Breaking Down Rajon Rondo’s Hand Fracture

The 2014-2015 season is picking up right where last year ended as the injury bug continues to claim players. Just hours after the first media days of the season had wrapped up, the Boston Globe’s Baxter Holmes reported that Celtics point guard Rajon Rondo had suffered a fractured hand after a fall in his home. Surgery was required to mend the break and the former All-Star is expected to miss at least six weeks.

Holmes reports that Rondo suffered a metacarpal fracture in his left, non-shooting hand. The metacarpals are situated between the carpal bones of the wrist and the bones of the finger and serve as an anchor site for muscle attachment. Additionally the tops of the metacarpals form the knuckles. This positioning leaves them vulnerable to breaking following a direct blow, an axial load (like a punch), or a fall onto outstretched hand (FOOSH). Two of these classic mechanisms of injury, a FOOSH and an axial load, fall in line with reports that Rondo slipped getting out of the shower and hit his hand.


Regardless of how it occurred, hand fractures are quite common in the NBA. Last season seven players, including former Celtic Paul Pierce, Pelican center Anthony Davis, and Finals MVP Kawai Leonard, suffered fractured metacarpals. Two of these players, Houston’s Patrick Beverley (29 days) and Golden State’s Ognjen Kuzmic (38) needed surgery.

The associated recovery time is dependent on several factors, the first being the specific bone broken. The second and third metacarpals, below the pointer and middle fingers, are tightly anchored to the carpal bones and are largely immobile. The fourth and the fifth metacarpals, located below the outside two fingers, are mobile to allow for a high degree of motion at the wrist and pinkie. Because of this mobility, fractures to the fourth and fifth generally require additional time to heal.

Another factor to consider when establishing a recovery time line is the nature of the break itself. If the broken pieces of the bone remain aligned, it is considered a non-displaced fracture. If the position of the bone shifts following the injury, it is considered displaced and surgery is often required to insure a proper union of the bone fragments.

The exact metacarpal Rondo injured has not yet been reported. However since he has already undergone surgery, it is safe to assume his fracture was displaced. The team has provided an estimated timeline of six-to-eight weeks, meaning recovery could spill into the regular season. The Celtics open the season on October 29, 33 days after Rondo’s surgery. However Rondo being available for the opener against the Nets shouldn’t be ruled out either. Last season Beverley returned to the Rockets lineup 29 days after surgery for a fractured fourth metacarpal and Kuzmic’s recovery from a fractured fifth metacarpal lasted just 38 days. Furthermore Rondo’s break is isolated to his non-shooting hand, meaning the adjustment back shouldn’t be as great.

The injury remains a setback for a player limited to just 30 games last season after recovering from a torn anterior cruciate ligament (ACL) in his right knee. However Rondo should be able to miss minimal time and the injury should do little to stop the trade speculations surrounding the Boston point guard.

Breaking Down Danny Woodhead’s Ankle Fracture

I’ve never liked the old saying, “Sticks and stones may break my bones…” As a kid that was picked on growing up, I found it largely inaccurate. Words can and do hurt. But now, years later, the saying drives me crazy for an entirely different reason. The injury analyst in me is constantly asking, “Well what kind of break are we talking about here? More details please!” I ask only because all bone fractures are not created equal and vary in mechanism of injury, amount of damage, and necessary treatment and intervention.

A bone fracture can be open, in which the bone pierces the surrounding tissue, or closed and isolated to the bone. The break can be a greenstick fracture that occurs frequently in adolescents and involves an incomplete break similar to the snapping of a green tree branch. Bone can splinter into multiple pieces in a break known as a comminuted fracture or it can be an avulsion fracture that happens when a muscle or ligament pulls away a tiny piece of the involved bone. Numerous other classifications exist including linear, transverse, and spiral fractures, each with their own set of complications.


The last few months the sports world has been filled with various types of fractures. Indiana Pacers guard Paul George suffered an open fracture of both his tibia and fibula. Sixers rookie Joel Embiid may miss the entire 2014-15 season managing a stress fracture in his foot. Brazil’s run in the FIBA World Cup may have ended differently had Neymar not suffered a fractured vertebrae in his back. In Major League Baseball, Giancarlo Stanton suffered a season-ending orbital fracture after be struck by a pitch while Pirates outfielder Andrew McCutchen missed time with an avulsion fracture to one his ribs. Bone fractures are more likely in a violent sport like football, a trend that has held true through three weeks in the NFL.

New Orleans Saints running back Mark Ingram will miss at least three more weeks recovering from surgery to realign a displaced fracture in his hand. Rookie Teddy Bridgewater has taken over the starting quarterback position in Minnesota after Matt Cassell suffered multiple fractures to his foot. However it is San Diego Charger running back Danny Woodhead that has endured the most significant bone fracture thus far, suffering a spiral fracture of his ankle in the team’s win over the Bills.

Bleacher Report’s Will Carroll is reporting Woodhead’s fracture is a very specific type of spiral break known as a Maisonneuve fracture.

The Maisonneuve fracture, named for French surgeon Jules Germain François Maisonneuve, occurs when the foot is planted while the leg is violently twisted outward. The torque on the leg tears the ligaments of the distal ankle, disrupts the connective tissue between the two lower legs bones, and causes the fibula to break near the knee. Associated avulsion fractures the lower ends of the fibula and tibia can also occur. Often the injury is reported as a high ankle sprain with a fractured fibula. The resulting damage can leave the ankle almost completely unstable and surgery maybe necessary to restore joint integrity.

Woodhead is expected to visit with other surgeons to determine the best course of treatment, though surgery appears likely. His season is all but over and he will spend the next several months recovering and rehabbing. A 2011 review of Maisonneuve fractures and treatment showed a high success rate in recovery, though the length of time evaluated ranged from six months to six years. Given that Woodhead is an elite level athlete and will have access to high-end medical equipment utilized by skilled professionals, a six-month recovery seems realistic with additional treatment carrying over into training camp.

Spotlight: Sacramento Kings Athletic Trainer Manny Romero

The Sacramento Kings, once a staple of the Western Conference elite, has been a franchise in flux for nearly a decade. A change in ownership and potential move to Seattle has added to the turbulence for a team that last appeared in the postseason in 2007. However throughout the discord one thing has remained consistent: the team’s highly effective medical staff. The Kings have finished below the league average for games missed due to injury or illness in five of the last six seasons. Those numbers include last season when Sacramento ranked 11th in the league with 127 games missed. The Kings’ rank improves to 5th in the league if the 28 games missed by Jason Terry for a preexisting knee injury are excluded. Terry, acquired in a midseason trade, never played for Sacramento and is now a member of the Rockets.

Head athletic trainer Manny Romero credits the team’s proactive approach to injury prevention for the team’s steady stream of good health.

“We’ve been on the forefront of the injury prevention paradigm shift in the NBA,” said Romero. “We started collecting data on athletes, not numeric data…like analytics, but we did a lot of movement screens and movement assessments in the early 2000’s.”

Some of this data included digital photos of the individual athletes that were then used to screen for any potential factors that could increase an individual’s inherent injury risk.

“Instead of reactionary, where we are taking care of an injury after the fact, we try to be pro active on trying to assess and indentify any movement dysfunctional patterns that may predispose them to injuries,” Romero stated.

Identifying these markers could be one reason why Kings players have successfully avoided surgery. Carl Landry’s two operations for a torn meniscus and torn hip flexor are the only two times in Romero’s tenure in which a Kings player needed surgery.

Romero feels the Kings medical team has only “gotten better and better year and year out,” and contributes support from the team’s new ownership group, led by Vivek Ranadivé, as a major reason. “Ownership has said, “If you need, we will get it for you”,” affirms Romero.

Ranadivé, along with Kings general manager Pete D’Alessandro, recognize the value of analytics and have made technology and statistics a significant part of developing the franchise. Romero has begun to witness this firsthand and understands how it could potentially impact on how he approaches the health of the Kings players. The organization has a partnership with Catapult Sports, the world’s biggest provider of wearable GPS tracking devices, to begin monitoring player performance in practices and workouts.

The hope, says Romero, is that the tracking equipment will insure “what we notice and work on is actually carrying over onto the court.”

The data collected through Catapult, as well as the data generated through the leagues’ STATS’ SportsVu partnership, has value but Romero maintains it’s still in the collection phase. Romero sees the application of the information as a good way of “correlating things and seeing if what we are seeing subjectively …correlate[s] with the data.”

For example, SportsVu data tracks distance traveled by a player during their time on the court. Last year point guard Isaiah Thomas led the Kings with 166.7 miles traveled while in the game. The thought is that by being aware of a player’s workload during a game Romero, along with coaches and the strength and conditioning specialist, may be able to alter upcoming practices or workouts to insure the individual stays fresh and isn’t overworked.

While the data has merit, Romero points out that its value is linked to who is utilizing it and in what way. “It’s important for the data to be utilized by the proper personnel [and] as an athletic trainer my mind is geared toward the basketball athlete,” emphasizes Romero. He continued by explaining that his previous experiences with the sport have made his eye sharper and may better allow him to blend the data with physical findings like joint movement or muscle activation.

Just like a statistical analyst and scout may differ on a player’s value and potential, statisticians and medical personal may disagree in their interpretation of collected medical data. The key is making sure the people generating the numbers are on the same pages as those that apply the information. “If the athletic trainer can be involved in some of those decision[s] and how to utilize data, that will be important to the sport moving forward,” said Romero.

Helping advance analytical concepts and approaches has become easier for Romero as the players, particularly the tech-savvy young ones, have become more receptive to change. “New guys are very interested in technology and always have their iPad or iPhone with them,” said Romero.

With programs like Fusionetics,a sports science platform designed to identify and aid in correcting biomechanical problems, now easily accessible through these devices, players are buying into the biometric and analytical side of sports medicine. Even veteran players, initially hesitant to change and outside the box thinking, have joined in and realized how these advancements could help extend their careers. Romero believes that technology and analytics could even eventually be applied to data on retired players to help future players smoothly transition away from the grind of the NBA.

But it’s not just the Kings that are implementing new programs and diving into injury analytics, teams throughout the league are taking steps to help promote good health amongst the players. Teams like the Trail Blazers and Spurs have made recent additions to their sports medicine teams, expanding to include departments focused on player health and performance and the utilization of applied sciences in sports.

Romero strongly emphasizes that the NBA athletic trainers of each team work in unison and are, “not competing against each when it comes to the health of the athletes.”

“Collectively the NBA and NBATA try to do as much as possible to improve the health of the professional basketball athletes,” says Romero.

The camaraderie amongst NBA athletic trainer is key when players spend their summer playing internationally, particularly for Team USA. Oklahoma City’s Joe Sharpe and Minnesota’s Gregg Farnam currently serve as the athletic trainers for Team USA and Romero is in “constant contact” with them regarding the health of both Rudy Gay and DeMarcus Cousins. Technology also helps bridge the gap as the aforementioned Fusionetics allows Romero access to instant feedback.

The ability to be a presence, even if it is a virtual one, helps NBA medical staffs ease some of the concern associated with participating internationally. These fears took center stage when Indiana’s Paul George suffered his horrific leg injury but Romero understands freak injuries are a part of the game and can happen in any setting. “It’s basketball. When you step on the floor there’s risk. [athletic training staffs] try to decrease the risk but anything can happen on the court.”

With international play winding down and players beginning to trickle in for training camp, Romero is now feverishly preparing for the upcoming season. After a relatively quiet summer, there’s an air of optimism in Sacramento. “Our job is to keep our players healthy. Their job is to compete. Playoffs are always the end goal and we will see how it goes this year.” If the Kings are to survive in a competitive Western Conference you can be sure good health and hard work from Romero and his staff will be a major contributing factor.

Breaking Down The Ice Bucket Challenge: Understanding ALS and Its Link to Sports

Athletic trainers are often all too familiar with ice and ice baths so when the phenomenon known as the ALS Ice Bucket Challenge started to take social media by storm I knew it was only a matter of time before a direct challenge was thrown my way. Of course a vengeful athlete who I had previously required to recover in an ice bath jumped at the chance.

However I was shocked at how little the people willingly dumping frigid water on each other actually know about the disease. I agreed to make a donation, soak myself, and help raise awareness for those afflicted with ALS. For a guy who makes a living analyzing and breaking down injuries and illness I’m electing to use my platform to help people better understand the disease behind the trend.

Amyotrophic lateral sclerosis (ALS) is a degenerative disease that attacks the spinal cord and the nerve cells of the brain. There are multiple types of neurons in the brain and throughout the body, including sensory and motor. Sensory neurons aid in the transmission of information linked to an individual’s senses like sight and sound. Motor neurons, as their name suggests, are involved with muscle movement. Some motor neutrons work involuntarily as muscles in the heart and digestive system act automatically and without a direct command. Other motor neurons depend on an individual choosing to act and are considered voluntary. These nerve cells come into play when you get out of bed, swing a baseball bat, or jump to snag rebound. Voluntary nerve cells also play a role in breathing.

ALS targets the voluntary motor neurons and causes them to degenerate. As a result, neurons can no longer perform their job and muscles can no longer function. A loss of function results in the muscle atrophying. Over time the degenerated neurons can be so ravaged by the disease that the affected individual becomes paralyzed. Victims in the latter stages of the disease begin to lose control of vital functions like swallowing and breathing.

Sadly ALS currently has no known cure. Medications, specifically a drug known as riluzole, can help slow the progression of the disease in its early stages but is unable to stop the degeneration from occurring. Research and education on the disease is ongoing and that’s where the numerous donations collected by the Ice Bucket Challenge come into play.

The sports world has been historically linked to ALS ever since Yankees great Lou Gehrig was diagnosed with the condition in 1939. ALS forced Gehrig into retirement and claimed his life just two years later. The attention Gehrig’s diagnoses brought the condition is why ALS is often referred to as “Lou Gehrig’s disease.” Since Gehrig’s death in 1941 numerous other athletes have succumb or been diagnosed with ALS including former Cy Young Winner James “Catfish” Hunter and NBA Hall of Famer George Yardley. The Ice Bucket Challenge was even started by an athlete, former Boston College baseball player Pete Frates.

ALS has hit the NFL particularly hard with multiple players receiving diagnoses within the last decade. Included on that list is former Tennessee Titan Tim Shaw who recently revealed his diagnosis on the team’s website. Scientists and researchers are currently looking to any potential links between traumatic brain injuries sustained in sports and ALS and other neurodegenerative disease.

The outpour of support from current and former players from the NHL, NFL, NBA and MLB has been impressive with millions of dollars being raised. However the Ice Bucket Challenge is more than a silly fad that should be quickly forgotten. Making a donation will not only aid people currently dealing with ALS but it can also help fund research that could go toward treating and potentially preventing the disease. has accepted the challenge and hope that you pair each bucket of ice water with a donation at


Breaking Down Paul George’s Horrific Leg Injury

The NBA world watched in horror as Indiana Pacer forward Paul George suffered a horrific injury Friday in a scrimmage for Team USA. The injury occurred as George collided with the basket stanchion as he attempted to contest a layup attempt by James Harden. His right leg buckled and teammates instantly reacted in shock as the medical team responded to the injury. George was placed in an air cast before being transported to a nearby hospital for surgery.

Continue reading