Of ‘Flat Tires’ & Brittle Basketball Players

Of ‘Flat Tires’ & Brittle Basketball Players

Andrew Charniga


“…. Imagine what happens when constrained volatility – choked systems explode.” Nasim Taleb, Antifragile

Two notable injuries of the 2018 – 2019 NBA season occurred as a result of players performing seemingly benign, routine for basketball, maneuvers ( figures 1 -4). An injury to a 3rd player on the same team as the athlete in figure 1  the Golden State Warriors (GSW) occurred early in the NBA playoffs; those injuries, ACL tear inclusive to another GSW starter in the finals, collectively eliminated any hope the team would win a third consecutive NBA title. 

Two Gonzaga {“Twice” https://www.spokesman.com/stories/2019/mar/11/gonzagas-laura-stockton-goes-down-with-left-knee-i/} university guards, members of one the top female basketball teams in the USA, went down in the same game. One cutting to the basket, suffered an anterior cruciate ligament (ACL) tear the other an ankle injury. Both were lost for the rest of the season.

Injuries most often associated with traffic or industrial  accidents such as tibial plateau and Jones fractures, Lisfranc fractures; coupled with Achilles rupture and quadriceps rupture/tear associated with aging athletes playing pick up basketball show a clear cut trend to be on the rise in younger athletes. 

A clear indication of a ‘rejuvenation’ tendency of catastrophic lower extremity injuries common to football and basketball; collegiate players are increasingly opting to skip a final bowl game (football) and/or leave leave college early (basketball and football) in order to be healthy enough to sign a pro contract.

“What we’re seeing is a rash of injuries among young players.” Holmes, 2019

A few examples. 

 An NBA draft prospect (22 years old) from the University of Michigan tears his ACL in a “pre – daft” workout; and, were he selected by the Boston Celtics; would miss the upcoming 2019 – 2020 NBA season.

A collegiate super star (18 years old) sprains knee slipping to the court when his shoe gives out. Inane speculation arises the injury was the fault of a defective shoe and not the athlete’s lower extremity compliance deficit, i.e., an inability of muscles, tendons, ligaments and fascia to yield elastically to a force applied, in this case the forces of falling. Put simply, he was too in – elastic to fall safely. 

He misses six games amid heightening speculation he should forego the rest of the season including the NCAA tournament; so as not to damage his prospects for the NBA draft by risking further injury (see figure 5).

Figures 1 – 2. Super elite basketball player ruptures Achilles tendon in right foot during 2019 NBA championships. Note: the injury occurs with near vertical shin and heel – to – toe flat footed plant as the athlete endeavors to cut around opposing player.

Despite exhortations from the literature (Hartman, 2013) and practical application of real world experiences (Charniga, A., “Reverse Engineering Injury Mechanism”); ignorance persists that restricting bending at the knee and ankle is not only safe; this partial bending is all that is needed to practice dynamic sports. Those responsible for a proliferation of this ignorance; the personal trainers, athletic trainers, physical therapists, strength coaches, doctors and others, are clueless or simply ignore the fact their beliefs and practices can result in dire consequences (see figures 1 – 5).

“….instruc­tions about a restriction of the forward knee displacement have to be strictly avoided. This recommendation is based on a misinterpretation of existing data and should be removed in future practical literature.” Hartman, 2013

Figures 3 -4. Super elite basketball player tries bending quickly to pick up dropped ball; suffering a groin injury in the process; as his knee angle reaches about 90°. Knee, hip and ankle compliance deficient; he is too tight to even perform what should be routine: picking up a dropped ball. The same athlete is seen practicing dis- functional strength exercise limiting bend at knee; and, especially bending at ankle joint in figure upper right.

Figure 5. 18 year old collegiate super star sprains knee slipping on court after left shoe breaks apart; young female weightlifter is uninjured despite falling with barbell more than twice her body weight on her chest.

A partial landscape of basketball injury incidence is listed below. The pre – season practice injury rate is particularly noteworthy; the pre – season is likewise an injury prone period for football players. Furthermore, the preponderance of lower extremity injuries in basketball mirrors those in football.

Injuries and incidence common to basketball  according to J Athl Training (2007):

  • Pre – season practice injury rates 3 – times higher than in season;
  • 60% of all game and practice injuries are to lower extremity;
  • Ankle sprains are the most common injury overall;
  • Knee injury being the most common to miss more than 10 games;
  • 60% of ACL injuries were non – contact;
  • Injury rate in NBA is nearly twice that of NCAA;
  • The majority of the reported injuries sustained in practices and games were soft tissue injuries to the lower extremity and lower back;
  • Knee injuries (ACL) tended to be non – contact.

Table 1. NBA players who suffered Achilles tear/ruptures; year; age; circumstance

Year Player Age/Circumstance
1992 Dominique Wilkins 32
1997 LaPhonso Ellis 26
2001 Maurice Taylor 24/off season
2004 Voshon Leonard 30
2007 Elton Brand 28/off season
2010 Mehmet Okur 30
2012 Chauncey Billups 35
2014 Anderson Varejao 32
2013 Kobe Bryant 34
2015 Brandon Jennings 26
2015 Wes Matthews 28
2017 Rudy Gay 30
2018 DeMarcus Cousins 27
2019 John Wall 28/at home
2019 Kevin Durant 30
Darius Miller
David Nwaba
Rodney Hood
Ian Mahinmi
Klay Thompson
30/pick up game
Dwight Powell
Darrell Arthur 23
2010 Jonas Jerebko 23
2005 Dan Dickau 27
2013 Jeff Taylor 24
1998 Christian Laettner 29/pick up game
1994 Gerald Wilkins 31
1994 Isiah Thomas 32
1994 Stanley Roberts 24
2012 Elliot Williams 23
2014 Pierre Jackson 22/summer league
2014 Xavier Henry 23

Mean age: 29.2; 7 under the age of 25; 11 at or under 27; mean age of NBA 27.

A list (which cannot be assumed comprehensive) of NBA players who have succumbed to Achilles tear/ruptures, relatively recently, is presented in table 1. Achilles injury tear/rupture is a catastrophic malady the NBA shares with the NFL; and, in general, American football. A survey/study (Cerynik, D.) of 18 NBA players who succumbed to a Achilles tear/rupture over a period of 23 years, from 1988 to 2011, established an average age of about 30; with a mean age of 27 years for NBA players.

The data compiled in table 1 of 32 players covers a period of approximately 27 years; although by no means comprehensive; it reveals an average age of 29.2; with eight under the age of 25 and 12 at or under the mean age of the NBA, i.e., a rejuvenation trend. It is also noteworthy that 26 of the 32 these catastrophic injuries have occurred since 2000; six in 2019 alone. Becoming all the more commonplace, an Achilles tendon rupture used to be an injury doctors would see most often with 40 – 50 year old males who were injured playing pick up basketball. 

An Achilles tendon rupture is a catastrophic injury for any athlete, especially one who makes his/her living running and jumping. Limited research shows a recovery time of up to a year; approximately 1/3 do not return to play;  virtually zero of the other 2/3 are unable perform up to their previous level.

That being said; proof positive part of the lower extremity injury problem in American sport is the influence of the medical community. Consider the quote below:   

“Dr. Chao said he made his initial diagnosis last month of an Achilles injury after reviewing video and seeing Durant ice his leg down near the Achilles. After reviewing video of Monday’s incident, he said it appears Durant’s calf muscle was so strong it overpowered his Achilles, which he says can be seen rippling in his lower leg in this replay.” https://www.sportingnews.com/us/nba/news/kevin-durants-original-injury-involved-achilles-sports-doctor-speculates/1pvd1agonr8jj1klkvppwc54wu

Calf muscles of skinny basketball players don’t blow out tough bio – materials like tendons. The maximum operating stress strain of tendons and ligaments must be below the failure stress strain limits otherwise animals could not run fast, jump high nor humans perform in power sports without chronic tendon blow outs. Compare the photo below (figure 6) to the instant of Achilles failure in figures 1 – 2.

In figure 1 – 2, an optimum muscle tendon compliance is lacking. Compliance is “the ability of a object to yield elastically when a force is applied” Merriam Webster. The calf muscles should stiffen and the Achilles tendon should stretch creating a spring mechanism to generate the power of running and jumping: the calf muscles function as  tensioners; the tendons the springs. This spring mechanism functions to produce power far exceeding what muscle contraction alone could achieve as well as to amortize the forces on the body. In the incident depicted in figures 1 – 2, the muscle – Achilles complex failed to function like a compliant spring mechanism; the tendon shattered like glass.


Figure 6. The weightlifter lifting more than 260% of body weight illustrates compliance of the muscle tendon spring mechanism of foot and ankle: calf muscles stiffen, tendon stretches amortizing the weight of the body and barbell. Subsequently, the spring (Achilles tendon) can recoil with more energy released than can be realized from mere muscle contraction. Charniga photo. 

It is not uncommon for an athlete to suffer another catastrophic injury upon returning to play; in many cases, requiring a rehabilitation of up to one year. For instance in the sixth game of his return from Achilles rupture, Kobe Bryant suffered a tibial plateau fracture; an injury doctors typically see with automobile accidents. 

Demarcus Cousins (Golden State Warriors) suffered an Achilles rupture at age 27 in the 2017 – 2018 season. Upon his return to play the following season, Cousins went down in game 2 of Golden State’s opening round playoff with a quadriceps tear. In the vernacular of the NBA a non – contact injury such as this is called a “flat tire”, i.e., hitting the floor with an injury, ‘untouched’.

Is it flippancy to point out  the obvious? Such a thing happens often enough they even have a name for it!

A Connection Between a Predisposition for ‘Flat Tires’ and the Three Point Play?

“The stand still  three point shot is a shot that everyone on this team has to be able to make”. Mike Krzyzewski, 2018

The dimensions of the basketball court are fixed; the same for everyone. The height of the rim is 10 feet (3.048 m); the court 50 feet (15.24 m) wide and 94 feet (28.651 m) in length. The ball is 9 inches (.2286 m) in diameter and weighs less than 1 kg. Consequently, one need not resort to algorithms to establish taller, faster athletes with long arms and big hands have the advantage.

Their arms are longer and they have a shorter distance to the goal; the height of which remains fixed. Furthermore, with long wing spans they are able to effectively cover more area, relatively speaking, on defense within the fixed dimensions of the court; especially its width.

Long a staple of collegiate basketball, the zone defense was banned by NBA. Consequently, possessed of extraordinary skills, super stars such as Michael Jordan were able to run roughshod over the allowable man to man defenses.


“In 2001, the NBA decided to scrap the “Illegal Defense” rule and allow teams to play zone. This was met with backlash from the players. Specifically, the star players. Michael Jordan stated that he likely wouldn’t have had the career he did if zone defenses were still allowed. Allen Iverson thought that the NBA game was more fun than the college game, because the college game had allowed zone defense before the NBA decided to allow teams to implement it.” Russell, 2017

With the zone defense now legal, the larger more gifted players of the NBA are able to effectively cover the area closer to the goal; forcing the offense to either attempt to penetrate the zone or shoot from the outside, where the defense is less aggressive; as the chances of sinking a basket recede as the distance from the goal increases.

Shooting from behind the three point line (at 23’9″ or 7.3 M;) is safer, injury wise. The likelihood of physical contact with a defensive player is lower. And, as a consequence, less likelihood of the offensive player will have to resort to rapidly bending and/or cutting to maneuver around defenders. Rapid maneuvering around a defender such as cutting; which means flexing the lower extremities; especially the inside leg of the leaning athlete. These are actions where the risk of a ‘flat tire’ rises (see figures 1 – 5; 7).

To this point, the three point shot from the baseline is more popular if for no other reason than it is only 22′ (6.70 m); a safer distance from the defense; yet closer to the basket. 

Basketball players are proportionally taller. They have a relatively high center of mass compared to other athletes. Bending with larger knee angles places less stress on joints; moments on the lower extremities are smaller; a common feature of cursorial locomotion (Alexander, 1987). Cutting and or otherwise evading coverage means larger bending in lower extremities, larger moments on joints. These movements tend to be hazardous to those athletes who are compliance compromised.

Figure 7. Super elite NBA player cuts around defender driving to the basket inside the key. The stress on the inside leg with knee flexing more than normal is significantly greater because the athlete has to accelerate and overcome the ‘toppling moment’ or centripetal forces of turning.

Although it should go without saying, one is more likely to suffer an injury driving to the basket or otherwise attempting to penetrate a zone defense because of a higher likelihood of physical contact. 

However, it is at least equally hazardous for today’s players to maneuver; they tend to be less compliant; especially so in the lower extremities. In many respects this situation is a creation of and a continuity, exacerbated by the above list of professionals involved in training and/or medicating athletes.

Consequently, the three point play; very much in vogue in the NBA and even the collegiate ranks,  yields more points if successful. But more to the point,  it is safer. The shot does not require quick maneuvering, especially cutting and bending the lower extremities beyond a partial 1/4 bend to jump. The likelihood is much lower, a player opting for a quick jump shot from beyond the three point line will get a ‘flat tire’.

Consequences of dis- functional training

“Prematurely aging the younger athlete” (Charniga, 2016)

Considerable detailed analysis has been devoted to establishing a connection between chronic administration of irrational conditioning methods; the negative influence of athletic trainers, doctors, physical therapists and a host of aberrants, such as strongman, devotees of exercise emporiums and so forth on the excessive lower extremity injury rates in dynamic sports (Charniga, A., www.sportivnypress.com). 

Not surprising basketball is not immune to these influences; if anything; the NBA for instance, with fewer players, extremely high pay checks and billionaire owners are if anything; more gullible, more susceptible to charlatans, snake oil salesmen and the like. In the midst of this incongruousness, the billionaire owners of the NBA and NFL franchises are probably the players most clueless.  

“… we know how smart we can be”. M. Cuban, 2019

A sports writer’s (Windhorst, 2018) recent expose is another case in point. According to the author, LeBron James (LBJ) spends more than $1,000,000.00 annually on personal trainers and such, to devise conditioning exercises and programs to which he credits the  longevity of his carrier in the NBA. Indeed, a good deal of credit is afforded all this hard work with his personal trainer; an ex navy seal; for his ability to play in all 82 games of the 2017 – 2018 season.

There is a plethora of videos of Messr James (LBJ) exercising with his personal trainer; and, with training NBA partners such as Kevin Durant (depicted figures 1 – 2). A casual viewing of LBJ shows him performing such ‘sports specific’ exercises as half squats with a barbell to a bench (shins vertical), half squats with bands (see figure 3); boxing; dancing; various twisting movements with bands; kneeling on an exercise ball with dumbbells; exercises wearing a gas mask; dead lifts with sumo stance (ankles still almost vertical); swinging two ropes up an down; pushups on exercise ball; more kneeling on exercise ball; walking carrying a tractor size tire; bodybuilding exercises for the upper extremities. 

In most of those videos feature LBJ, working out shirtless; looking like some egocentric teenager; amidst a ritual narcissism. These videos pedestalize ignorance;  are misleading and banal on many levels. Why? Because young impressionable athletes view this stuff with an uncritical eye. And, will copy the dis – functional training methods assuming they are worthwhile; because an elite athlete is doing them.

LBJ pulled a groin reaching to pick up a dropped ball (figures 3 – 4); missing five weeks of the season. He was only able to play in 55 games of the 2018 – 2019 season. Of his $35,000,000.00 annual salary, 1/3 went to injured reserve time. Shouldn’t picking up a dropped ball without fear of injury be implied; certainly, at the very least, part of a $35,000,000.00 man’s job description?

It is highly unlikely the uninformed, the easily impressionable will make the connection between the goofy, made up exercises in the videos and the inability of LBJ to even pick up a dropped ball without sustaining an injury.

Further confirmation of the unsuitability of the dis – functional training for highly skilled athletes engaged in dynamic sports like LBJ; is the fact one of his training partners; apparently so brittle he took a step and shattered his Achilles like a rock hitting a plate glass window (figures 1 – 2). Both injuries impacted the entire outcome of the 2018 -2019 NBA season.

At the present time, uninformed and misguided sports writers such as Windhorst, 2018, endeavor  to credit an ex – Navy Seal, dis – functional training exercises and the like, for LBJ’s longevity in the NBA as well as his playing in all 82 games in 2017 – 2018. The same people and training methods need to be given equal credit for the 2018 – 2019 season which LBJ appeared in only 55 of 82 games.

Figure 7. Unable to pick up a dropped ball (figures 3 -4) without getting injured, LBJ missed 27 games of the 2018 – 2019 season. Shown here walking with a huge tire and balancing on an exercise ball with dumbbells to prepare for the  complex dynamics of basketball.

The people least likely to know, such as sports writers (Windhorst, 2018) speculate a personal trainer is the key to LBJ’s longevity in the NBA. However, both LBJ and Kobe Bryant  for example, skipped college, going straight to the NBA, i.e., avoiding four or more years of the joint stiffening powerlifting/bodybuilding training; dis – functional training exercises; athletic trainers taping ankles and feet, misguided medicaments, and the like; administered in the collegiate ranks. Both players entered the NBA in the full bloom of youthful elasticity; avoiding the suppleness aging rigors of the college ranks (see figure 5). 

“I don’t think people realize how common back problems are, among NBA athletes,…” Holmes, 2019

Golden State Warriors stars Kevin Durant (ruptured Achilles) and Klay Thompson (torn ACL) suffered serious injuries in the NBA finals. A third GSW starter DeMarcus Cousins went down early in the playoffs with a quadriceps tear. Three serious injuries. They’ll be sidelined for much, if not all, of next season. Coincidence? All dropped essentially untouched. Three ‘flat tires’!

Comprehensive injury data in American sports, especially the circumstances and accurate diagnosis of injury, high school to professional ranks inclusive, is not readily available; and, at that, at best convex. However, the quantity of medicaments routinely dispensed just at the university level is astonishing.

Ketorlac (trade name Toradol) is a very powerful anti-inflamatory drug which is available in tablet form, can be injected or administered by IV. A expose by a TV station in Colorado obtained the following from a request through the freedom of information act:

“Of the schools admitting use of the pain killer Toradol {Ketorolac} between 2012 – 2014 the U of Oklahoma administered 4,086 doses; across every varsity sport; including rowing. Football lead all sports with 1,490 doses over the three year period or an average of about 500 doses per season; approximately an average of 5 doses per player on a team with 100 – 116 athletes.” https://www.youtube.com/watch?v=t2yBe0HwNhM

The obvious question: why so many young athletes in so much pain?


/ Charniga, A., “Reverse Engineering Injury Mechanism”, parts 1 – 4; www.sportivnypress.com

/ Charniga, A., “Why Safe is Unsafe”, www.sportivnypress.com 2019

/J Athl Training. 2007 Apr – June: 42(2):194 – 201; PMCID: PMC -1941286; PMID:17710167

/ Kerr, Y. et al. “College Sports Related Injuries – United States, 2009 – 2010 Through 2013 – 14 Academic Years, 12/11/2015/64(48):1330-6; https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a2.htm

/ Windhorst, B., “How Lebron James fixed his back and is on track to play all 82 games”, https://www.espn.com/nba/story/_/id/22778062/how-lebron-james-fixed-back-track-play-all-82-games-nba

/ https://www.cbssports.com/nba/news/nba-draft-prospect-charles-matthews-tears-acl-during-celtics-workout-no-timetable-set-for-his-return

/ Hartman, H., et al, “Analysis of the Load on the Knee Joint and Vertebral Column with Changes in Squatting Depth and Weight Load”, Sports Med, (2013) 43:993-1008 DOI 10.1007/s40279-013-0073-6

/ Russell, J., “How Zone Defense Changed the NBA”, https://aminoapps.com/c/hoops/page/blog/how-zone-defense-changed-the-nba/o3aF_duBMl1KGM2baPd3L8W3GNnxoVW

/ Alexander, R. McN., Elastic mechanisms in animal movement, Cambridge university press, 1988.

/ Biewener, A., Animal Locomotion, Oxford University Press, 2007

/ Cerynik, D., https://www.reuters.com/article/us-nba-retire-achilles-tear/nba-players-often-retire-after-achilles-tear-idUSBRE95Q0ZC20130627

/ Holmes, B., “The threat of Youth Basketball”,https://www.espn.com/nba/story/_/id/27125793/these-kids-ticking-bombs-threat-youth-basketball 

/ https://www.youtube.com/watch?v=t2yBe0HwNhM

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