Rush The Court

John Stevens is a featured columnist for RTC.  His columns will appear on Tuesdays throughout the season.

Fine.  If it has to be me, then it has to be me.  I don’t mind, I’ll take the heat.  I’ll be the one to bring up the subject that nobody else wants or has the stones to bring up.

I’m calling him out.

I don’t know what Tyler Hansbrough’s plans are for this Wednesday, but they had better involve showing up at Ford Field in Detroit at around 9pm.  In uniform.  Ankles taped.  Ready to play, a self-proclaimed 100% healthy.

Or, they better involve not just a DNP, but a long-term hiatus from basketball.

Now, I know that, in college basketball circles, saying anything negative about Tyler Hansbrough is just the worst thing you can do.  To know that he has an injury but still demand that he get out onto the floor and actually play basketball paints me as unfeeling, a heathen — possibly even a heretic, given the public perception of Hansbrough, his head coach Roy Williams, and the entire UNC basketball program which has gotten to the point to where the image surrounding all of them can only be described as, well…almost HOLY, for some reason.  I might as well go tell a bunch of little kids that I hate puppies or a roomful of girls that I can’t stand weddings.

I don’t care.  I’ll be the one to suggest that there’s an ugly truth behind the false beauty.  I’m going to point at the emperor and call him naked.  Someone has to say it, and I’m volunteering, because it’s best for college basketball – and for Tyler Hansbrough – that he and his handlers make a decision on his status once and for all.

I say “he” because that’s who the play-versus-sit decision evidently falls to before every game.  Since the season began, we’ve heard that Hansbrough is the one who determines whether he’s well enough to go or not.  We’ve heard nothing about team physicians or their opinions.  We’ve seen Ol’ Roy (expectedly so, since it’s what you’re supposed to do) talk about how Tyler’s just rip-roarin’ to play and how they basically need to use chains to keep the guy on the bench…but the decision to play or not has still been Hansbrough’s.  The only thing close to an exception has been their last game against UNC-Asheville where we were told that Hansbrough was “held out,” though it wasn’t specifically stated who did the holding.

That in mind, let’s look at Tyler’s season so far.

The DNP against Penn wasn’t surprising.  The “stress reaction” was relatively new and, with all due respect to the Ivy League, it was the first game and it was against Penn.  Enough said. 

Then came the game against Kentucky, the headline event (which turned out to be a snooze) on ESPN’s 24-hour de-facto opening night marathon of college hoops, a game that was hyped as much as any Final Four match-up in recent years.  I thought Hansbrough would play in this one, since in last year’s UK-UNC game (which also featured a #1-ranked Tarheel team against an unranked Ketnucky), in his sixth game as a collegian, Kentucky’s Patrick Patterson largely outplayed Hansbrough and I thought the reigning POY would want to exact revenge in such a high-profile game.  When Hansbrough sat out, I began wondering if this shin injury was worse than we were being led to believe.

But then, the puzzler.  Three days later against Cal-Santa Barbara…Hansbrough started and played 25 minutes.  So let me get this straight – you DON’T play in a hugely-hyped game in prime time against one of your arch-rivals in Kentucky because of this injury, but you DO play three days later against UCSB?  Could those three days have made that much difference for the stress reaction?  If what we hear about Hansbrough’s desire to play is true, that they basically have to tranquilize him and put him in a cage to keep him from playing, it seems to me that the game he’d WANT to play in is the Kentucky game, since he’d be the headline player on the headline team in the headline game in that situation, and it would have afforded him the chance to go up against Patterson again.  Any highly-confident, top-flight athlete would LOVE that stage on which to perform.  I can’t buy that the three days between the games made that much difference to this nebulous, ill-defined injury – at least not a Kentucky-to-UCSB difference.  Then the thought, sinister as it is, crept into my head – maybe Hansbrough didn’t want to run into Patrick Patterson again, especially on prime-time TV (and right there in front of Erin Andrews, and all).

Three days after playing against UCSB, Hansbrough logs another DNP against Chaminade in the Maui, but then plays on consecutive nights against Oregon (19 minutes) and Notre Dame (a 30-minute, 34-point performance).  His appearance in the Notre Dame game had me rethinking the issue until I learned that Luke Harangody HAD FREAKING PNEUMONIA which certainly made Hansbrough’s night relatively easier (even though Harangody, after receiving a day’s worth of IV fluids, did put up 13 points and 7 rebounds in 27 minutes against him).  At this point, with UNC having claimed the Maui in most impressive fashion, everyone assumed Hansbrough was healthy and that the issue was settled. 

Four days later he DNPs in that pantsing of UNC-Asheville and now we hear that he’s a game-time decision for the chance to play in front of a leviathan crowd at Ford Field tomorrow against the highest-ranked team they’ve faced so far this season.

College basketball fans, and especially UNC fans, should be getting sick of this.  I began thinking Hansbrough was ducking certain teams/players or sitting out of “meaningless” games, or maybe that his coaches were really keeping him out of games where he might not be truly needed.  This would be especially alarming, because…well, you have to play them all, or at least make it apparent to the rest of the team that the guy is at least willing and able to go.  You can’t play the guy in some games and sit him in others because, despite Hansbrough’s valuable future, that’s even more insulting to your opponents and the game overall than a 70-point bitch-slapping.  Either be a college basketball player, or don’t, you know? 

But rather than fall victim to this negativity, I felt that I should go learn more about this injury.  Now, what I’m about to describe is not the result of a double-blinded, well-powered, randomized controlled trial.  It’s the result of me talking to a couple of orthopedic surgeon and radiologist friends and some internet searching, so take it however you want.  There are probably orthopods and radiologists out there who can explain it better than me.    But here’s what I found as far as how this works…

An athlete – say, a college basketball player – notices some pain somewhere in his lower leg after practices/games and decides to go to his coaches and/or team trainer/physician about it because it’s not going away.  It’s not bad, but it’s annoying enough for the player to seek advice about it.  The team physician will probably ask very specific questions about this pain (sharp or dull?  Constant or intermittent?  What makes it better or worse?) and do a complete physical exam. 

As helpful as all of that is, the doctor will probably send this athlete for some kind of imaging of this leg – like (in usual ascending order of image quality) an X-ray, and/or maybe a CT scan, bone scan, or an MRI.  Based on what is found on those images, the treatment plan is determined.  In fact, it’s just flowchart thinking at that point.  You see this on your imaging?  Well, here’s your treatment plan.  It’s already been determined by decades of medical practice.

So let’s say our athlete has some imaging done and his doctor tells him hat he has a “stress reaction,” implying that it is NOT an actual stress fracture, but rather a condition of  “pre-fracture.”  There’s no guarantee that the injury will develop into a fracture with continued use, but there’s medical evidence that says it’s certainly more LIKELY to happen in that area.  And with continued pounding and loading of that bone (like with continued running, jumping, etc.), it sure as hell ain’t gonna get any better.  How did the doctor come to this diagnosis?  From the way the specific area appeared on the imaging, or combination of various imaging studies like X-ray or MRI.  You can see what the bone is doing on these pictures.  Is it building itself up or is it breaking down?  Is there a fracture or just some irritation or swelling?   Most likely in a stress reaction, the doctor will not see an actual fracture line, but rather a change in color or density in that part of the image taken.  As noted above, based on that appearance, the treatment plan is pre-determined.

And this, my friends, is the compelling part of this whole situation to me.  I don’t know whether Hansbrough’s leg has been put in the X-ray machine or the MRI scanner or whatever (I’d assume it has, since he’s a big-time athlete at a big-time program), but once something – ANYTHING – is found on any imaging study, the decision to play or not play is no longer Hansbrough’s to make.  Not if his best interest is being considered.  The ONLY way that Tyler Hansbrough should be asked “Can you play tonight or not?” should be if his doctor’s examination and the imaging studies showed a TOTALLY NORMAL leg.  The results of the imaging studies are graded on severity and that is what determines the treatment plan.  The MINIMUM – and here is where I did indeed find some ranging of opinions – rest period (since rest is the only real treatment for a stress reaction) based on imaging is THREE WEEKS of consecutive rest.  Has Hansbrough had this?  And since the injury hasn’t improved clinically, should he even be trying to play or practice?  If there’s even a hint of a fracture line on those imaging studies, some people say that a minimum of 6 to 16 weeks (!!) of rest is warranted. 

This leads me to believe that one of two things is happening, here.  We have to assume that Hansbrough and his coaches are aware of what was found on the imaging studies, assuming they were done (there’s really no doubt they were done).  If Hansbrough is allowed to practice or play on his injury, either his imaging showed nothing and his leg is totally normal except for an unexplained pain, OR his coaches are ALLOWING him to play on an injury they know should be rested longer, most likely because of Hansbrough’s intense desire to play that we keep hearing about, and the program’s desire to win.

If it’s the first, and Hansbrough has a totally normal leg after his doctor’s physical exam and by the imaging, then the guy’s got no excuse to be missing a second of practice or game action.  Basically, he’d just need to suck it up and get out there in the assumption that nothing’s wrong with his leg.  It would definitely warrant a downgrading of his nickname from Psycho T (majorly depressed T?  seasonal affective disorder T?).  But if it’s the second of those possibilities, other questions have to be raised.  I’m a big admirer of players who  play through pain to help their team.  I’m all for putting team first and self second.  But in this case, where the athlete in question has millions of dollars waiting on him that are dependent on his health, if there was something on that imaging (and, I’m assuming, multiple re-imaging to assess progress), if I were a coach or a team physician I’d be putting Hansbrough on the pine if I was really worried about his best interests.  Plus, it’s not like this UNC team needs him.  The way they’ve looked this year so far, with those basically un-guardable guards and the play of Deon Thompson and Danny Green, UNC’s just fine without him for a while.  Plus, a full 20% of the regular season schedule is over.  Can Hansbrough really do anything to improve his draft status at this point?  Or can he do more to hurt it?

I’m not going to sit here and try to figure it out or place blame on either Tyler Hansbrough or the coaches/physicians.  As far as I know, nobody knows what his imaging studies have shown or how this is being handled behind the scenes.  I’ll leave that to the readers of this column, and I’d love to hear what you think.  I’ve got to tell you, because I’ve even slightly implied something negative about the UNC basketball program, I feel like Winston Smith in Orwell’s 1984.  I’m convinced that I’m going to be followed, my house will be bugged and my phones tapped.  I’m convinced that I’ll walk out to my car tomorrow and find at least one flat tire.  Hell, I’m even afraid to start the thing.  Before you go climbing telephone poles and putting steak knives in my Goodyears because I’m questioning something about Carolina basketball, all I ask is that you consider the question.  A diagnosis of a stress reaction mandates a certain treatment — and it seems that if the injury is persistent, even more caution is warranted.  Has he received even the minimum time-off for the injury?  Maybe so.  But it isn’t any better.  Logically, either the leg is fine and Hansbrough needs to suck it up and play ALL the time, or he’s being allowed to continue to practice and sometimes play on a leg that is apparently begging for rest.  It’s not my job to lay blame or tell these people what to do, because they know better than me.  But whatever’s being done for Mr. Hansbrough, let’s hope the insiders and decision-makers in this situation have done a true, honest risk-versus-reward analysis and figured out what’s best for this guy and his future.