Investigation of the effect of circadian rhythm on the performances of NBA teams

Professional athletes competing in the NBA are frequently exposed to time-zone-shifting travels. These time zone changes may cause circadian rhythm (CR) phase shifts and these shifts affect sportive performance. The aim of this study was to investigate the effects of CR phase shifts on the performance of NBA teams. 25016 regular season games across 21 consecutive seasons were included in the CR phase shift calculations. To examine the CR phase shift effect on team performance, teams were divided into three groups regarding Coordinated Universal Time (UTC): the same internal UTC as the local UTC (LS); the internal UTC ahead of the local UTC (LA); and the internal UTC behind the local UTC (LB). With a different approach, teams were divided into another three categories: the same internal UTC as its opponent's internal UTC (OS); the internal UTC ahead of its opponent's internal UTC (OA); and the internal UTC behind its opponent's internal UTC (OB). 24985 game data were used to compare these groups in terms of 25 variables. Statistical analyses were conducted separately for home and away teams. For home games, it was found that LA and OA are the most and LB is the least successful group in winning and scoring performances. For away games, it was determined that LS is the most advantageous group with the best winning percentage. These results revealed that teams from more west may have a CR advantage in regular season home games. However, it is thought that the performance of away teams depends more on travel fatigue than CR phase shifts.

Facial injuries in the National Basketball Association: 2013-14 through 2017-18

OBJECTIVE

To describe the epidemiology, mechanisms, treatment, and disability for facial injuries in National Basketball Association (NBA) athletes.

METHODS

This was a retrospective descriptive epidemiological chart review using NBA Electronic Medical Record (EMR) system. Responses to injuries reported in games, practices, and other activities were used for all data analysis, except for game incidence rates. Incidence rates were calculated by the game-related facial injury incidence per total athlete exposure (player-games).

RESULTS

There were 440 facial injuries among 263 athletes during the 5 NBA seasons with an overall single-season risk of 12.6% and a game incidence of 2.4 per 1000 athlete-exposures (95% CI: 2.18-2.68). The majority of injuries were lacerations (n = 159, 36.1%), contusions (n = 99, 22.5%), or fractures (n = 67, 15.2%), with ocular (n = 163, 37.0%) being the most commonly injured location. Sixty (13.6%) injuries resulted in at least one NBA game missed (224 cumulative player-games) with ocular injuries resulting in the most cumulative games missed (n = 167, 74.6%). Nasal fractures (n = 39, 58.2%) were the most common fracture location followed by ocular fractures (n = 12, 17.9%) but were less likely to lead to games missed (median = 1, IRQ: 1-3) than ocular (median = 7, IQR: 2-10) fractures.

CONCLUSIONS

An average of one in eight NBA players sustained a facial injury each season with ocular injuries being the most common location. While most facial injuries are minor, serious injuries, especially ocular fractures, can result in games missed.

Changes in injury type among NBA athletes in response to the COVID-19 pandemic

CONTEXT

The 2019-2020 NBA season was altered significantly by the COVID-19 pandemic with a midseason suspension of games, the NBA 'bubble' tournament, and a shortened offseason. Concerns were raised regarding player conditioning and the potential increased risk of injury due to the schedule changes. The purpose of this study was to determine the impact of the COVID-19 pandemic and associated schedule changes on NBA injuries. It was hypothesized that injury rates would be higher in the year following the pandemic and teams who participated in the bubble would have higher injury rates in the following season than non-bubble teams. Furthermore, the types of injuries would shift toward more severe injuries in the condensed 2019-20 season and the following 2020-21 season.

DESIGN

Retrospective Cohort Study.

METHODS

The NBA's public injury reports were queried to identify players listed on an injury report. Standardized injury events were calculated for four pre-COVID-19 seasons (2015-2019), the COVID-19 season (2019-2020), and the post-COVID-19 season (2020-2021). Injury characteristics including type and location were extracted for each year and differences within each period were calculated.

RESULTS

When excluding injury events related to COVID-19 health and safety protocols, the overall injury events per 1000 exposures were not significantly different between time periods of pre-COVID-19, COVID-19, and post-COVID-19 seasons; (p = 0.199), and no difference was found in the rates of teams who participated in the bubble. Injuries, including soreness and strains, significantly decreased while fracture injuries significantly increased in the COVID-19 year.

CONCLUSIONS

The COVID-19 pandemic led to an increased number of games missed, but no increase in injury rates when accounting for health and safety protocols. Additionally, bubble participation had no impact on injury rates. However, despite no changes in injury rates, the types of injuries changed with an increased proportion of severe injuries and decreased proportion of minor injuries.

The Athletic Intelligence Quotient and performance in the National Basketball Association

Prior to selecting an NBA player, teams consider multiple factors, including game film and tests of agility, strength, speed, anthropometry, and personality. In recent years, as the other major professional sports have begun to place greater emphasis on the measurement of cognitive abilities, so too have representatives in the NBA. In this study, the predictive validity of an empirically-supported measure of cognitive ability (AIQ) was examined vis-à-vis performance outcomes in the NBA. Specifically, AIQ scores were obtained from 356 NBA prospects prior to their draft between 2014 and 2019. The players' professional status and subsequent performance were assessed through composite and isolated NBA statistics. ANOVAs demonstrated that there were significant differences between NBA and non-NBA players, and subsequent independent samples t-tests revealed that NBA players had significantly higher AIQ scores than non-NBA players for 3 out of 4 factors and the Full Scale AIQ Score. Additionally, using hierarchical multiple regression analyses, it was demonstrated that the AIQ predicted some modest statistically significant relationships with multiple NBA stats (e.g., Player Efficiency Rating, Effective Field Goal Percentage), after controlling for the impact of draft placement. While the effect sizes for these differences and relationships were somewhat small, such findings are consistent with sport analytics and the restricted range when evaluating professional athletes. Given the expanding role of analytics and cognitive assessment in the NBA, the potential importance of the AIQ is considered in the draft process.

Accelerated rehabilitation following thumb ulnar collateral ligament repair with suture tape augmentation: A case series of professional basketball players

STUDY DESIGN

Case series.

INTRODUCTION

Rehabilitation protocols following thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) repair typically do not allow for return to sport until 12 weeks post-surgery. The potential for accelerated rehabilitation following thumb MCP UCL repair with suture tape augmentation has yet to be explored.

PURPOSE OF THE STUDY

To describe the accelerated rehabilitation following thumb MCP UCL repair with the suture tape augmentation in professional basketball players.

METHODS

Three professional basketball players underwent thumb MCP UCL repair with suture tape augmentation. The athletes followed an accelerated rehabilitation program post-surgery that began with range-of-motion exercises at 2-3 days, proximal strengthening at 7-10 days, grip/pinch strengthening at 1-2 weeks, followed by progressive sport specific intervention with a custom orthosis.

RESULTS

At 5-6 weeks post-surgery, active thumb MCP range of motion returned to 83%-100%, grip strength to 81%-100%, and tripod pinch strength to 73%-78% of the contralateral side. All athletes successfully returned to sport within 5-6 weeks post-surgery.

DISCUSSION/CONCLUSION

This is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. In this series, professional basketball players were able to return to sport in half the routine recovery time. Further prospective studies re-thinking current rehabilitation protocols are warranted.

An empirical link between motivation gain and NBA statistics: applying hierarchical linear modelling

BACKGROUND

This study tested whether the motivation gain in groups is the result of social compensation or the Köhler effect by examining scaled individual salaries of National Basketball Association (NBA) players. Both factors explain the positive effects of a group, unlike social loafing. However, differing causes in motivation gain relate to whether players are low or high performers and the Köhler effect or social compensation.

METHODS

To test motivation gain, this study used 11-year NBA statistical data of 3247 players by applying hierarchical linear modelling (HLM) and HLM 7.0 was used for analysis. The players' individual statistics and annual salaries were collected from the NBA and ESPN websites, respectively. Whereas previous studies have looked at motivation gain through track-and-field and swimming relay records, this study verified motivation gain through salary variations among NBA players and their affiliated teams.

RESULTS

The high performers, while selecting teams with larger performance gaps among team members, earned a higher salary than while selecting teams with lower performance gaps among team members. This study found that motivation gain existed in high performers, which can be interpreted as support for social compensation rather than the Köhler effect.

CONCLUSIONS

We used our result to elucidate the basis for play-by-play decisions made by individuals and team behaviour. Our results are applicable for the enhancement of coaching strategies, ultimately improving team morale and performance. It can be interpreted that the motivation gains of high performers in the NBA are driven by the Cost Component of the Team member Effort Expenditure Model (TEEM), rather than the Expectancy and Value Components.

Validity of Video-Based Analysis for Analyzing Shoulder Injuries in the National Basketball Association

Background

Shoulder injuries are very common in athletes playing in the National Basketball Association (NBA). With increasing injury video uploads available online, we may be able to identify and systematically describe the mechanism of these injuries in these athletes.

Purpose

To (1) determine the validity of video-based analysis to evaluate mechanisms of shoulder injuries in NBA players during the 2010-2020 seasons and (2) report on commonly sustained injuries, circumstances associated with injury, and number of games missed owing to injury.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

An injury report data set was queried for shoulder injuries among NBA players between the 2010-2011 season and the 2019-2020 season, and results were cross-referenced using YouTube.com to identify high-quality videos of the injuries. Out of 532 shoulder injuries in this time frame, video evidence from 39 (7.3%) were evaluated for mechanism of injury and other corresponding situational data. From the remaining shoulder injuries, a randomly selected control cohort of 50 injuries occurring in the same interval was assessed for descriptive injury data, incidence of recurrence, necessity for surgery, and number of games missed, to compare with corresponding data from injuries in the videographic evidence cohort.

Results

In the videographic evidence cohort, the most common mechanism of injury was lateral contact to the shoulder (41%; P < .001), which was associated with an injury to the acromioclavicular joint (30.8%; P < .001). Injuries occurred more often when the team was on offense (58.9%; P < .001) versus defense. Players who required surgery missed 33 more games on average than players who did not require surgery (P < .001). For the injured players, a 33% incidence of reinjury was identified in the 12 months after their initial injury. As compared with the control cohort, no significant differences were noted in injury laterality, recurrence rates, necessity for surgical management, time in the season, or number of games missed.

Conclusion

Despite its low yield of 7.3%, video-based analysis may be a useful tool to determine the mechanism of shoulder injuries in the NBA, given the similarities of injury characteristics as compared with the control group.

Reliability and Effectiveness of a Lateral Countermovement Jump for Stratifying Shuffling Performance Amongst Elite Basketball Players

Though research suggests that basketball players spend approximately 31% of game actions shuffling laterally, limited data are available on the kinetic factors that separate fast and slow shufflers. The purpose of this study was twofold: (1.) Examine the reliability of kinetic metrics from a single-leg Lateral Countermovement Jump (LCMJ) (2.) Determine if kinetic metrics from the LCMJ can stratify above (i.e., “fast”) or below (i.e., “slow”) median shuffling performance. Twenty professional basketball players participated in the reliability study (21.7 ± 3.5 years, 1.98 ± 0.1 m; 89.9 ± 10.9 kg). One hundred seven professional and thirty-three collegiate basketball players (N = 140) (22.7 ± 3.5 years, 2.0 ± 0.1 m; 98.4 ± 11.9 kg) participated in the experimental study examining the ability of LCMJ kinetics to stratify shuffling performance. Reliability was assessed using Bland−Altman plots, coefficients of variation (CVs), typical errors (TEs), and intraclass correlation coefficients (ICCs). Anthropometric and LCMJ kinetic differences between fast and slow shufflers were assessed with an independent t-test. Four kinetic metrics (peak vertical force, peak lateral force, relative lateral force, and lateral impulse) met within- and between-session reliability thresholds (CV < 10% and ICC > 0.70). Faster shufflers generated significantly more relative lateral force than their slower counterparts (9.51 ± 0.8 Nx/kg vs. 8.9 ± 0.9 Nx/kg, %Diff 6.3, p < 0.00007, ES = 0.70). Basketball practitioners who have access to triaxial force plates may consider adding the LCMJ into their testing battery, as relative lateral force is a reliable metric that can stratify fast and slow shufflers.

Return to play and performance in the National Basketball Association after undergoing operative or nonoperative treatment for foot fracture

Background

The incidence of distal lower extremity fractures in National Basketball Association (NBA) athletes continues to increase. There is a paucity of data regarding return-to-play (RTP) rates and performance after sustaining foot fractures in these athletes. The purpose of this study is to quantify RTP rates and performance in NBA players after sustaining a foot fracture.

Methods

Sixty-two NBA athletes suffered foot fractures between 2005 and 2021 according to publicly accessible online data. Each athlete was matched to a control player based on age at start of career, age at index injury year, body mass index (BMI), and position played. Performance statistics from 3 seasons prior and 3 seasons following the index injury season were recorded.

Results

We found that players who suffered foot fracture injuries are expected to make a full recovery and reach their previous level of performance within three years. 100% of players treated nonoperatively returned to play; meanwhile only 90% of players who were treated operatively returned to play. This difference is statistically significant.

Conclusion

NBA athletes have a high RTP rate after sustaining a foot fracture. Players may experience an initial decrease in playing time and performance when returning to play, however, these variables were found to return to baseline over time. After three seasons, player statistics returned to baseline in mostly every category, including player efficiency rating (PER). We found that players are expected to make a full recovery and return to their previous level of performance, regardless of whether they were treated operatively or not. Players treated nonoperatively returned to play at a rate of 100% meanwhile those treated operatively returned at a rate of 90%. Therefore, it is our recommendation that players opt for nonoperative treatment when possible.

Home is where the hustle is: the influence of crowds on effort and home advantage in the National Basketball Association

Studies have consistently shown crowds contribute to home advantage in the National Basketball Association (NBA) by inspiring home team effort, distracting opponents, and influencing referees. Quantifying the effect of crowds is challenging, however, due to potential co-occurring drivers of home advantage (e.g., travel, location familiarity). Our aim was to isolate the crowd effect using a "natural experiment" created by the Coronavirus disease 2019 (COVID-19) pandemic, which eliminated crowds in 53.4% of 2020/2021 NBA regular season games (N = 1080). Using mixed linear models, we show, in games with crowds, home teams won 58.65% of games and, on average, outrebounded and outscored their opponents. This was a significant improvement compared to games without crowds, of which home teams won 50.60% of games and, on average, failed to outrebound or outscore their opponents. Further, the crowd-related increase in rebound differential mediated the relationship between crowds and points differential. Taken together, these results suggest home advantage in the 2020/2021 NBA season was predominately driven by the presence of home crowds and their influence on the effort exerted to rebound the basketball. These findings are of considerable significance to a league where marginal gains can have immense competitive, financial, and historic consequences.

Intra-articular Hip Injuries in National Basketball Association Players: A Descriptive Epidemiological Study

Background:

Since the most recent epidemiologic study of injuries in National Basketball Association (NBA) players was completed in 2012, the understanding and diagnosis of intra-articular hip injury has advanced.

Purpose:

To report the epidemiology of intra- versus extra-articular hip injuries in NBA players with regard to missed games, risk factors for injury, and treatment types.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The NBA injury database was queried for all reported hip and groin injuries from 2013 to 2017. The injuries were then divided into intra-articular and extra-articular types. Variables compared between injury types included player age, NBA tenure, season schedule (preseason or offseason), onset type, injury mechanism, roster position, games missed, time to return to play, and need for surgery.

Results:

A total of 224 athletes sustaining 353 total hip pathologies were identified. Of these injuries, 216 (61.2%) were sustained during game competition and affected 156 (69.6%) of the athletes. Intra-articular injuries represented 39 (11.0%) cases and involved 36 (16.1%) players. The time to return to play was significantly longer after intra-articular versus extra-articular injury (44.6 ± 96.0 vs 11.8 ± 32.0 days; P = .03), and the number of games missed was significantly greater after intra-articular versus extra-articular injury (8.0 ± 18.7 vs 1.54 ± 4.9 games; P = .03). Patients with intra-articular hip injuries were more likely to undergo surgery (odds ratio, 5.5 [95% CI, 1.8-16.7]; P = .005). There was no statistically significant difference in the number of games missed due to surgery (35.2 ± 8.3 [intra-articular] vs 35.4 ± 11.6 [extra-articular]; P = .42) or nonoperative treatment (4.2 ± 3.4 [intra-articular] vs 1.3 ± 0.5 [extra-articular]; P = .11). Years of NBA tenure were not significantly different between intra-articular and extra-articular injuries (7.1 ± 3.7 vs 6.3 ± 4.0 years). For both types of hip injury, there was no correlation between player age and either days to return to play or number of games missed (R² = 0.014).

Conclusion:

NBA players with intra-articular hip injuries underwent surgery more frequently and had a longer return-to-play time compared with those with extra-articular hip injuries. NBA tenure and player age were not correlated with the risk of developing hip injury or the need for surgery.

Better Offensive Strategy in Basketball: A Two-Point or a Three-Point Shot?

To better understand and explore the development trend of the offensive strategies of the world's top basketball leagues, this study took NBA shooting data in the regular seasons from 2009/2010 to 2018/2019 as the samples and analysed the relationships between the shooting score ratio and game win probability, and the practical application of offensive strategies in games. The results showed that (1) increasing the number and the percentage of three-point offenses in the game can improve the probability of winning. However, too many two-point shots can affect the team's winning probability to a certain extent. (2) The strong teams in the NBA focused more on the outside offense, while the weak teams focused more on the inside offense. (3) Statistical data further showed that whether a team's opponent is strong or weak, taking the offensive strategy that tends toward the outside shot can lead to a higher game win probability than the offensive strategy that tends toward the inside offense.

The Injury Rate in NBA Players Did Not Increase Following Return to Play After the COVID-19 Stay-at-Home Order

OBJECTIVE

The purpose of this study was to investigate the injury rate in NBA players following return to play during the post-COVID-19 shutdown 2019-2020 NBA season.

METHODS

This study was a retrospective review of all NBA players who were placed on the injury report during the preseason and first 4 weeks of the regular season as well as playoffs from the 2017-2018 through 2020-2021 NBA seasons. The data were compiled using publicly available injury reports. All injuries were recorded, and injury rates were calculated per 1000 athletic exposures. Risk ratio with 95% confidence intervals compared injury rates between the 2 cohorts.

RESULTS

Over the course of the study period, 399 injuries were reported. The highest injury rate per athletic exposure was observed to have occurred during the first month of the regular season in the 2 seasons prior to the COVID-19 pandemic. There was no significant difference in the average number of games missed before and after the pandemic for the preseason (P = .95), first month of regular season (P = .62), and playoffs (P = .69). There was no significant difference in the rate of injury when comparing injury rates before and after the pandemic for the preseason (P = .25), first month of the regular season (P = .11), and playoffs (P = .3).

CONCLUSION

The rate of injury in NBA players following the COVID-19 pandemic was not significantly higher than 2 recent past NBA seasons.

"It Will Ruin His Career": Does Violence Against Women Really Damage the Careers of NBA Players?

Arrests for acts of violence against women are a common occurrence for professional athletes, including National Basketball Association (NBA) players. Many sports fans, players, and those involved in professional sport believe that arrests for acts of violence against women, whether they result in a conviction or not, are highly detrimental to an athlete's career. We matched all 30 NBA players arrested for acts of violence against women between 2000 and 2016 with similar players who were not arrested and examined the effects of the arrest on postarrest average annual salary and career longevity. We found no significant difference between arrested players' careers and the careers of nonarrested counterparts. From a social learning perspective, this lack of punishment or loss of reward could be an important factor in continued acts of violence against women among NBA athletes.

Quantifying Training and Game Demands of a National Basketball Association Season

Purpose: There are currently no data describing combined practice and game load demands throughout a National Basketball Association (NBA) season. The primary objective of this study was to integrate external load data garnered from all on-court activity throughout an NBA season, according to different activity and player characteristics. Methods: Data from 14 professional male basketball players (mean ± SD; age, 27.3 ± 4.8 years; height, 201.0 ± 7.2 cm; body mass, 104.9 ± 10.6 kg) playing for the same club during the 2017-2018 NBA season were retrospectively analyzed. Game and training data were integrated to create a consolidated external load measure, which was termed integrated load. Players were categorized by years of NBA experience (1-2y, 3-5y, 6-9y, and 10 + y), position (frontcourt and backcourt), and playing rotation status (starter, rotation, and bench). Results: Total weekly duration was significantly different (p < 0.001) between years of NBA playing experience, with duration highest in 3-5 year players, compared with 6-9 (d = 0.46) and 10+ (d = 0.78) year players. Starters experienced the highest integrated load, compared with bench (d = 0.77) players. There were no significant differences in integrated load or duration between positions. Conclusion: This is the first study to describe the seasonal training loads of NBA players for an entire season and shows that a most training load is accumulated in non-game activities. This study highlights the need for integrated and unobtrusive training load monitoring, with engagement of all stakeholders to develop well-informed individualized training prescription to optimize preparation of NBA players.

Tendency of Driving to the Basket Is Associated With Increased Risk of Anterior Cruciate Ligament Tears in National Basketball Association Players: A Cohort Study

Background:

Driving to the basket in basketball involves acceleration, deceleration, and lateral movements, which may expose players to increased anterior cruciate ligament (ACL) injury risk. It is unknown whether players who heavily rely on driving have decreased performance on returning to play after ACL reconstruction (ACLR).

Hypothesis:

Players with a greater tendency to drive to the basket would be more likely to tear their ACL versus noninjured controls and would experience decreased performance when returning to play after ACLR.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Season-level performance statistics and ACL injuries were aggregated for National Basketball Association (NBA) seasons between 1980 and 2017 from publicly available sources. Players’ tendency to drive was calculated using 49 common season-level performance metrics. Each ACL-injured player was matched with 2 noninjured control players by age, league experience, and style of play metrics. Points, playing minutes, driving, and 3-point shooting tendencies were compared between players with ACL injuries and matched controls. Independent-samples t test was utilized for comparisons.

Results:

Of 86 players with a total of 96 ACL tears identified in the NBA, 50 players were included in the final analysis. Players who experienced an ACL tear had a higher career-average drive tendency than controls (P = .047). Players with career-average drive tendency ≥1 standard deviation above the mean were more likely to tear their ACL than players with drive tendency <1 standard deviation (5.2% vs 2.7%; P = .026). There was no significant difference in total postinjury career points (P = .164) or career minutes (P = .237) between cases and controls. There was also no significant change in drive tendency (P = .152) or 3-point shooting tendency (P = .508) after return to sport compared with controls.

Conclusion:

NBA players with increased drive tendency were more likely to tear their ACL. However, players who were able to return after ACLR did not underperform compared with controls and did not alter their style of play compared with the normal changes seen with age. This information can be used to target players with certain playing styles for ACL injury prevention programs.

"I'd Rather Be with Them Than Doing Anything Else": Kobe Bryant's Status as the MVP of Girl's Dads

Over 40 years ago, Cazenave (1979) provided one of the first scholarly examinations of how middle-income Black fathers defined the provider role. Since that time, scholars have studied the realities of biological and social fathers (Coles et al., 2010; Connor & White, 2006; Hamer, 2001, 1997; McDougal III & George III, 2016; Ransaw, 2017), as well as the relationship between fathering and sport (Fletcher, 2020). This qualitative work examined the words the late Kobe Bryant (January 23, 1978-January 26, 2020) used to describe his role as father to four daughters. To determine the underlying messages behind Bryant's words, I used Phenomenology as the theoretical framework. Qualitative analysis of the words featured in the Insider article, "Kobe Bryant's 10 Most Touching Quotes on Fatherhood and Raising Daughters" By Emily Cavanaugh (February 25, 2020) revealed three themes: (1) Bryant made being a present father a priority; (2) Bryant publicly praised his late daughter Gianna and her sisters; and (3) Bryant saw himself as a role model to children. Most important, Bryant's fame and status in professional basketball along with his narratives regarding being a father to daughters is a strong, enduring counter narrative to the "absent Black father" trope that is common in society. The work also discussed the reasons why in light of the rape scandal Kobe Bryant is a good role model. Implications for how fatherhood will shape the Bryant legacy will be discussed.

Playing-Side Analytics in Team Sports: Multiple Directions, Opportunities, and Challenges

This paper describes developments in the player-side analytics in major team sports. We take a decision-making lens to the role of analytics in player decisions by general managers and coaches. We outline key accelerators and inhibitors to the wider adoption and acceptance of data analytics playing a greater role in the decisions of clubs.

Mechanics of the Jump Shot: The "Dip" Increases the Accuracy of Elite Basketball Shooters

The present study assessed the mechanics of the basketball jump shot to determine whether or not the “dip” increased shot accuracy. There remained a debate between coaches who believed “dipping” was too slow and coaches who believed “dipping” increased accuracy. A mixed design was used for the present study with elite high-school and university players all performing shots with and without the “dip” at four distances: the last hash mark before the free throw line (3.125 m), the length of an imaginary hash mark beyond the free throw line (4.925 m), the top of the free throw circle (6.025 m), and the three-point line (6.750 m). These distances best emulated where the majority of shots were attempted in a game. Thirty-six athletes completed the study, with accuracy and shot quality being measured using Hardy-Parfitt’s six-point scale. The results of the present study indicated that the “dip” led to approximately a 7–9% increase in accuracy of the jump shot for both high school shooters, and university shooters, suggesting that coaches should begin to teach the “dip” in a player’s shooting motion to improve scoring results.

The 2020 NBA Orthobiologics Consensus Statement

This 2020 NBA Orthobiologics Consensus Statement provides a concise summary of available literature and practical clinical guidelines for team physicians and players. We recognize that orthobiologic injections are a generally safe treatment modality with a significant potential to reduce pain and expedite early return to play in specific musculoskeletal injuries. The use of orthobiologics in sports medicine to safely reduce time loss and reinjury is of considerable interest, especially as it relates to the potential effect on a professional athlete. While these novel substances have potential to enhance healing and regeneration of injured tissues, there is a lack of robust data to support their regular use at this time. There are no absolutes when considering the implementation of orthobiologics, and unbiased clinical judgment with an emphasis on player safety should always prevail. Current best evidence supports the following: Key Points There is support for the use of leukocyte-poor platelet-rich plasma in the treatment of knee osteoarthritis. There is support for consideration of using leukocyte-rich platelet-rich plasma for patellar tendinopathy. The efficacy of using mesenchymal stromal cell injections in the management of joint and soft tissue injuries remains unproven at this time. There are very few data to suggest that current cell therapy treatments lead to any true functional tissue regeneration. Meticulous and sterile preparation guidelines must be followed to minimize the risk for infection and adverse events if these treatments are pursued.Given the high variability in orthobiologic formulations, team physicians must stay up-to-date with the most recent peer-reviewed literature and orthobiologic preparation protocols for specific injuries.Evidence-based treatment algorithms are necessary to identify the optimal orthobiologic formulations for specific tissues and injuries in athletes.Changes in the regulatory environment and improved standardization are required given the exponential increase in utilization as novel techniques and substances are introduced into clinical practice.

Gender disparity among NBA and WNBA team physicians

BACKGROUND

Female physicians are underrepresented across a broad range of medical specialties, especially at senior levels. Previous research demonstrated poor representation of women in sports medicine leadership roles in the National Collegiate Athletic Association (NCAA) compared to their male colleagues.

PURPOSE

The purpose of this study was to evaluate the distribution of men and women among team physicians on the medical staffs of National Basketball Association (NBA) and Women's National Basketball Association (WNBA) teams in the last 10 years and assess regional differences in representation of female physicians.

METHODS

A Google search of publicly available data regarding team physician gender, medical specialty, and medical degree was conducted in October 2019 for team physicians in the NBA and WNBA over the last 10 years. Descriptive statistics were used to analyze the data. This data was then stratified by physician specialty and region of country in which NBA/WNBA franchises are located to provide regional comparison of team physician characteristics.

RESULTS

We identified 125 team physicians for NBA franchises. Of these, 122 (97.6%) were male and 3 (2.4%) were female. In the WNBA, a total of 28 physicians were identified. 20 (71.4%) were male and 8 (28.6%) were female. The Northeast had the highest proportion of female team physicians, with 5 of 18 (27.8%). Female physicians were represented in the remaining geographic regions as follows: 3 of 41 (7.3%) in the Midwest, 2 of 45 (4.4%) in the South, and 1 of 48 (2.1%) in the West.

CONCLUSION

This study demonstrates a substantial difference in the number of female physicians with leadership roles in both the NBA and WNBA compared to male physicians. It is important to try to understand what barriers female physicians face in their pursuit of upper level positions in sports medicine and to implement strategies to provide equal opportunities to both male and female physicians.

An analysis of Google Trends following athletic injuries by high profile NBA players during the 2019 NBA finals

CONTEXT

Injuries are common among high profile players in the National Basketball Association (NBA), and could provide an opportunity for physicians to provide accurate sports injury information and reliable rehabilitation data to the general public in the immediate aftermath.

OBJECTIVES

To evaluate social media trends to investigate public interest in athletic injuries in the NBA and to evaluate the length of maintained interest in these injuries.

METHODS

The Google Trends tool was used to analyze search data around two high profile players-Kevin Durant and Klay Thompson-who suffered injuries during the 2019 NBA Finals. The results were compared to the expected search forecast derived from an autoregressive integrated moving algorithm model.

RESULTS

Both players were associated with a mean increase of 1,052.4% (standard deviation [SD], 703.96%) in relative search volumes for terms related to their injuries. This data showed a significant increase in search engine activity related to injuries associated with NBA players in the first 6.13 days (SD, 3.14 days) following the injuries, marking a substantial timeframe for public engagement.

CONCLUSIONS

Search traffic information may be beneficial to the sports medicine community, as social media can provide a platform for patient education in a limited timeframe. By increasing patient awareness and knowledge regarding athletic injuries, social media can expand the pool of potential patients for physicians and surgeons.

Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

Background:

Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR).

Purpose/Hypothesis:

To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2.

Study Design:

Case series; Level of evidence, 4.

Methods:

An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints.

Results:

A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season (P = .0056). Performance in the second postoperative season was not significantly different versus preinjury.

Conclusion:

NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

Urgent wake up call for the National Basketball Association

NONE

Frequent air travel and the condensed game schedule typical of a National Basketball Association (NBA) team during the season, often results in accompanying sleep disturbances related to sleep length, sleep quality, and sleep timing (with highly harmful impacts on health, both physical and mental). These issues are not only problematic for NBA players, but also the coaches, training staff, and management support. In this narrative review, we summarize the detrimental effects that this travel and game schedule could have on NBA team members' sleep, as well as their physical and mental health. Multiple peer-reviewed articles address the role of sleep in athletic performance and health; however, to date, the literature focused on sleep-related issues that are unique to the NBA schedule is scarce. Firstly, this review addresses the impact of the NBA schedule, outlining the number of games and the travel involved (number of flights, the timing of flights, timings of arrival at destination and hotel); we also outline a typical daily NBA travel schedule, providing the reader a glimpse of what this encompasses. Secondly, we provide a brief overview of sleep science and discuss specific applications related to the NBA. Finally, we provide comment on the unique current situation of the NBA "bubble". Based on this review, there appears to be considerable scope for further investigation of the acute and chronic effects of sleep disturbances concerning the NBA travel and game schedule. Sleep science recommendations need to inform practice, target sleep interventions, and personalized protocols designed to enhance sleep health that can be incorporated at the organizational level.

Integrity Fees in Sports Betting Markets

Sports leagues have requested state legislatures to pass so-called integrity fees or taxes on the entire amount bet on their games, ostensibly to provide resources to protect against game fixing and other corrupt behavior. These fees might just augment league revenues. Integrity fees have different consequences if they are placed on a sports book's handle or hold. We model one possible consequence of an integrity fee placed on the handle, that sports books might be motivated to avoid pushes, after which they have no hold but face a tax liability. One approach moves to half-point lines which eliminate pushes but might be second best in terms of betting market efficiency. As a case study, we describe the characteristics of recent betting lines in four North American sports. Based on predicted pushes, actual pushes, half-point lines, and the intertemporal correlation between the annual number of pushes and the annual number of half-point lines, it appears that sports books already actively set lines that avoid pushes and could easily adjust to half-point lines motivated by integrity fees.

Impact of Knee Injuries on Post-retirement Pain and Quality of Life: A Cross-Sectional Survey of Professional Basketball Players

BACKGROUND

Professional basketball players are at increased risk for knee injuries. Epidemiologic data exist on the prevalence of such injuries in players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes before after retirement.

QUESTIONS/PURPOSES

The goals of this study were to evaluate the rates and characteristics of knee injury before and during NBA players' careers and how those injuries correspond to knee injury, pain, or surgery, as well as quality of life, after retirement.

METHODS

A cross-sectional survey study was performed. The survey instrument was designed with the aid of a multidisciplinary focus group. Data collected included patient demographics; length of professional career; injuries before, during, and after the athletes' NBA careers; and post-retirement quality of life, assessed using the EQ-5D and Tegner Activity Scale. The survey was distributed electronically to 900 retired NBA athletes. Descriptive statistics were used to present means and proportions, and multiple regression analysis was performed to assess for potential factors correlated to injury.

RESULTS

One hundred eight retired NBA players participated (a response rate of 12%). Almost a third (32.4%) sustained a knee injury before starting their NBA career; 51 (47.2%) sustained knee injury during professional play in the NBA, and nearly two-thirds of those players (62.7%) needed surgery. Among those who reported knee injuries during their NBA career, a majority had knee pain that continued until retirement (72.5%). Two-thirds (67%) reported having knee pain currently (at the time of the survey). More than a third (34.0%) underwent knee surgery after retirement, which included nine total knee arthroplasties (8.3%).

CONCLUSION

A majority of retired NBA athletes in our study had knee pain, and many needed operative management during and after their NBA careers. NBA players score lower on quality-of-life measures than average North American men of similar age. Further research is needed to elucidate the best strategies for recognizing and treating knee injuries in these athletes.

Effect of Achilles Tendon Rupture on Player Performance and Longevity in National Basketball Association Players

Background:

National Basketball Association (NBA) players who return to sport (RTS) after Achilles tendon rupture have been reported to have poor outcomes.

Purpose:

To evaluate the effect of Achilles tendon ruptures on player performance and career longevity in NBA athletes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

NBA players who sustained Achilles tendon ruptures between 1970 and 2019 were identified using publicly available resources and were matched 1:1 to a healthy control group by age, position, height, and body mass index. Demographic characteristics, player utilization (games and minutes), and performance efficiency rating (PER) were documented for all athletes. The season of Achilles tendon rupture was set as the index year, and statistical analysis compared postindex versus preindex data both acutely and in the long term. Percentages relative to preoperative values were calculated to compare the injured and control groups in a standardized fashion.

Results:

Of 47 players, 34 (72.3%) with Achilles tendon ruptures returned to play at the NBA level after surgical intervention. A total of 7 players were excluded from the study. No differences were found in demographic characteristics or PER (2 years before injury) between the remaining 27 players and matched controls. The injured players had significantly shorter careers compared with control players (3.1 ± 2.3 vs 5.8 ± 3.5 seasons, respectively; P < .05). Injured players demonstrated significant declines in games per season (GPS), minutes per game (MPG), and PER at 1 year and 3 years after RTS compared with preindex baseline (P < .05). Injured players, compared with control players, had reduced relative percentages of games started (GS) (50% vs 125%, respectively), MPG (83% vs 103%), and PER (80% vs 96%) at 1 year after return (P < .05), but reductions at extended 3-year follow-up were seen only in GPS (71% vs 91%) and GS (39% vs 99%) (P < .05).

Conclusion:

Our study found that 72.3% of NBA players returned to play after Achilles tendon repair, but they had shorter careers compared with uninjured controls. Players returning from Achilles tendon repairs had decreased game utilization and performance at all time points relative to their individual preindex baseline. However, for the injured players when compared with controls, game utilization but not performance was found to be decreased at 3-year follow-up.

Effect of Workload After ACL Reconstruction on Rerupture Rates in NBA Players

Background:

Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-altering injury sustained by players in the National Basketball Association (NBA). Strategies have been employed by the league to prevent reinjury of players after ACL reconstruction (ACLR), including minute restrictions and rest games; however, it remains unknown whether workload metrics after ACLR influence the risk for reinjury and revision surgery.

Purpose:

To evaluate whether workload changes after return to play (RTP) from primary ACLR influences the risk of rerupture in NBA players.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We identified NBA players from 1975 to 2018 who underwent primary ACLR as well as those who required revision ACLR. Primary outcomes included workload measures such as games played, games started, and minutes per game. Secondary outcomes included in-game performance statistics. Statistical analysis was used to compare relative workload and performance 3 years before and 3 years after undergoing primary ACLR. Workload was also compared between the control group of NBA players who underwent primary ACLR and those who required revision ACLR.

Results:

A total of 68 players who underwent primary ACLR were included, 8 of whom subsequently required revision ACLR. In their first season upon RTP, control players (primary ACLR) demonstrated a significant reduction in all workload metrics relative to the season before injury (P < .001), while the revision group demonstrated an unchanged to increased workload. In a comparison between the primary and revision groups during the first season after RTP, the primary group demonstrated significantly fewer games started (mean ± SD, 22.2 ± 3.0 vs 35.8 ± 8.3; P = .039) and minutes per game (20.5 ± 1.1 vs 27.0 ± 3.1; P = .048) than revision players. The primary ACLR group demonstrated reduced cumulative workload trends for the first 3 years after RTP relative to 3 years before injury, which was not demonstrated in the revision ACLR group, albeit statistically insignificant.

Conclusion:

Our study found that after ACLR, a reduction in workload parameters relative to preinjury baseline was associated with players who did not sustain rerupture. Further study is required to determine if workload measures following RTP from primary ACLR should be individualized relative to preinjury baseline.

Different Movement Strategies in the Countermovement Jump Amongst a Large Cohort of NBA Players

Previous research has demonstrated large amounts of inter-subject variability in downward (unweighting & braking) phase strategies in the countermovement jump (CMJ). The purpose of this study was to characterize downward phase strategies and associated temporal, kinematic and kinetic CMJ variables. One hundred and seventy-eight NBA (National Basketball Association) players (23.6 ± 3.7 years, 200.3 ± 8.0 cm; 99.4 ± 11.7 kg; CMJ height 68.7 ± 7.4 cm) performed three maximal CMJs. Force plate and 3D motion capture data were integrated to obtain kinematic and kinetic outputs. Afterwards, athletes were split into clusters based on downward phase characteristics (k-means cluster analysis). Lower limb joint angular displacement (i.e., delta flexion) explained the highest portion of point variability (89.3%), and three clusters were recommended (Ball Hall Index). Delta flexion was significantly different between clusters and players were characterized as "stiff flexors", "hyper flexors", or "hip flexors". There were no significant differences in jump height between clusters (p > 0.05). Multiple regression analyses indicated that most of the jumping height variance was explained by the same four variables, (i.e., sum concentric relative force, knee extension velocity, knee extension acceleration, and height) regardless of the cluster (p < 0.05). However, each cluster had its own unique set of secondary predictor variables.

Female Team Physician Representation in Professional and Collegiate Athletics

BACKGROUND

Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized.

PURPOSE

To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM).

STUDY DESIGN

Cross-sectional study.

METHODS

Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally.

RESULTS

Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons (P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women's National Basketball Association (31.3%).

CONCLUSION

Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.

National Basketball Association combine performance after a partial meniscectomy

BACKGROUND

An arthroscopic meniscectomy is one of the most common orthopedic procedures in athletes. Return to play rates and deficits in muscle function have been reviewed after meniscectomy, but no study has reviewed functional performance after an isolated partial meniscectomy.

HYPOTHESIS/PURPOSE

To compare the performance of elite-level basketball players after a partial meniscectomy to a control group of players with no previous reported knee injury. We believe that there is no difference between the two groups in functional performance.

STUDY DESIGN

Case Series.

METHODS

Functional performance results from the National Basketball Association (NBA) combine were reviewed between 2000 and 2015. Twelve out of 1092 players were found to have undergone a partial meniscectomy prior to competing in the NBA combine. The partial meniscectomy group was compared to an age-, size-, and position-matched control group with respect to functional performance testing such as the shuttle run test, lane agility test, ¾ court sprint, vertical jump (no step), and vertical jump (max).

RESULTS

The meniscectomy and the control groups that there was no significant difference between the two groups in agility, quickness, sprinting, and jumping ability. However, there was a - 0.596 spearman correlation between months after surgery and agility (p = 0.041), while there was a + 0.690 and + 0.650 spearman correlation between both months after surgery and standing vertical and max vertical (p = 0.013 and p = 0.022).

CONCLUSIONS

Athletes competing in the NBA combine who have undergone a partial meniscectomy perform as well as uninjured athletes in all NBA combine performance testing. Furthermore, as athletes are further out from surgery, they have an improvement in both standing and max vertical jump.

Return to play and performance after shoulder instability in National Basketball Association athletes

HYPOTHESIS

We hypothesized that players in the National Basketball Association (NBA) who sustained a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type.

METHODS

We used publicly available data to identify and evaluate 50 players who sustained an in-season shoulder instability event (subluxation/dislocation) while playing in the NBA. Demographic variables, return to NBA gameplay, incidence of surgery, time to RTP, recurrent instability events, and player efficiency rating (PER) were collected. Overall RTP was determined, and players were compared by type of injury and mode of treatment.

RESULTS

All players (50/50) returned to game play after sustaining a shoulder instability event. In those treated nonoperatively, athletes who sustained shoulder subluxations returned after an average of 3.6 weeks, compared with 7.6 weeks in those who sustained a shoulder dislocation (P = .037). Players who underwent operative management returned after an average of 19 weeks. Athletes treated operatively were found to have a longer time interval between a recurrent instability event (70 weeks vs. 28.5 weeks, P = .001).

CONCLUSION

We found 100% rate of RTP after a shoulder instability event in an NBA athlete. Players who experience shoulder dislocations were found to miss more time before RTP and were more likely to undergo surgical intervention compared with those who experienced a subluxation. Surgical repair maintained a longer interval between recurrent instability. Future investigations should aim to evaluate outcomes based on surgical procedures and identify possible risk factors predictive of recurrent instability or failure to RTP.

Key Anthropometric and Physical Determinants for Different Playing Positions During National Basketball Association Draft Combine Test

Annual draft combine test of National Basketball Association (NBA) is a key player testing process where prospective players with extraordinary athletic abilities are evaluated and the assessment results would further inform the determination of prospective players for the league during draft day. Nonetheless, key attributes from the combine test that distinguished successful players in the draft from those unselected has yet to be investigated. The study was aimed to: (i) compare the difference between NBA drafted and undrafted players from five playing positions, considering anthropometric characteristics and physical fitness ability during draft combine test; and (ii) determine the key combine test factors that most effectively discriminate between draft groups. A total of 3,610 players participating in the 2000-2018 NBA draft combine test were included. Independent t-test was applied to compare difference between drafted and non-drafted players in variables related to anthropometrics, and strength and agility test. A descriptive discriminant analysis was subsequently used to identify which variables could best discriminate between two draft groups in each playing position. The significance level was set at p < 0.05. The drafted players from five positions outperformed the undrafted in height, wingspan, vertical jump height and reach, line agility and three-quarter sprint test (p < 0.01, ES = 0.26-0.87). The discriminant functions for each position (p < 0.001, Λ = 0.81-0.83) were emphasized by specific variables that discriminated both draft groups. The findings revealed that in addition to height and wingspan, leg power served as key determinants for being drafted as guards, as did agility and speed for power forwards and centers.

Ankle Sprains in the National Basketball Association, 2013-2014 Through 2016-2017

BACKGROUND

Ankle sprains are one of the most common injuries in basketball. Despite this, the incidence and setting of ankle sprains among elite basketball players are not well described.

PURPOSE

To describe the epidemiology of ankle sprains among National Basketball Association (NBA) players.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

All players on an NBA roster for ≥1 NBA game (preseason, regular season, or playoffs) during the 2013-14 through 2016-17 seasons were included. Data were collected with the NBA electronic medical record system. All NBA teams used the electronic medical record continuously throughout the study period to record comprehensive injury data, including onset, mechanism, setting, type, and time lost. Game incidence rates were calculated per 1000 player-games and per 10,000 player-minutes of participation, stratified by demographic and playing characteristics.

RESULTS

There were 796 ankle sprains among 389 players and 2341 unique NBA player-seasons reported in the league from 2013-14 through 2016-17. The overall single-season risk of ankle sprain was 25.8% (95% CI, 23.9%-28.0%). The majority of ankle sprains occurred in games (n = 565, 71.0%) and involved a contact mechanism of injury (n = 567, 71.2%). Most ankle sprains were lateral (n = 638, 80.2%). The incidence of ankle sprain among players with a history of prior ankle sprain in the past year was 1.41 times (95% CI, 1.13-1.74) the incidence of those without a history of ankle sprain in the past year (P = .002). Fifty-six percent of ankle sprains did not result in any NBA games missed (n = 443); among those that did, players missed a median of 2 games (interquartile range, 1-4) resulting in a cumulative total of 1467 missed player-games over the 4-season study period.

CONCLUSION

Ankle sprains affect approximately 26% of NBA players on average each season and account for a large number of missed NBA games in aggregate. Younger players and players with a history of ankle sprain have elevated rates of incident ankle sprains in games, highlighting the potential benefit for integrating injury prevention programs into the management of initial sprains. Research on basketball- and ankle-specific injury prevention strategies could provide benefits.

Hip and Groin Injuries in Professional Basketball Players: Impact on Playing Career and Quality of Life After Retirement

BACKGROUND

Professional basketball players are at increased risk of hip and groin pain. Epidemiologic data exist on the prevalence of hip and groin issues among players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes after retirement.

HYPOTHESIS

A high proportion of retired NBA athletes would have hip and/or groin pain.

STUDY DESIGN

Cross-sectional survey.

LEVEL OF EVIDENCE

Level 4.

METHODS

A survey was developed through an interdisciplinary focus group. The survey was developed to capture data regarding demographics, collegiate and professional athletic injuries, and current quality of life and musculoskeletal health. The questionnaire was electronically distributed to all members of the National Basketball Players Association using SurveyMonkey (N = 900).

RESULTS

A total of 108 (12%) retired NBA players completed the survey. More than one-third (36.3%) of athletes report currently experiencing hip and/or groin pain, and 17.6% had received injections for hip or groin conditions since retiring from the NBA. Since retiring, 14.7% of respondents had undergone total hip arthroplasty. The median Tegner activity level scale was 3 out of 10. Nearly one-third (32.4%) of athletes report moderate to severe problems with mobility, and close to half (48%) had moderate to extreme pain/discomfort.

CONCLUSION

Hip and groin injuries are common among NBA athletes, affecting players throughout their careers and into retirement. A subset of athletes may exist in whom intra-articular hip pathology is not appropriately identified and treated while playing in the NBA.

CLINICAL RELEVANCE

Retired NBA athletes are at high risk of hip and groin pain after retirement and are more likely to require total hip arthroplasty compared with the general population.

Foot Alignment in Symptomatic National Basketball Association Players Using Weightbearing Cone Beam Computed Tomography

Background:

Weightbearing cone beam computed tomography (WB CBCT) allows detailed 3-dimensional imaging of the foot and ankle in a weightbearing state and provides improved accuracy and reliability of foot alignment measures, especially when compared with conventional radiographic views.

Purpose:

To describe the foot alignment in National Basketball Association (NBA) players with different symptomatic foot and ankle injuries using WB CBCT and to determine if any predominant morphotype would be identified.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 45 active NBA players (mean age, 24.4 years [range, 20-34 years]; N = 54 feet [29 right, 25 left]) were assessed using WB CBCT. Measurements included the following: (1) foot and ankle offset (FAO), (2) calcaneal offset (CO), (3) hindfoot alignment angle (HAA), (4) angle between the inferior and superior facets of the talus (Inftal-Suptal), (5) angle between the inferior facet of the talus and the horizontal floor line (Inftal-Hor), (6) forefoot arch angle (FAA), (7) navicular-to-floor distance, and (8) medial cuneiform–to-floor distance. Measurements were then compared with values available in the literature for a “normal” foot morphotype.

Results:

Among the 54 feet, the mean FAO was 0.48% (95% CI, –0.25% to 1.21%), the mean CO was 1.18 mm (95% CI, –0.50 to 2.87 mm), and the mean HAA was 1.42° (95% CI, –0.80° to 3.65°). The mean Inftal-Suptal angle was 5.31° (95% CI, 3.50°-7.12°), while the mean Inftal-Hor angle was 4.04° (95% CI, 2.56°-5.51°). The mean FAA was 15.84° (95% CI, 14.73°-16.92°), the mean navicular-to-floor distance was 38.30 mm (95% CI, 36.19-40.42 mm), and the mean medial cuneiform–to-floor distance was 26.79 mm (95% CI, 25.30-28.28 mm). None of these values were found to be significantly different when comparing forwards, guards, and centers.

Conclusion:

NBA players presenting with symptomatic foot and ankle injuries had a fairly “normal” foot morphology, with a tendency toward a varus hindfoot and a high-arched morphotype. No significant differences were found between players based on their position on the court. WB CBCT may help to shed light on anatomic risk factors for common injuries in professional players and may aid in the planning of specific prevention programs.

The Negative Influence of Air Travel on Health and Performance in the National Basketball Association: A Narrative Review

Air travel requirements are a concern for National Basketball Association (NBA) coaches, players, and owners, as sport-based research has demonstrated short-haul flights (≤6 h) increase injury risk and impede performance. However, examination of the impact of air travel on player health and performance specifically in the NBA is scarce. Therefore, we conducted a narrative review of literature examining the influence of air travel on health and performance in team sport athletes with suggestions for future research directions in the NBA. Prominent empirical findings and practical recommendations are highlighted pertaining to sleep, nutrition, recovery, and scheduling strategies to alleviate the negative effects of air travel on health and performance in NBA players.

Choking or Delivering Under Pressure? The Case of Elimination Games in NBA Playoffs

Neoclassical economic theories foretell that individuals exert the most effort, and consequently produce their best performances, when the net returns to effort are highest. We scanned through 33 NBA seasons and analyzed 1930 playoffs games in order to test this prediction. Analysis of win probabilities in games where one of the two teams faces elimination from the playoffs, demonstrated that the threat of severe losses didn't lead to elevated level of performance. While previous studies analyzed mainly single-level performance in a stable environment, our results shed light on collective performance in a dynamic setting. These findings can be applicable to other realms as we suggest that managers should refrain from deliberate building of high-pressure environments with hopes of achieving performance enhancement effect among their groups.

Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows

Background

Intravenous regional anaesthesia (IVRA) and hindfoot four-point nerve block anaesthesia (NBA) are recommended for local anaesthesia (LA) in the distal limb of dairy cows. Two studies were conducted to compare the efficacy, time until onset and stress responses to IVRA and NBA in dairy cows. In the first cross-over designed study, eight healthy unsedated German Holstein cows, restrained in lateral recumbency (LR) on a surgical tipping table, were treated with IVRA and NBA using procaine 2% as a local anaesthetic. Distal limb desensitization was tested by electrical (e-), mechanical (m-) and thermal (t-) nociceptive stimulation 10 min before and 15 and 30 min after LA. Hormonal-metabolic (blood concentrations of cortisol, lactate, non-esterified fatty acids, and glucose) and cardio-respiratory (heart and respiratory rate, mean arterial blood pressure) stress responses to treatment were assessed at predetermined intervals. In the second study, six healthy, unsedated German Holstein cows in LR were treated (crossover design) with IVRA and NBA. Short-interval e-stimulation was measured by the time until complete distal limb desensitization.

Results

In the first study, four of eight cows responded to e-stimulation 15 min after IVRA, while none of the cows treated with NBA responded until the safety cut-off level was reached. E-stimulation revealed complete desensitization of the distal limb 30 min after LA in all cows. Half of the cows did not respond to m- and t-stimulation before LA, so no further evaluation was performed. Stress reactions to IVRA and NBA treatment were similar, but differences may have been masked by stress response to LR restraint. In the second study, complete desensitization was achieved 12.5 min after NBA, while one of the six cows still responded to e-stimulation 20 min after IVRA.

Conclusion

Hindfoot nerve block anaesthesia and intravenous regional anaesthesia induced complete desensitization of the distal hind limb in dairy cows. However, the anaesthesia onset after NBA was significantly faster than that of IVRA, which may be clinically relevant in the field, particularly when distal limb anaesthesia is required for major claw surgeries under time constraints.

Athletic performance and career longevity following anterior cruciate ligament reconstruction in the National Basketball Association

PURPOSE

To identify the impact of anterior cruciate ligament (ACL) reconstruction on performance and career longevity for National Basketball Association (NBA) players.

METHODS

Seventy-nine players (80 knees) with acute ACL tears in the NBA between the 1984-2014 seasons, and 112 age, height, weight, and performance-matched controls were identified. Pre- and post-injury performance outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, steals, blocks, turnovers, personal fouls, usage percentage and player efficiency ratings were compared between cases and controls using independent samples t tests and Fisher's exact tests.

RESULTS

Sixty-eight of seventy-nine players (86.1 %) returned to play in the NBA following ACL reconstruction. Mean length of post-operative play was 1.84 years shorter than matched controls (P = 0.001). There was a significantly higher rate of attrition from professional basketball for players with a history of ACL reconstruction (P = 0.014). In the first full season following surgery, players started in 15.5 fewer games (P = 0.001), they played in 17.3 fewer games (P < 0.001), and had combined player efficiency ratings 2.35 points lower (P = 0.001) when compared to matched controls. Over the length of their careers, players competed in 22.2 fewer games per season (P = 0.009).

CONCLUSIONS

There is a high rate of return to sport in the NBA following ACL reconstruction, although playing time, games played, player efficiency ratings and career lengths are significantly impacted in the post-operative period. These data should be used to manage patients' expectations regarding their abilities to return to elite levels of athletic performance.

Risk Factors for Reoperation and Performance-Based Outcomes After Operative Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis

Background:

Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity. These players are concerned with efficiently returning to play at a high level. Return-to-play rates after operative treatment have been previously reported, yet performance outcomes after such treatment are generally unknown in this population.

Hypothesis:

Overall, professional athletes sustaining a foot fracture would return to play at high rates with little impact on postoperative performance or league participation. However, National Football League (NFL) athletes would have a significantly greater decline in performance due to the high-impact nature of the sport.

Study Design:

Case series.

Level of Evidence:

Level 4.

Methods:

Athletes in the National Basketball League (NBA), NFL, Major League Baseball (MLB), and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance data were collected before and after surgery. Statistical analysis was performed, with significance accepted as P ≤ 0.05.

Results:

A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% (76/77) of players were able to return to play, with a median time to return across all sports of 137 days. Players returned to preoperative performance levels within 1 season of surgery. Six players (7.8%) sustained refracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary operative treatment was a predictive factor for reinjury (99% vs 40%, P = 0.001).

Conclusion:

Athletes returned to play at a high rate after foot fracture fixation, with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at greater risk of reinjury compared with other athletes. Returning to high levels of athletic participation soon after surgery may predispose athletes to refracture and subsequent reoperation.

Clinical Relevance:

Players, coaches, and team physicians should be aware of the impact of foot fractures on career performance and longevity to best guide therapy.

Athletic Performance at the National Basketball Association Combine After Anterior Cruciate Ligament Reconstruction

Background:

Anterior cruciate ligament (ACL) injuries are significant injuries in elite-level basketball players. In-game statistical performance after ACL reconstruction has been demonstrated; however, few studies have reviewed functional performance in National Basketball Association (NBA)–caliber athletes after ACL reconstruction.

Purpose:

To compare NBA Combine performance of athletes after ACL reconstruction with an age-, size-, and position-matched control group of players with no previous reported knee injury requiring surgery. We hypothesized that there is no difference between the 2 groups in functional performance.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 1092 NBA-caliber players who participated in the NBA Combine between 2000 and 2015 were reviewed. Twenty-one athletes were identified as having primary ACL reconstruction prior to participation in the combine. This study group was compared with an age-, size-, and position-matched control group in objective functional performance testing, including the shuttle run test, lane agility test, three-quarter court sprint, vertical jump (no step), and maximum vertical jump (running start).

Results:

With regard to quickness and agility, both ACL-reconstructed athletes and controls scored an average of 11.5 seconds in the lane agility test and 3.1 seconds in the shuttle run test (P = .745 and .346, respectively). Speed and acceleration was measured by the three-quarter court sprint, in which both the study group and the control group averaged 3.3 seconds (P = .516). In the maximum vertical jump, which demonstrates an athlete’s jumping ability with a running start, the ACL reconstruction group had an average height of 33.6 inches while the controls averaged 33.9 inches (P = .548). In the standing vertical jump, the ACL reconstruction group averaged 28.2 inches while the control group averaged 29.2 inches (P = .067).

Conclusion:

In athletes who are able to return to sport and compete at a high level such as the NBA Combine, there is no significant difference in any combine performance test between players who have had primary ACL reconstruction compared with an age-, size-, and position-matched control group.

Clinical Relevance:

Athletes with previous ACL reconstruction who are able to return to high-level professional basketball have equivalent performance measures with regard to speed, quickness, and jumping ability as those athletes who have not undergone knee surgery.

Outcomes After Lumbar Disc Herniation in the National Basketball Association

BACKGROUND

Professional basketball players are at risk for lumbar disc herniation (LDH), yet the evidence guiding treatment after operative or nonoperative management of this condition in the National Basketball Association (NBA) is limited.

HYPOTHESIS

NBA players with LDH will have different performance outcomes based on treatment type.

STUDY DESIGN

Case-control study.

LEVEL OF EVIDENCE

Level 4.

METHODS

Athletes in the NBA with an LDH were identified through team injury reports, transaction records, and public sports archives. A 1:2 case-control study was performed in which LDH players and players without LDH were matched for player variables. Statistical analysis was employed to compare pre- and postindex season performance (games played and player efficiency rating [PER]) and career longevity between test subjects and controls in the operatively treated (OT) and nonoperatively treated (NOT) cohorts.

RESULTS

A total of 61 NBA players with LDH were included, of whom 34 underwent discectomy and 27 were managed nonoperatively. Return-to-play (RTP) rates did not differ between NOT and OT players (77.8% vs. 79.4%). When compared with controls, OT players played significantly fewer games and had a lower PER than controls during the first postoperative season, but no difference was seen 2 and 3 years after surgery, with no difference in postoperative career length. In contrast, no difference in games played or PER was seen between NOT players and controls, although NOT players played significantly fewer postindex seasons.

CONCLUSION

NBA players have a high RTP rate regardless of type of treatment for LDH; however, postindex performance differs between surgically and nonoperatively managed patients when compared with players without an LDH. However, further studies with a larger sample size are required for more definitive recommendations.

CLINICAL RELEVANCE

There is a high RTP rate after LDH in the NBA, although postindex performance may differ based on operative versus nonoperative treatment.

Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

Background:

Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players.

Hypotheses:

NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear).

Study Design:

Case-control.

Methods:

NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables.

Results:

Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P < 0.05) regarding games per season; minutes, points, and rebounds per game; and field goal percentage. However, following the index year, controls’ performances declined significantly in games per season; points, rebounds, assists, blocks, and steals per game; and field goal and free throw percentage. Other than games per season, there was no significant difference between cases and controls.

Conclusion:

There is a high RTS rate in the NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low.

Clinical Relevance:

There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls.

Return to Sport and Performance After Microfracture in the Knees of National Basketball Association Players

Background:

Use of microfracture in the knees of National Basketball Association (NBA) players is controversial.

Hypotheses:

(1) There would be a high rate of return to sport (RTS) in NBA players following microfracture, (2) players would RTS the season following surgery, (3) preoperative player performance would not be significantly different on RTS, and (4) there would be no significant difference in RTS rate or postoperative performance in players undergoing microfracture in comparison with an age-, position-, NBA experience–, and performance-matched control group.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

NBA players undergoing microfracture were evaluated. Age-, body mass index–, position-, NBA experience–, and performance-matched controls were selected from the NBA during the same years as those undergoing microfracture. An index year was selected (controls) to match the number of seasons of NBA experience in microfracture cases. RTS and performance were analyzed and compared between cases and controls. Student t tests were performed for analysis of within- and between-group variables.

Results:

A total of 41 NBA players underwent microfracture and were compared with 41 demographic- and performance-matched controls. Rate of RTS after microfracture was 73% in the NBA and 83% in professional basketball (NBA, D-league, and International Basketball Federation [FIBA]). Time to RTS in NBA was 9.20 ± 4.88 months. Seventy-one percent (29/41) of players RTS the season following microfracture. Length of NBA career following microfracture (4.10 ± 3.91 years) was not significantly different from controls. After microfracture, case athletes played fewer games per season and with fewer points and steals per game (relative to premicrofracture; P < .05). Performance was better in control (after index year) versus case players (after microfracture) with regard to points per game, games played per season, and field goal and free throw percentage (P < .05).

Conclusion:

Eighty-three percent of NBA players undergoing microfracture returned to professional basketball. Career length was not significantly different between players undergoing microfracture and controls. However, following microfracture, players competed in fewer games per season with fewer points and steals.

A chronic high fat diet alters the homologous and heterologous control of appetite regulating peptide receptor expression

Leptin, ghrelin and neuropeptide W (NPW) modulate vagal afferent activity, which may underlie their appetite regulatory actions. High fat diet (HFD)-induced obesity induces changes in the plasma levels of these peptides and alters the expression of receptors on vagal afferents. We investigated homologous and heterologous receptor regulation by leptin, ghrelin and NPW. Mice were fed (12 weeks) a standard laboratory diet (SLD) or HFD. Nodose ganglia were cultured overnight in the presence or absence of each peptide. Leptin (LepR), ghrelin (GHS-R), NPW (GPR7) and cholecystokinin type-1 (CCK1R) receptor mRNA, and the plasma leptin, ghrelin and NPW levels were measured. SLD: leptin reduced LepR, GPR7, increased GHS-R and CCK1R mRNA; ghrelin increased LepR, GPR7, CCK1R, and decreased GHS-R. HFD: leptin decreased GHS-R and GPR7, ghrelin increased GHS-R and GPR7. NPW decreased all receptors except GPR7 which increased with HFD. Plasma leptin was higher and NPW lower in HFD. Thus, HFD-induced obesity disrupts inter-regulation of appetite regulatory receptors in vagal afferents.

Game Indicators Determining Sports Performance in the NBA

The main goal of the present study was to identify basketball game performance indicators which best determine sports level in the National Basketball Association (NBA) league. The research material consisted of all NBA game statistics at the turn of eight seasons (2003–11) and included 52 performance variables. Through detailed analysis the variables with high influence on game effectiveness were selected for final procedures. It has been proven that a limited number of factors, mostly offensive, determines sports performance in the NBA. The most critical indicators are: Win%, Offensive EFF, 3rd Quarter PPG, Win% CG, Avg Fauls and Avg Steals. In practical applications these results connected with top teams and elite players may help coaches to design better training programs.