March Madness is back! While the best 68 collegiate basketball teams around the country ready themselves for a run at a National Championship, some players have inevitably been lost to injury throughout the course of an arduous season. In anticipation for tomorrow’s tip off, our team of EXCEL experts are outlining the most common basketball injuries, how we treat them and how you can help prevent them. Check them out below to learn more!
Ankle Sprains
Ankle sprains are one of the most common basketball injuries that occur on the court. The most frequently seen type of ankle sprain is called an inversion sprain. This type of injury occurs when the ankle rolls inwards and injures the ligaments on the lateral (outside) aspect of the ankle. The anterior talofibular ligament is the most commonly involved ligament, while the calcaneofibular ligament and posterior talofibular ligament may also be injured. Additionally, a group of tendons called the peroneals (which work to rotate your ankle outwards, or evert your ankle) can be affected as well.
Ankle sprains typically occur when a player lands from a jumping position and the ankle inverts with a lot of force. It can also occur when there is contact, tripping, a sudden stop or when a player lands on another player’s foot. These injuries are seen frequently in basketball players because of the nature of the sport.
Basketball involved a great degree of jumping, cutting and changing direction on one leg. This requires the athlete to have a high level of balance, coordination and stability. High degrees of stress are placed on the ankle which must work to withstand these forces. If a player lacks motor control, stability or balance, they may be at an increased risk of spraining their ankle while playing basketball.
If a player sustains an ankle sprain, recovery may take a few weeks up to a few months. In the early stages of recovery, elevation and ice application can be helpful in reducing swelling. Once swelling has subsided, it is critical to progressively load the ankle to regain strength, balance, and range of motion. When we see a patient who has sprained their ankle in the physical therapy clinic, we being them with isolated movements focused on improving strength, then begin to progress towards functional single leg movements which simulate the demands of basketball.
The risk of ankle sprains can be reduced by building strong feet and ankles outside of playing basketball. Focus on exercises that target single leg stability, especially during changes of direction. Exercises such as single leg reverse dead lifts (RDL’s) and single leg side to side hops are a great way of challenging your balance, coordination and strength in your ankles, and overall leg muscles.
Patellar Tendinopathy
Patellar tendinopathy is characterized by pain localized to the inferior pole of the patella and load-related pain that increases with the demand on the knee extensors, notable in activities that store and release energy in the patellar tendon. In other words, patellar tendinopathy is the medical term for pain at the bottom of the kneecap that gets worse when there is increased stress on the quad and patellar tendon. This condition is extremely common amongst the basketball population. Every time a basketball player jumps, their quadriceps muscles are activated to extend the knee. The energy from that contraction is stored and released in the patellar tendon. Because of the amount of jumping required in the sport, it’s easy to see why this condition is present in up to 36% of basketball players!
Our role as physical therapists is to find out what biomechanical factors and movement patterns may be putting excess stress on the tendon as well as improve the work capacity of the tendon. Treatment of patellar tendonitis or tendinopathy is typically non-surgical. Physical therapy treatment will include a stretching and strengthening program as well as anti-inflammatory modalities. In rare and/or severe cases where underlying anatomical abnormalities may or may not be present, surgery can be recommended.
We can take action to help prevent patellar tendonitis in the first place by making sure the patellar tendon is ready for the force demands of playing in an NCAA game. The focus of intervention would be to strengthen the muscles in the hip, knee, and ankle and get the patellar tendon used to being under stress. We can also improve jumping/landing mechanics and prepare the athlete for what he/she will encounter on game day.
Shoulder Injuries
Injuries to the hips, knees, and ankles most frequently come to mind for basketball athletes, but there is another uncommon injury that can affect performance, lead to missed games, or even an early end to the season – shoulder labral tears.
The labrum is a rim of cartilage on the glenoid (shoulder “socket”) that acts to provide additional stability and better fit the shape of the “ball” of the humerus (upper arm bone). It can be injured by a fall on an outstretched arm or in movements like blocking or rebounding when an athlete’s shoulder is forced back when the arm is overhead or out to the side. In severe instances the ball part of the joint may even dislocate either partially or fully from the socket part of the shoulder joint.
There are different types of labral tears, primarily based on which part(s) of the labrum are injured. Labrum tears can affect basketball athletes because in addition to pain and discomfort, the joint can become unstable affecting an athlete’s ability to reach overhead.
Many athletes respond very well to a course of rehab to strengthen the muscles around the shoulder to compensate for the loss of structural stability. Injuries that cannot be relieved from symptoms conservatively would be candidates for surgical repair. Surgical cases do have a high likelihood of returning to play at their previous level, although they can take 4-6 months to fully recover and must undergo extensive post-surgical physical therapy. However, there are many well-known NBA players that have experienced shoulder labral tears, all of whom eventually returned to play after treatment. Those names including Kobe Bryant, Carmelo Anthony, Dwight Howard, Paul George, Anthony Davis, and Pascal Siakam.
Prevention of this type of injury includes strengthening the muscles of the shoulder and upper back. It is important to strengthen these structures while the arm is in a position of vulnerability – such as overhead or out to the side, which better replicates the demands of actual sport.
ACL Injuries
The first question you will get after sustaining a knee injury is, “did you feel a pop?” When I injured my knee on a Saturday morning my freshman year of high school, I did in fact feel “the pop”. This popping sensation has become synonymous with a tear to the anterior cruciate ligament (ACL) of the knee.
ACL injuries are typically season-ending due to their long recovery time. In the United States, there are approximately 200,000-250,000 ACL injuries annually, a rate that has doubled in the past 20 years and is increasing by 2.5% each year. ACL injuries can happen to anyone, but in high school athletes, females have a 1.6x greater rate of injury than males.
When I injured my ACL, I was cutting to lose my defender. I planted my right foot to change directions but instead was on the ground in pain. This type of injury is considered a non-contact ACL injury and is common amongst basketball players because of the constant rapid changing direction and deceleration required in the sport. ACL sprains or tears can also be the result of landing incorrection from a jump or from direct contact of another player.
ACL injuries are categorized as either a sprain (Grade 1-3) or a rupture. The degree of injury will guide an athlete’s treatment options, varying from rest to surgical intervention, but almost always requiring some form of physical therapy. The most high-profile injuries are typically full ruptures that are season ending and require surgery. These injuries can sideline an athlete for 9-12 months (or more).
So, can ACL injuries be prevented? The frustrating answer is yes and no. There are many factors that have been found to predispose an athlete to an ACL injury and as result, ACL prevention programs have been created to address these factors. These programs encourage dynamic warmups, teaching proper jumping and cutting techniques, and correcting muscle imbalances, to name a few. These programs are excellent and have been shown in research to decrease the incidence of ACL injury. However, even the best and most prepared athletes (think Klay Thompson and Derek Rose) can suffer an ACL tear due to non-modifiable or external factors.
My best advice is if you do find yourself with an ACL injury, find the right team to put you on the road to recovery. Your team will include family, coaches, and teammates, but it is just as important to find an orthopedic surgeon you trust and a physical therapist and athletic trainer who understand your goals. Other than home and school, an athlete will spend most of their post-injury time in physical therapy which is why finding the right therapist and facility is paramount. The good news is that with the right team around you, most athletes return to sport – some even better than before!
While we hope for a healthy, competitive (but injury uneventful) tournament, the risk of injury tends to be higher in the post season with tired bodies and a National Championship at stake. If you’re a basketball athlete (or really any athlete for that matter) and want to learn more about how you can prevent these injuries and more, make sure to talk to a physical therapist about putting a customized exercise program together for you!