Sports News Without Fear, Favor or Compromise
Sports News Without Fear, Favor or Compromise

Can Science Predict An Injury-Prone Future Draft Pick?

Illustration for article titled Can Science Predict An Injury-Prone Future Draft Pick?

Freshman basketball phenom Andrew Wiggins’s college debut tonight for the University of Kansas is one of the most anticipated arrivals in a generation. When he steps on the court at Allen Fieldhouse against the University of Louisiana at Monroe, scouts from every NBA team will presumably be watching because Wiggins—a 6’8" small forward with freakishly long arms reminiscent of LeBron James—is expected be the first pick in the 2014 draft. In the coming months, NBA teams will subject Wiggins to a battery of mental, physical and psychological tests off the court in the name of due diligence to determine if he is destined to become an NBA superstar and not an injury-plagued bust. That doesn't mean anyone is asking the right questions.

Advances in sports medicine are changing the way we predict future athletic injury. But the changes are happening so quickly that it's hard to imagine that every team is keeping up. Because every organization has its own team of doctors and trainers, the interpretation of the pre-draft medical evaluation is not standardized, creating the potential for market inefficiency. Injuries are the new Moneyball, you'll hear from time to time. Are some teams better at avoiding players who will eventually be bitten by the injury bug?

The latest research about the nature of injury prediction suggests we're heading into a new era, one which may involve more sophisticated and probing medical questions that will help teams make better decisions about draft picks and contract extensions. For example, recent research suggests that an athlete’s range of motion can predict future injury at the joint, while other scientists have shown that joint laxity or even posture can influence future trips to the disabled list. Most surprisingly, it now appears that a seemingly harmless injury in one part of the body—the hamstring, for example—might predict a devastating injury in another part, like the ACL. So passing a pre-draft physical may be only part of the story. It's also important to remember that given what's riding on the examination, players may not be entirely honest during the pre-draft physical.


Nearly 30 years ago, the Portland Trailblazers famously selected Sam Bowie instead of Michael Jordan in the 1984 draft after he passed his own pre-draft physical. But Bowie went on to spend the majority of his professional career injured and later admitted he'd been dishonest about the extent of his injuries leading up to the draft. In an ESPNU documentary, Bowie said of his pre-draft evaluation, "I can still remember them taking a little mallet, and when they would hit me on my left tibia, and, 'I don't feel anything' I would tell 'em. But deep down inside, it was hurting. If what I did was lying and what I did was wrong, at the end of the day, when you have loved ones that have some needs, I did what any of us would have done."

There are undoubtedly many athletes who feel this way and there's not much a team can do to prevent someone from misrepresenting a medical condition when so much money is on the line. Or is there? As we confront the brave new world of increased team and fan access at the expense of diminished player privacy we should consider what other sources of information about player health are available. What if a team could examine something objective, like DNA?

Our DNA contains genes that control the production of muscle, cartilage, bone formation, metabolism, and blood oxygenation. DNA sequence variations, known as gene mutations, can sometimes confer athletic advantages, a topic David Epstein explores extensively in his terrific new book, The Sports Gene. Epstein examines the way our DNA impacts performance and allows some to achieve superhuman feats of strength and endurance as well as the genes that might predispose a player to future injury, like a mutation in collagen which can lead to something called Ehlers-Danlos Syndrome. Athletes with this condition can have superhuman flexibility but they can also have joint instability and frequent dislocations. A genetic mutation might be a benefit at the age of 18 and a detriment at age 28. Should teams request genetic testing to determine if players are at risk for musculoskeletal disease?


Most of these diseases occur before a young athlete rises to prominence, but not all of them do. People who have frequently sustained sports-related injuries are now undergoing genomic testing to understand why. Earlier this year, a new gene mutation was found in an oft-injured man who broke his foot while playing volleyball. NBA scouts would undoubtedly like to know if Andrew Wiggins has the same mutation.


If a genomic analysis of two equivalent players could determine which one was more likely to get injured, should teams have access to that information? And should a player be compelled to provide it? It’s something that would have to be collectively bargained with the players union, but it’s important to know that the idea of genetically testing athletes is not unprecedented. In fact, according to Yale geneticist Marios Kambouris, an English Premier League club reportedly subjected its players to genetic testing to help determine who was more injury-prone.

The cost of whole genome sequencing was once prohibitively expensive. But late last year, Gene by Gene, Ltd. started offering whole genome sequencing for just $5,000, and this cost will almost certainly continue to drop as the technology advances. Given the amount of money riding on professional athletics, this seems like a small price for a team to pay for whatever peace of mind contemporary science can offer.


This issue of genetic testing is not simply an issue for the draft. Teams often grapple with players over the perception that a player will breakdown. Warriors center Andrew Bogut signed a contract extension with his team in late October and was possibly underpaid because he has been labeled injury-prone, a reputation he vigorously disputes. “I’ve had a hard run with injury,” Bogut said earlier this year, “everyone knows that. But these last two injuries, if you take them away from my career—take away two split-second moments out of my career, and the ‘injury-prone’ label’s gone. One of them is getting a little shove in the back and coming off the rim, 10 feet high, and breaking my elbow. And the other one is getting under-cut by Kyle Lowry after he shot a floater and falling on his ankle. Take those two split-seconds away, I’ve only really ever had one injury, which is a little back stress fracture.”

Like it or not, the Warriors weren’t certain that their big man is going to remain healthy. "We put a lot of money into believing he's going to be healthy," Warriors general manager Bob Myers said. "In this business, you're taking risks on players, whether they stay healthy or not. We used all our analysis, all the things we knew, all the information that was at hand with us to make the decision we did.” It’s not hard to imagine a future where people like Myers have access to information that involves DNA sequences.


But there’s another side to this. What if Bogut, who has only played in 44 games over the past two seasons, underwent genetic testing to show that he doesn’t harbor a gene mutation that predisposes to him injury? Should he do it? Perhaps it would allow him to more convincingly argue that he’s been the victim of freak injuries, statistical improbabilities that are unlikely to happen again.

Many find the genetic testing of employees or potential employees troubling, arguing that it's unjust to treat people differently on the basis of fixed characteristics, such as race, sex, or genetic endowment because people have no control over them. Others caution that certain genetic mutations are often associated with race or ethnic background and teams may discriminate. Genetic testing may also stigmatize a healthy athlete as genetically "defective" when, in fact, he or she might still go on to play a productive career. This sort of actuarial decision-making is not uncommon, but it's going to be interesting to see how it plays out on a stage as public and personal as professional sports.


Setting aside the ethical dilemma of genetic testing, I'm not convinced that there is a sufficient understanding of gene mutations to make the testing of professional athletes worthwhile, even if the player’s unions agreed to it. There are those broad indicators for a few diseases, of course; but what teams and fans really crave is a key that unlocks some magical spreadsheet. Roy Hibbert is 54 percent less likely than an average player to suffer an ACL tear, it might say. For now, that isn't realistic. But that may soon change as we identify more genetic defects that affect muscle, tendons, and cartilage and confer a high risk of profound musculoskeletal injury. We may soon be able to predict if Andrew Wiggins will spend his career in the spotlight or on the sideline. I'm not certain that's a good thing, but with so much money on the line it seems inevitable.

Matt McCarthy is board-certified in internal medicine. You can follow him on Twitter here.

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