76ers

What's next for Markelle Fultz? One physical therapist gives insight

What's next for Markelle Fultz? One physical therapist gives insight

With the news that Markelle Fultz has been diagnosed with thoracic outlet syndrome, there’s a lot to untangle.

On Tuesday, we spoke with Dr. Mark Schwartz, medical director for Virtua Sports Medicine, to gain a better understanding of Fultz’s condition (see story).

With physical therapy being the next course of action for Fultz in his rehab, we spoke with Josh Sabol on Wednesday. Sabol is a doctor of physical therapy and a sports certified specialist who works for The PrivatGym in Philadelphia. He’s treated professional athletes and dealt firsthand with TOS.

Sabol is not treating Fultz.

Why didn’t the Sixers diagnose this as TOS?

As has been mentioned, TOS is much more common in baseball pitchers than in basketball players. Sabol said this is because of the “repetitive, violent motion” pitchers use. While a jump shot is repetitive, it could hardly be described as a “violent motion.”

This may be the reason the Sixers — and a host of other reported specialists — didn’t reach this diagnosis.

“With a basketball player, that’s not going to be at the top of your list,” Sabol said in a phone interview. “Personally, I don’t think [the Sixers] missed it or misdiagnosed him. I will tell you that the symptoms of thoracic outlet syndrome can be very variable. You can see one patient that has these symptoms and the other person has totally different symptoms but it’s all classified under thoracic outlet syndrome. That’s the other thing that makes the diagnosis a little more tricky.”

10-plus specialists?

John Clark of NBC Sports Philadelphia reported that Fultz has seen over 10 specialists over the past year. It does seem odd that through all the evaluations, this hadn’t come up (according to Clark, one of the specialists mentioned TOS as a possibility but said it shouldn’t stop Fultz from playing).

The circumstances are odd.

“It’s surprising that it took [10 specialists] to get to the end diagnosis that they’re hanging onto,” Sabol said. “He’s spent more time in doctor’s office over the past two years than most of us have ever. That’s why it was surprising that they come out with this diagnosis because you would think somewhere along the line, somebody would’ve at least mentioned this.”

Scapular imbalance vs. thoracic outlet syndrome

The whole timeline of events isn't clear, but it’s interesting to note how this all started and where we are now.

Fultz was diagnosed with scapular imbalance last season. He then missed 68 games of his rookie season. While Sabol said the term scapular imbalance is pretty vague as far as medical terminology, he did have an interesting way of defining it — especially for those who think Fultz’s issue could just be the “yips.”

“[Scapular imbalance is] just a broad term to say your shoulder blade is not moving correctly,” Sabol said. “The treatment for that would come down to basically retraining him on how to move his whole shoulder girdle. In that case, it’s usually a brain-to-muscle connection. You kind of have to re-educate someone on how to move their shoulder blade and their whole shoulder girdle.”

Here’s where things get more confusing. Fultz dealt with the scapular imbalance and missed time last season. This offseason, he claimed to be healthy and reportedly took 150,000 jumpers with trainer Drew Hanlen.

If the thoracic outlet syndrome has been the issue since last year, how could he have gotten that work in? How would he have hit four threes in his first seven games to start this season?

“There was a point during this season where he was healthy, he was playing and he kind of worked out the kinks in his shot, but then all of the sudden he started to decline again," Sabol said. "That’s where things get confusing. His reported symptoms last season didn’t sound like TOS. A scenario where he had TOS last season and it went away without mention of that diagnosis, then all of the sudden came back, doesn’t seem like a common scenario. If it’s truly TOS, I believe that is something that developed recently.”

What's next

Fultz will now begin physical therapy with hopes of returning to the court. Sabol said it’ll likely be a mix of soft tissue work to stop the nerve from being impinged, and since TOS affects the neck as well, breathing exercises and better positioning/posture could help.

Fultz will reportedly be out three-to-six weeks. 

“(Within the first few weeks) you should see some type of change in symptoms,” Sabol said. “If not, then you’ve got to change the treatment. With really any diagnosis, which holds true for thoracic outlet syndrome, I wouldn’t say you would expect him to be 100 percent in three weeks, but you should at least see some improvement in his symptoms.”

Surgery an option?

And what if the physical therapy doesn’t work and Fultz is forced into a surgical option? Normally surgery would require the patient to have part of their first rib removed because that’s where nerves normally get impinged.

While it’s heavily a patient and case-dependent situation, Sabol said it should be a last resort.

“You see in baseball, it’s usually a career-ending surgery for these guys,” Sabol said. “They come back but their velocity is way down, they’re not nearly as effective. Matt Harvey is the most recent example of that. 

“Basketball, I’m not familiar with anyone that’s had it and come back so it’s hard, but to me, you want to make absolutely sure that you’ve exhausted all your conservative options before you go and start removing bones and structural things. I would tend to be much more on the conservative side so I would give it at least a few months before you just jump to surgery.”

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NBA Eastern Conference power rankings: As Bucks limp to finish line, Sixers starting to look dangerous

NBA Eastern Conference power rankings: As Bucks limp to finish line, Sixers starting to look dangerous

In this edition of our Eastern Conference power rankings, things are getting interesting at the top as we inch closer to the playoffs.

1. Bucks (53-19) Last ranking: 1
Milwaukee had one of its toughest weeks of the season. After the Bucks lost to the Sixers at home, they beat the Lakers before losing to the lowly Cavs. The biggest culprit is the injury bug which has ravaged their deep roster. Giannis Antetokounmpo missed two games with an ankle injury. Malcolm Brogdon and Nikola Mirotic are both out for an extended period. George Hill and Sterling Brown are also out. Milwaukee is limping to the finish line.

2. Raptors (51-21) Last ranking: 2 
There’s a chance Toronto could catch Milwaukee, though the Raptors are dealing with injury issues of their own. Kyle Lowry missed their win over the Thunder and will miss the rematch Friday night. Kawhi Leonard is still on his back-to-back restriction. The other thing I’m still curious about is Marc Gasol. He’s been OK. Meanwhile, Jonas Valanciunas has been really good for Memphis. He had a monster 33-point performance against the Rockets and has averaged 19.4 points over his last 11 games.

3. Sixers (47-25) Last ranking: 3 
Don’t look now, but the Sixers are the hottest team in the NBA. They’ve won six straight — including wins over Milwaukee and boogeyman Boston — and are now 7-1 when all five members of their new starting five are in the lineup. The Sixers have one of the easiest remaining schedules, but it seems unlikely that they’ll catch the Bucks. They appear to be a near-lock for the three seed.

I’m keeping them at three here only because of the body of work this season. With that said, the Sixers have to be looked at as a team nobody wants to face in the postseason. We’re just eight games into “Sixers 3.0.” This new starting unit may just be scratching the surface. Scary.

4. Celtics (43-29) Last ranking: 4
Boston continues to be one of the most confounding teams in the NBA. On some nights, they look unbeatable. On other nights … not so much. There still appears to be a struggle to mesh Kyrie Irving’s abilities as an iso player with Brad Stevens’ offensive system. It’s also evident that the Sixers picked on Irving defensively with great success Wednesday night. We won’t truly learn about the Celtics until the playoffs begin.

5. Pacers (44-29) Last ranking: 5
Indiana has dropped four in a row and that’s to be expected while missing All-Star Victor Oladipo and having one of the toughest schedules in the league to close out the season. The Pacers are clinging to the four seed but will likely drop and face off against Boston in the first round.

6. Pistons (37-34) Last ranking: 8
Detroit came back down to earth after its ridiculous run, but this is a team that’s figured some things out. The Pistons will go as far as Blake Griffin and Andre Drummond will take them, but it’s the recent resurgence of their perimeter players like Reggie Jackson, Wayne Ellington and Langston Galloway that’s fueled their recent success.

7. Nets (37-36) Last ranking: 6
I did struggle to drop Brooklyn because they did have a brutal road trip that took them to Oklahoma City, Utah, Los Angeles (to play the good L.A. team), and Sacramento. As their monster comeback against the Kings — in which D’Angelo Russell dropped 44 — shows, they can be wildly entertaining when playing well.

8. Heat (35-36) Last ranking: 7 
Miami is doing its best to hang on to that eighth seed with three impressive wins this week over the Hornets, Thunder and Spurs. Goran Dragic is rounding into form since returning to the lineup and has given Miami a huge boost off the bench. He averaged 22.3 points in the three wins and shot a sizzling 64 percent from three.

9. Magic (34-38) Last ranking: 9 
Orlando kept pace with Miami, winning three in a row as well. All three wins occurred after the arrival of Michael Carter-Williams. Coincidence? Yes, definitely.

10. Hornets (32-39) Last ranking: 10 
Charlotte gave the Sixers quite the scare, but it’s looking like the Hornets will come up short in their quest for the playoffs. It’s not surprising. All season in this space we referenced the need to get Kemba Walker help. That help never came.

11. Wizards (30-43) Last ranking: 11
Thomas Bryant looks like he might be a legitimate prospect. Other than that … #FreeBradleyBeal

12. Hawks (25-48) Last ranking: 12 
You have to respect what Lloyd Pierce is doing in Atlanta. The Hawks are coming off a nice win against Utah and Trae Young is making a late push to overtake Luka Doncic as Rookie of the Year. They won’t be a pushover for the Sixers Saturday.

13. Bulls (21-52) Last ranking: 13 
Same deal with the Bulls, who look like they might have something with the quartet of Lauri Markkanen, Zach LaVine, Otto Porter Jr. and Wendell Carter Jr. Though they’re playing to win, it would be something if they got the No. 2 pick and wound up with Murray State’s Ja Morant.

14. Cavs (19-53) Last ranking: 14 
Speaking of Morant, he’s looking like one hell of a consolation prize if Cleveland can’t get the No. 1 pick (again). A backcourt duo of Collin Sexton and Morant could run a few teams out of the building.

15. Knicks (14-58) Last ranking: 15 
They’re watching the NCAA Tournament with bated breath, hoping Zion Williamson gets delivered to them healthy.

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Sixers PA announcer Matt Cord on the origin of his pronunciations and his biggest fans

Sixers PA announcer Matt Cord on the origin of his pronunciations and his biggest fans

If you’re a Philly fan in a Sixers jersey walking down South Street, you may have been subject to an impromptu version of the Sixers' starting lineup intros.

“I’ll do the BEEEEENNNNN Simmons and they’ll look at me, like that guy's weird,” public address announcer Matt Cord joked.

Now in his 22nd season, Cord is always working on his craft, even if that means soliciting the reaction of fans strolling to their neighborhood bar. 

How he enunciates and emphasizes players names is constantly evolving, as are the physical movements he delivers them with, sometimes resulting in an inadvertent whack to those that dare cross behind his perch.  

For Cord, the starting lineup introductions are his performance, and the mic is his stage.

It wasn’t until about a handful of years ago that Cord started incorporating physical gestures into his routine. Out of necessity due to a neck accident, a stationary mic was switched out for one that Cord could move around with more freely, giving new life to his performance.

Recently, Stephen Curry approved.

“I totally knew he was watching everything, but I didn’t know anyone had taped it,” Cord said. “Now everywhere I go, people say that to me, ‘Hey! I saw that video Steph posted!'”

But, since Joel Embiid was out, there was one thing Curry missed.

“He missed my Process,” Cord said.

***

It’s true. There’s nothing quite like when Cord introduces the Sixers' "crown jewel" at Wells Fargo Center — especially if you sit behind the scorer’s table.

“When I do Joel ... from Kansas ... No. 21… JO-el, The Process EMMBEEEEEEEAD ... I turn around for ‘The Process,’ for whoever is sitting behind me.”

Take a look for yourself.

But, it wasn’t always this way.

In the summer of 2016, Cord ran into Embiid at a music festival.

“I go up to Joel and say, ‘Hey man, you’re going to start next year, and I’m working on your name and I need something else.'”

“Call me Hans, that’s my middle name,” Cord remembers Embiid saying.

“So then, the very first game, I see him in the back (at the arena), and I’m like Joel HANS Embiid, and he’s like, ‘No, no, no. I’ve changed it to ‘The Process.’ He was joking around, and he said he legally changed his name to The Process, so you have to call me The Process.”

Cord, worried Embiid could get in trouble, decided against it.

“I didn’t do it the first game … and he kind of looked at me a couple times in the game when he scored.”

And now, the rest is history.

***

Embiid isn’t the only player who has influenced Cord’s introductions.

“Years ago, (Allen) Iverson came up to me and said, ‘Make me 6-2.’"

And so, Cord obliged.

“And finally … a 6-2 guard…

“The next game, I did it again. And the next game, Eric Snow (formers Sixers point guard) came up to me and said, 'Can you make me 6-4?' And I’m like no, stop this, I’m going to get in trouble, everyone’s going to be seven feet by the end of this!”

Lucky for Cord, that same game, Iverson re-thought his request.

“He came up to me and said I think we better go back to six-foot.”

***

If you catch Cord at the arena, there’s one thing you’ll always see him doing: Smiling.

“Honestly, since I’ve been here, and I know you can’t have a bad game as a PA announcer, but he’s just always smiling,” T.J. McConnell said. “And just the way he announces so enthusiastically, he comes up with these things like Three-J (when McConnell shoots a three), and even stuff he said when I was a rookie with Ish Smith, like a 'dish from Ish.'”

Well actually, Cord doesn’t come up with all of those sayings. But, he did come up with Three-J.

Longtime statistician Ron Pollack has offered up sayings like, "Dish from Ish," "Feed from Embiid," and "Embiid indeed!" It’s a joint effort.

***

For players like JJ Rrrrrrrrrredick and Allennnnnn Iiiiiii-versooooonnnn, both say that when fans come up to them in the streets, they say their name like Cord says their name.

“That’s the coolest thing ever,” Cord smiles.

But what means more to him than anything else is his biggest fan, his almost 16-year-old niece, Lily, who has Down syndrome.

“She is fantastic, she imitates me. She can do Embiid. She can do Iverson,” Cord said as he pulled out his cell phone.

“Here she is doing Bobi, down by the beach.”

Watch out Matty, Lily might be coming for your job.

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