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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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Sixers at Nets: 3 storylines to watch and how to stream the game

Sixers at Nets: 3 storylines to watch and how to stream the game

The Sixers (28-16) are looking for their second straight road win in Brooklyn against the Nets (18-23) on Dr. Martin Luther King Jr. Day.

Joel Embiid will miss his seventh straight game as he recovers from surgery to repair a torn ligament on the ring finger of his left hand. Al Horford is also listed as questionable (sprained left hand), possibly leaving the Sixers in a tough spot at center.

The Nets are also banged up at the five as DeAndre Jordan (dislocated right middle finger) is out. They’ll also be without former Sixer Wilson Chandler (left hamstring tightness).

Here are the essentials:

When: 3 p.m. ET with Sixers Pregame Live at 2:30 p.m.
Where: Barclays Center
Broadcast: NBC Sports Philadelphia Plus
Live stream: NBCSportsPhiladelphia.com and the NBC Sports MyTeams app

And here are three storylines to watch:

Hurting at the five

The Sixers have gone 4-2 since Embiid went down. Though Horford’s play has been up-and-down, he’s a big part of the reason why. If he misses Monday’s game, Brett Brown will be in a difficult spot.

Two-way player Norvel Pelle is coming dangerously close to his 45 NBA days running out. When that happens, the Sixers will either have to offer him a full NBA deal or Pelle will be able to sign with another team. The plan is for him to be active today, but that plan could change.

The other main option is veteran Kyle O’Quinn, who saw his first action of 2020 against the Bulls Friday. Jonah Bolden is with the team in Brooklyn. In a pinch, they could have him dress.

Road woes over?

The Sixers barely snapped their six-game road losing streak at Madison Square Garden Saturday night in a 90-87 win over the Knicks. Yes, it was against a bad team, but it has to help their psyche just to put one in the win column away from the Wells Fargo Center. 

They’re playing a dangerous Brooklyn team. The Nets have lost three straight, but those games were to the red-hot Jazz, the Sixers and the NBA-best Bucks. Kyrie Irving came out humming after returning from his injury, but has struggled in the last two.

Unlike last season, the Sixers are well-equipped to handle the likes of Irving, Spencer Dinwiddie and Caris LeVert. We saw what Ben Simmons, Josh Richardson and Matisse Thybulle were able to do to that trio last week in Philly. This should be a good one.

MLK Day

The slate of NBA games on Dr. Martin Luther King Jr. Day has become a tradition. It’s one that players around the league don’t take lightly.

Tobias Harris addressed the Wells Fargo Center crowd before the Sixers’ last home game before MLK Day. Harris spoke about King’s message of love and equality.

“Martin Luther King stood for equality. He stood for love. Amongst everybody, all the different individuals of life, to be able to walk out and embrace each other and cherish everything that we do on a daily basis. In our world, what he and his message brought to everybody, is meant for now more than ever. On behalf of myself, the NBA, the organization and my teammates, we want to thank you guys for being here tonight and to also celebrate and cherish the life of Dr. Martin Luther King, Jr."

Harris was excellent that night, scoring 11 of his game-high 34 points in the fourth quarter to help seal the win.

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2019-20 NBA power rankings: Taking stock heading into the second half of the regular season

2019-20 NBA power rankings: Taking stock heading into the second half of the regular season

With the trade deadline a little over two weeks away, every team in the NBA has played at least 41 games.

Let’s take stock as the second half of the regular season begins: 

The top 10

It took the second triple-double of Markelle Fultz’s career Wednesday to snap the Lakers’ nine-game winning streak. 

Jimmy Butler has gotten to the free throw line in every game he’s played besides one this season and is third in the NBA in free throw attempts per game (9.3).

Mike Conley returned from a hamstring injury Saturday for Utah, and the Jazz have won 16 of 18.

The Rockets have lost three straight and the Mavs have won four straight, but Dallas has a difficult upcoming schedule with the Clippers and Jazz on tap this week. 

Ben Simmons has been stellar in just about every way besides fourth-quarter scoring for the Sixers in Joel Embiid’s absence and is averaging 21.3 points, 9.5 rebounds and 7.3 assists over his last four games. 

Though Marcus Smart set a franchise record with 11 threes and scored a career-high 37 points in Saturday’s defeat to the Suns, Boston has lost three in a row. 

1. Milwaukee Bucks (38-6) 
2. Los Angeles Lakers (34-8)
3. Los Angeles Clippers (30-13)
4. Denver Nuggets (29-13) 
5. Miami Heat (29-13) 
6. Utah Jazz (29-13) 
7. Dallas Mavericks (27-15) 
8. Houston Rockets (26-15)
9. Sixers (28-16) 
10. Boston Celtics (27-14)

The middle 10

The Raptors shot over 50 percent from the floor in every game this week and could easily be higher in our rankings — it’s tightly bunched in the six through 12 range. 

Memphis has seven straight wins. Ja Morant is mesmerizing, and both he and Jaren Jackson Jr. are shooting over 40 percent on threes. 

Kyrie Irving talked Wednesday at Wells Fargo Center about the Nets requiring “one or two more pieces,” then reached out to teammates to clarify his comments.

Zion Williamson is expected to debut Wednesday vs. the Spurs, exciting news if you enjoy basketball. 

After their trade with the Kings, Portland got 34 points from Damian Lillard and a career-high 30 from flu-stricken Gary Trent Jr., and they still lost by 13 to Oklahoma City.

11. Toronto Raptors (28-14)
12. Indiana Pacers (28-15) 
13. Oklahoma City Thunder (24-19) 
14. Memphis Grizzlies (20-22)
15. Brooklyn Nets (18-23) 
16. San Antonio Spurs (18-23) 
17. Orlando Magic (20-23)
18. Phoenix Suns (18-24) 
19. New Orleans Pelicans (16-27) 
20. Portland Trail Blazers (18-26)

The bottom 10 

The Bulls’ last win over a team currently in playoff position was on Dec. 14, but Zach LaVine is putting up big numbers, including 42 points Saturday vs. Cleveland, and trying to push for a home All-Star appearance

Sekou Doumbouya, the league’s youngest player, scored 24 points on 10 of 13 shooting Wednesday night at TD Garden. 

It appears that a clear bottom four has separated from the pack. Stephen Curry is targeting a March 1 return, according to The Athletic’s Marcus Thompson. 

21. Chicago Bulls (16-28)
22. Sacramento Kings (15-27) 
23. Detroit Pistons (16-27)
24. Minnesota Timberwolves (15-27) 
25. Charlotte Hornets (15-29)
26. Washington Wizards (13-28)
27. Cleveland Cavaliers (12-31)
28. New York Knicks (11-32)
29. Golden State Warriors (10-34)
30. Atlanta Hawks (10-33) 



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