Below is a Q&A with Lakers head athletic trainer Gary Vitti, who offered insight on Julius Randle’s season-ending leg injury, his recovery and how the Lakers handle his workload heading into training camp beginning on Sept. 29 in Hawaii. I detailed Randle’s efforts in those areas as well as his improved dietary habits in the print edition. But below is an expansive transcript of part one of my interview with Vitti earlier this summer at the Lakers’ practice facility in El Segundo.
How do you think Julius has handled the playing restrictions during Summer League?
Vitti: “Before he went, I told him he was not going to play on a back-to-back. He would play at a maximum 20 minutes just to start out the first couple of games. Then he would not play more than 5 minutes in a row. That’s hard to do. That’s hard to get in a rhythm. But I wanted him to understand that was the plan.
He and I sat down. I said, ‘We have three goals for you. A short-term goal, a mid-term goal and a long-term goal. Short-term goal is to have you playing in the summer league. There’s no guarantee that he was ready to play. The mid-term goal was first day of training camp at full tilt. The long-term goal was the first game of the season. We would not sacrifice one of the first two goals for the third goal. The ultimate goal was to have him ready to play the first game of the season. That would be about one year because he had gotten hurt the first game of the season.
In orthopedic circles, they consider a tibia fracture with a rod to need around 90% healing of the bone. That is good enough to go. He’s more than that. But it may take a year or a year plus before there’s absolutely no translucency in the x-ray at all. You might still see a little bit of a fracture line. But in orthopedic circles, there’s enough bone healing to handle the loads. He’s healed. But then as you load soft tissue or bone, it will lay down more soft tissue and more bone to handle the load. If the load is put on the soft tissue or the bone, before you lay down more bone and soft tissue to handle the load, then that tissue, whether it’s soft tissue or bone, will start to go through some metabolic change and eventually come apart.
If you keep loading the tendon that isn’t prepared for that load, then the tendon will become inflamed. If it’s not handling the load correctly, then the tendon will become inflamed and you will get tendinitis. If you keep loading a tendon with tendinitis, eventually you will change the properties of the tendon and you’ll get tendinosis.
Then the bone could start to go through a metabolic change. You have a stress reaction. If you keep going on a stress reaction, eventually you’ll have a stress fracture. If you continue to go on a stress fracture, eventually you can get a comminuted fracture. The bone will fracture. Even though his bone is healed, we want to apply the loads gradually not just to the bone, but to the soft tissue too to avoid any other injuries. He’s probably going to be fine with that rod in there. That bone is stronger now than what he was born with. But there’s other things that can happen as well.
So you take a 20-year old kid who feels great and thinks he’s invincible and one of the strongest people on the court and he knows that. He knows that he’s strong. When he wants to move somebody, he just moves him. Then you have me telling him, ‘You are not as strong as you think you are.’ Not in the sense that he can’t move people. But his structures need to be loaded in a way that we can bring him back without risking anything else happening to him.
He started out with non-weight bearing. Then he started out walking. Then he started out with partial weight-bearing running and then there’s full weight-bearing running. He went one-on-one. Then he went two-on-two. Then he played three-on-three. Eventually he got to four-on-four and five-on-five. Then he got to full contact and full court. But everything that we did cannot mimic a summer league game.
So no matter what we do – we bring in officials, we scrimmage, have a little intrasquad scrimmage, that’s more than what he was doing before. But it’s not as much as summer league. No matter what they’re doing in summer league, it’s not going to mimic training camp. We’re going to play eight preseason games . Whatever those eight games are like and the practices in between, even though the loads and intensity are going to be greater than what we experienced in summer league, there’s still not going to be the same as a real NBA game. When you’re playing with your five guys and playing against their best five, there’s nothing you can do to recreate that. I don’t think people fully understand that. So it takes somebody like me to protect him from himself.”
What was Julius’ reaction to all that?
Vitti: “He was angry. Once he had to actually had to do it that first game and only play five minute spurts and only play 20 minutes total, he couldn’t get into a rhythm. That’s an art in this league. That’s why some people can come off the bench and some people can’t. You can come straight off the bench and somehow find their rhythm. Other people have to get into the game and everything. He was angry.
He called me right after the first game. But I missed a call. So I wrote back, ‘Julius, just saw you called. If you want to chat, great. If you called to tell me you want to play tomorrow because it’s back to back or if you called me to tell me you want to play tomorrow or you want more minutes, have a nice day off, use it to recover and keep it in perspective. It’s your first game back and it’s a summer league game. The NBA is a marathon, not a sprint. I love you for wanting more. Someday you’ll love me for making you do less.’
That was the first text. So then he didn’t play the second game. Then after he played the third game, he was even more frustrated. Then I wrote to him, ‘I know you’re frustrated with the minute restriction and how hard it is to get into a rhythm. Don’t focus on it too much. Don’t force it. Slow down and let the game come to you. Once it does, then you can turn up the speed and be under control. You’ll be fine. Someday this will be a distant memory. Trust me on this.’ He wrote back, ‘Got you G, Thanks.’
Then you saw [the next game], he did much better. At halftime, I wrote to him, ‘Much better. Proud of you.’ He wrote back, ‘Thanks GV.’ He’s starting to get it. I wanted to get him on the court with nine other people in a competitive situation. I wasn’t trying to have him show the world what he can do.”
So what will be the plan for Julius once training camp starts?
Vitti: “The plan is we get to the first day of training camp, we talk to our doctors and hopefully he will be able to participate in everything. But men plan and God laughs. So that’s the plan. That’s the mid-range plan. I said there were three goals. First is to get him to play in summer league. Second goal was to get him at first day of training camp and get him to do everything. Third goal is to get him to play in the first regular season game without restrictions.
We achieved goal one. Now we’re moving toward goal two. We won’t know if we’ll achieve that goal until we get there. But he’ll be evaluated then. Then we’ll make that decision when we get there. We certainly will not sacrifice goal two just to say he’s doing everything in camp. Ultimately, we’re looking at the first game of the season. If he’s not ready to play unrestricted games of the season, then he’s not ready. Then, the next goal is when he’s ready, he plays. But we’ve got our fingers crossed that he’ll be able to participate in a full training camp and play in the first game of the season.”
What things you measure with Julius to determine whether he needs any restrictions?
Vitti: “Number one is pain. The things that we look at are pain, inflammation and swelling as well as talking to him on how he feels. It’s also his performance on the court and his recovery on the court. We look at things like load and intensity. So when we’re in a game at an NBA arena, we have an eye in the sky. The eye in the sky tells us how many accelerations there are to the left and how many accelerations there are to the right as well as how many decelerations. We can tell how many accelerations and decelerations there are and the trajectory of them. That information goes in an algorithm that tells us the average speed that the player played at. We multiply that by the distance that he ran in a game. We multiply that by his body weight. That gives us a number that we call load. We look at that number. But then we also take that number and divide it by time, which is minutes played, and that gives us intensity.
So what we want to see as his load goes up, does his intensity go up with it. If it does, then we’re okay. If the intensity goes down as the loads are going up, then we have three zones. Red, yellow and green, like a traffic light. If the loads and intensity are going up at the same time, we let him go. If the intensity starts going down, some of that is to be expected and that goes into a yellow zone, we pay a little bit more attention and then we figure it out. Maybe we let them play, but we hold back in practice. Or maybe we cut the minutes and we push a little harder in practice so that down the road he can play more minutes. Maybe we cut minutes in games and in practice. It depends on the situation. Then of course if he gets into a red zone, all bets are off. We really feel we have to restrict him.
This isn’t just for Julius. We do this for all of our players. If a guy is getting into the red zone, we have to really start paying attention to how we’re playing him and how we’re practicing those people. We sit down with the coaching staff. Then when it comes around the preseason, preseason is preseason. But when it comes around the games, we still have to win games. That gets a little bit dicier in terms of decision making.
As much science as we have, it’s still an inexact science. We have analytics. We have accelerations, decelerations, average speed, trajectory of the accelerations, we have years and years of knowledge of watching the game and the difference in how the game is played. There are objective measurements we have with eye in the sky. There are subjective things collectively with how we are looking at in how we’re playing. When we put it all together, we feel like we have some control over being able to predict what’s happening and what’s going to happen. But it’s still inexact.
That’s why no matter what you do, there’s still going to be injuries out there, especially with the speed of the game. This is a point-guard dominated league. These kids are flying up and down the floor. It’s really the one thing that has changed in the game despite all the things that [NBA Commissioner] Adam Silver is looking at with the schedule, etc. We still have eight preseason games and 82 regular season games. The practice facilities are better. I came into the league, the courts we played on were just wood over concrete. Nobody had a practice site. We were at YMCA’s or Inglewood High School. We didn’t even have locker rooms. We just showed up with a bag of balls. The training is better. The travel is better. The hotels are better. The food is better. The diets are better. Everything is better. Everything. Everything about the game is better.
The one thing that has changed is the speed of the game. This game is a much different game than the Lakers played in the 80’s when we were a running team. That’s what we were. We were not a half-court team. We were ‘Showtime.’ This game is much faster today. When you look at the millennium teams with Phil [Jackson] starting in 2000, our first championship with him was really a slow game. We played the triangle [offense] and walked the ball up the floor in very very controlled situation. So you add all those things together and you have a guy like Julius, who is a big man and can play at a fast speed. You really need to make sure he comes back in a way that he’s not outrunning himself. We cannot sacrifice his long-term plane the season to get some extra minutes in summer league or have him do more in training camp. We can’t play catch up with this. We can’t speed it up. We can only screw it up.
On top of that, you have mentioned to me and others that the constant stop-and-go and the subsequent torque have also contributed to the large amount of injuries in the NBA. Since Julius is considered a versatile playmaker, what can he do to minimize those movements?
Vitti: “You can’t avoid it. That’s the point. You can’t avoid it. That’s the way the game is played now. The only thing you can do is prepare yourself the best you can to do that. The thing you’re talking about that I have talked about in the past, the two things your body does not like is slowing down at a high rate of speed and the second thing is torque and twisting. Those are the two things you’re doing in the game today. So you have players flying at a very high rate of speed as fast as they can go. Then at some point, they either have to stop. They have to slow down first to stop or they have to turn. To do that, they also have to slow down. It might not look like they’re slowing down. It looks like they’re going full speed.
When you watch Russell Westbrook play, he to me is amazing because he can fly at the highest rate of speed and stop on a dime right in front of the defender. When he stops, he either goes left or right or straight up. When he stops and goes straight up, he goes straight up vertically. His momentum doesn’t even take him forward. I don’t know how he does it. But he does it. He’s the best at it that I’ve ever seen. But even he got hurt, twice.
So even when Russell Westbrook is coming at you full speed and he stops and he goes straight up and it looks like he’s going top speed, he actually right before he stop has to slow down. It doesn’t look like he’s slowing down because he’s moving so fast even when he’s slowing down. But he actually is. We call those contractions on eccentric loads. Your muscles are not shortening. They are actually lengthening at that moment. Those eccentric loads are when athletes get hurt. Then when they pivot, go left or right, they put torque on their body.
That makes them very susceptible to injuries, too. When you look at the human body and different levels of joints, you want your foot to be mobile. You do not want a rigid foot. So you want to be able to absorb the shock of running and jumping. But then as you move up to the kinetic chain to the knee, the next joint, you don’t want a mobile knee joint. You want a stable knee joint. If you don’t have a mobile knee joint, that means you’re missing stuff in there. The anterior cruciate and medial collateral ligament and meniscus, all of those things provide stability in that knee joint. You want a mobile foot. But you want a stable knee. You want a mobile hip. But you want a stable spine. You don’t want your vertebrae sliding on each other like Steve Nash and Luke Walton had. These guys had vertebrae that was displaced.
So we look at that whole kinetic chain. Then you take a guy like Julius, who is a very big man and can move at that fast rate of speed and put that kind of torque and eccentric loads on his body, the only way we can get him to do that once the regular season starts is to prepare him now by making sure his biomechanics are good and he has the strength and endurance of his bones and his muscles to handle those loads. Once he fatigues, he will go into what we call a default position and that’s when he won’t be able to stabilize his joints. He makes his joints susceptible to injury. Plus he has already broken two bones in his body. We certainly don’t want a third one or a repeat of the first two. The only way to do this is bring him along in a a multiple progression.
So you said Julius has a rod in his right tibia?
Vitti: “Yes, in his tibia with four screw permanently. We may take the screws out. But the rod stays.”
What does the rod do?
Vitti: “It allows for the fracture not to displace while it’s healing.
So Julius is going to have the rod there for the rest of his life?
Vitti: “He’s got a rod in his tibia for the rest of his life.”
Return to the Inside the Lakers blog later today for part two of my interview with Vitti.