Chasing Perfection: A Behind-the-Scenes Look at the High-Stakes Game of Creating an NBA Champion

by Andy Glockner

  “This asymmetry is our first window into some sort of injury, whether or not it’s compensation, or otherwise,” Leidersdorf said. “It could be something where, in this guy’s case, where he has some injury and develops a compensation pattern and is moving away from it, or this could be the calm before the storm. And you can’t tell this with the naked eye when he jumps that you have 20 percent more force in one of your legs. And if you use that over the course of a couple of years, there goes the meniscus.”

  Next Leidersdorf went back to the on-screen skeleton and, as it was simulating the jump, he pointed to its right leg.

  “Now, when he goes through the movement, you see his right knee start to dive in a little bit,” he said. “When he contacts the ground, his right knee sinks inwards. That’s called a valgus maneuver, or knock-kneed—a medical term. It’s closely linked to a number of knee injuries: ACL, MCL, meniscus, all the things that are associated with this movement pattern.”

  As the skeleton continued its movement, Leidersdorf pointed out another red flag.

  “So, beyond going into this aggressive valgus motion, at the end of the movement, you see this [extra] rotation, so this knee swings into-out pretty aggressively compared to everyone else we have tested. So this is a combination of a couple of factors. He’s overloading this right side, and he also has this aggressive twist in and twist out, so there’s something going on there which is a little scary.”

  Leidersdorf then noted that this player also has a significant differential in his ankle flexibility, which is an additional piece of concerning information.

  “All these things together say ‘We’re worried about your right side, but specifically, that right knee is not going to hold up if this keeps happening,’” he said.

  As it turns out, this particular player had a foot issue in college, and his current jumping motion was leftover compensation from when he was feeling pain in that foot. More crucially, the player had recently disclosed that he had been experiencing some burning in that right knee. Luckily, he was only suffering from some swelling, and P3 helped diagnose his muscle imbalances and movement deficiencies before any major damage to ligaments was done. P3 prescribed a set of transformational exercises for the player to the team’s strength coach, and the team installed a set of force plates at its own training facility. The player comes back periodically for a follow-up exam of sorts, so the P3 staff can see his development and how closely his adjusted movements are staying to what is optimal. Through the end of the 2014–15 season, the player had remained healthy.

  As Leidersdorf wrapped up his explanation with the visuals, Elliott wandered over from where he’d been chatting with the NBA team’s strength coach. His floppy hair and relaxed demeanor suggest someone who may have seen a surfboard or two in his time, but he was anything but laissez-faire about his enterprise and its potential growth.

  From its humble start where former Utah Jazz players Paul Millsap and Ronnie Brewer were among the first to buy into the testing, P3 has made significant headway with a large number of NBA teams. One drawback of the business, though—at least until 2014—was that P3 was working exclusively with athletes who already had made it to the NBA, which meant any testing started with advanced medical baselines and, in most cases, somewhat incomplete data sets. In essence, P3 was exploring players who already had established physical habits or may already have been injured significantly, so it was harder to know exactly what was possible or how a player used to perform before the injury.

  Ahead of the 2014 NBA Draft, though, the league quietly invited P3 in to do some testing of prospects at the Combine. Elliott and his staff were able to get force plate baselines established in the normal vertical leap (stand on the plates and jump as high as you can), the drop jump (as described above) and the lateral skater test (where you push off one leg and stride as far as you can to one side or the other). Additionally, Adidas reached out to P3 to do similar baseline testing for high school and college prospects at its high-profile Adidas Nations camp.

  “Seven or eight years ago, we decided to stake out this claim and do this objectively. And originally, the data was interesting, but we had no context for it,” Elliott said after that year’s testing had been done. “We tested a player, and he had a difference in impact spike of like 15 percent, and we’d say ‘OK, this is a problem. We need to balance this out, make this side stronger, to absorb more of the force.’ But now we have a database of, oh, I don’t know, 160 NBA players and we know that the mean delta in spikes on impact in an NBA player is 16 percent. We know this now. We know how they move. And we can’t generalize and study a population walking around the street and compare them to NBA players. It doesn’t work.

  “The last couple of years, [the business is] starting to really sing,” Elliott continued. “And it’s just going to do this [pointing upward on a diagonal with his hand] right now because of how much data flow we have coming in. From the best teams in the league sending players to us to the players coming back to getting guys at the Combine and Adidas Nations, it’s just going to be ridiculous.”

  Starting to build a data set of teenage athletes was a very important development for P3 (and companies like it). Not only will getting the data earlier provide them with additional insights in terms of their overall strategies and data ranges, but they will get a first look at an athlete when he’s still relatively formative, which means they will have the cleanest baseline information possible to use as a reference for the rest of that player’s career. This is all highly desirable information when potential NBA players are such a limited resource to begin with.

  “These guys get talent ID’d at twelve [years old], and it’s a pretty small cohort. It’s not like baseball. There aren’t that many of them, and very few are going to be the next thing,” Elliott said. “We have the potential to have some of the best guys in the league serially tested from when they’re like sixteen, maybe four or five times before teams even have them. We’ll know what their development curve looks like, what some of these propensities for injuries look like, if they’ve had some radical change in their biomechanics, if that ankle they sprained changed everything about how they move and now they’re wearing out their right knee. It could be crazy valuable.”

  P3 isn’t the only enterprise trying to unlock the promise (and profits) from merging technology and kinesiological improvements. One of the other leaders in this industry is Dr. Michael Clark, who is the founder of Fusionetics, which has developed a technology platform that helps design and track training programs for everyone from middle-aged gym members to world-class athletes. Initial testing on the client yields data that is interpreted into thousands of variables in the Fusionetics system, and then the platform creates a workout plan designed to fix whatever flaws registered.

  Clark, though, is much more widely known as the visionary behind the training program for the Phoenix Suns, who long have been considered the NBA’s most successful team in terms of helping their players avoid and recover from injuries. Clark has worked since 2000 with Suns head trainer Aaron Nelson, first creating and then sophisticating an all-inclusive program that has regularly placed the Suns among the NBA’s league leaders in fewest player games missed, and has resurrected the injury-affected careers of stars like Grant Hill and Shaquille O’Neal.

  “What we wanted to build is a comprehensive athletic performance system that focuses on three pieces: injury prevention, performance, and recovery. And so what we did is change the whole structure [in Phoenix],” Clark said. “We tested every single athlete’s movement efficiency, their performance, and then we implemented manual therapy two to three days a week on all of the starters. Then they would get something called DMS, which is deep muscle stimulation and vibration in the muscle, followed by stretching.

  “So every other day, they’d get manual therapy, so soft tissue and joint work. And the next day they’d get vibration and stretching, and then after either of those sessions, they would go through very specific co
rrective exercises and then we implemented very specific functional training programs that we actually published, and we showed that the functional training approach was anywhere between 50 and 200 percent better than traditional lifting.

  “And then after that, we had a very specific recovery process where again, every guy had to either wrap ice on their knees, ankles, and shoulders, or they had to get into the ice tub. Now, we have the cryosauna; back then, we didn’t. And then they either had to go home and stretch themselves, or we would put them on the table and stretch them back out. Every athlete had that.”

  Clark went on to say that while technology has improved in the sixteen years since he started with the Suns, his overall approach has remained the same, with stretching, muscle balance, and proper movement being huge keys to the equation. He estimates that an NBA player’s flexibility is reduced by 25 percent after they have played a game, and the muscle tightening can increase a further 12 percent if the player then has to get on a plane to head to the next road destination. His staff and the recovery program are designed to minimize that impact as much as possible.

  So, Clark and his team have overseen ongoing improvements in player nutrition, vitamins, and supplement intake. They pay attention to the amount and quality of sleep players get. They now use boots and other compression gear to help in recovery after muscle stress. Instead of ice baths, they now have a cryochamber that helps cool the athletes’ muscles and creates what Clark called “a significant, total body effect.”

  Clark believes his focus on overall movement rather than issues at the point of a problem is what has separated his program from most others’ to this point. Traditional NBA strength and recovery programs tended to be what Clark termed patho-anatomical, or “bad structure” oriented. Clark’s plan is patho-kinesiological, or focused on fixing bad motion in a player’s movement.

  In listening to Clark talk about the three-pronged basis of his plan, he makes things sound very simple, but even after his long-term involvement with an NBA team, very few other franchises have approached the Suns’ level of success in terms of player health. While entities like P3 are helping place more and more trainers at NBA teams themselves, there’s still a vast range of training and recovery capabilities across the league. Technology is a great equalizer in that every team can pay to have data on their players collected, but you still need to be able to properly interpret that data, and also have a comprehensive plan in place that knows what to do with it.

  “Aaron and I have, so many times, just scratched our heads and said, ‘Why are people making this so difficult?’” Clark said. “It’s not rocket science. Guys have to be able to bend their ankles, rotate their hips, extend their hips, because they have to be able to jump and run, and so there’s a few things that you do to make that work.”

  A good example of this was the Suns’ work with Hill, who had been a star in his six seasons with the Detroit Pistons after being drafted No. 3 overall in the 1994 draft. Hill then moved to the Orlando Magic in a sign-and-trade deal in the summer of 2000, and suffered through a brutal stretch of ankle-related injuries there. Hill only played in four games his first season with the Magic, and only managed to compete in a total of forty-seven games in his first three seasons in Orlando.

  Hill’s ankle issues were so bad, he underwent surgery in March 2003 where his ankle was rebroken and realigned with his leg. That surgery resulted in his contracting a MRSA infection, and he ended up missing the entirety of the 2003–04 season, as well. Hill managed to play in sixty-seven games the following year and averaged almost twenty points a game, but then a sports hernia—thought to be caused by his compensation for his ankle issues—cost him most of the 2005–06 campaign. By the time he signed with Phoenix in the summer of 2007, there was considerable talk of Hill retiring, as he was a shell of the player he once had been.

  “When he came to us at Phoenix, he had had seven surgeries on his ankle. That’s all published data,” Clark said. “But the biggest thing for him is that his ankle didn’t bend. Obviously, he needed surgery, but still, nobody really worked on it, and the big thing for him is his hip didn’t rotate. So he played with Detroit against Chicago, went up for a dunk on the left-hand side of the rim, dunked, landed on his hip, and pushed his hip out of position. It changed his leg length, and as his leg length changed, it forced his foot to turn out and his leg to compensate.

  “Over a little bit of time, he started to get pain in his Achilles, his foot, and the next thing you know, seven surgeries later, everyone’s still focusing on his foot. They’re doing all this laser therapy, everything you can imagine on his foot. But when he came to us, his problem was his hip. We loosened his hip, then loosened up his ankle, and his ankle could stay loose because his hip could bend. Then, in three weeks, the guy was back, and he played I don’t know how many seasons for us, only missing a couple of games because of his appendix and once he was sick.”

  Hill played five seasons in Phoenix (and one more after that with the Los Angeles Clippers), including the 2008–09 season when Hill appeared in all eighty-two games for the first time in his career.

  O’Neal’s story was fairly similar, where it actually was a toe problem on his opposite foot that was causing him hip issues. In Shaq’s autobiography, written with longtime Boston Globe and ESPN NBA writer Jackie MacMullen, he credited the Suns’ training staff with prolonging his career.

  Just like Elliott’s team at P3, Clark’s group also has been doing evaluations at the NBA Draft Combine to test the incoming prospects, and the two groups came to a similar conclusion: There were a lot of players in the 2014 rookie class who were in danger of significant injury based on the way they moved and the muscle imbalances they measured. Months later, that class did indeed suffer a number of season-ending and significant injuries, which piqued the league’s attention.

  “They’re trying to wrap their head around it, to be honest with you,” Clark said. “They’re trying to figure out what is this. This is kind of an epidemic, and these numbers are bad. Red [the color-coded danger area for Clark’s measurements] is bad.

  “Sometimes, when you’re just measuring movement or performance with gravity, what happens is you’ll see compensation,” Clark continued. “What we do is, we lay the person down on the table, take gravity away and we measure every joint. Their big toe, their ankle, the back of the knee, their hip rotation and hip extension. And those things, there’s very, very specific range of motion of every one of those joints that’s very well documented.

  “And what we can identify is your knee might be caving in on the right, but it could be coming from your left ankle, it could be coming from your left knee, or left hip, or thigh joint. So we can precisely identify it, then we score that. And then our two scores—the movement score and the mobility score—come together, and from that, you literally predict what stresses an athlete’s going to be under. And most importantly, you can fix it. It’s really easy to fix.”

  In Clark’s opinion, the young players he has seen in the past five to ten years are showing worse and worse movement. Today’s budding basketball talents are building more strength and weight earlier in their growing process while also working on their basketball-specific skills, but Clark believes they are not doing enough proper stretching or figuring out the efficient way to move or jump. P3’s Hewitt agrees, noting that among the most surprising things they see in their data capture is “how untrained” the major-college players are when they are tested. Their muscles are not developed symmetrically and they have dangerous movements that are putting strain on their joints and ligaments. According to Clark, every ten degrees of inward bend of a knee when jumping or running puts 50 percent more torque on a player’s anterior cruciate ligament. He also said that he believes 75 percent of all muscle-related injuries are preventable through proper training, monitoring, and treatment.

  This kind of off-court movement training has become an increasingly large part of what is an increasingly sophisticated data puzz
le for NBA teams, with the so-called Holy Grail of athlete injury prevention and performance improvement expertly connecting in-game tracking data, practice tracking data, and so-called off-site biometric data culled from tracking sleep, monitoring diets, and taking periodic bloodwork to check players’ vital levels. Unfortunately, all of this data continues to come from disparate sources, with different levels of exactness, and all of it is complicated by the National Basketball Players Association (NBPA)’s collective bargaining agreement with the league, which prevents certain current measures, while others—namely, possible invasions of privacy like blood samples—will be a major talking point for the next agreement that could come as early as 2017 should either the owners or players opt out of the existing deal. That seems likely in light of the new $2.6 billion national TV contract the league struck late in 2014, which creates a huge new pot of money for the franchises and players to haggle over.

  The current agreement allows players to wear biometric tracking devices that keep constant track of players’ vital signs and workloads in practices, but not in games. According to a CBSSports.com column by Ken Berger during the 2015 NBA Finals, twelve NBA teams used Catapult devices during the 2014–15 season. They included the usual analytics suspects like the Dallas Mavericks, Golden State Warriors, Houston Rockets, Philadelphia 76ers, and Toronto Raptors, as well as the Memphis Grizzlies, New York Knicks, Orlando Magic, Sacramento Kings, and San Antonio Spurs. Zephyr Technology Corporation is a competing firm that makes wearable harnesses that monitor things like core temperature, heart rate, and other body data. Zephyr clients include the Phoenix Suns, the Oklahoma City Thunder, and (of course) the Houston Rockets.

  Because of the limitation of such devices to practice, though, in-game data has to come from the three-dimensional player tracking provided by SportVU, which is still a fairly rough interpretive cut of player workload. An additional issue with the value of practice data is that NBA team schedules are very compact, so teams tend to practice less and less as the season wears on. If they do practice at all, the effort levels in those sessions usually are well below the standards needed in games, so even if the players are being monitored, there is a question as to the value of the data being collected. Getting data established at the beginning of a season, when players are going harder in practice, is valuable—especially as a baseline if a player is injured and you need to gauge their recovery—but in-season data can start to lose value pretty quickly in terms of real-time monitoring of player loads.