Dime Q&A: Expert Surgeon Talks Yao Ming & Preventing Injuries

Don’t you all feel like something was stolen from you? Yao Ming. He could’ve been one of the greats, should’ve been one of the greats. But science and physics took him away from us this summer, and for good this time. After the big man missed just two games through his first three NBA seasons, Yao played over 57 in a season just once for the rest of his career. With a number of foot and ankle problems that never quite healed, Yao called it quits at 30 because his body couldn’t take it anymore.

So I again caught up with Dr. Bal Raj – who was named one of the “Top Orthopedic Surgeons in Los Angeles and a Leading Physician of the World” by the International Association of Orthopedic Surgeons, and someone who has a lot of experience with high-profile athletes – to talk about the problems that can occur when you grow too fast. He’s already helped explain the surgery Kobe Bryant had earlier this summer, as well as Gilbert Arenasknee problems and the plantar fasciitis that plagued Tyreke Evans all summer. Now, he helps explain why big men always seem to have lower-body problems.

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Dime: Talk about Yao Ming. He seemed fine for a while but once he started having problems with his lower body and feet, it never stopped. Can you talk about what happens when guys are almost too big for their own body?
Dr. Bal Raj: When you start having feet problems, which can be stress fractures or turf toe, what happens is as a big guy, every time these guys jump up and down there’s a magnifying of overuse in this scenario because of their weight. Their weight goes through one thing and is dissipated to a smaller area, and because the stress is dissipated to a smaller area, they’re more at risk of reoccurrence with that problem.

It’s a law of physics. Force equals mass times acceleration and if you have a lower surface area accepting that force, then you’re bound to have foot problems with that issue.

Dime: When I was younger, I grew pretty fast. I was like six feet tall by the eighth grade, and I had some knee problems. What things can come from that? What problems can arise if you’re growing too fast when you’re younger?
DBR: Oh yeah, that’s a great question. When you’re growing too fast, here’s what happens: Your bones grow but your tendons and muscles don’t accommodate to that. Your getting your muscles stretched. They don’t grow traditionally in the same way. So what happens is suddenly your tendons are all stretched, which puts more forces on your knees, on your hips, on your back issues. The most common thing with kids on a general knee basis involving the area is the patellar tendon because the tendon is under tension as well as the muscle tightening up in the quad. So they start having pain underneath their kneecaps from mal-alignment.

So this is a traditional problem, and it takes someone to just recognize “Hey I’m growing fast. I need to start stretching.” Stretching is the secret…at a young age because our muscles and tendons are flexible enough that we can stretch and it makes a difference.

Dime: Yeah, that was actually my next question. If you’re a teenager growing up, as far as stretching goes, if you stretch enough can you stop yourself from having those problems or will they always be an issue if you’re getting tall?
DBR: Yeah you can definitely…if you stretch more, you can definitely mitigate your changes of having the problems because by stretching, you are also stretching the tendon and the muscle appropriately and you can appropriately strengthen those fibers in an eccentric fashion, which will strengthen them up to 150 percent more.

So by stretching and strengthening, you’re actually protecting your joints and mitigating injury.

Dime: With stretching, I’ve heard different things. Is it more important to stretch before you do stuff? Or after?
DBR: My recommendation is both. I think before you even start stretching…lets say you wake up in the morning, the first thing you should do is just a gentle warm-up to get some blood flowing through your tendons, through your ligaments, through your joints. Maybe jogging…or something just to get your body going, get your joints going. After that, you stretch, because now you have enough blood supply where it actually makes a difference and you are warmed up.

I recommend stretching before, and then after you’ve done an activity of high intensity, stretching afterwards. People debate on which is the right way to do it. But there is absolutely no harm in stretching twice a day versus once.

Dime: Besides stretching, are there any other habits high school kids can get into to help them? Maybe something that they don’t normally hear about?
DBR: Stretching is important but the warm-up before stretching works. Once you wake up and you go into an aggressive activity, if your body isn’t warmed up, you’re more prone to spasm, you’re prone to inflammation. A gentle warm-up: it could be a brisk walk or a light job, just to get the blood flowing throughout all of your body because you actually endeavor into an aggressive activity. That’s number one.

Number two, a healthy diet. I can only stress that. You are what you eat, and it’s true for kids as well. Don’t expect to be a high functional athlete…on any level, you have to eat well. If you eat a big fatty meal beforehand, you are going to be slowed down, you’re gonna have cramps and you’re not gonna function at the level you should be functioning at. And you will be more prone to injury.

Dime: If high school athletes are overexerting themselves…for instance if they played all year and then in the summer are playing every day as well, what type of injuries can you get from that? How do you kind of keep yourself away from getting those injuries?
DBR: With high school athletes and athletes in general, remember while we are doin the activities, we need guidance. You’ve got trainers. You’ve got coaches. When a lot of these athletes are by themselves, the issue really, the general issue is they feel like they can conquer the world. They feel that if they put in 150 percent, they’re going to improve that way, and that’s absolutely not true. It’s so important to realize that as an athlete. Even myself when I go weight training without a companion, I can control or push myself too far. You’ve got to kinda back up and listen, “You are more prone to injury when an exercise program or an activity is guided by your own conscience, especially if you’re a high school athlete.” You have to do background and pay attention to all those tips that your coach told you in terms of warming up, in terms of conditioning, in terms of not doing things too crazy too fast.

That’s why people injure themselves in the summer. They’re by themselves and they feel like they can conquer the world because it’s their own turf. Then suddenly, they’re on their own and they’re trying to do what they normally do under a coach’s guidance.

What do you think?

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