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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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With richest contract in Sixers history, all eyes are on Tobias Harris

With richest contract in Sixers history, all eyes are on Tobias Harris

They say the only constant in life is change. 

You don’t have to tell Tobias Harris that. Harris has played for five teams in eight seasons so the Sixers’ roster upheaval this summer doesn’t faze him much.

The biggest change for the forward is something he’s craved for years: The opportunity for stability and, as Mike Scott would say, to “cash out.”

He has that now after signing a five-year, $180 million deal. It’s the richest contract in Sixers franchise history. With that come expectations for Harris and the Sixers. The team is banking on the 27-year-old to continue his NBA ascension and help realize their championship aspirations.

And Harris believes he’s ready to accept that challenge.

The press conference at the team’s practice facility last Friday welcomed Al Horford, Josh Richardson, Kyle O’Quinn and Raul Neto and welcomed back Harris and James Ennis. Harris’ role on the court became a big topic. 

When Harris arrived from the Clippers, he was coming into a situation where Joel Embiid, Ben Simmons and JJ Redick were established and Brett Brown was still trying to figure out how to use Jimmy Butler. With Butler in Miami and Redick in New Orleans, the pecking order has changed. 

While it probably wasn’t fair to expect Harris to fit seamlessly into that situation in just 27 regular season games — many without a healthy Embiid — he’ll have an entire offseason and training camp to assume a larger role.

I know last year, when you come over from a trade, with the talent level of this group, obviously had to sacrifice for the unit,” Harris said. “But I know my game, I know how I continue to improve year after year, and I look to come into next year with that type of energy, that type of fire to improve my game and show different parts of my game, too. Obviously being more with the ball in my hands in different situations, and I'm ready for that. I've been working out all summer to get ready for that position, just to help our team grow and get further than we were last year and contend for a championship. That's the only thing on my mind.

The idea of giving Harris a max contract — granted he took $10 million below the max — wasn’t necessarily a no-brainer. He’s never been an All-Star and last season was just the second time he’s been to the postseason and the first time his team advanced beyond the first round.

But the Sixers are counting on Harris to continue his trajectory. Last year was easily his finest NBA season. If he’d spent the whole year in the East, he likely would’ve played in his first All-Star game. He scored a career-high 20 points a game and shot just below 40 percent from three. There’s a reason Elton Brand paid a hefty price to acquire Harris.

It certainly didn’t go as planned for Harris and the Sixers. Harris was inconsistent both in the regular season and playoffs, but his postseason performance was especially marred by a rough Game 4 against the Raptors in which he shot just 7 of 23 and 2 of 13 from three. A couple more makes and perhaps the Sixers would’ve returned to Toronto with a commanding 3-1 lead.

Did the pieces ever quite fit for the Sixers last season?

Not as well as they should've,” Harris said. “We had good little spurts of it but they weren't really consistent for us. I felt like what we got out of it as much as we could've in that timeframe with the different types of games, different types of personalities or whatnot. We needed more time. We needed more time, we needed more cohesiveness. That's something that we have now, so we have to really maximize that fully.

Butler was tremendous in the playoffs as a shot creator and clutch shot maker and Redick played a critical role in the Sixers’ offense.

But “the different types of games” and “personalities” should help Harris flourish. Replacing Butler and Redick with Horford and Richardson will likely help with ball movement, something Harris has said since he arrived in Philadelphia that he thrived with.

At times toward the end of the season, Harris did initiate the offense occasionally. He showed an ability to run the pick-and-roll as a ball handler — something Brown hasn’t run a ton of in the past, but did with Butler. There also could be potential with Harris to run a little of the two-man game with Embiid. Embiid and Redick were deadly using dribble handoffs. If Harris shoots at the level he did in Los Angeles, running that with Embiid could be equally lethal.

Harris is ready to assume a similar role to Butler, but also sees an opportunity for his teammates to shine in clutch situations.

A lot of times what we ran for Jimmy was high screen-and-roll, put the ball in his hands,” Harris said. “I've been best with the ball in my hands for some years now. I definitely think of myself as being that person with the ball in their hands. I look at us as a team, also. I think if a guy has it going or there's a mismatch, we can excel at that. That's what I really work for, those type of moments and opportunities.

So now he has stability. He secured the bag, as the kids say. He’s also looking at a role as one of the team’s focal points offensively.

There's certainly added pressure, but in Harris’ case, change is good.

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Source: Sixers, Ben Simmons reach 5-year contract worth $170 million

Source: Sixers, Ben Simmons reach 5-year contract worth $170 million

It felt inevitable, and now it’s done.

The Sixers have signed All-Star Ben Simmons to a rookie max contract extension for five years and $170 million, a team source confirmed to NBC Sports Philadelphia. Shams Charania of The Athletic was the first to report the deal.

While Simmons still has work to do on his jump shot and game as a whole, there was more risk in not getting this deal done. It was a no-brainer for both sides. For Simmons, it’s obvious: This is the most money for the most years he can possibly get. For the Sixers, it avoids the possibility of a major headache next offseason.

The Sixers could’ve let the season play out and let Simmons become a restricted free agent next summer, meaning they would’ve had the right of first refusal. Part of it is peace of mind for Simmons. He can play this season without that potential extension looming over him. It’s also peace of mind for the team. They know the cap situation and won’t have to answer constant questions about “why they don’t believe in Simmons” or something to that effect.

While the Sixers could’ve certainly matched any offer Simmons would have gotten as a restricted free agent, it’s a super dangerous game to play. The Sixers are going to be right up against the cap for the foreseeable future with Tobias Harris, Joel Embiid and Al Horford all locked in. Another team could have had Simmons sign an offer sheet for a shorter term — the shortest term a team can offer is two years — but for a higher salary. If you match that, it could mess up your cap plans and you’d also only have Simmons for two years. It's similar to what the Nets did with "poison pill" offer sheets to players like Tyler Johnson in the past. You also run the enormous risk of souring what’s been a good relationship between the player and the team.

And it appears Simmons isn’t taking the new extension and higher expectations lightly. After making an announcement earlier this summer that he’d be playing for the Australian national team in the FIBA World Cup this summer, Simmons may be changing course. He’s now reportedly “doubtful” to play for Australia so he can “spend his full offseason preparing only for the Sixers season,” per ESPN’s Adrian Wojnarowski. He’s already had an active offseason on social media, posting photos of himself working out with other NBA players – including Harris – in Los Angeles with trainer Chris Johnson. Johnson has trained several NBA players, including the departed Jimmy Butler.

Simmons, who will turn 23 later this month, was a first-time All-Star in 2018-19. It’s clear the Sixers view the Australia native as a franchise player for years to come – that’s the biggest reason this came together so quickly.

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