Playing through pain can make things worse

Tape holds up the two snapshots, much like those that dot the locker of a high school sophomore.

Except this locker has no front, and it’s full of basketball gear that hasn’t been touched in months. This is Brandon Roy’s cubby, at the far end of the Timberwolves’ locker room, and those are picture of his two children, Brandon Jr., 5, and Mariah, 4. They’re the little boy and little girl who’ve watched, however unknowingly, as their father has morphed from NBA star into forced retirement and now into his current incarnation: stuck in limbo.

I will begin this by saying one thing: I do not know the answer. Nor does anyone else, really, not definitively. I don’t know the answer to what Roy is going through, to the question of whether he actually believed he was healthy, or more important whether he actually felt healthy.

What I do know is that I’m the daughter of a surgeon and a skeptic and that I was taught to question things, hence this questioning. I know that the treatment Roy had on his knees over the summer, called Regenokine, is a variation of platelet-rich plasma therapy (PRP), a procedure that’s grown in popularity in the NBA since Kobe Bryant went to Germany to undergo it in July 2011. I know that biologic medicine, in which a patient’s tissues are extracted, manipulated and then re-injected into the body, is a growing phenomenon in sports medicine. I know how it works, at least rudimentarily, how the patient’s blood is spun to isolate its component parts, how the platelet-rich plasma is then injected into the site of the pain in order to dull it and speed healing. (There are variants, sure, procedures that heat the blood, like Regenokine or further manipulate it, but those are the basics.)

I know that doctors who perform the procedure swear by it. I know that plenty of traditional orthopedic surgeons and physicians are skeptical.

I know that it is currently impossible to regrow cartilage.

I know that more and more high-profile NBA players have undergone some variation of the procedure: Bryant, Roy, Dwight Howard, Deron Williams, to name a few.

What I don’t know — and no one knows — is how this and other experimental pain relief procedures are going to change the way things work in the NBA.

This is not something that can be just glanced over or packaged neatly. There is no example case, and it seems more and more that there’s not even a model for how and when these treatments are implemented. If Bryant is the seed from which biologic medicine in the NBA has sprung, then things have taken quite a turn from his initial approach.

Bryant doesn’t speak publicly about the Regenokine treatments he received in Germany in June and October of 2011, but here are the facts: His knees were in pain, but he was still able to play basketball. Most likely, he was looking for improvement and to stave off further decline, and so in the offseason he received the treatments, hoping they’d improve his play and health for the 2011-12 season, which didn’t start until Christmas. Bryant had another great year in 2012, months after he received the treatments, and that was that.

It sounds like a pretty reasonable approach for a procedure that has few scientific studies to prove or disprove it. Really, athletes are the closest thing to a lab-controlled experiment for PRP and its variants, and it’s important to remember that these procedures are still on the very fringe of medicine. Sure, flying across the Atlantic to receive the injections sounds a bit extreme, but Bryant was as responsible as anyone could have wanted him to be in his decision, He had to have been certain there wouldn’t be detrimental effects — there really haven’t been documented cases of such, just some exhibiting a lack of results or fewer results than one might have wanted — and he went in the offseason, giving himself time to heal. He also likely knew that his career didn’t hinge on a successful treatment.

There’s no scientific or definitive proof that Bryant’s way was the right way, but looking at both his career and the directions that biologic medicine has taken in the NBA since then, you’d have to think it looks pretty damn good.

Roy is an example of one direction to with with PRP: Forced into retirement, knees devoid of cartilage, he decided to undergo Regenokine as he mounted his comeback. The procedure relieved the pain for a bit, he says, but what is so easily forgotten is that it does not regrow cartilage, and that was Roy’s biggest problem. When he was working out solo, or even practicing with the Timberwolves, it was fine, but one bump, innocuous to anyone else, and the jig was up. Roy hasn’t played since Nov. 5, hasn’t really practiced, either, and the treatments or procedures — or whatever the word du jour might be — Minnesota claims he’s undergoing either aren’t working or don’t exist.

The other direction is even more interesting: in-season PRP. The Lakers’ Howard underwent it in early February, flying back to Los Angeles in the middle of a road trip and then rejoining the Lakers a few days later. He missed three games over the course of five days and admitted to feeling stiff afterward, and his approach drew criticism from Bryant, who publicly questioned his own habit of playing through shoulder injuries in the past. In an interview with the LA Daily News, Bryant called the fact that he’d played through such injuries “crazy,” stressing that no one should play through an injury that could affect his career. Ultimately, though, the facts were there: PRP might help with the pain, but it wasn’t going to fix the problem.

“Will the shot take all the pain away?” Lakers coach Mike D’Antoni asked hypothetically about Howard’s procedure on Feb. 1. “That I don’t know. But you can play right away (after it).”

The Nets’ Williams also underwent PRP on Feb. 11, following a similar pattern as the Lakers’ big man. He missed that night’s game against Indiana and another two nights later against Denver in order to get the injections in his ankles, and then he returned to the court and hasn’t missed time since. There’s no telling whether PRP was a long-term or final solution — it likely wasn’t — or whether Williams will miss more time down the line, but it helped, and he’s playing, and that was the goal.

Pain management in the NBA is a tricky — and interesting — subject. There are retired players in spades who blame a reliance on pain management in lieu of actual healing for dooming their careers, but in the moment, these are competitors who struggle with missing even a handful of games. When Timberwolves forward Andrei Kirilenko missed five games before the All-Star break with a fairly routine quad strain, he admitted to being fed up with watching the team on TV, with his kids asking why he wasn’t playing — with really anything related to the fact that he was sidelined. That, after barely more than two weeks. Multiply that by 10, and that’s what guys like Howard, Williams and Bryant feel, when they have nagging injuries they know might flare up at any time. Multiply it by a hundred, and you’ve got Roy and even Greg Oden, another former Trail Blazer attempting to mount a comeback. (Although there’s been no word of any forays into biologics for Oden, I wouldn’t be surprised if we hear something to that effect either before or during said comeback.)

These men want to play, and they want to play badly enough that they’ve latched onto something. Kobe did it, so we can too, no matter that he did it in the offseason, on a functional joint, with time to rest. That’s not to say that one way is the right way, but if Roy is an example and we’ve learned anything in the past few months, especially in Minnesota, it’s that there might be a wrong way.

Last summer, when Roy was about to sign with the Timberwolves, I talked with several practitioners of PRP, along with a few more traditional orthopedic surgeons. The physicians who administer PRP were as excited and convincing as you’d expect, not quite snake-oil salesmen but definitely conscious that what they’re doing is still experimental, still in flux. The orthopedic surgeons were more skeptical — again, no surprise — but not quite dismissive. Bradley Nelson, a physician at the University of Minnesota School of Medicine, discussed the pain relief he’s seen and heard about from patients with arthritic knees who’ve had PRP injections. He acknowledged that component, but he couched the thing in one massive caveat: “It does not grow new cartilage,” he said. “It does not reverse the course of cartilage damage. It just helps with the pain associated with arthritis.”

And so maybe in-season treatments are okay. Or maybe they’re masking pain and leading to worse consequences. If the player was going to play through the injury anyway, as D’Antoni indicated Howard would have, then it’s hard to see how PRP would hurt — but at the same time, you have to question the rationale underlying it all, that a torn labrum isn’t enough to sit a player out long-term. But that’s a bigger issue, one that has just a tiny bit to do with biologics and more to do with a pervasive culture.

But back to those pictures, the ones above Roy’s locker. Roy doesn’t see them too much, or at least not as much as he would if he were suiting up for games. He’s in the locker room sometimes, still, after whatever minimal workouts he can muster, and now his children must watch as his contract is brought up in trade talks, as a buyout is discussed, as basketball has reached its silent conclusion that biologics could not salvage his career. The question now will be whether the whole ordeal has had any negative impact on his future.

There’s no test case of five, 10 years out, of what this year of pounding and those few months without pain will do to Roy’s knees down the line. He’s confident he hasn’t done any further damage, he said in late January, but that’s as much one man’s hope as it is any educated guess.

It’ll take time to tell, time in which more players will undergo the procedures and — one has to hope — more about their efficacy will be known. It’ll take Roy’s children growing up a bit, hoping their dad’s knees are still strong enough to run and play with them, before there are the studies and the test cases and anything even approaching a consensus or proof.

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