How to Ruin a Champion’s Knees – Why Brandon Roy needed good rehab!
This post is thanks to Derek Tan - a physiotherapist who used to work for me and now has his own private practice. He shared with me some stuff he found on Brandon Roy. You can find Derek at Tan Hands Physiotherapy - Shop 218-219, Level 1 (Inside Medical Centre), Carlingford Court, CARLINGFORD, NSW, Australia 2118. Phone: +61 2 9872 8155.
Brandon Roy - An All Star whose career got cut down too early!
You can read about Brandon Roy here but from what Derek tells me, he was one of the best shooting guards in the last decade with the Portland Trail Blazers NBA Basketball team. He was an All-Star and co-captain of his team. He was getting paid $13-14 Million for the 2010/11 season. But he suffered from knee injuries... here is a list of what I can tell he has had to do with his knees, not including the other hamstring and ankle issues...
First knee surgery 2004 (lateral meniscus)
NBA Rookie of the year 2006-7
2008 - L knee surgery (meniscus)
2010 - R knee surgery (meniscus)
2011 - bilateral arthroscopy cleanout
end of 2011 - retires aged 27 with quote "(no) cartilage between the bones of both knees"
Where did it all go wrong?
OK, Basketball is a tough sport and these guys aren't small and light. However, isn't 27 years old too young to retire due to cartilage wear and tear?
Also, I am not his Physiotherapist obviously, nor was I involved in his rehab. If I was, I would have had PLENTY to say!
I have only gathered this information via some videos I have watched which are listed below...but they are enough to tell me that his rehab wasn't done right...
Evidence Exhibit 1 - Resistance Band Walking Lunge with Med Ball Rotation
This blog post has some walking lunges with resistance band and ball rotations - an advanced exercise that requires lot of different body regions working properly to get it done right. I want you to watch his knees. Now what SHOULD happen is that his legs stay in line with his feet and perpendicular to his body. Tell me, is that what you see?
That's right! His hips do what we call "internal rotation" and cause his knees to come in towards his midline. The net result of this is that the top part of the knee (the femoral condyles) twists and rubs on his lower part of the knee (tibial plateau). Guess what is between those 2 bones? That's right - his cartilage (meniscii)!!! But wait, there's more.
Evidence Exhibit 2 - Dumbell Clean Pull to Armpit Exercise
So, now you have begun to see what we physios like to look for - knees SHOULD NOT come in at all during his exercise. If one of my exercise staff did to one of my patients, believe me, they would be chewed out severely! Let's look at another video...
So, what did you see this time? Yep, you are right again - his knees caved in. I am beginning to think that he has a hip stability problem, not a knee problem. Has any of his medical staff or rehab staff ever looked at his hip stability? I am beginning to think NOT!
Evidence Exhibit 3 - Split Squat Jump with Resistance Bands
OK, so are you sure you know what to look for now? This is such a basic problem that it should be taught everywhere in every Personal Training course in the world!!!
Now if you found the other videos hard to pick what is wrong...here is an obvious one for you...
Sorry - you have to click on the link to watch it...<click here>
Oh. My. Goodness. I can almost hear the cartilage cracking and splitting and grinding away from here in Australia! It is this kind of video that needs to be used on HOW NOT TO DO exercises! What is the trainer do there? He is standing right next to Brandon Roy and is not correcting his form. I personally wouldn't hire this guy to help my patients!
How often do I see this problem?
This is so common it is not funny. I even wrote a post earlier about it - I see mainly "motor control" problems - this is where people have trouble coordinating and controlling their bodies.
From the videos I saw tonight, Brandon Roy has motor control problems. I don't know where the primary problem is but you have to suspect the hips at the very least!
Are these exercises wrong?
Absolutely NOT. They are great exercises! But as with ALL exercises, they need to be done right. Finding the right trainer to help you is very difficult. They need to have eagle eyes and be aware about so much. It has taken me years to train my exercise staff and they still have some things to learn! but the net result is that my staff know more than most physiotherapists do 🙂
What does this mean for you?
1. If you do this during your exercises, go see someone who understands how to stop your knees from coming together - Women have more trouble than men in this for a number of reasons including their wider hips, their cultural training to "keep your knees together" when wearing skirts and dresses and a general lack of good gluteal strength.
2. If you see someone at the gym or your local exercise class doing it, tell the trainer to correct them. If the trainer won't correct them or doesn't care, stop seeing that person!!
3. Seek a professional who understands about how to assess, identify and rectify motor control problems. In my experience, the best people are well-trained musculoskeletal and sports physiotherapists - but you must be selective - not all physios are the same!
4. If you can't find someone to trust, then leave a message and I will try to find someone in your area of the world who can help.
My advice to Brandon Roy?
1. Get some DECENT rehab - it isn't too late for your knees...it is just your elite level career at the moment that is gone. Ditch that guy in the video - he hasn't helped your knees at all.
2. Get someone to look at your hips, feet, back, pelvis etc. You need someone to diagnose your problems holistically - from the upper body videos I saw, they looked ok
3. Get the most anal instructor on form you can find. If you can't find someone, come to my clinic and I will kick your butt for a very small price!
4. For a modest price, I am happy to come over there and get you back up to scratch and help you return to the NBA!
What do you think? How often do you see the same problems? Leave your thoughts and comments below!
About Post Author
If I was Brandon I’d be shattered. Sounds like he really had a lot left in his NBA career had it not been for such chronic knee issues. What is average age of retirement for a basketbal player? I doubt it’d be 27! How long had he been with this trainer? What qualifications does he have? Did Brandon not ever seek a second, third, forth opinion with regards to appropriate rehab pre and post surgery? As a trainer, it is never wrong to seek advice from other professionals regarding how to help your athletes. They have a duty of care like any other health professional. Refer him on to someone else if you can’t help – that’s being professional. I know you wont be able to answer those questions, but as an elite athlete, isn’t having the best qualified professionals treating you of paramount importance? I’m not a qualified physio, nor even a physio student (however I’d be lying if I said I did not have aspirations to one day be a physio!), but even I can see that the form he has on those videos is so wrong! After the many thousand air squats, back squats, front squats etc I’ve done over the past 6+ months, solid technique comes before loading up the weight. There is definitely nothing glamorous in having a sports injury – specially if it has originated from poor form from day one. Brandon, if you ever happen to read this, get yourself on a one-way, non-stop flight to Sydney – Antony will look after you 🙂
I suddenly feel *very* privileged to have a coach (Mick @ CFX) who hammers me every day on correct technique and doesn’t let me increase the weight until he is satisfied it is safe to do so. Also, it’s awesome to know I have a very qualified and experienced physio not far away in the event I need some rehab 🙂
I’m off to do some wall balls now. What’s this you ask? While holding a medicine ball – 6kg (for females) or 10kg (for guys), do a squat facing a wall and then throwing the ball to reach a height target on the wall, then catching the ball and repeating – all in a fluid continuously. It’s hard being a shorty though – I have to jump as I throw it to have a chance of reaching the target!!!). “Don’t let the knees cave in!”
Excellent comments Julia. Yes, I agree with what you have said there – It is simple things like that that can save ordinary weekend warriors through to elite level players! Thanks for your comments!
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Brandon Roy was a Shooting Guard.
Good point. Will correct the post. Thanks!
Hello, I am a college basketball player and I recently had knee surgery. I had something called an Osteochondral Fracture. A big piece of the cartilage in the back of my knee broke off. Obviously I will be doing rehab with our training staff, but any tips on what I should be doing? Thanks
Hi Abraham,
Obviously everything that I say on here is general in nature – please be guided by your health professionals…
However, some points to check and ask them about.
1. “How does this exercise you have given me help me get back to playing ball.”
2. “I DO NOT want to progress until I can do the exercise perfectly – show them the videos in the blog as an example of what NOT to do!”
3. “Are these exercises and rehab program helping to coordinate my body in all 3 planes of motion? Transverse, Sagittal and frontal plane?”
4. “What are your benchmarks in determining when I am able to progress on to the next stage of rehab”
5. Your rehab should focus on maintaining the upper body and good leg’s strength you have, it should develop the operated leg so that ideal tracking of the femur and tibia occurs and it should also focus on ensuring you don’t grind the area where you had your osteochondral defect/fracture.
Hope that helps. Let me know if you have more questions.
Also, pass on this blog post link to all of your basketball playing friends so they know how to avoid doing bad exercises…this is sooooo important!
Cheers
I am a kinesiologist who has worked with University Basketball players for 10 years. The fact that Brandon Roy was allowed to do those exercises with such obvious problems with his form is shocking. Knee tracking and hip/pelvis stability is and should be the first priority with every basketball player (or athlete in general). This is a great series of videos outlining this. Yet another example why people should not work with a trainer, but instead find somebody (Kin, H.Kin, CSEP, CPT) who is actually qualified.
Yoshia Burton @innovativeabby
Hi Yoshia. I am afraid I don’t know much about Kinesiologists in the USA. I always say that there are good and “bad” (perhaps I mean below average) in every profession…
My personal preference as a physiotherapist (Physical Therapist) is to have a good team around you so everything can be covered. I work as the head of our team – the massage therapist and exercise scientists follow my directions and I have trained them up personally. We refer to medicos that know their stuff.
I personally like physical therapists to be in charge of rehab because we understand the pathology and surgical rehab side of things quite well and can take action to help joint, myofascial, nerve, visceral and psychosocial issues as well as the whole integrated rehab side of things.
Thanks again for your comment!
Antony,
A Kinesiologist is someone with a degree in exercise physiology. We do a lot of rehabilitative work after the diagnosis and recommendation has been made by a Physiotherapist or Sports Chiropractor. There is no doubt that there is good and not as good in every profession, mine is no different.
The main issue I see here is that the mechanics and form in these exercises should have been identified long before it became a problem that needed rehabilitation. We do a biomechanical assessment with every athlete and client that we have to flush out these problems before they become a problem.
What is shocking is that somebody was working with an NBA player (or anyone for that matter) and could not see the obvious flaws in these movements and that comes from either incompetence or inexperience. Either one is not excusable.
We are in full agreement.
Keep up the good work.
Yoshia
@innovativeabby
Antony,
I’ve always struggled with why it is so essential to keep your knees from going inwards. If somebody did a complete rehab program with any basketball player, never allowing him/her to have anything but perfect form in lunging, they aren’t preparing the player for the game. Let’s just be honest, in basketball, your knees will not be in a perfect line every time you are required to lunge. Neither will you lumbar spine, your subtalar joint, etc.
So why would you train the person this way and cross your fingers hoping that they are never put in a vulnerable position? Isn’t it better to prepare the person for that situation?
I’m not proposing you train somebody’s ankle with extreme inversion to prepare for an ankle sprain, but shouldn’t you make the drills as similar to real life as possible?
I like your stuff, just a thought that I’d like to get your take on. Thanks!
Mike Taylor
Short Answer: By allowing ANYONE to exercise with poor form you are not only causing excessive wear on the joint by doing multiple repetitions during exercise but also strengthening the muscles to perform said motion with poor form causing excessive wear at that joint during any activity (enter vector forces and the oh so fun physics of it all). Proper training with emphasis on “motor control” including assessing muscular imbalances through the kinetic chain will aid in preventing injury, especially when joints are in a vulnerable position as the muscles will be able to properly aid in stabilization of that joint.
Hi Mike. Great points you make and I would like to address them properly…let’s see how I go for time!
I think it is best to start with philosophy – basically the human body hates movements that are repetitive. We know this because of the litany of injuries that can occur – repetitive strain injury, carpal tunnel, De Quervain’s tenosynovitis, stress-shielded tendons, joint wear and tear etc etc. We know that the tissues in the body respond to repetitive loading with mechanical creep, micro tears and ultimately tissue failure (tear, fracture, etc).
The solution to this is to vary your loading on the joints. I think I heard this from Peter O’Sullivan…that if you have only one way to do something, you are stuck in a groove, if you have 2 choices, you have a dilemma but if you have 3 or more ways to do something, you have choice. The body likes choice.
The “ideal” way of maintaining alignment of the femur with the tibia is to share the load most evenly across the joint surfaces.
So with knee rehab, all too often, people default to only being able to do squats and lunges with their knee tracking in. That means every step up a hill, even walking, every time they landed on their leg during running would have hip internal rotation occurring. This is not choice, this is a massive amount of loading in one direction on your joints. Ask an orthopedic surgeon how often he sees a Grade IV medial compartment of the knee but only Grade I-II changes in the lateral compartment. It is so prevalent that they do hemiarthroplasty – half knee replacements – just so the good side of the knee remains intact because it is not worth removing.
In Brandon Roy’s case, I am going to guess that he never really did his exercises properly. I think he probably only did them the way that he defaulted to and this caused all the trouble and the need for surgery. If he didn’t change the way he did his rehab (and it looks like he didn’t), then he would continue to wear down the areas he already wore down. I don’t think anyone would deny that NBA level players work hard at keeping fit and put in thousands of hours on the court. It is a massive load on the body and I don’t think anyone changed the way he loaded his knees.
So to sum up that section, I think the body needs to have many ways to do a task. There is a more efficient way of doing things and this should be the default way to spread the load across as many joints as possible.
______
The second point I want to make is addressing the concern that the knee is rarely in a “good” position.
I agree. Functional training is most important. However, I believe in setting good foundations. In nearly every sport that I can think of, you start by learning the basic moves and gradually move up into the more complicated moves as you demonstrate proficiency at each level. Unfortunately, dazzling talent like Brandon Roy can distract you from some basic fundamental errors like knees that don’t track properly. Combine that with the fact that he could overcome this inefficiency and still take on the best proves how good he was/is.
I think there is enough static postures and inefficient positions in our life to warrant a focus on doing things efficiently. I think if someone demonstrated efficiency at the “ideal” alignment, I would (and have) then progress them to more difficult exercises.
Believe it or not, there is a more efficient way to cut/jink/twist/sidestep etc. Watch some of the best running backs in the NFL and you will see that they stack their bones up nicely in ideal alignment for the task to maximize their power and weight transfer.
And, in case you are wondering, I do progress my ankles to the point that they can control their inversion eccentrically as much as possible – they start by unloading using a table or rails and lots of weight through the arms then progress until they can do it slowly and controlled.
All of that functional training into tougher positions must not be done until competency can be demonstrated at the fundamental levels first.
The way I have explained it to patients in the past is to think about playing sport with someone better than you. You can only do your best and it will never be good enough to be better than the other person…occasionally you might beat them at something but they could always pull out a better performance. The better player has the option to play to the best of their ability or to lower their performance. They have the choice to be able to do that.
In the same way, if your knees only prefer to work with hip internal rotation because external rotation is weaker, then they can only do their best. However, their performance at the knee will never be as good as the player who can control their knee through all ranges of hip rotation (both internal and external).
I hope that all makes sense.
What a great question…I think I might turn this into a blog post (rewritten of course!).
Thanks Mike.
Huge Blazer fan and just came upon this article… Heartbreaking to read especially knowing all the hard work B-Roy had put in to get where he was at. He was one of the best in the game in every aspect and it’s sad not seeing him out there. I wonder if the Blazers have anything to do with that Personal Trainer as they had another player, Greg Oden, who suffered from many knee injuries and never reached his great potential because of it. I’m guessing there is no relation to the cases, but interesting for sure.
Thanks for the article! Very informative and interesting.. Now get over here to work with Brandon!
THanks Will. Let’s see if we can get the blog post into Brandon Roy’s hands! He can then fly me over and I can try get him back into the NBA. Too young for sure to retire! He was great to watch – been watching some highlight reels as background for the blog post 🙂 Thanks for the comment
Cheers, I just stopped in to visit your site and thought I’d say I had a great visit.
I do agree with all of the ideas you have got presented inside your publish. They are incredibly convincing and can absolutely get the job done. Nevertheless, the posts are incredibly short for beginners. Could you please extend them a bit from up coming time? Thanks for the publish.
Hey antony
A story has recently come out about a kinesiologist who actually made recommendations to the Portland medical staff in 2008 before the injury occurred and was laughed off.
http://cosbysweaters.com/2012/04/14/blazers-ignored-oden-and-roy-injury-warnings-and-guide-to-preventing-them/
Huge news. His name should stick too – Zig Ziegler! i’m not kidding
D
I have medial bone on bone from wear and tear of basketball. I dont want to stop playing ball but the pain on inside of my knee stops me. Is it possible to do some kind of therapy or weight training to alleviate the pain? And is there any brace that really works for this condition? thank you
Hi rob.
It’s really hard to give you specific advice in an ethical way.
In general, for most people, there are lots of things can be tried. This includes exercise and braces and understanding how pain works.
It’s a damn shame what happened to Brandon Roy…