Sam Bowie is fortunate that his right leg broke all the way through. It will surely heal faster than the stress fracture he suffered in his left leg. On Nov. 7, 1986, 12,666 people in Portland's Memorial Coliseum saw Bowie catch the ball at the low post on the right side of the key, pivot and go up for a jump shot. As Bowie left the floor, those sitting near the court heard a sickening crack. By the time he landed, his right shinbone was all but sticking through the skin.
The stress fracture in Bowie's left leg was different. No one knows how or when that injury occurred, only that it was discovered in 1981 while he was a junior at Kentucky and caused him to miss two college seasons. Bowie didn't snap it going up for a shot, he didn't land the wrong way and nobody fell on him. In fact, nothing happened that Bowie or anyone else could point to and say: It occurred on this or that play. Stress fractures aren't clear-cut.
When an athlete injures himself in the absence of witnesses, doubts can arise—in the minds of coaches, fans and doctors and even the athlete himself. He knows he's hurt but doesn't know how badly. An athlete is trained to play with pain. So how does he distinguish a nagging soreness he feels after last night's bump under the boards from the pain of a broken bone that could end a season or a career? Stress fractures are insidious because they occur over time. They sneak up on an athlete and may, if he keeps playing, develop into full-fledged, clear-through-the-bone fractures. And they probably afflict basketball players, whose legs and feet take incessant and tremendous pounding, with greater frequency than any other group of athletes.
The Boston Celtics' Bill Walton has become a sort of guru to stress fracture sufferers. The injury has interrupted his career three times, once almost ending it. "One of the hardest things about stress fractures for athletes is the mental uncertainty," says Walton, who suffered his first such injury in his left foot as a member of the Trail Blazers in 1978. "There has been no impact that tells a player, 'I know I'm hurt.' Nothing has changed, but he can't play anymore. Players have come to me angry and confused. I have to let them know that they're not faking."
One of those who went to Walton was Philadelphia's Andrew Toney, who missed some of this season and most of last because of stress fractures in both feet. Chicago's Michael Jordan and Portland's Clyde Drexler have also had stress fractures. Washington's Frank Johnson is recovering from his fourth in two years. Utah's Darrell Griffith and New York's Bill Cartwright missed most of last season because of them. "We see many more than when I started," says Ron Culp, the Trail Blazers' trainer who has worked in the NBA for 17 years. "And it's not that there are more of all kinds of injuries—just more stress fractures."
Dr. Norman Scott, the Knicks' team physician, agrees, saying, "At least one third of the players in the NBA have had foot fractures of some kind." That adds up to about 100 players. However, no one knows exactly how many stress fractures have occurred in the NBA, or whether there were more this season than in seasons past. To get some answers, the NBA has begun studying what it considers to be a stress fracture epidemic. In addition to determining their frequency, physicians are seeking to learn how they differ from more acute breaks and how best to detect, treat and, most important, prevent them.
Stress fractures impair not only the health of the athlete but also the health of his team and league. "They're affecting performance and economics," says Bullets team physician Dr. Steve Haas. "People won't come to a game if a player like Michael Jordan is out. And it's obviously an economic factor to the player, too. The study is in everybody's best interest. [NBA commissioner] David Stern doesn't want all his guys breaking their feet. Agents, owners and players don't, either."
After Jordan's fracture was diagnosed in late October 1985, the Bulls appeared to ignore economics when they asked him to sit out the rest of the '85-86 season. With Jordan out of the lineup, Chicago's average home attendance dropped 17%. But the Bulls were thinking of Jordan's long-term revenue potential as well as his health. There may also have been another factor in the Bulls' thinking. Had Chicago played all season without Jordan, it might have been a contender for the NBA's top draft choice. As it was, Jordan returned in March at his own insistence, after suggesting that the club may not have been doing its best to win.
Dr. Lyle Micheli, director of sports medicine at Children's Hospital in Boston, says that because basketball requires players to work so hard, it is "set up for stress fractures." Running, jumping, starting and stopping on hard floors night after night puts tremendous torsion on players' legs. "In running, 2.8 times body weight hits the ground with every stride," says Dr. Tony Daly, team physician for the Clippers who has also worked with Olympic runners and athletes in almost every sport. "In jumping, it's 4.5 times body weight, and that figure is for the average athlete, not the NBA player."
A stress fracture begins when the shocks and strains of playing game after game create microscopic cracks in the outer layers of bone—usually in the legs and feet. If the pounding continues and those tiny crevices, which often go undetected, aren't allowed to heal, they can enlarge. When the cracks become large enough to cause pain, they are stress fractures.