July 2015

Out on a limb: The NBA takes on fatigue

1Limb-JordanaBy Jordana Bieze Foster, Editor

After a season in which too many of its most market­able stars spent too much time in street clothes, the National Basketball Association (NBA) is making a commitment to injury prevention. Interesting, however, the approach being discussed is only indirectly related to bio­mechanics. And that’s not necessarily a bad thing.

The NBA has partnered with General Electric Healthcare (a major manufacturer of magnetic resonance imaging systems and other diagnostic imaging equipment) to promote research on injuries specific to the sport, particularly musculoskeletal injuries such as ligament tears and hamstring strains.

But when John DiFiori, MD, chief of the Division of Sports Medicine at University of California, Los Angeles and chair of the advisory committee that will oversee the new NBA initiative, spoke with ESPN.com about the program, he didn’t talk about kinematics, kinetics, strength, flexibility, or neuromuscular training. He talked about scheduling.

The NBA is famous for its grueling 82-game schedule, filled with cross-country flights and back-to-back games. The league has already experimented with shortening the length of each game from 48 minutes to 44, which was relatively successful during the 2014 preseason, and now will examine the possibility of reducing the number of consecutive games and sets of four games in five nights.

Most star players are on the court, running continuously on an unforgiving surface, for the majority of each game. That in itself is a significant risk factor for overuse injury, and it seems feasible that reducing those minutes could reduce injury risk.

The other injury risk factor that could be addressed through scheduling is fatigue—and that may have an even greater potential upside.

Multiple studies have demonstrated that athletes are more likely to sustain musculoskeletal injuries when they’re tired—near the end of the first or second half of a game, or near the end of a season. A March 2014 study found that adolescent athletes—who were not all that much younger than some NBA rookies—were 1.7 times more likely to be injured if they got less than eight hours of sleep per night. One reason for this, which has also been documented in multiple studies, is that fatigue has a negative effect on postural control and the biomechanics of running, cutting, and landing.

And, although no study has yet analyzed the effect of air travel on injury rates in athletes, a 2014 study found that Australian rugby players reported more leg tiredness on days of away games than home games, even when their travel didn’t involve crossing time zones. It seems safe to assume that jet lag would only compound those effects.

Training athletes to maintain proper mechanics when fatigued would appear to be a logical approach to this problem. But in reality, that has turned out to be difficult to do. So, if schedule changes can reduce fatigue and jet lag, which in turn can reduce injury risk, that might actually be a much more effective—and cost-effective—solution.

Convincing NBA players to forgo the club scene for a full night’s sleep, of course, is another thing entirely. The committee assigned to that task definitely will have its work cut out for it.

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