Why Lonzo Ball's Knee Injury is a Result of Mismanagement

"Doctors all over the country are baffled by Lonzo Ball's injury."

Recently it has been reported that Lonzo Ball of the Chicago Bulls will likely miss most, if not all, of the 2023/24 season due to his nagging knee injury. Back in January 2022, his last game played, he tore the meniscus in his left knee. He was expected back in 6-8 weeks post-rehab, but never came back due to still experiencing pain and discomfort in the knee.

Initially, Lonzo underwent arthroscopic surgery to repair the meniscus. The second surgery, prior to the current season, back in September was arthroscopic debridement, and still couldn’t play without pain after his weeks of rehab. This third time around Lonzo will receive a meniscus transplant.

“Ball's flown all over the country and had seen so many doctors and specialists all over the country but to no avail. None of them could provide a concrete answer as to why Ball is still experiencing pain and discomfort in his knee at this time and is unable to perform high-level basketball activities.”

Lonzo is not the first NBA player to have meniscus issues and knee surgery. Many players have returned to play after injury and rehabilitation. So why is Lonzo an outlier case, having three surgeries since 2022 and still unable to return to play? From his strength staff, sports medicine doctors, surgeons, and physical therapists, I believe he has been completely mismanaged by the system of care provided.

It is evident the shortcomings of the resources provided to Lonzo. From my perspective as a manual therapist, the organization’s objective and system of care to get Lonzo back to a functional state, ie, return to play, failed miserably and has resulted in him having to have a third surgery and potentially being unable to play next season. In other words, it appears that the techniques used were suboptimal or even made him worse.

The diminishing returns of the systems and procedures aimed at returning Lonzo to competition culminated in his third knee surgery, indicating that the methods implemented were not effective in addressing his specific needs and improving his performance.

One significant reason for Lonzo Ball's current situation is a lack of effective leadership in his medical team. The doctors treating him and the strength staff all seem to lack a cohesive plan for his treatment, with surgeries being used as conditional attempts to address his ongoing knee pain. The lack of clear direction or accountability has resulted in a situation where the doctors are "baffled," with nobody taking responsibility for the lack of progress. This lack of effective leadership has likely contributed to Lonzo's unsuccessful treatment and has resulted in multiple surgeries.

Moreover, I believe that a lack of knowledge contributed to Lonzo's situation. Specifically, the sports medicine and strength staff lacked training in how to effectively use training as a means to change the system from one state to another. They failed to grasp the concept of systems within systems, and used ineffective methods on a system that was unresponsive to the training. Despite this, they continued with unsuccessful attempts twice, and are now preparing for a third.

From a treatment and training perspective, it seems that the staff lacks the strategic and tactical knowledge to effectively manage and organize Lonzo's knee joint from a post-surgical dysfunctional state to a return to play and functional state. They appear to have a limited understanding of the biological and neurological components involved and their trainability. Consequently, Lonzo's chances of remaining healthy and competing at high levels are low, and he remains trapped in a recursive loop of failed attempts. Ultimately, Lonzo is the only one who bears the consequences of others' shortcomings.

Joint Specific Training

It seems glaringly obvious that a key component missing for Lonzo post-surgery was and is joint-specific training. Whereby performing specific work that changes the physical state of the joint to have increased joint space, improved connective tissue architecture and its ability to bear load, and an increase in muscular work capacity. Using particular means and methods targeted at the joint and connective tissue levels to improve rotation and joint workspace from which to build upon other behaviors is one example.

A joint is the connection of two or more bones and the ability for motion to occur relative to one another. The space between these bones is joint workspace, and the connective tissue that encapsulates those bones is known as the joint capsule and is our capsular workspace. Joints are often made up of several other elements of connective tissue which include ligaments, tendons, and cartilage (meniscus). 

Joints are plastic to training, and joint-specific training will elicit positive multifaceted effects to change the physical state of the joint in ways that increase function, fitness, and health. By simply training the joint to have more rotation and joint space the nervous system will then have more access to biological tissues in order to organize.

Traditional strength training models typically focus on training muscles and tend to overlook the biological elements that contribute to joint health and function. While muscle strength and endurance are important factors for an NBA player, joint space, connective tissue architecture, and load-bearing capacity are equally or more important, and they can be trained through specific exercises and training means. By neglecting these joint-specific training elements, athletes can be at a higher risk of injury, and their joint function and overall health can clearly suffer.

It is my opinion that joint-specific training is what Lonzo needs if he wants to return to an NBA basketball court and compete at an elite level. The failing of systems and procedures, the lack of responsibility, and the lack of knowledge at all levels of the Bulls organization, from the very top down to the ones whose responsibility it is to keep players healthy and playing, all seem to have collectively mismanaged Lonzo Ball given the doctors are “baffled” by his case and he is still not set to play until 2024/25.