Plain English with Derek Thompson - The Mysterious Rise of Major Injuries in Professional Sports

Episode Date: July 9, 2025

Sign up for the Derek Thompson newsletter. In Game 7 of this year's NBA Finals, Indiana Pacers guard Tyrese Haliburton tore his Achilles in the first quarter while attempting to drive to the basket on an injured calf. It was the third major Achilles injury of the 2025 NBA playoffs. Curiously, Achilles tears are typically an older-dude injury, as they're most common in middle-aged men, according to a 2018 study published in the Journal of Biomechanics. So the sudden clustering of this injury among star athletes in their prime has inspired a lot of head-scratching among NBA fans and even the league itself. “We had already convened a panel of experts before Tyrese’s most recent Achilles rupture,” NBA commissioner Adam Silver said. When you zoom out from basketball and consider the broader landscape of sports, the injury surge seems quite real. In baseball, we’ve seen a huge increase in the so-called "Tommy John surgery," which repairs a torn UCL in a pitcher’s elbow. In soccer, ACL injuries have been rising, particularly in women's soccer. And that's before we get to the huge amount of media attention that’s been paid to concussions in football. What's going on here? Vern Gambetta, a conditioning coach, trainer, and adviser to professional soccer, baseball, basketball, and Olympics teams, explains why major injuries might be surging across sports—and what it tells us about the risks of pushing the human body to its physical limit. If you have questions, observations, or ideas for future episodes, email us at [e-mail]. Host: Derek Thompson Guest: Vern Gambetta Producer: Devon Baroldi Learn more about your ad choices. Visit podcastchoices.com/adchoices

When you hear the word Seattle Supersonics, what comes to mind? Maybe it's Sean Kemp, The Rain Man, or Gary Payton, the glove, or maybe an image of a tall and skinny 19-year-old rookie, Kevin Duran. For fans in Seattle, it's something else. It's tragedy. It's theft. An iconic team with an incredible fan base that packed its bags and shipped off for Oklahoma City. From Spotify and the Ringer, I'm Jordan Ritter-Con.

And in my podcast, Sonic Boom, I talk to players, politicians, owners, and fans about how Seattle lost the Sonics. You can listen to it on the Book of Basketball feed, on Spotify or wherever you get your podcast. Before today's show, a casual reminder that my full-time writing has moved to Substack. You can sign up for the Derek Thompson newsletter by clicking on the link in today's show notes. Today, the surge of injuries in professional sports. In Game 7 of the NBA Finals this year, Indiana Pacers' guard, Tyrese Halliburton, tore his Achilles in the first quarter,

while attempting to drive to the basket on an injured calf. This was the third major Achilles injury of the NBA playoffs. Milwaukee Bucksguard, Damian Lillard, tore his left Achilles in the first round against the same Indiana Pacers, and Boston Celtics forward, Jason Tatum, ruptured his right Achilles tendon in the second round game against the New York Knicks. Coincidentally, all three players wear the number zero. What might not be a coincidence, however, is the surge of Achilles' injury suffered by other basketball players recently, including the young guard, DeJante Murray. Curiously, Achilles' tears are typically an older guy injury.

They're most common in middle-aged men, according to a 2018 study published in the Journal of Biomechanics. So the sudden clustering of this injury among star athletes in their athletic prime has inspired a lot of head scratching among NBA fans and even, the league itself. Quote, we had already convened a panel of experts before Tyrese's most recent Achilles rupture, end quote. NBA commissioner Adam Silver recently said. Now, it's always good when evaluating something that seems like a trend to ask, wait, is this actually a trend? Or did I just grab three data points that I happen to remember from the last two months and just sort of mush it together to create the illusion of a trend? Well, when you zoom out from basketball, and consider the broader landscape of sports.

The injury surge among professional athletes seems quite real. In baseball, for example, we've seen a huge increase in so-called Tommy John surgeries, which repair a torn UCL in a pitcher's elbow. These surgeries and injuries used to be quite rare. Today, however, more than one-third of active pitchers have blown out their elbows already and have had the procedure. Many of these surgeries aren't just happening in the major leagues. they're happening to pitchers in high school and college.

Meanwhile, in soccer, ACL injuries have been rising, particularly in women's soccer. And of course, there's the huge amount of media attention that's been paid in the last 10, 20 years to concussions in football. Now, sports really isn't my, like, professional expertise. It's really what I do when I'm not doing anything professionally, is listening to Ringer podcasts about sports.

And biomechanics really, really isn't my expertise. So to know if there was a story here, before even trying to investigate why it was happening, I called around to several trainers and biomechanics researchers. I wanted to find somebody who wasn't a narrow specialist in one sport or injury type, but rather someone whose career had spanned several decades in sports. Finally, I got a hold of Vern Gambetta, a conditioning coach, trainer, and advisor to MLS soccer teams, major league baseball teams, and Olympic teams in several sports. I told Vern I had three questions.

Number one, was my impression that sports injuries were rising across sports just my own pathetic recency bias? Or does it reflect an actual trend? Number two, if it is real, why is it happening? And what can we do about it? And maybe most interestingly, number three, how do we think about the fact that injuries are rising at the same time that elite athletes, like LeBron James, Tom Brady, and Novak Joakovich are more

durably excellent than ever. What do we make of an era of sports when many players are more injured than ever, but some players are more durable than ever. I'm Derek Thompson. This is plain English.

Verni Gambetta, welcome with the show. Thank you. It's good to be on. I want to structure this show, I think a bit like a mystery, like a murder investigation. But the first thing you have to do in a murder investigation is to prove that the body is actually dead. So I want to make sure that there's a mystery to solve here.

It certainly seems to me, as a non-expert, as just a casual sports fan, that Achilles injuries are up in basketball, arm injuries are up, basically normal, extremely common in baseball. Leg injuries have been more common in other sports. You're the expert here, though. Is my impression correct?

Is there a surge in injuries across sports that has a set of common variables and common explanations. Well, I'll be, I'll be Sherlock Holmes and you'd be, you'd be Watson. And so if we look, if we start, hmm, you know, I scratch my chin and I go like, what's going on here? And I pick up the sports page today and look at, you know, the American sports page. And I look at baseball. I don't know if this, we're just hypothetically now, right?

And last night there was two pitchers that had to come out of games, one with shoulder, one with elbow. There's the Copa America going on in soccer right now. Three people went out with hamstring pulls. Somebody in the WNBA tore in ACL. And so in investigating with my, what do you call it, magnifying glass and looking at the data, the data supports our ear hunch that, yes, the body is dead and absolutely injuries have gone up or remain steady at a fairly high level and a common there's common threads though that are interesting because I've had the opportunity to work with in my career with 22 sports and of you know and and and still consult with

some of the, with individuals working in the high level pro sports here in the U.S. and overseas, especially Australian in England, there's definite commonalities. And I think it's, you know, they need Sherlock because they're not seeing the forest for the trees, is what I'm saying. And what you have driving this now is what I call the medical model. So, you know, we were, I was talking with a, with a friend of mine, Bill Noles, who's our probably the best rehab specialists in the world did people like Tiger Woods, you know, you name it. And the surgeons are saying, don't do this, don't do that, don't, you know, and the surgery heals everything. Surgery doesn't heal. That's the last resort. So you have a

medical model that drives it. When the medical model says, don't do that, be careful, you know, and the performance model says, we've got to go ahead. We've got to use good principles, good training principles, what we know about the biomechanics of the body, what we know about the biomechanics of the sport, and move forward and prepare for the game we have to play. But the medical model says, now, wait a minute, we've got to have some more days off, we're training too hard, you know, don't do this, don't do this, don't do that. That's so interesting. I want to get back to that point in just a second, this idea that medical progress, better surgeries, improved reconstruction techniques has changed the way athletes and

teams think about injury. We're going to put a pin in that because it's a thread. We're definitely going to pick up later. Before we get to specific sports, I want to ask you about a trend that I think you'll agree spans across sports, and that is specialization, early specialization. My friend David Epstein, the author of the great book, Range, has written about how today's student athletes are pushed to specialize. in sports from a very early age. So rather than this old model of the talented athlete playing football in the fall and then basketball in the winter and then tennis or baseball in the spring, which is giving the body

this kind of automatic cross-training experience, now there's a lot of pressure for talented young athletes to pick one sport and fill their entire lives with it. Do you think this early specialization phenomenon is an important contribution? to the rise of injuries that we're seeing across sports. No question and worldwide. What we've done is we try to identify them early, and I'm talking seven, eight years old now. You know, some of the tennis academies and the soccer academies

are literally trying to identify down to that level. And then they become very, very narrow in their range of movements and skills. So they're very focused on that movement. And what this does is what the old model of playing multiple sports, some people, the experts call it sampling, you know, you sample different sports. You get a robustness. You get an adaptability where you become familiar with a lot of different movements, a lot of different positions instead of just repetitively repeating the skills of your sport.

I call it just a lack of movement literacy. Okay. So there's common movements, fundamental movements, that precedes specific sports movements, reaching, bending, falling, rolling, lunging, squatting, all of those kinds of things. Where now you've got seven, eight, nine-year-olds just repeating the movement of the sport. And then they get, and now you use basketball as an example.

Now you're adding a one-on-one trainer to a 9, 10, 11-year-old where they're really working on just specific movements, a year-step, different things like that. And they're not preparing them for the stress of the actual sport. That would be an overriding theme that I would have. And that's the result of specialization. And there's a lot of reasons for that. The parents, you know, this 10,000-hour myth, which is a myth, you know, and David does a good job of talking about that in his book. And now they're offering NIL contracts to 10 and 11-year-olds.

So, you know, it's like Jerry McGuire follow the money, you know, to a certain extent. Yeah, so. I'm glad you brought commerce into this because I think that when you pull apart what we're calling early specialization, there's a lot of things happening at once. You're replacing cross-training. You're doing the same motions over and over again. You mentioned the fact that there's an economic incentive here. If you are the parents of a 10-year-old who demonstrates extraordinary aptitude, let's say a kick-out serve, well, then you might feel this incentive to train that 10-11-year-old in 10-year-old. to the exclusion of all sorts of other sports that in the long run might give them the kind of well-rounded

biomechanics that lead to a longer career. In fact, David's book begins, I think, with Roger Federer, being the opposite of early specialization, being someone who played a ton of sports before he became arguably the goat of his sport. I want to throw one more piece into the mix here, which is, I don't know exactly how to put this, but it's something like the group psychology of early specialization. I feel like if you're in the 1970s, let's say, and you're a 17-year-old, and you're pitching in the mid-80s, I guess that's pretty good, you might still have a normal life. You play other sports. But now there's this pressure that's like, if I move on to other sports in the fall and the winter, if I don't push myself to the max, well, right now I'm exactly as good

as my friend Johnny at pitching fastballs. But if he works his butt off for the next nine months, just throwing over and over again, he'll raise his fastball from 84 to 80s. He'll raise his fastball from 84 to 86, and my fastball will decline from 84 to 82. But I'm falling behind what's become a norm of specialization, which has early returns and long-term risks. Can you talk a little bit about how this psychology, this sort of like this culture of specialization and perfectionism, might create this dynamic of, it yields wonderful returns in the short run, but it creates these long-term risks to injury and burnout in the long run. Yeah, absolutely. The social cultural aspect of it is huge.

And, you know, as my daughter was an excellent soccer player and an excellent sprinter, and my background is track and field. And most of the parents had no idea at the time that I was working in the MLS. And I'd sit and just sit there and listen. And they're 12 years old and they're talking about scholarships. And Kristen was really fast. And they said, well, what schools is she looking at? And I go, well, I don't know, you know, Sarasota High School, I guess, or something like, you know.

And they're already trying to figure out, well, what camp to go to so I can give Susie Q more exposure so she can get a scholarship, you know, or something like that. And now that's multiplied because it's hiring personal skill trainers and then a personal trainer on top of that to take care of the strength, to speed. They don't talk to each other. and then they go play for their club team, their high school team. And it's just, it's an endless web of repetitions of movements that they're not really prepared to do. So it's, in a sense, it's accumulation of classic overuse. And what a lot of us old guys do is sit around and think, whatever happened to. Think of all the phenoms that, you know, and that have been.

been in a, when Sports Illustrated was a magazine, you know, they'd have in their faces in the crowd, you know, prospects that never, you know, that, that, uh, never panned out, you know, and we're suspects, you know, and, and, and this is what, what happens, you know, a lot. I mean, we, we don't see what the human cost of this is, both in terms of psychological, but the physical cost is a lot of these, I don't want to say burned out. They're worn out. They're freaking just worn out. It seems like a really interesting tradeoff because, and tell me if you think this is wrong,

I'm concerned about the rash of entries. I'm concerned that individuals, especially kids, are pushing their bodies to the physical limit and pushing their bodies over the physical limit. But I think to see the full picture clearly here, we have to acknowledge that this hyper-optimized approach is producing some of the greatest athletic specimens the world has ever seen, right? It's not as if this is, it would be easy, Vern, if this was clearly just bad. What's complicated, what's rich about it, is that we're producing the greatest athletes in the history of the human species at the risk of pushing bodies, especially young bodies,

into a biomechanical place that raises the risk of injury. It's definitely a fair way to look at it, and I call it the roadkill factor. You know, I mean, yeah, we've got some amazing phenoms that have arisen out of these systems, you know. But we don't, you know, we don't take into account the poor young boy or young girl that fell by the wayside, you know, and that. And but it's the thing is, and I, I don't like to call it an industry, but youth sport is a multi-billion dollar industry now. And so the people that are running this have no vested interest in really changing this. It's getting more kids out.

You know, I live five blocks from Golden Gate Park. Right down here, there's, there's at the end of the park, there's turf, soccer fields, four soccer fields between lacrosse and soccer, it's like ants on that field and individual trainers and the little kids, you know, that don't know how to run yet are being taught how to dribble a soccer ball. There's something wrong with that picture, you see. And and, but the people that are standing there collecting $50 a day, a day, an hour, that's cheap 100 150 dollars an hour they're they're not going to you know they're they're they're they're not going to um turn that down you know so we're we somehow and what bothers me is again

we're talking about the problem and the solutions are so myriad i mean i'm an old guy i want to go back to to to my first year's coaching where we had a football season a basketball season a track season, a baseball season. Summer baseball was in the community. Summer basketball was in the community, you know, and that kind of stuff. But it's not going to go back. No, it's not. It's not precisely because an economy has been created out of this. And so it's in no individual's incentive to unwind this equilibrium that is doing some extraordinary things at the cost of some bad things. I want to get really specific here. Let's talk about baseball. You have lots of experience. training pitchers. In the last 20 years, the average velocity of a fastball in the major leagues

has gone from about 88, 89 miles per hour to 95 miles per hour. Pitchers throw harder, period. And their arms blow out more than ever. Elbow surgeries like Tommy John, UCL injuries have also gone up quite a bit in the last 20 years. And what's really interesting to me and why it clicks into the point you're making right now is it a really shocking share of UCL reconstruction surgeries are happening for players under 20 years old. It's not just players in MLB that are having to remake their elbows after they're blown out. It's often these kids who are 17, 18, 19, throwing as hard as they can to get that first contract. Tell me a little bit about what you're seeing in the picture here, what you're seeing in baseball that's leading to the rash

of injuries. Yeah, what they're done is there's a lot of these commercial facilities now. And we can measure everything. So we can measure spin rate, you know, all these different things. And certainly, and shape, they call it shaping your pitches and that kind of stuff. But you take a 14 or 15 year old boy who's not anywhere close to physical maturity, probably hasn't shaved yet or anything like that. And you're putting overweight, underweight balls. You're doing all this very narrow specific training to achieve one thing. They call it V-L-O. Let's get V-L-O. Let's get V-L-O-U-O-U-L-U-U-L-U-U-L-U- What is V-L-O meaning velocity here? My thing is, is look, if you want to be a pitcher, say somebody comes to me and says, I want you, you know, we've got Johnny, he's 14 years old, he loves baseball, that's the key, and he wants to be a pitcher.

And I say, that's great. Let's go out to a field and let's play catch. Let's watch him throw. I want to watch him run. I want to watch him move. Okay. And then let's physically prepare him for the demands of pitching by, first of all, be an athlete first and a pitcher after. Okay. So we're going to work on body awareness. We're going to work on agility.

We're going to work on running speed. Yes, we're going to work on appropriate strength training of the whole kinetic chain. We're not going to focus on the arm and the shoulder. and balance and all of those kinds of things. I would put my reputation on that, that that person that does that versus Jimmy over here that just goes and throws over and underweight balls and pitches to a catcher every day,

that this one has a better chance of getting hurt, the person. This one also has a better chance of being better in the law. long run. That's what we've shown. You know, there's a big thing. The number one pick was, I don't know if to say his name right, by the Pittsburgh Pirates. But, you know, he didn't become a pitcher. He didn't become a pitcher till halfway through his sophomore year, I think, at the Air Force Academy. He was a catcher, and then he became a pitcher, you know, and that. And he does a lot of the, and we did. And we do. I'm a believer. And, in the specialized training when you have a broad member,

be an athlete first. I have a good friend who's a pitching development coordinator for a major league team. He says, I want good movers, and we can make them better pitchers. Yeah, you're referring to Paul Skeens, who I'm reading his Wikipedia page right now. He played three years of varsity baseball as a two-way player. He played catcher, first base, and third base,

in addition to pitching. And it's only in his junior year. year at the U.S. Air Force Academy that he had his breakout season with a 0.67 ERA at the Air Force Academy, which is pretty good. One more point to make on baseball. I want to fold in economics and culture again, because I think it's such a huge part of this. If Major League Baseball teams weren't giving out huge lucrative contracts to people who tour their UCL, then we might have a different situation. It might change training upstream. But instead, it seems to be a lot of It seems to me, and again, you're the expert here, and I'm just a casual fan, but it seems

to me like it's actually very normal for pitchers who earn tens of millions of dollars a year to blow out their arms, maybe every few years, they'll still get these extraordinarily rich contracts, and it's almost as if the contracts contain within them the expectation that the pitcher is going to miss sometimes because their elbow is going to blow up. And so it seems like there's a culture here between the individual athlete, the trainer, and the team itself that essentially says, you should throw as hard as possible all the time because even in the inevitability that you blow out your arm

are still going to pay you that $25 million a year. And so if I'm some kid and I'm, you know, whatever, I got 93 mile an hour fastball when I'm 19 years old, well, I'm going to say, look, everything, the economics, the culture, the level of competition, my trainers, my agent, everyone is telling me, just max out on Velo, max out on revs per minute, that's what I'll be paid handsomely to do, right? There's an entire economy around this incentive.

No question. So there's, well, I call it Next Man Up syndrome. So like the Tampa Bay Rory's a notorious, one of my really good friends that we used to work together with the White Soxas with them for a long time. They're pitching, their pitching development coordinator. He said, we were so confident in our rehab that will draft players. that are actually have just had Tommy John surgery. This was a few years ago.

And you see it all the time now. And the way I say it, and this is what really bothers me, and I've distanced myself some from baseball because of that. It's not only expected, okay, it's accepted that this is going to happen. And it doesn't have to happen if you prepare. And again, I have a very strong bias. Remember, my real expertise is in physical preparation. If you do a really great job of preparing the athlete, the pitcher, as an athlete for the demands of pitching, this should be no matter how hard you throw. It shouldn't be, but it's training the whole kinetic chain.

The injury happens at the elbow. The injury happens at the shoulder. But if you lack hip rotation, if you lack leg strength, you know, you're shooting bullet, you're playing Russian roulette with six bullets in the chamber. But the problem is you're right. It's accepted. And there's a whole pool of talent. The draft is going on soon. And there's a whole pool of talent that will come in to replace the people that are there now.

It's interesting what you just said made me think that, like, there's no break on this system, right? Team contract strategy could be a break because teams could say, we're not going to pay you if we think that there's a UCL injury risk, but they do. They pay handsomely. Medical technology could not progress. I think it's good that medical technology is getting better, but as surgeries get better, then more people are thinking, well, look, yeah, I'll blow up my arm, but then I'll get reconstructive surgery, and I might come back even better. I mean, Shoah Otani just through his fastest pitch ever. Ever.

Coming back from the Tommy John surgery. Two Tommy Jones. Right. Yeah. He got that thing made super tight. So I think it's all these things together that are creating, you know, I sometimes hate to use this term, but like a kind of permission structure around this approach to optimizing for velocity.

I want to move from baseball to basketball, although I think listeners are going to hear a lot of themes resonating. We just had this rash of Achilles' injuries in the playoffs. And it really does seem, not trying to be a prisoner of recency bias here, but it really does seem like in the last few years, just about every NBA playoff season has had multiple injuries to top stars. Is this also a place where you think early specialization and a certain kind of training intensity

is creating a similar risk for wearout and injury? in my opinion, and I've studied this pretty carefully and talked to a lot of people day-to-day involved in the sport. And I've worked extensively in basketball. And just a couple of weeks ago, I was up in Canada with, I used to work with the Canadian national team with the men's team and then the women's team and his husband and wife coaches. And we were talking a lot about this and some people, you know, up there. And it's just more time on the court, working on individual skills. starting at very, very young ages. Just an Uber emphasis on skill development, well, narrow range of skills, you know, without, as I said earlier,

without the foundational movements and without the proper, notice I'm using the term strength training, not weight training, to allow them to, remember, it's about force production and force reduction. Stopping is a big part of the game. stopping, turning, pivoting, and repetitively doing that without the preparation for that. I have a routine that we do every day that prepares them for that. Mike Joyner would love this. They used to jump when I played high school basketball and even when I worked with the Canadian

national team, and we just to jump rope every day. And what does you say? Jump rope. Well, that's hand-eye, hand-foot coordination. It's repetitively preparing you for the, for. for the force reduction in that, preparing your connection of ankle and the hip, particularly you're utilizing your ankle and your foot. So some of the solutions are actually, you know, pretty simple.

But it's like, gosh, we can't get too far away from the skill or we won't get better. But if you're, you know, if you're in the tub, you can't make the club. My equipment guy, when I played football in college, I was sitting in the whirlpool one day. And he says, he says, Gambetta. he said, get out of the whirlpool. He said, you can't make the club if you're in the tub. And I thought, you know, if you're in the training room, you can't make the team, you know. So, yeah.

And here again, I do have a little bit of sympathy for some of these coaches and trainers where if, you know, if you're in a seven-game series in the playoffs and you think the other team is, you know, drilling ways to break your zone. And you're like, okay, well, we only have so many hours of practice. We can either amend our zone defense in order to anticipate what they're going to do, or we can do some basic training exercises. I can see how, at the very least, there's this tension that some coaches feel in weighing the short-term versus long-term benefits of optimizing for strategy versus optimizing for kind of long-term. Yeah, there is that tension there.

But I can tell you, having worked in a myriad of sports and high-level rugby, Eddie Jones, like knowledge, is probably one of the greatest coaches. in the world across sports is a rugby coach. And he took Japan and they beat South Africa in the first round of the World Cup, which were the greatest upsets in the history of any sport. Japan's biggest guy was 220 pounds. South Africa's smallest guy was 220 pounds. But every practice was a blend.

So if they were going to work on a particular rugby drill, they did a physical preparation drill for two minutes. Two minutes. So over a course of a. an hour and a half practice and over the course of multiple days. So if I know I'm going to have to play a certain zone defense, let's break it down and figure out and work on the footwork patterns and the things you need to do to be able to effectively do that. So you marry the two, you know, it's not, it's not exclusive. Two other factors I want to pull in for basketball,

and one that's gotten a lot of play on media recently is footwear. I was actually talking to another trainer in the reporting for this show, and he said, Derek, I'd look pretty hard at the shoes. Today's shoes, he said, are engineered to stabilize the ankle, to avoid ankle turns, but the ankle doesn't just turn left and right, east-west. It twists front and back, north-south. And if you limit the east-west movement of the ankle with a high shoe or with a sort of a strong shoe, it pushes torque toward the calf muscle and the Achilles. It increases strain on the back of the leg when you're doing explosive movement. How do you feel about the argument that we are over-engineering footwear to reduce one kind of entry and incidentally increasing another?

There's no question about that, particularly in basketball. And remember, the forces have to, so your body is a kinetic chain. And the foot is what contacts the court or the ground, okay, and how I can use the foot to attenuate those forces up. And it goes, the way I think of it as I go foot, because there's multiple joints in the foot, ankle, knee, hip. Okay. And I use as many joints as I can to produce force to drive or whatever, and I want to use as many joints as I can to reduce force.

But what they've done, by over-engineering the shoes, I think that's a really good term. they've taken away foot function and transferred forces up the chain. And, you know, the cav and the Achilles structure is going to take a lot of the beating. You know, it's really, that's probably the simple. Somewhere the force has got to be dissipated. So over the course of a season, and Achilles tendon, I'll tell you, my first exposure to this, when I first started training for

decathlon in 1968, the guy I was training with had Achilles tendonitis, Achilles tendonitis. And he probably could have meddled in the games. He was that good. And he went to Canadian trials and blew as the first time I heard of this,

blew his Achilles out, pole vaulting. And I thought, jeepers, this is really, is that a, this is, you know, I'm just first year coaching and all of that. And yeah, so I think that's a factor.

You know, and now you don't want to go back to the old, if you look at pictures of Will Chamberlain and those guys, the shoes they wore, but there was, you know, less, the game was different in a lot of ways. You know, and, but I think you've got to really look at this. You know, the shoe companies have to really look at this. I want to pick up on this idea that the game has changed. So I was looking at some motion data suggesting that today's NBA players cover about 20% more ground per game.

They're running 20% more miles per game. And if you multiply that out over the whole season, that's essentially like taking the 82 game regular season and making it a 100 game regular season, right? given that, you know, 80, 81, 20% of 81 is 18, 18 plus 82 gets you to about 100 games per season. So some of that is about faster pace of play, but I also think some of it has to do with spacing, too, because, like, if the dominant offensive strategy is someone driving to the basket, and then the defenders collapse into the basket, and the ball sprayed out to the three-point line, that means defenders have to suddenly break into an all-out sprint whenever the ball is kicked out. And I wonder whether that might create more opportunities for, like, explosive torque that's going to exacerbate the risks that you've already described.

How do you think gameplay plays into all of this? The beauty is, particularly NBA, in all arenas and all practice arenas now, you know, they have different analysis systems. So we're not, you're not just speculating. I mean, the game is, is faster. There's more significant moments, if you want to call it in the game, and at higher. speed and here's one of my and what you have because of you have fixture congestion because you might seldom you only play like well only three or four times maybe back to back but you have a day off in between that's a travel day so you really don't get to train and prepare and again so basically

if you have a choice are you going to prepare technically and tactically for basketball or are you going to do strength training and flexibility work and that kind of stuff, that gets shoved to the side. Okay. And then that, and what we have to remember, training and training stress is accumulative. It doesn't add up one, two, mathematically. It multiplies geometrically, not whatever it is. I, you know, I wasn't very good. Geometrically, exponentially, something manually.

Yeah. Explancially is the word. Yeah. And so this is, and nothing can be done. They're not going to reduce the number of games, but it's a matter of, and see, the collective bargaining agreement in basketball and in football limits the amount of time the players can train. So what do the players do?

They go outside the team and they hire personal trainers and they hire personal therapists that have no connection with the team. They don't know what they did at practice, and this is a problem. Okay. So they could have had a hard scrimmage today because they had two days off, but the personal trainer just makes them do a crazy lifting workout, and now they're fatigued for two days. So it's a multidimensional problem that the players in associations in some ways

have brought upon themselves by limiting training and preparation time. And that's because coaches and teams have abused it, right? But somewhere in between, I mean, like right now, I know we're talking about basketball in the NBA and the NFL, the coaches can't have any contact with the players. But they're paying them a lot of money. The players cash the paycheck every two weeks. But so who's preparing the player for the season. I want to throw two takes at you and tell me which story you believe.

Story number one is that today's athletes are bigger, faster, stronger. And if we're going to dance along the outer edge of what the human being can do on soccer fields and basketball courts and pitchers mounds, we are

inviting inevitable injury. So injury risk is a necessary trade-off given the level of athletic excellence that today's players feature. Story number two says, no, that tradeoff isn't necessary at all. Injury risk is not a necessary tradeoff with athletic excellence. We're not training appropriately. We could have bigger, faster, stronger players, and also more resiliency. But the problem is we've forgotten the art of proper training. So which story do you think is right?

Story number one, meaning that athletic excellence incurs a certain risk of injury, or story number two, no, there's no tradeoff for just not training properly. The ladder, the latter. And no question, great athletes. Look, if you see behind me, Summer McIntosh just broke three world records, okay, and swimming. The number eight jersey, that's one of the greatest female athletes on the planet, best, best cricket player ever, World Cup soccer player at the same year, right? And 34 years old, she's not slowing down.

And she's going to play on the edge. You've got to play. If you want to be the best, you have to play on the edge, you know, but you have to prepare to play on the edge. And some of that is the responsibility of the athlete doing the extra things getting there, early doing certain things. But I think that teams have been, I mean, most basketball teams now, the Golden State worries, I don't want to misspeak, but I think they have 33 support staffs, staff. And that's common across the NBA.

I just happen to live in San Francisco in that. Are we doing a better job? That's the question that I ask. Are we doing a better job of preparing the athletes to play on the edge and prepare for the game that they have? But what we're doing is we're measuring everything. Okay, like we know the numbers, but we're coaching the numbers. Now listen, this is an important distinction. We're coaching the numbers, not the athletes that are performing the numbers.

So the data analysis in soccer, I was reading some stuff on Liverpool and that. I mean, they've got data analysis more than NASA has, you know. But again, the excuse is given, well, the game is faster, it's harder. Well, fine, you've got the information. Get me ready for the game. You know? Let me. I get pretty bad.

No, I love it. I love it. Let me, let me end by subverting the entire purpose of this interview. I could have had you on this show, not for a show that's essentially called what's behind the surge in sports injuries, but rather for a show called why are modern athletes so durable. I mean, we are seeing both an increase in certain kinds of injuries and a golden age. in, you just mentioned, Perry, playing until she's in her mid-30s, LeBron James being exceptional until his 40s, Tom Brady being exceptional into his mid-40s, Novak Joachovic being the best tennis player in the world

until he was 37, 38 years old, which is like eight years after I saw Pete Sampras's body basically break down in Wimbledon to the U.S. Open in his final year. I mean, we are in a golden age of elite athletes, durability while at the same time we're in a period of high injury risk. How do those stories fit together? Well, they do, and I think the problem, look, I got the opportunity to work with Michael Jordan a bit, both in basketball and baseball, you know, and I'm not, I don't say very much about, I've been around some of the greatest athletes in the world, you know, and track

athletes, Edwin Mose, Daly Thompson, people like that. But I think from the, outside, people tend to look at them as outliers. And I looked at what they did every day, you know, and I'm going, wait a minute, they don't, at least she doesn't cut any, she doesn't cut any corners, you know, and I watched Tom Seaver at the end, he was with the White Sox at the end of his career, and talked to him for two hours one day. He was, and, and he paid attention to details, you know. So many are called, my statement is many are called in few shoes, you know, I mean, I look at, I look at Federer, I look at Nadal, I look at Djokovic, you know, wow, look at, you know, they really take care of themselves. They pay attention to all aspects of what

they have to do to prepare to play. And of course they practice tennis, but they do all the other things that are necessary to. Yeah. And by the way, those three tennis players were all great athletes first. They were skiers. They were soccer from Nidal and and Federer, you know, had to choose between soccer and tennis, you know. So, you know, we have to look at that, look at those case studies, those stories. And I think it incumbent upon all of us to highlight those kind of stories so that the parents of the young athletes hear these stories, you know, and the young athletes hear these stories. Let me try to synthesize what I'm hearing from you. It's that, you know, we've been talking

today about how there are these economic and competitive pressures to specialize, to push the body to its limit, to incur the risk of injuries that might be catastrophic or might simply require a sort of one-year recovery period from something like Achilles surgery or ACL surgery. So on the one hand, you have these economic and competitive pressures. But on the other hand, we're also in a golden age of resources and information about how to sustain physical excellence in sports. And it's only some truly elite athletes who maybe have both sort of elite physical gifts and elite conscientiousness and elite sort of cognitive gifts who can take advantage of those resources and that information and therefore can sort of dance at the edge of physical excellence without pushing their bodies too far into the extreme. that create the most catastrophic injuries. Is something like that a full picture?

Yes. Unequivalable. Yes. All right. Then we'll wrap there. Vern Gambetta. Thank you so much. This is really fun. I learned a lot.

It's exciting. It's exciting. It's exciting. It all represents opportunities. That's the way I look at it. You know, I just greater opportunities to create greater excellence, you know, and coach the person in front of you. That's my, in my old age, that's my theme.

Many thanks to Vern Gambetta. I want to try to summarize for my own benefit what I learned from this episode about the factors that might be driving an increase in major injuries across professional sports. Number one, and this is just starting chronologically, I do think early specialization

plays a pretty significant role, both because it might create wear on the body and because when you take away the cross-training that's intrinsic to someone sampling from different sports, right? someone playing football in the fall and then basketball in the winter and then tennis in the spring, if you replace that kind of full-body cross-training with repetitive motions, just practicing the same curveball over and over and over again,

I can see how that might lead to the sort of wear that would create a surge in Tommy John surgeries for teenagers, which is exactly what we're seeing now. That's number one. Number two, I do think that there might just be a natural trade-off between, faster, stronger athletes and more pressure on ligaments and joints. And so while clearly there are some athletes like LeBron James or, you know, Tom Brady, Tom Brady being the best example here, who just like finds a way to avoid serious injury for the vast majority of his career, despite the knee injury, I believe, in the middle of his

career, you do have those exceptions, but for the most part, it does seem like maybe, you know, like, as I said, like dancing at the edge of what the human body is capable of is going to create stressors on ligaments and joints that ultimately creates more injuries. So that's, that's category number two. Category number three, I sort of think of as like the dark side of optimization culture. Practicing or forcing the arm to throw faster and faster and faster, right, with the average fastball in Major League Baseball rising from about 88 to 89 miles per hour just 20 years ago to about 95 miles an hour today. And some of these starting pitchers, that are coming into baseball now,

is the skeins and that guy for the Milwaukee Brewers throwing like 100, 101 miles per hour at like 23, 24 years old, maybe this optimization for the biomechanics necessary to make a ball move 100 miles an hour is going to incur this injury risk. I also think it's just so interesting. Speaking of optimization,

that there's this explanation about shoes in basketball, limiting the East-West momentum of, ankles to avoid ankle turns and then making all that kinetic energy push back toward the calf muscle, which would essentially incur this risk of you're going to turn your ankle less, but you're going to hurt your calf more because of the design of the shoes. I think in both cases, in the case of baseball arms, in the case of basketball shoes, you have this dark side of optimization. That's an interesting third category to explore. Number four, the fact that medical science is better, The fact that surgeries are better means that in a weird way, like the risk of injury is less than it used to be, right?

If you blew out your elbow in like, I don't know, 1930, 1940, maybe you're just not coming back. But now, like, the fact that Shohei Otani is throwing his fastest baseball pitches ever after two Tommy John surgeries speaks this idea that, like, if you're a young athlete or a coach or a trainer or a GM, you know, maybe in lots of sports you're thinking, yes, you know, the way to. that we train, the way that we play, might have an injury risk, but because I trust the doctors around us to repair that injury risk better, we're much less likely to have injuries and player careers. And that leads to, I guess, explanation number five, which is that I don't think there's like any break in the system here. It's BR, A, A, K, E. Any break in the system where a major group is essentially saying, let's not push it too far. You've got, you know, the economic incentives to win now. You've got the economic incentives of the individual athletes to push their bodies,

to achieve as much as they can while they have the youth to be able to achieve it. And then you have surgeons who are saying, yeah, I can fix whatever is broken. And so you put all of that together, and it's like every single actor within this ecosystem is pressing athletes to push their bodies to the extreme, rather than focus on this sort of holistic professional training that Vern Gambetta has been an advocate for. So I do think that when you put all of that together, it does make the surge of major injuries across professional sports seem almost, I should say almost, almost inevitable. I learned a lot from this, and I hope you did too. We will talk to you next week.