Fultz Is Out Until Further Notice
Another season for the Sixers, another rookie on the shelf. Fultz is seeing a specialist about his shoulder pain that is now limiting him from lifting his arm above his shoulder. The rumor has been that shoulder pain is the reason for the change to his shot. Most evident in his free throw form there is a noticeable difference between his shot at Washington last year and with the Sixers this year. Specifically Fultz has a much lower release point because he is not moving his arm above his head. There are a number of problems that could be the cause but there are clues to point us toward what could be the cause of his shoulder pain.
What We Know
Fultz is unable to bring his arm above his head without pain, this is evident on his shot and he has lost 15 to 20 degrees of motion at minimum. Second we know that he had a cortisone injection in the shoulder, this narrows down the possibilities. It does not seem to affect him when his arms are below his shoulder height which allows him to dribble and pass without much change. The start of the pain was between summer league and training camp as he had his change in form prior to the preseason games. Fultz put on weight between his final games at Washington and his NBA debut (at least the 5 lbs listed) which is likely from gym work. The Sixers felt he could play through it which suggests an MRI revealed no significant damage to the shoulder. This is due to the Sixers being keen to operate early and often with their players during The Process.
What We Do Not Know
We do not know if this was an accumulation of pain over time or if it was an event such as a fall on his shoulder while training. This would help tell us what structures are in pain as well as if the shoulder is the primary issue. There is also a lack of transparency about his training routine after summer league. This would tell us how this issue and if it came up over time and led to a gradual change in his shot. There seems to be a no pain no gain problem with the treatment of Fultz. Why treat him different than the past seasons when a stubbed toe would warrant a month out for anyone with a modicum of NBA talent?
What Our Information Tells Us
When it comes to what we do and do not know we can conclude Fultz is unlikely to have a structural tear or damage because the Sixers are quick to operate in that case. This means that his labrum, rotator cuff, and bones appear healthy on MRI and x-ray. Because we know there is swelling in the shoulder we know that the structures are irritated. This can cause a lack of space issue for the shoulder muscles and other tissues. The fact Fultz is unable to comfortably lift his arms above his shoulder means the pressure to the muscles and tendons is at a point where it causes pain. This range is consistent with a secondary impingement from overuse or trauma to the shoulder. In other words the shoulder does not have enough space for the muscles to contract and move. The most likely culprits to the problem are bursitis, tendinitis, or a muscle strain.
In our joints there are sacs full of fluid. They act as cushions between bone and other tissue such as muscle and tendon. This helps reduce friction. Overuse of the shoulder can cause swelling and an increase in fluid in the shoulder. This can further irritate the muscles of the shoulder including the rotator cuff. This can limit a person even with simple tasks such as dressing. For bursitis to recover the person needs to rest for a brief period and recover pain free motion before returning to resisted or forceful movements of the shoulder. This includes repetition with shooting.
Tendons are the tissue that attaches muscle to bone. Inflammation or irritation of the tendon can occur from a strain such as a pull or stretch. It can also occur over time due to repetitive wear. The common tendons that affect the shoulder are the rotator cuff and bicep tendons. This could be the case for Fultz due to over training in the off season and matches up with his weight gain in the last 6 months. To recover from tendinitis a decrease in activity and recovery of strength while following pain response rules is necessary. This means that pain for the sake of pain will not help recovery.
Muscle Strain (Tear)
A muscle strain, or partial tear, can cause swelling and inflammation. This can be due to a quick motion or overtraining of muscle that results in damage. A partial tear is more likely in the case of Fultz because an MRI is more likely to show a full tear. Also a full tear would likely result in a loss of strength. For a partial tear treatment tends to be around giving the muscle or tendon time to heal with rest. After an initial rest phase the focus is on improving control and motion of the shoulder. Lastly strength and endurance exercises are necessary to fully recover. This is very much like recovery from a bad ankle sprain.
The Best Part
We learned that Fultz is a fighter. A player that even after injury wants to push forward and contribute on a team. This is also a reflection of the culture in the Sixers organization switching to what most would call a “winner’s mentality” or a win now mindset. We can only hope that this does not translate into being reckless with a player’s future. Some people during recovery need to be pushed and some need to be held back. Right now Fultz just needs to be held back.