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LeBron James’ cramps underscore the importance of advancing injury science

Jun 5, 2014; San Antonio, TX, USA; Miami Heat forward LeBron James (6) kneels on the bench after being injured during the fourth quarter against the San Antonio Spurs in game one of the 2014 NBA Finals at AT&T Center. Mandatory Credit: Soobum Im-USA TODAY Sports

It is undoubtedly an indelible image: LeBron James crouched on the sideline, head buried in agonizing pain as his own body betrayed him, unable to force the flesh to cooperate and allow his reentry into the fourth quarter. The rest, as they say, was history. San Antonio closed the game on a 31-9 run, and the Spurs defeated the Miami Heat (and a million temperature-related headline puns) in Game 1 of the 2014 NBA Finals.

On a spectrum from understanding acceptance to complete derision, LeBron James’ cramps elicited seemingly every perspective imaginable. And that trend seems in no particular hurry to slow itself; be you brave enough, dear reader, open Twitter and watch the vitriol fly. Yet when the frothing rage does subside, there will be a substantive conversation to be had here. James’  cramps represent an important talking point, but it’s one that has nothing to do with James himself.

Hell, it has nothing to do with these Finals, really. There are global questions of basketball and physiology at play here, and there’s a glimpse at the future to be had.

The truth is that we don’t yet know what exactly we know about cramping. That’s an odd thought, since so many of us are personally familiar with the agonies of an acute muscle cramp brought on by exertion. And if you’ve had cramps before, you understand that the solution is hydration and electrolytes — things that end in -ium, like sodium, potassium and barium.*

*Okay, maybe not every chemical element that ends in -ium. But it’s a good rule of thumb.

And the solution, in turn, becomes self-evident to everyone watching at home. Drink more fluids. Eat a banana. Pop a salt tablet. Eventually, the body will recover, and you’ll be able to get back out there. While that’s all well and good, it misunderstands the nature of cramping, and LeBron’s cramps in particular. After all, we’re familiar with LeBron’s tendency to cramp. It’s happened before, to the point that cramps have become his Kryptonite, as ESPN’s Brian Windhorst wrote. And it will happen again.

But why? Why does LeBron cramp so often? Chris Bosh pointed out last night that it may have something to do with James’ muscle density, which seems a solid point. Doesn’t it seem just as likely, however, that the Heat and LeBron would have gone out of their way by now to ensure James was on a proper hydration routine? Shouldn’t a team as smart as Miami have contingencies in place for something like this?

In all probability, they’ve done a significant amount of legwork to ensure that LeBron is ready to go in situations like this. Still, they’ve failed. Why?

There may well be larger issues at play here, and they butt up against the new frontiers of injury prevention and sports medicine, and James’ problems with cramping might extend far beyond his fluid intake.

A 2011 study in the British Journal of Sports Medicine conducted among ultra-marathoners produced interesting results. There was no relation between exercise-associated muscle cramping (EAMC) and “age, body mass index, sex, recent and past personal best running times, pre-race muscle pain and pre-race training (duration and frequency).” Further, and more importantly for LeBron and the Heat, “significant risk factors for EAMC were a past history of EAMC […] and a faster running time (min) for the first 28 km split time of the race.”

Though the applicability of the faster running time over 28 kilometers is questionable, the former risk factor — that a past history of EAMC tends to indicate a likelihood of future EAMC events — is clearly at play with LeBron. There’s not much predictive value there, however, as cause and effect are virtually indiscernible. A person who has been prone to EAMC in the past might be prone to cramps in the future because of an outside factor, right?

True to some extent, assuredly, but a 2013 study published in the Clinical Journal of Sports Medicine raises another red flag for James. It found a possible link between a genetic variant (COL5A1) and a risk for exercise-associated muscle cramping. That is to say that chronic cramping may very well be a genetic condition, and LeBron’s body may very well be sabotaging him on a level that he and the team don’t fully understand.

Broadly, this is not a new thought in the world of sports medicine. The importance of genetic testing — and its potential downsides — has been a topic of conversation for at least the past several years, and it’s almost certainly been a pipe dream of trainers stretching back for decades. What’s exciting at this point in space and time, however, is that we’re getting closer and closer to answering these questions. Companies like Catapult Sports are measuring every player’s every movement (outside of games, at least, though that may change in the near future), quantifying the stresses and damage that players do to their body in practice and training environments. More and more teams are investing in sleep doctors to ensure that their players are well-rested, and effectively so. Every day brings another breakthrough in understanding the physiology of the athlete, and every day brings another team into the fold, willing to try something new in the pursuit of better performance and healthier players.*

*Probably in that order.

Yet LeBron James’ cramps last night drove home a point that cannot be overstated. Each of these players is an individual, a complex, complicated creature with a million different moving parts acting in symphonic conjunction to defy the laws of physics in ways that leave cynics slack-jawed and believers enraptured. What might impact one may not affect the other nine on the floor.

So maybe Michael Jordan wouldn’t have cramped up in Game 1. Perhaps Magic and Bird are bigger men than LeBron for their ability to play in the Boston Garden. But if you’re not considering all of the possibilities when it comes to LeBron James’ cramps, it’s not your fault. You’re just in the same place as science.

For now.

UPDATE: LeBron says he’s been tested for cramping issues over the course of his career, and that the tests have come back negative. It’s a brief glimpse behind the curtain at the lengths to which NBA teams are already going to ensure the health of their players, but it also raises questions about what kind of tests LeBron means. Genetic? Musculature predisposition? Electrolyte imbalances? It’s a fascinating topic, and the more we learn, the more we realize we still have to discover.

Andrew Lynch

When God Shammgod created the basketball universe, Andrew Lynch was there. His belief in the superiority of advanced statistics and the eventual triumph of expected value-based analytics stems from the fact that he’s roughly as old as the concept of counting. With that said, he still loves the beauty of basketball played at the highest level — it reminds him of the splendor of the first Olympics — and the stories that spring forth from the games, since he once beat Homer in a game of rock-paper-scissors over a cup of hemlock. Dude’s old.