Full translation of Manu Ginobili's La Nación column

[diego]

There have been a lot of changes in the understanding and treatment of stress fractures, just in the last decade. A lot of "good" doctors cling to the old ways, even after it should be obvious that there are better treatments. Stress fractures take a long damn time to fully heal, and longer as we age. The accepted treatment these days is a period of inactivity, followed by a slow rehab process. One big contributor to stress fractures is when the muscles can't handle the full load, and more of the impact is transferred to the bone. And since the muscles deteriorate during the initial period of inactivity, it's important to strengthen the muscles ahead of any increase in impact training (weeks, not days).

Manu has had this same problem in his right leg, over and over. And since he's never taken a summer off (that I can remember) it's possible, maybe even likely, that it has never fully healed. The really bad thing is that if a stress fracture doesn't completely heal, it makes it easy to re-injure. And after a while, it can reach a point where it will never heal properly. After 6 weeks, he could have started strengthening exercises. But "ramping up" his training regimen, to try and make up for the period of inactivity is just ing stupid. No if's, and's, or but's - just ing stupid.

The Spurs had a legitimate, contractual right to tell him not to play or train with the NT this summer. He ignored them and started an accelerated training regimen that no up-to-date doctor would have approved. If he's not 100% by the beginning of training camp, I'm pretty sure the team could terminate his contract. I don't think there is any chance the Spurs would ever do that. But by running off and ignoring their instructions, he pretty much has to hit training camp running, just to prove that he didn't re-injure his leg. I love Manu and what he's done for the Spurs over the years, but this was selfish. He needs to come back and get on a supervised rehab program, and work things out with the FO to stay on light duty at least through the end of camp, and (even more) limited minutes until after the AS break. A healthy Manu really improves the Spurs' chance of a repeat. He's been through enough training camps with the Spurs, and they will be fine without him in November and December.

I don't believe that this is an elaborate story to try and make everyone happy about him not playing with the NT. If he really went there and started training, it says he was really planning on playing this summer. With his injury, and his age/history, I don't think there is any legitimate sports osteopath who would say that was something he should do. I don't know who the doctor in Chicago was, but he should start thinking about retiring, too.

If manu has had this problem for such a long time, why didn't the spurs sit him out? Why resign him?

The spurs doctors failed to diagnose this fracture for at least two months. If you went to your company doctor multiple times because of pain and he told you to keep working, and then right before vacations told you you had a serious condition and couldn't go on vacation, you wouldn't be at least a little su ious of that doctor? Bottom line is that the spurs docs failed to diagnose this injury when it happened there's no disputing that.

Manu said all along that if he wasn't fit to play he wouldn't. When the pain came back he stopped as he said he would. if the spurs doctors had diagnosed the injury when he felt pain instead of days after he decided to play for the NT he probably wouldn't have even committed to the NT.

[littlecoyotecoin]

If manu has had this problem for such a long time, why didn't the spurs sit him out? Why resign him?

The spurs doctors failed to diagnose this fracture for at least two months. If you went to your company doctor multiple times because of pain and he told you to keep working, and then right before vacations told you you had a serious condition and couldn't go on vacation, you wouldn't be at least a little su ious of that doctor? Bottom line is that the spurs docs failed to diagnose this injury when it happened there's no disputing that.

Manu said all along that if he wasn't fit to play he wouldn't. When the pain came back he stopped as he said he would. if the spurs doctors had diagnosed the injury when he felt pain instead of days after he decided to play for the NT he probably wouldn't have even committed to the NT.

Your books are so wrong there is no wonder your bottom line is, too.

[GSH]

The only thing I'll say about this is that according to reports, the stress fracture was very small. I'm not a doctor, and I don't pretend to be one (most of the time anyways), but, you know, there was that.



I'm pretty sure he's going to rest now. Last summer, the Spurs sent a physical trainer with him to Argentina, and judging by the good season he had, it worked well.
Obviously, this summer I don't expect he'll be doing much of anything until he returns for training camp.

You always have good reasons for your positions. Even when I come to a different conclusion, I don't doubt your logic or the validity of your arguments. Sometimes you even change my mind. (Occasionally, I even admit it.) I didn't know the team sent a trainer with him last year. I hope they are doing the same this year. More - I hope he's listening to them. He's such a fierce compe or, I can see him thinking he can just push harder and work through this. This is one injury that just doesn't work that way.

I'm no doctor, but I do have a little experience with these injuries. Early on, stress fractures can't even be seen with x-rays - that's why it took a CAT scan to find Manu's. I wouldn't be nearly as concerned, if he wasn't 37 years old, with a long history of injuries to that same bone. The size of the injury isn't nearly as important as the possibility that it's the same injury, and has never really been allowed to heal fully.

When a stress fracture is forming, the connective tissue around the bone becomes inflamed, and that is the pain that people feel. The problem is, they think that when the pain is gone, they are better. But the inflammation goes away a lot more quickly than the tiny fissures in the bone. I know what Manu is thinking: "My leg isn't hurting, so I must be better." (I've been there.) It's logical - it's just very, very wrong. Keep re-injuring the bone, and eventually it causes some structural changes. The little fissures just won't heal anymore. Also, our bone mass increases until somewhere around age 35. Manu is reaching an age where it is much more important for him to let a stress fracture completely heal. So far this summer, that hasn't happened. Knowing what I know, I don't see how he can be though (proper) rehab, and ready for a full-speed training camp.


I'll say this: I understand why the fans in Argentina want to see him in the uniform one more time. And I was wrong to call him selfish for trying to make it happen. He was playing with the same injury during the playoffs, for the benefit of the Spurs. But I do think there's a time when a great athlete has to understand that, no matter how badly they want it, playing injured risks the bigger picture. I would love to see him have one more (at least) really good season, and not finish his career saddled with a chronic injury. I'd rather see him miss games at the beginning of the season, rather than the end.

[ElNono]

I'll say this: I understand why the fans in Argentina want to see him in the uniform one more time. And I was wrong to call him selfish for trying to make it happen. He was playing with the same injury during the playoffs, for the benefit of the Spurs. But I do think there's a time when a great athlete has to understand that, no matter how badly they want it, playing injured risks the bigger picture. I would love to see him have one more (at least) really good season, and not finish his career saddled with a chronic injury. I'd rather see him miss games at the beginning of the season, rather than the end.

There's also the fact that there's better odds for him to do something big with the Spurs next season than with the NT right now. Going out on top with a back to back championship (a first for the franchise to boot), would be a great way to close an amazing career.

[GSH]

If manu has had this problem for such a long time, why didn't the spurs sit him out? Why resign him?

The spurs doctors failed to diagnose this fracture for at least two months. If you went to your company doctor multiple times because of pain and he told you to keep working, and then right before vacations told you you had a serious condition and couldn't go on vacation, you wouldn't be at least a little su ious of that doctor? Bottom line is that the spurs docs failed to diagnose this injury when it happened there's no disputing that.

Manu said all along that if he wasn't fit to play he wouldn't. When the pain came back he stopped as he said he would. if the spurs doctors had diagnosed the injury when he felt pain instead of days after he decided to play for the NT he probably wouldn't have even committed to the NT.

The fact is, he HAS had this problem for a long time. That part isn't even up for debate. Check his game logs - they did sit him out. And they re-signed him because, even at 37, he's a bad MF. They obviously expect that he will be healthy.

You can read what I just said to Nono. Low level stress fractures aren't that easy to spot. The (early) pain comes from inflammation around the bone, not the bone itself. Should they have done CAT scans during the season? I damn sure would have. But then again, I don't know if they did or didn't. Like I said, they aren't that easy to spot until they get much worse. What I do know is that once a stress fracture is found, there are some well-understood treatment steps. The Spurs have a very admirable history of protecting injured players, rather than pushing them to go back on the floor. I have no doubt that they would have held him out, if they knew. Maybe they let him play in the Finals, knowing that he had some pain. I still want to believe they would have kept him on the bench if they knew that he had a stress fracture. But if they suspected it was his last season anyway? Who knows?

Your comment about the pain going away is EXACTLY the problem with stress fractures. Like I said above, the inflammation (and pain) goes away long before the injury is fully healed. It's a VERY common problem with compe ive athletes. They think if they feel no pain, they can go back to normal duty. And when the pain isn't too bad, they think they can just play through it.

You need to check the facts. The injury was diagnosed in his exit physical with the Spurs. He committed to the NT knowing that, apparently based on the advice of the doctor in Chicago. That doctor told him that 40 days would be more than enough time to heal, so he decided he could play over the summer. There's a difference between not being able to spot an early stress fracture, and giving bad advice about how to treat one that is known. Out of the whole incident, it's the doctor in Chicago that I have an issue with, based on Manu's own comments.

Unlike many people here, I don't think the Spurs' doctors are superior because they are American, or just because they work for the Spurs. But I do know that the team has a long history of protecting players' health, rather than encouraging them to play injured. They have even been good to ex-players who have gotten injured. So I won't suspect them of endangering a player, unless I see some very solid evidence.

[GSH]

There's also the fact that there's better odds for him to do something big with the Spurs next season than with the NT right now. Going out on top with a back to back championship (a first for the franchise to boot), would be a great way to close an amazing career.

On this, we're in 100% agreement. It would be a beautiful thing. I got nothin' to add.

[littlecoyotecoin]

The fact is, he HAS had this problem for a long time. That part isn't even up for debate. Check his game logs - they did sit him out. And they re-signed him because, even at 37, he's a bad MF. They obviously expect that he will be healthy.

You can read what I just said to Nono. Low level stress fractures aren't that easy to spot. The (early) pain comes from inflammation around the bone, not the bone itself. Should they have done CAT scans during the season? I damn sure would have. But then again, I don't know if they did or didn't. Like I said, they aren't that easy to spot until they get much worse. What I do know is that once a stress fracture is found, there are some well-understood treatment steps. The Spurs have a very admirable history of protecting injured players, rather than pushing them to go back on the floor. I have no doubt that they would have held him out, if they knew. Maybe they let him play in the Finals, knowing that he had some pain. I still want to believe they would have kept him on the bench if they knew that he had a stress fracture. But if they suspected it was his last season anyway? Who knows?

Your comment about the pain going away is EXACTLY the problem with stress fractures. Like I said above, the inflammation (and pain) goes away long before the injury is fully healed. It's a VERY common problem with compe ive athletes. They think if they feel no pain, they can go back to normal duty. And when the pain isn't too bad, they think they can just play through it.

You need to check the facts. The injury was diagnosed in his exit physical with the Spurs. He committed to the NT knowing that, apparently based on the advice of the doctor in Chicago. That doctor told him that 40 days would be more than enough time to heal, so he decided he could play over the summer. There's a difference between not being able to spot an early stress fracture, and giving bad advice about how to treat one that is known. Out of the whole incident, it's the doctor in Chicago that I have an issue with, based on Manu's own comments.

Unlike many people here, I don't think the Spurs' doctors are superior because they are American, or just because they work for the Spurs. But I do know that the team has a long history of protecting players' health, rather than encouraging them to play injured. They have even been good to ex-players who have gotten injured. So I won't suspect them of endangering a player, unless I see some very solid evidence.

You are a saint for devoting your time to a well-reasoned response.

[diego]

The fact is, he HAS had this problem for a long time. That part isn't even up for debate. Check his game logs - they did sit him out. And they re-signed him because, even at 37, he's a bad MF. They obviously expect that he will be healthy.

You can read what I just said to Nono. Low level stress fractures aren't that easy to spot. The (early) pain comes from inflammation around the bone, not the bone itself. Should they have done CAT scans during the season? I damn sure would have. But then again, I don't know if they did or didn't. Like I said, they aren't that easy to spot until they get much worse. What I do know is that once a stress fracture is found, there are some well-understood treatment steps. The Spurs have a very admirable history of protecting injured players, rather than pushing them to go back on the floor. I have no doubt that they would have held him out, if they knew. Maybe they let him play in the Finals, knowing that he had some pain. I still want to believe they would have kept him on the bench if they knew that he had a stress fracture. But if they suspected it was his last season anyway? Who knows?

Your comment about the pain going away is EXACTLY the problem with stress fractures. Like I said above, the inflammation (and pain) goes away long before the injury is fully healed. It's a VERY common problem with compe ive athletes. They think if they feel no pain, they can go back to normal duty. And when the pain isn't too bad, they think they can just play through it.

You need to check the facts. The injury was diagnosed in his exit physical with the Spurs. He committed to the NT knowing that, apparently based on the advice of the doctor in Chicago. That doctor told him that 40 days would be more than enough time to heal, so he decided he could play over the summer. There's a difference between not being able to spot an early stress fracture, and giving bad advice about how to treat one that is known. Out of the whole incident, it's the doctor in Chicago that I have an issue with, based on Manu's own comments.

Unlike many people here, I don't think the Spurs' doctors are superior because they are American, or just because they work for the Spurs. But I do know that the team has a long history of protecting players' health, rather than encouraging them to play injured. They have even been good to ex-players who have gotten injured. So I won't suspect them of endangering a player, unless I see some very solid evidence.

First to be clear i'm not trying to antagonize you, just discuss the situation. I usually dont bother to respond unless I have a little bit of respect for the other person.

That said you are wrong about some things. Manu waited to the end of the season to commit to the NT, precisely on the argument that he wanted to see how he felt to end the season. He committed June 20, game 5 was June 15, his injury was reported July 2. that was the timeline.

After all that (and the Chicago specialist) manu went to Argentina, in his press conference he said the pain was there for 2-3 months and tests came back fine so he kept playing. I understand the type of injury is difficult to diagnose (perhaps it was difficult to diagnose because it was a very small fracture and not that serious?), but the fact remains that it was diagnosed late and the timing was su ious. I have no reason to distrust the spurs medical staff, but the fact remains one of their players was in pain and limping around and they let him play, iirc he played more in the PO than RS too.

I don't know what game log I should check to see manu rested because of a stress fracture. Obviously in 08/09. But other than that, i don't think he's ever been rested because of a stress fracture, unless you mean limited minutes, to which I would answer that pop does that for everyone. Manu came back strong from the 08 injury. 10 and 11 were some of his best years, probably among his highest in minutes played, he got freak injuries in the PO that had nothing to do with overuse/fragility. 2012 another unlucky injury (broken hand vs Minnie) and then pop dropped his minutes drastically- IMO that had more to do with the arrival/blossoming of green, Leonard, and jack than injury. If you really believe manu has had this problem for a really long time, then I would have expected the spurs to shut manu down 4-6 months to fully heal it.

If manu didn't see the risk of playing through the pain its probably because he's been doing it for months with the spurs blessing. Again, if the diagnosis was made before the end of the season and not after committing to the NT that changes things significantly.

[BillMc]

There's also the fact that there's better odds for him to do something big with the Spurs next season than with the NT right now. Going out on top with a back to back championship (a first for the franchise to boot), would be a great way to close an amazing career.

I agree. That said, part of me wanted him to play 2 more years and then go out with his national team in the Olympics. But, I just get the feeling from what he has said, that this was his last shot at international play, which probably means also that this is his last season in the NBA too. Certainly, I could be wrong and certainly things could change.

[spurastic]

It is wise to get second opinions with medical situations. One should not just accept what the "doctor" says. They are only human. I admire Manu for his dedication to the sport, the Spurs and his home country. This situation just increased my admiration for his intelligence.

[littlecoyotecoin]

It is wise to get second opinions with medical situations. One should not just accept what the "doctor" says. They are only human. I admire Manu for his dedication to the sport, the Spurs and his home country.

We all agreed on that about 30 seconds into the discussion. But, thanks for restating that. Regarding the part omitted, his decision was emotional, not logical or intelligent.

[TMTTRIO]

by the way any word on if Manu's going to need surgery on it. I know he had surgery a few years ago on it to clean it out and they said that eventually in a few years he may need it again.

[littlecoyotecoin]

by the way any word on if Manu's going to need surgery on it. I know he had surgery a few years ago on it to clean it out and they said that eventually in a few years he may need it again.

I don't think there is any idea, yet. He will have to go through a REAL recovery period, and rehab, before we know if it will heal on its own.

[ElNono]

by the way any word on if Manu's going to need surgery on it. I know he had surgery a few years ago on it to clean it out and they said that eventually in a few years he may need it again.

No word yet, and he did NOT have surgery on that injury before.... (he had surgery on his left ankle in 2008, this is on the right fibula)

http://sports.yahoo.com/nba/news?slu...iinjured040609

[TMTTRIO]

Well fortunately Manu doesn't seem to down or depressed about not playing.

[ElNono]

There's a new interview in La Nación with him talking about a bit of everything, including the injury. Too late now, but I'll translate tomorrow if nobody beats me to it:

http://canchallena.lanacion.com.ar/1...l-seleccionado