so much, American Academy of Sports Physical Therapy for this opportunity!
Hey everyone! Happy Fourth of July! Yesterday the Seattle Storm played their "Kid's Day" game, a tradition around the WNBA hosting games early in the day - always a rowdy event with lots of children attending games and singing along with what's going on in the arena. Today was the first time I've ever head "Baby Shark" at a WNBA game. I certainly hope it's the last. If you don't know what that is, it's here for your viewing pleasure, but know that you have been warned: your day is about to be ruined.
As the Storm Physical Therapist, I have the opportunity to work with some of the players who are injured while they rehab to get back to playing. This season, the Storm seems to be battling a curse that started in the off-season when Breanna Stewart's ruptured Achilles which I wrote about here, followed by Sue Bird having a knee surgery that was written up in the Seattle Times here. And the list continues after that. There are articles here about Jordin Canada's injury, which she has returned from, and an article here about Jewell Loyd's ankle injury, and an article here, about Kaleena Mosqueda-Lewis injuring her ankle earlier today. What a mess!
But I'm not here to write about the Storm Players' injuries (affter all, there are laws against that). Watching another player getting injured today made me reflective on the woes of the Storm this season and then start looking into the other teams to see how they're faring. There is a site which lists WNBA injuries, here, which I used for the starting point of this research. And so, without further ado, my research findings of injuries from around the WNBA.
ATLANTA:
Angel McCoughtry, a 2x Olympian and WNBA All-Star tore her ACL in August 2018. Based on typical rehab timelines, I'm not really sure why she hasn't made it back to the court by now - this article and this one from last week both say it's due to strength deficits, which would definitely be a reason to delay returning. I previously wrote about Angel here when I saw a video of her rehab in the off-season that I found appalling. I hope things have gotten better for her recovery since they filmed that session. Earlier this season, Tiffany Hayes had an ankle injury that was written about by High Post Hoops here, but she's been playing through it for the past eleven games.
CHICAGO:
Katie Lou Samuelson has missed all but three games with a broken right wrist. I recently read this article about her injury where she was working with my long-time friend and the Sky Strength and Conditioning Coach Ann Crosby about all the cardio "Lou" has been doing while she's been casted, hoping to stay in good shape for when she's cut out of the plaster and allowed to start dribbling again. High Post Hoops also covered Katie Lou and her teammate Jamierra Faulkner who had a knee injury in this article. Faulkner tore her right ACL last July (her left ACL was injured in 2017), and like Angel in Atlanta, appears to have had some complications with her recovery delaying her return to the court.
CONNECTICUT:
Last week, Layshia Clarendon underwent surgery on her ankle, putting her on the injured list for several months. The Sun, the team I worked for from 2007-2010, posted the news here. If she recovers on the fastest timeline for her particular surgical procedure, she might be able to step on the court by the end of the WNBA playoffs. But basically, she's going to be watching a lot of basketball and not playing, which is unfortunate, because she's fun to watch! With Connecticut winning lots of games right now, if they can manage to stay healthy, I think they'll still be playing in September. And they have one of the most experienced (and also long-time friend) Head Athletic Trainers in the WNBA, Rosemary Ragle.
DALLAS:
It bothers me a little bit that pregnancy is included on the injury list - but they also list players who are unavailable to their teams for overseas basketball commitment, so maybe the list should be called "players who won't dress" rather than being an injured list? Anyways, Skylar Diggins-Smith had a baby boy in April and is set on returning to the court this season, but hasn't yet. The team has had so many issues with players being unavailable (Skylar, Glory Johnson in the Eurobasket, and Tayler Hill about to have knee surgery - all listed here) that they were ultimately able to add NCAA WBB Player of the Year Megan Gustafson about three weeks ago. Even USA today had a little blurb about Tayler Hill having surgery here- and they didn't have a single article during the WNBA Finals last year. (At least they had no articles in print - maybe there were some online that I didn't see.) And Dallas has Isabelle Harrison back after suffering two concussions early in the season.
INDIANA:
Victoria Vivians is out with an ACL injury from overseas during the off-season and Natalie Achonwa missed a game or two with a finger injury, but otherwise, I haven't seen anything about Fever injuries.
LAS VEGAS:
Aces center Liz Cambage came in for the season with Achilles tendinitis but has returned to playing. Point guard Sydney Colson also had a concussion in June but has since returned. Another crew that's overwhelmingly staying healthier than most.
LOS ANGELES:
Team Super Star Candace Parker sat out the first several games of the season after a hamstring injury during a pre-season game, but has returned to the team. Alana Beard also missed about a month of the early portion of the season with a leg injury. That's two key players missing the first month of the season - so now that they're getting back into the swing of things, it will be interesting to see if LA can turn some of their early season woes around.
MINNESOTA:
Things got so bad in Minnesota, they were approved TWO roster exemptions so they could add players because they are facing multiple season-ending injuries. Two new players on the roster after more than a third of the season is over is incredibly challenging to teach your basketball system and try to build chemistry. They're having a lot of knee troubles. Karima Christmas-Kelly hurt her knee and underwent surgery two days ago and is listed as out for the rest of the season. Jessica Shepard is also out for the season with an ACL injury and Seimone Augustus has not yet played in a game this season from a May knee surgery - but she is expected to return at some point. Damiris Dantas is also out with a calf injury expected to return in about two weeks. And we don't have to mention the absence of Maya Moore, who is not injured but is pursuing some personal ventures this season... (OK of course I had to mention her)
NEW YORK:
The NY Liberty mostly has personnel issues due to several team members playing overseas, though they'll be returning shortly. Rebecca Allan has a finger injury keeping her sidelined and she did not play against us in Seattle yesterday. New York has had a lot of front office struggles in the news in past years which hopefully are improving now that they have new ownership - so maybe they deserve a break from the injury bug while they try to make positive changes in one of the few remaining cities to have an original WNBA team despite their move away from Madison Square Garden.
PHOENIX:
In my opinion, the greatest basketball player of all time is Diana Taurasi. She's also an exceptional human being. Unfortunately, Diana has been sidelined all season so far following spine surgery, but is tentatively expected to return to the court this week. Sophie Cunningham had back pain two weeks ago that limited her playing and DeWanna Bonner had an ankle injury last week, but both have returned.
WASHINGTON:
Kiara Leslie underwent a meniscus surgery at the end of May with expectations of about 3-4 months of rehab. Kristi Toliver had an injury to her right quad and Aerial Powers had an injury to her left glute, but both have made it back to the court. Superstar Elena Delle Donne has had some lingering issues with her knee since injuring it during the 2018 playoffs, but only missed the earliest games of the season.
I'm sure I missed other injuries.. and the ones listed above are just the ones I found when google searching - which means these are the athletes that missed a game - or many. Having been around teams for so long, it's easy to say that most WNBA players are battling nagging aches and pains and are getting regular treatment - either massage or chiropractic care or acupuncture or just spending time in prehab/rehab with the athletic trainer and strength and conditioning coach. Or in the unlikely event, as I wrote about here, with their physical therapist.
TAKE HOME MESSAGES:
1) The WNBA is experiencing a lot of injuries this season, and reviewing these articles, they're not just small injuries like ankle sprains removing athletes from 1-2 games. These are surgical interventions and months-long rehabilitations including year-long recoveries when you consider the Achilles tear for Breanna Stewart and the ACL injuries of Angel McCoughtry and so many others.
2) It's really hard to know if this rate of injuries and the number of "severe" injuries is more than previous years or not. It looks to me like it's definitely more, at least here in Seattle. But, from what I've learned in the past two years having had discussions with league representatives about my interest in researching WNBA injuries is that the system by which the league collects injury data has not been monitored or really enforced in many of the previous seasons and there isn't anyone with access who can put this information together into a report. I don't have access. Teams have to submit their injuries. Some teams are really good about it. Others are less diligent. In my dream world, I'd be taking the data from all the WNBA seasons with injury information in the past and I'd be analyzing it to see what kinds of trends can be identified to try to help with injury prevention programs at the youth, high school, and collegiate levels, with particular focuse on female athletes, but it certainly would not hurt males. I'd also be working to compare it to the NBA because their work conditions and medical equipment and support staff limitations are so different, it would be interesting to see if any correlations could be found. Someday I'll figure out how to take this project on and develop meaningful data that can be used to help future WNBA players - and elevate the world of women's sports. Someday.
3) How awesome is it that there are so many more news sources reporting on the WNBA!?!?!?! LOVE THIS! CBS Sports even posted this article about the Connecticut Sun soaring while all the other teams are figuring out how to deal with their injuries.
4) There are a lot of former UConn Huskies on this injury list... and while that probably isn't relevant, it is apparent. Maybe that's because there are so many in the WNBA - or it could be several other reasons. I won't try to suggest what it could be, but watching UConn basketball players getting injured in college and the WNBA is what drove me to go to PT School in the first place. I'm feeling a little disheartened that there hasn't been enough progress in injury prevention in these athletes, and potentially we're doing worse in the WNBA.
5) When the Seattle Storm won the championship last season, many of the medical providers felt that the WNBA season is a marathon - not a sprint - and that the team with the least severe and least number of injuries during the season would be the last team standing. This is part of the game in all sports. But I'd prefer it if the last team standing, hoisting that awesome WNBA Championship trophy overhead, was the one who had the most talented basketball players with the best chemistry and showed us all how beautiful this game really can be.
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!
The 2019 WNBA Season is almost here!!! This week, the Seattle Storm Sports Medicine Staff gathered at Storm Headquarters to prepare for our upcoming team physicals and training camp! Players will be starting to arrive in Seattle and get settled in their apartments with camp starting on Sunday, May 5th! It was nice to see the Championship Trophies, including the most recent 2018 WNBA Championship Trophy, proudly on display along with catching up with all my sideline pals. This will be my fifth season with the Storm and many of the medical providers have been there for at least three of those other seasons - so it's always a bit of a reunion getting back together after the off-season.
All of this is occurring in the same week as the Women's National Soccer League announcing their official roster for the 2019 World Cup and a group of over 200 professional women's hockey players announcing they'll be sitting out this upcoming season. So much going on in women's sports! We're facing a time of change. You can see it in politics. You can see it in education. You can see it on the news. You can see it at work. And, without question, you can see it in sports. It has been inspiring to see the platform athletes have through sports, and I do not take it for granted that I have the opportunity to stand on the sidelines and watch with a front row seat. But, in the wake of all this change, we have the chance to embrace opportunities and seize every chance that presents itself.
So today, I'll highlight a little about what the beginning of the WNBA Season looks like for the medical team working behind the athletes. In truth - all sports teams require multiple teams to operate at their best. You have the athletes on the court, the sports medicine providers - like the team doctor, athletic trainer, strength and conditioning coach, and other specialists - you have the business staff that makes sure the front office operates - and this can include your ticket sales team, marketing team... so many teams!
Our meeting was to get everyone organized. New members of the crew were introduced. We reviewed the medical status of all of the incoming players. This is helpful to prepare for our physical exams that will occur in the upcoming few days to know who is coming in injured and may need some rehab programming right from the start versus getting a strength and conditioning program ready. We get details on who will still be playing overseas in the European Leagues - because some of the Storm players are going to be playing for championships in other countries and will join us later than other players. We won't get into the discussion on why this occurs - it's financially based and it certainly increases the risk of injury on these athletes by not allowing them rest breaks or an off-season - which makes our physical exams even more important.
Truly, doing physicals for incoming WNBA players and attending training camp practices has been one of my favorite times to work with the team. Here's why:
1) The WNBA has 12 teams with 12 players on each team - so there are 144 professional female basketball players in our league. This compares to the 30 teams in the NBA which have 15 player spots available for a total of 450 possible jobs to play professional basketball. That means, whoever gets invited to training camp is the cream of the crop, ultimate best at what they do. Who doesn't want to meet, and work with, the greatest athletes in the sport they love? Of the group that comes in, a handful won't make the team, but they will get exposure from their invitation to training camp which will help their future in basketball anyways.
2) The rookies are usually coming in from college, their first job away from home, and it's an awesome opportunity to help them in whatever way possible. They all have different needs. For example, one year, the Storm Strength Coach and I were doing our physical exams on a player who had come from college... she hadn't even graduated yet. We asked her how she was settling into Seattle and she expressed some concerns about grocery shopping and cooking. Her college team and college dining halls had fed them most of their meals - so she had never had to do those things before. We could provide her with resources from day one of where to shop, what things to look for, and which players on the team were excellent cooks that they should ask for advise on techniques. The team also has a nutritionist that they can meet with to help design meals, but for starters, we needed to make sure they stopped eating out every meal, because it is far too expensive and time consuming.
3) Some of the best basketball practices are during training camp. Because there are only 12 spots on the team, these athletes are fighting hard for their spots. At this level, they work hard almost all the time, but for sure this is some of their best basketball. Training camp or the playoffs. When it really matters the most. And the coaching staff sets the tone for the whole season right from the start. So you're just in for a good time if you're on the sidelines.
What will we do at team physicals? Well - the team physician will go through the usual things that any other person would have done at a physical exam. Height, weight. Any pain? How is the body moving? How is strength? Any recent illnesses? Listen to heart and lungs, look in eyes, ears, and mouth. Any reason to get any blood tests? Nothing out of the ordinary. Hopefully you've had your own physical recently... and if it has been more than a year - schedule one!
The team Strength Coach and I will do movement screens that we have developed over the past few years. When I was with the Connecticut Sun, our team physical therapist and strength coach did movement screens too, so I would imagine all the teams in the league are doing some sort of assessment to determine where they should start their strength and conditioning programs for each athlete and see how everyone looks. As a physical therapist, I’m looking at their squats, jumping and landing, overhead motion, and some core strength tests. If you're not assessing your athletes before a season, you're guessing with their training for the whole time. Baseline measures are essential. And that's about it. Then we can prepare for the season!
