Breaking Down Julius Randle’s Tibia Fracture

After back-to-back seasons wrought by bad healthy and unfortunate accidents, the Los Angeles Lakers again find themselves beset by injuries. Point guard Steve Nash will not play this season after his congenital back condition became too much to manage. Now rookie Julius Randle will miss an extended period of time after breaking his leg in the team’s first regular season game of the year.

Randle was injured while driving to the basket. He went up for a layup attempt and his right leg buckled. He slid to the baseline, instantly grabbing his leg. Randle was carted off the court and after the game players reported hearing a “pop” when the injury occurred. X-rays taken at the arena revealed a fracture to his right tibia.

The tibia, or shinbone, is the larger of the two lower leg bones and is the primary weight bearing bone in the body.  There is very little surrounding musculature and players frequently suffer tibia contusions when kicked in the area. Isolated traumatic tibia fractures occur much less frequently though are possible. Violent fractures, like the one suffered this summer by Indiana’s Paul George, are often accompanied by a fibula fracture.

While Randle’s fracture happened on an isolated play with a specific mechanism of injury, the rookie forward may actually be dealing with a stress-related injury. Bleacher Report’s Will Carroll explains that Randle’s break could be classified as stress fracture that was exacerbated on the play in which the injury appeared to have occurred.

If this is indeed the case, history shows that the necessary treatment will ultimately decide how long Randle will be sidelined. Multiple players have endured tibia stress fractures in recent seasons with JaVale McGee and Jrue Holiday the most noteworthy. Both McGee and Holiday had hardware surgically inserted to stabilize the area of concern. The average number of games missed by these two and others who needed surgical intervention is 49 games, over twice the numbers of games missed by those who did not require surgery.

Tibia

Like any injury, there’s a great deal of variability to mention. The bones of the body are constantly remodeling themselves to handle the stress they are subjected to daily. In some instances, the body simply cannot keep up with these demands and the bone tissue fails.  Factors like height, weight, and age of the athlete all contribute to the cause, especially when a weight-bearing bone is involved.

Location of the fracture is also key. If you will recall, Randle’s teammate Kobe Bryant missed time last season with a tibia fracture of his own. However Bryant, as well as Lorenzen Wright and Yao Ming, suffered traumatic fractures to the proximal end of the bone, specifically the tibial plateau. The tibial plateau is closer to the knee and comes with its own set of issues. Randle’s injury, based on footage and pictures of the injury, appears to be to the distal end of the tibia closer to the ankle. This area is responsible for a large amount of weight bearing and as a result often requires additional time to heal. The distal end of the tibia, known as the plafond, is reasonable for nearly 90% of the load placed on and through the ankle joint.

Finally an athlete’s history must be considered. Randle suffered a fractured fifth metatarsal in his right foot while attending Prestonwood Christian Academy in Texas. The injury became an area of concern shortly before this year’s NBA Draft when fears about the integrity of the hardware surfaced. The Lakers were willing to assume the associated risk and the injury appeared to be a non-factor during Randle’s prep work for the new season. Now, with another fracture on the same leg, special considerations must be applied to Randle’s recovery and rehabilitation to insure this area is not aggravated.

The Lakers are expected to provide an update on Randle’s condition Wednesday, detailing the intended course of treatment. Surgery remains an option and will influence the rookie’s potential return to play date. For now the development of Randle as well as the future of the Lakers franchise has been temporarily placed on pause with injuries again wreaking havoc on the team.

UPDATE: Ramona Shelburne of ESPN Los Angeles revealed Randle underwent surgery Wednesday morning. The fracture was reportedly a complete, clean break.

A Retrospective Look at Steve Nash & The Injuries He Endured

This isn’t how it was suppose to end. After years of marveling fans with impossible passes and improbable shots, Steve Nash deserved an ending worthy of an old Western. A brazen cowboy should always get to ride off into the sunset. Instead the 40-year old point guard’s season, and likely his career, is over due to a villain he’s fought for years.

It’s a shame certain fans will question Nash’s ability and durability based on his time with the Lakers. Yes, his Hollywood ending never happened, but Nash’s story is more about the journey than the end result.

Doubted since high school, the point guard from Victoria, British Columbia was able to not only secure a Division I scholarship but piece together a NBA career that includes two league MVPs, eight All-Star appearances, three All-NBA first team nods, and countless other accomplishments. Even more impressive is the way in which he endured, overcoming physical obstacles throughout his time in the league.

The Phoenix Suns drafted Nash with the 15th pick in the 1996 Draft. Buried on the depth chart behind Kevin Johnson, Sam Cassell, and Jason Kidd, Nash did his best with limited minutes. His health was never a real issue with minor contusions to his thigh, hip, and calf as the only injuries of note. Nash was traded to the Dallas Mavericks during the 1998 Draft. Nash, along with the recently drafted Dirk Nowitzki, would join a Mavericks team considered one of the worst franchises in sports.

Nowitzki and Nash’s first year in Dallas was anything but impressive as the Mavericks stumbled to a 19-31 record. However the duo quickly bonded, forging a friendship that would prove to be a building block for the years ahead. The 1998-99 season was significant for another reason as it marked the first time the Nash was formally introduced to the foe that would end his career, a congenital condition known as spondylolisthesis.

The spine is comprised of individual vertebra. Each vertebra is stabilized by small joints known as facets that are joined by a small segment of bone known as the pars interarticularis. The pars can be fractured in an injury known as spondylolysis. However if the injury is degenerative or reoccurring it becomes considered a spondylolisthesis. In a spondylolisthesis, the broken fragment often shifts from its normal location. The slippage can impede on neighboring nerve structures and can require surgery to fix. Additional issues can develop if inadequate bone remodeling occurs. Degenerative spondylolisthesis often affects the individual’s lower extremities, particularly the hamstrings, altering the way in which they walk and run.

Nash’s problems actually began prior to the 1998-99 season when he took a hard fall during a pickup game in January. He played a majority of the season with the injury before the associated back spasms became too much, forcing him to miss the final 10 games of the year. The Dallas medical staff was the first to make the spondylolisthesis diagnosis and believed the issue dated all the way back to Nash’s adolescence.

However, as he would throughout his career, Nash took a proactive approach. He learned the importance of biomechanics and enlisted the aid of physiotherapist Rick Celebrini. Together the two emphasized core strength and began to outline the necessary steps Nash would have to take to remain on the court.

The 1999-2000 season would be the beginning of the turnaround in Dallas as the team showed signs of promise. Nash’s back held up but he struggled with an ankle injury originally sustained in training camp. The sprain and strain would require multiple cortisone injections and cost him 25 total games. Still the Mavs finished the year with positive energy, supplied by new billionaire owner Mark Cuban and the improved play of the team.

The 2000-01 season would serve as a breakout season for both Nash and Nowitzki. The two paired with franchise stalwart Michael Finley to create a formidable Big Three and helped Dallas end their 10-year playoff drought. A left hamstring strain, along with a mild calf contusion and a battle with the flu, cost Nash 12 total games throughout the year but again his back held up.

Nash’s rise to the top continued over the next two seasons as he made his first two All-Star teams and led Dallas on two extended playoff runs. The team won 60 games during the 2002-03 season before losing to the San Antonio Spurs in the Western Conference Finals. More importantly Nash played in every single one of Dallas’ 192 games despite bouts with illness, fatigue, and shoulder soreness.

The 2003-04 Mavericks were a hodgepodge of talent after offseason trades were made for Antoine Walker and Antawn Jamison. Nash remained the driving force behind the offense but he failed to make the All-Star team and missed a handful of games with various ailments. He played through a facial laceration that required stitches and missed just one game after partially dislocating his left shoulder. A stomach virus cost him two more games. However more troubling were the back spasms that resurfaced following a game against the Jazz. The pain tricked into Nash’s right hip but only kept him out for one game. The season ended with a swift dismal by the Sacramento Kings and Nash entered the offseason a free agent.

The Suns quickly recruited the 30-year old point guard and offered him a six-year, $63 million contract. Leery of Nash’s age and back issues, Cuban elected to let his point guard walk. Motivated by questions about his long-term health, Nash spent the summer with Celebrini. Together again the two reshaped Nash’s gait, focusing on muscle deficiencies and repetition.

The marriage between Nash and the Suns was perfect. Nash served as the ideal motor for head coach Mike D’ Antoni’s breakneck offense while the elite Suns training staff, led by head athletic trainer Aaron Nelson, made sure the engine was running smoothly. The work of Nelson and company would be a key contributor to Nash run at two MVP trophies. Despite a concussion, ankles sprains, thigh contusions, and, of course, back spasms, Nash missed just eight games to injury from 2004 to 2006.

However during this time period, Nash began experiencing nerve-related issues in his hamstrings as a result of his spondylolisthesis. Though he was able to manage the associated symptoms, it was a sign of things to come.

Nash turned in another stellar campaign during the 2006-07 season but missed six games due to his back. Four of the games were the result of shoulder pain and inflammation directly tied to the spondylolisthesis. Other injuries occurred along the way, including a hyperextended right elbow, a bruised bone in his right hand, and the infamous nose laceration during the playoffs against the Spurs.

Nash’s final five seasons in Phoenix would be a rollercoaster of emotion. The team would make the playoffs just twice and familiar faces Shawn Marion, Raja Bell, Amar’e Stoudemire, and eventually even Mike D’Antoni left, fired, or were traded by the organization.

Nash endured, missing just 16 games over that span despite a laundry list of injuries. The 2007-08 season included a chipped tooth, a nasty stomach bug, and, as always, soreness in his back, shoulder, and hamstrings. 2008-09 came with multiple sprains of his right ankle and more issues with the back. In 2009-10, Nash played in 81 games despite stitches in his lip, an abdominal strain, a fractured nose, and right hip impingement. The back spasms and hip issues continued for the next two seasons though Nash, ever informed about his body, refused to yield. He played in 62 of the team’s 66 games during the lockout-shortened season despite a condensed and demanding schedule. Nash’s time in Phoenix ended shortly there after when the team, ready to being the rebuilding process, agreed to a sign-and-trade with the Los Angeles Lakers.

Nash joined the Lakers with title aspirations. His arrival, along with Dwight Howard, was to mark the beginning of one last title run for the franchise. However in just his second game with the team Nash collided with Portland’s Damien Lillard. The impact caused a non-displaced fracture to the head of his fibula and Nash would be sidelined for 24 games. His back also remained an issue and he missed the final eight games of the year battling spasms that trickled down into his hip and hamstring. He underwent multiple epidurals and returned for the Lakers’ final two postseason games, both losses to the Spurs. His 32 games lost to injury were the highest total of his career up to that point.

Things failed to improve last year in what Nash called one of the darkest moments in his career. A collision with Kirk Hinrich aggravated the nerve issues stemming from his leg fracture and Nash would remain limited for the remainder of the season. He finished the year playing just 15 games. Now just days away from opening night, Nash’s 2014-15 season is over after the long withstanding nerve problems in his back and hip resurfaced after he attempted to pick up a bag.

Dr. Robert Klapper suggests Nash’s current issues may be linked to a condition known as Double Crush Syndrome. In the syndrome, it is believed that a nerve impaired in one area (like Nash’s back) may make the individual more susceptible to other nerve problems along the same neural pathway (Nash’s leg). Together the two seemingly unrelated episodes compounded each other and simply became too much.

Nash’s final years in the league should not be his lasting legacy. Instead he should be celebrated for succeeding despite a crippling congenital condition. Nash opted to educate himself about his injury and in the process became one of the most informed players in recent years. His attention to biomechanics is largely unprecedented by an athlete and his attitude to injury management and diet caused countless teammates including Jared Dudley and Grant Hill to alter their own approaches. He was a dazzling highlight reel and a deep thinker, smart enough to throw an impossible pass and speak on pertinent social issues. For that Nash deserves to walk into the sunset perceived as a hero and not an aged, limping cowboy.

Breaking Down Kevin Durant’s Jones Fracture

Thunder forward Kevin Durant will not be available to start the 2014-15 season after it was discovered the reigning MVP has a Jones fracture in his right foot. The Thunder stated they are currently considering all their options and will provide a timeline when a course of treatment has been decided.

Durant’s fracture is to the fifth metatarsal. The metatarsals are the long bones of the foot that bridge the bones of the midfoot to the bones of the toe. The fifth metatarsal is located on the outside of the foot and serves as an attachment site for several muscles. These muscles make the bone susceptible to fractures when the ankle is forced inward like when making a hard cut or landing on the foot of an opponent.

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Breaking Down Bradley Beal’s Scaphoid Fracture

After an impressive 2013-14 campaign, the up-and-coming Wizards spent the offseason bolstering their frontline. The team resigned center Marcin Gortat and quickly signed veteran forward and former Finals MVP Paul Pierce when incumbent starter Trevor Ariza left for Houston. They also completed inexpensive deals for Kris Humphries and DeJuan Blair. Unfortunately early injuries have derailed these plans as Humphries and emerging star Bradley Beal are slated to miss the beginning of the regular season with injuries.

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Breaking Down Nick Young’s Thumb Injury: What is a Radial Collateral Ligament?

The last two seasons have been disastrous for the Los Angeles Lakers and poor health has been one of the primary factors contributing to the team’s struggles. Last season was particularly bad as the Lakers finished last in the number of games lost to injury with 320. The injuries, particularly Kobe Bryant’s recovery from Achilles surgery and his subsequent leg fracture, had even bigger financial impact, as the team lost over $44 million to injuries.

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