There will always be tape and ice.
Beyond that, there may be nothing in an NBA training room that isn't touched by the advance in technology that we've seen over the last decade. The tools in the arsenals of team physicians have changed as rapidly as cell phones, allowing NBA teams to get more out of their players.
With an 82-game schedule, back-to-back games and high-dollar athletes who have demanding coaches, agents and fans, the medical staffs have looked to improve not only what they do in standard ways but also by improving their tools. Computers have started to change the game, including sensor- and camera-driven technologies.
Behind the scenes, there's even more of this going on.
Few will see Kevin Durant with his legs in a pneumatic recovery system, but they see the results. Kobe Bryant has shown several technologies being used during his recovery, including guided injections and anti-gravity treadmills. All of these and more were likely used by Derrick Rose during his rehab as well. In fact, it's more likely that every injured player is using some combination of these technologies to avoid injuries as well as return from them more quickly.
I was recently able to see some of these technologies in use at St. Vincent Sports Performance in Indianapolis. SVSP is one of the top sports medicine centers in the country and has done work with thousands of athletes, including those at the professional and Olympic levels. In fact, they were the ones responsible for handling Greg Oden's rehab. You may have also seen SVSP's athletic trainers and doctors in action when Louisville's Kevin Ware broke his leg during last season's NCAA tournament in Indianapolis.
Ralph Reiff, the executive director of SVSP and a recent inductee into the National Athletic Training Association (NATA) Hall of Fame, allowed me in and demonstrated the devices he and his staff use on a daily basis, explaining how they could be used in the NBA and beyond. (I should mention here that sitting just feet away and working on an athlete was David Craig, the longtime athletic trainer for the Indiana Pacers, who now works at SVSP.)
One technology that NBA players are very excited about is the pneumatic recovery unit. One company, NormaTec, and its NTRecovery units have become the leader in this market. The pneumatic units pump air into large boots or sleeves. The units can go all the way up the leg—though for NBA players, they tend to only go about knee high. The units sequentially inflate, giving the sensation of a massage while moving blood and lymph through the leg.
"Runners love these," Reiff explained as the unit inflated. He had just been at a national-level cross-country meet and had taken six of the units to help these runners. One of them set a national record and promptly bought one of the NormaTec units. They are easy to travel with, consisting of the boots (which fold and deflate) and the pump, which is about the size of a lunchbox.
Prior to a game last season in Indianapolis, Durant and several of his Thunder teammates weren't out on the floor doing the standard stretch and bounce warm-ups. They shot some, they ran some, but before the game, they were back in the locker room using their NormaTec units to help get the blood flowing.
"For that, they're just flat-out better," said one NBA trainer who could not speak on the record due to league regulations. "No one rolls an ankle. No one gets tired. Heck, it just feels good. I take a unit home sometimes."
The price of the device has been coming down rapidly too, with the company now selling its MVP units for around $1,500. That price drop is why so many players are buying their own and using them at home. Roy Hibbert is another big fan of NormaTec, purchasing his own and tweeting out a picture of it. Almost every team is using these units, or a variant of them, and usually travels with as many as six.
Cold laser sounds more like something from the next Star Trek film instead of a simple system that uses light to give players who are dealing with short-term pain some release. While the actual mechanism under which these systems works remains unknown and is the subject of significant research, there's a good deal of anecdotal evidence supporting the practice along with a lack of negative consequences. As such, its usage has become quite common in the NBA.
The system, also known as Low Level Light Therapy, works very simply. An LED of a certain wavelength is placed over the body and "fired." The light acts on the body in much the same way as acupuncture, according to practitioners. A small handheld unit can go directly to trigger points on the body, though there is debate on exactly where is best. Some say joints see the best results, while others focus on areas of enervation.
"Those are everywhere," said Reiff, pointing to a unit between two treatment tables that was in use with one of their clients. "We have a couple units here, and the athletes get a good response to them."
Their size and ability to be used quickly have put similar units in training rooms around the NBA. Several ATs I spoke with said they used to travel with a unit but are now usually able to share the use of the home team's unit. (This is a common arrangement for advanced modalities.)
Cold laser might be an unknown technology to most NBA fans, but it's actually one of the more mature technologies used. The downside is that while players like the immediacy and non-invasive nature of the process, the long-term efficacy is low.
"They get it, they feel good and they play," said one NBA athletic trainer. "Then they're back. It doesn't last, and it becomes something of a time issue. I'd rather use stim (electrical stimulation) for most things, but they don't like it as well." I get the sense that many medical staffs feel the same way and hope that cold laser is replaced by something with more lasting results.
The Alter G treadmill has been noticed more since Kobe Bryant tweeted out a picture of himself running on one of the high-tech machines during his rehab from Achilles reconstruction. The treadmill is a combination of a brace that removes some of the weight from the athlete and a vacuum-sealed skirt that covers the surface of the treadmill. It connects to the athlete via the skirt—it actually looks more like a tutu—and inflates to various pressures. The vacuum can take on anywhere from 20 to 80 percent of an athlete's weight, reducing the stress on the body, especially the legs.
For rehabs involving the lower extremities, this type of activity is key. Not only is the pounding on the leg reduced, but athletes can begin walking and running earlier, helping the injured part adapt. It also allows the athlete to work on cardio without the stress of full-impact activity. For runners, an Alter G can also be used as a "light day" workout, giving the distance work without the stress on the legs. For basketball players, the same is true.
"We can control all the variables," said Reiff as one of his employees strapped into their Alter G. There was almost no change in the gait, but the demonstrator said he perceived significantly less effort. "It's like being on a cloud," he said.
Most of the Alter G devices are leased, but they would normally cost around $20,000. This is more cost-effective for many teams since the alternative is to build an underwater treadmill, which would require more space and maintenance. Small pools do have more uses than an Alter G, so at many training centers in the NBA, there are both options.
Money does not seem to be an object when it comes to outfitting the training room, but the medical staff has to make long-term decisions on what to have and what not to have from year to year. Leasing frees up a bit more cash, and companies like Alter G don't mind seeing their products used by top-name athletes without having to cough up huge endorsement deals.
You're more likely to see advanced ultrasound on the sidelines before any of the others. The small units are widespread in European soccer, where soft tissue injuries and muscular injuries can be diagnosed in seconds. While not as accurate as an MRI, they're much more cost-effective and can be used more widely. Ultrasound units not only diagnose but can help visualize the rehab process, such as seeing how a strained muscle is repairing itself. It can also guide injections to increase the efficacy of those significantly.
Another emerging technology is body and hydration analysis. SVSP uses a combination of sweat analysis and body composition analysis using a technology called a Bod Pod. Reiff says the results can be dramatic. "Using both together amplifies things," he explained.
Ronald Nored of the Butler basketball teams that went to back-to-back Final Fours is one of his top examples. "We were able to do the analysis and come up with a hydration plan that kept him from cramping up, and we saw immediate results," Reiff says. He believes that new machinery to collect and analyze sweat will speed the process and make it more accessible.
Teams are also getting a bit retro at the same time they're using more advanced medical technologies. New exercise programs in the NBA hearken back to simpler times, with more teams using Pilates and yoga variants.
SVSP has a top-of-the-line Pilates reformer just feet away from its Alter G treadmill. Unsurprisingly, Kobe Bryant has been one of the lead proponents of the system, but he's hardly alone. The use of suspension training like TRX and speed-resistance devices is also creeping into basketball, a bit later than it did with track and football.
It's important to remember that these are just tools, cool as they are. The key to their success is still going to be the hard work of the medical team and the determination and focus of the athlete.
As the game and technology have evolved over the last decade, it's no surprise that the tools used have evolved as well. The NBA is all about getting the best out of its amazing athletes, so pushing forward the technologies used to help get them to peak condition is a good investment for a team or for a company with a big idea.
Of course, as with any new technology, it necessitates a big check and a spot in the training room, and there will always be questions regarding effectiveness. Also, even with all of these tools, the scientific data—especially data that specifically addresses efficacy in a pro setting—is sparse. What counts here is results and the happiness of the athletes. That they are specifically asking for these types of technologies and driving their usage is key.
I asked several athletic trainers in the NBA and Reiff what they thought was coming next. All of them immediately pointed to sensor and camera data. "Big data," Reiff said. "We're getting a lot of location and movement data, but I haven't seen much in the way of analyzing that data for sports performance. I get some of it for shots and defense, but for recovery and conditioning, there's going to be a lot of it coming over the next months and years."
Jeff Stotts of Rotowire, an athletic trainer himself, also pointed to cryochambers as an emerging technology. Several teams, including the Phoenix Suns and Minnesota Timberwolves, have these units in place. You can see the T-Wolves using it, including Kevin Love, at this link. The rapid cooling of the chambers is not comfortable, but its effective use in recovery is well documented.
The great part is that all of this technology will trickle down to help the rest of us. Alter G treadmills are being used successfully with stroke victims and people adjusting to artificial limbs. Ultrasound units are coming down enough in price that they'll likely be standard at all levels of sport and perhaps available to first responders to make more accurate on-the-spot diagnoses. Cryochambers may become as common as saunas at gyms.
If and when this finally happens, we'll be able to thank the NBA and its medical staffs for their part in popularizing and testing these wonderful advancements in technology.
All quotes in this article obtained firsthand, unless otherwise noted. Special thanks to the staff of St. Vincent Sports Performance for their time and expertise, and to Abby Gras of U/S Sports Advisors for her help with this article.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and the New York Times.
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