Yao, Oden, Mutumbo….the list goes on and on.  Conventional thought goes something along these lines, “Hey, they’re bigger, of course they’re going to take more of a beating, break down, and get injured.  It’s inevitable. ‘The bigger they are, the……'”  

I want to present another option.  A better option.  A more objective option that is not based on assumptions, or wives tales with no statistical, musculoskeletal, or biomechanical foundation.

I want to associate the “BIG” theory with the “RUNNER” theory.  There is the prevailing saying out there, and I’m sure you’ve heard it, that goes, “Running is bad for you, it’s bad for your knees and wears down your joints.”  If you’re a runner, hopefully this statement ticks you off and you have not bought into it. This is just illogical and I will address it in a bit.

Is it true?  Do “Bigs” have more injuries?  When I was trained to determine if a concept is true or not, I had to apply certain criteria.  1). Is it FACTUAL?  The only way to find this out in regards to injury and BIGS is stats.  Injury reports and meta-analysis.  I do not have all of that data at my finger tips nor do I want to take the time in this post to do the survey.  However, from a cursory overview of injury reports, the BIGS do not statistically get injured more than other players.  Obviously, there are many factors to consider in analyzing the data such as contact or non-contact injuries, fewer percentage of BIGS compared to other players, time of season, etc. However, statistically, I do not think it plays out.

Another criteria in determining if a concept is true: 2). Is it Contradictory? In other words, does the theory have contradictions or say one thing then say the opposite?  If the theory is that BIGS get injured more just because they are BIG, then it leaves too many unanswered questions that seem to contradict the notion.  If they break down because they are “BIG”, then why do we not see more injuries in other joints/tissues instead of the one that is getting all the press (i.e. why doesn’t Yao have knee, hip, shoulder, back, problems in addition to his ankle, why just one ankle and not both)? Wouldn’t there be a higher incidence of injury across the board for BIGS, for ALL BIGS?  If it is true, then ALL BIGS would get injured and have a higher incidence of injury.  Why isn’t there a higher attrition rate for BIGS?  There seems to be too many contradictions.

Last criteria to determine truth: 3).  Is it viable?  In other words, can you live by it, does it play out in life, on the court, in the game?  For example, I recall talking to a guy about his religious beliefs as we were driving, and he stated that there is no evil, it is all just in the mind, or just a theory.  Then he proceeded to lock his doors as we got out of the car.  Dude, you can’t live by that philosophy, it doesn’t play out in real life, therefore it’s not true.  Hello! In my experience in working with basketball players, it seems the guards get more injuries.  Yes, it is due mostly to the demands of the position and not “size.”  If you follow that poor logic, one could make the statement that the “SHORTS” will have more injuries because they are smaller and cannot dissipate the forces as well as a BIG.  In fact, I believe size has nothing to do with injury or injury rates.  Come on now.  Be honest.  You guys who have experience in this, wouldn’t you agree?  There are so many other factors that have more influence on injury rates other than SIZE. 

BIGS, your ears should be perking up right now.  This is good news.  You are not just a victim of circumstance or something you cannot control.  Yes, there may be some coordination issues to overcome, but they can be trained and overcome.  A small player has his obstacles to overcome as well, and has the same chances of injury as the BIGS.   

I am going to address it from my perspective, and that has to do with BIOMECHANICS.  I believe this is a major contributor to injury, regardless of the size of the player.  Back to the “running is bad for you, bad for your knees, bad for your joints” (of course most people who say this are not runners, even the physicians) theory.  If you take this to its logical conclusion then EVERY runner would have knee and joint problems and NO ONE should run.  Again, this statement contradicts itself.  There are many runners who compete into their seventies, with no injuries.  If it “ruins” your knees, then why do runners with knee problems usually have it in one knee?  The ANSWER……it’s BIOMECHANICAL. 

A plausible reason most runners continue running and some have repetitive, chronic injuries, is because it’s biomechanical in nature . I’m not saying EVERY runners injury is biomechanical.  There is obviously the occasional strain, or pain from an increased training regiment, or the post marathon recovery.  Most of these are temporary.  I am talking the CHRONIC injuries.  For example, a simple leg length discrepancy of 1/4″ can have an enormous impact.  All kinds of compensations can occur from a leg length discrepancy that cause increased ground reaction forces and wear and tear on one side of the body.  Yes, rest may help, but it does not solve the problem.  It’s a sin to just tell a runner to stop running or just do dorky knee exercises without trying to biomechanically assess and find the causes so they run again. 

Back to the BIGS.  The reason BIGS break down is Biomechanical in nature.  Being “BIG” is just an excuse.  If Yao had my foot at the end of his leg, then YES, the size of that leg would blow out my size 10 foot.  No doubt.  But isn’t it proportionate?  I’m telling you it is illogical and is just an excuse for not going deeper to find out why any BIG has injuries.  A small biomechanical deficit can have a significant impact on the system.  There is the rule of 3’s; where 3 times the forces occuring 3 times faster, makes biomechanical faults 3 times more significant.  If an athlete, say Yao, has a structural foot deficit such as a forefoot varus (don’t worry, I won’t muddy up the waters by going into the details) then it will cause 3 times more ground reaction force and torque at his ankle than further up the chain at his hip.  A small biomechanical fault will amplify the forces of gravity in sport.  It’s not the size.  Or take Greg Oden for example.  He’s had knee cap (patella) problems that have hindered him.  The patella is probably one of the mot reactive joints in the body.  It reacts to what’s coming down from the hip and what’s coming up from the foot.  The hip and the foot drive the patella.  They can drive  it to go places it does not want to go and cause problems.  Just doing knee exercises or patellar mobs is weak and will not solve the problem. 

If a slight biomechanical deficit can have such a major impact, then think how much of an influence CORRECTING THE BIOMECHANICAL FAULT would have on a BIG’s injury or performance.   Let me say it again….correcting the biomechanical deficits can be BIG in helping the BIGS. 

In fact, it can be such a driver in affecting a BIGS injury and performance, that I won’t even start a performance exercise progression aimed at their tight and weak tissue until AFTER  I have addressed the biomechanical faults.  I submit to you that unless the biomechanical deficits are assessed and tackled, then they won’t get better; the BIG will have BIG time problems.

Michael Griffith PT, CSCS

3D Performance Systems