NBA: New Orleans Pelicans' No 1 draft pick Zion Williamson returns to action, but will his knee hold up?

The New York Times

New Orleans: In the months before rookie phenom Zion Williamson made his belated and stirring NBA debut on Wednesday at age 19, he spent his rehab from knee surgery as a 6-foot-6, 284-pound gymnast learning to stick the landing.

With guidance from the medical staff of the New Orleans Pelicans, Williamson tried to correct biomechanical flaws suspected of contributing to a tear in the lateral meniscus €" a rubbery, shock-absorbing cartilage on the outside of his right knee.

The meniscus was trimmed during surgery in October. Then, said Williamson, who can leap so much higher and is so much more agile than one might expect of someone his size, it was time to learn how to run and jump more safely. Williamson trained himself to land with his knees bent, instead of straight-legged. The bent-knee landing helps disperse the pounding forces of basketball. He also worked to avoid tilting his knees inward when landing with a rebound or making a sharp cut, which can put added stress on the outside of the joints.

In his first official game, Williamson scored 22 points in a loss to San Antonio, including 17 in a breathtaking flurry over three minutes of the fourth quarter. Still, he has missed half of his rookie season. And while his nascent professional career is full of luminous and generational possibility, it is also emblematic of growing worry among NBA officials about young players who have played basketball almost exclusively as teenagers and then enter the league more vulnerable to injury than they should be.

It may seem logical that the best way to get better at basketball is to play it more often. But specialisation and intense training of repetitive movements from a young age, researchers say, can leave muscles overstressed and prone to imbalance, subjecting players to the possibility of injury and, eventually, shortened NBA careers.

The delayed start to Williamson's rookie season is "smoke in front of the fire" to Dr. Neeru Jayanthi, director of sports medicine research and education at Emory University in Atlanta and a leading expert on youth sports and training patterns.

"What is wrong with the basketball culture that we have continual patterns of top players not making significant contributions related to injury?" Jayanthi asked in a recent interview.

Last summer, NBA Commissioner Adam Silver called addressing the rising injury rate of young players "the highest priority for the league" in an interview with Baxter Holmes, an ESPN reporter who has been at the forefront of examining the issue.

Early, intense training and specialisation in one sport can age young players' bodies three or four years beyond their chronological age, Jayanthi said. This has led him and other medical experts to question whether Williamson will be able to sustain a pro career of 15 or more years, like LeBron James and Michael Jordan.

"It makes me skeptical," said Jayanthi, who has not treated Williamson.

But David Griffin, the Pelicans' executive vice president of basketball operations, said the post-rehab Williamson "is a radically improved physical version of himself."

The Pelicans declined to make their medical staff available to discuss Williamson. Griffin said that Williamson had gained more flexibility in his ankles and hips through rehab, which had helped relieve undue force on his knees and permitted him to move with more agility on defense.

An ongoing challenge, Griffin said, is keeping the young forward, who packs on muscle quickly, strong enough to control his movements but light enough not to generate more torque.

Williamson said he had dreamed of being a basketball star from the age of four. By five, he played AAU travel ball with nine-year-olds. By nine, he was waking up at 5am to practice shooting and other drills. By seventh grade, he had stopped playing football and American football and committed himself fully to basketball. During his freshman year of high school in Spartanburg, South Carolina, he received his first scholarship offer to play in college, and his summers became filled with extensive travel and organised games.

A generation ago, many elite athletes, such as Jordan, had played multiple sports growing up. That conditioned their bodies to various types of movement. And they often took breaks from repetitive-motion activities in the summer. Now top high school basketball stars like Williamson can end up playing nearly as many organised games in a year as an NBA player.

A 2017 study published in The American Journal of Sports Medicine examined 237 NBA first-round draft picks from 2008 to 2015. It found that 43 percent of those who played a single sport during high school suffered a major injury in their pro careers, compared with 25 percent of those who played multiple sports. Multi-sport athletes also tended to have longer NBA careers.

Dr Brian Feeley, a sports medicine orthopedist in San Francisco who was a co-author of the study, said there was little evidence to indicate that, for a boy, specialising in a sport before reaching skeletal maturity around 16 or 17 would necessarily make him better. But such specialisation is associated with higher injury rates.

The NBA now recommends that players not begin specialising in basketball until age 14 or older; limit the scheduling of organised games; and rest at least one day a week and for a longer period each year.

"The question is whether somebody like Zion should have taken breaks," said Feeley, who did not examine Williamson. Feeley added that a meniscus tear sustained by a teenager might suggest that young muscles and joints have been overloaded "when they're not really ready for it yet" and a predisposition to types of injuries as a professional that "you may not necessarily experience until you were in your 50s or 60s."

Griffin said the Pelicans were not "overly concerned" with the potential health effects of Williamson's specialisation as a youth, given his willingness to work to correct his biomechanical flaws.

Williamson expressed some frustration with his rehab and being unable to make his customary explosive moves. He said that, at times, he wanted to "punch a wall or kick chairs," but he dismissed any concern over his decision to specialise in basketball since middle school.

"My advice would be, if you love the sport, just play it," Williamson said.

The risk is real, though. Recent research, Jayanthi said, suggests that forceful, specialised training from a young age may contribute to biomechanical flaws. Such movement deficiencies have been widely studied by Dr Marcus Elliott, a physician and founder of P3, a sports performance company that is completing a five-year study of nearly 500 current NBA players.

Elliott tested Williamson in high school using a ballistic jumping drill that roughly mimics rebounding. The force that Williamson exerted into the ground, Elliott said, was greater than for any other NBA player or other professional athlete his company had tested. This was dramatically demonstrated last season when Williamson famously blew out a sneaker while playing at Duke.

There has been much speculation in the news media that Williamson's weight might have left him prone to knee injuries. But research indicates that weight alone does not present the most threatening risk factor for knee injuries, Elliott said.

Rather, the biggest risk factors for serious knee injuries among NBA players seem to be biomechanical, Elliott said. The most significant risk factor, he said, appears to be the rotating of the femur (thigh bone) inward, while the tibia (shin bone) rotates outward, which can cause a shearing effect in the knee.

When biomechanical flaws are present, weight can amplify the chance of knee injury, Elliott said. He declined to discuss his findings regarding Williamson, but, speaking in general terms, said, "If your biomechanics are clean, you don't increase your risk of having a knee injury by being 280 pounds."

A number of doctors and athletic trainers applauded the Pelicans for being conservative in rebuilding Williamson's suspension system €" joints and muscles known as the lower kinetic chain €" a process that extended beyond an initial team prediction of six to eight weeks.

"You don't want a Ferrari engine and Yugo brakes," said Dr Manuel Romero, a former head athletic trainer for the Sacramento Kings.

Now begins the extended effort by New Orleans' hoops pit crew to keep Williamson from breaking down again.

"He's a genetic lottery winner, and everyone is so excited to see him play," Elliott said. "It will feel like a big cultural loss if he's unable to be what he potentially could be."

Jeré Longman c.2020 New York Times News Service

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