• Special to RealGM by Dr. David Schechter & Alec Kassin
Michael Porter Jr. played some of the best basketball of his life this season.
Helping to lead the Denver Nuggets to the Western Conference Semifinals by eliminating LeBron James and the Los Angeles Lakers in five games, Porter averaged 22.8 points, 8.4 rebounds and 1.2 steals per game, and shot 49.8% from 3-point range.
LeBron summed it up by saying, “Michael Porter’s the one who kicked our ass.”
And yes, the Nuggets lost their next series in seven games to the Minnesota Timberwolves, and Porter apologized to his teammates for not performing at his best.
Performance aside, what isn’t debatable is the fact that Porter was healthy and on the court this entire season - for the first time in his career.
It’s not by accident.
Porter has struggled with back pain since high school. Despite becoming the #1 ranked player as a teenager, he was diagnosed with Degenerative Disc Disease in 10th grade.
He missed his first season in college due to his first back surgery. Since then, he’s had two additional back surgeries, neither of which eliminated his pain for good.
After his third surgery by the age of 25, Porter didn’t know if his career was going to survive.
Generally, the more surgeries one has, the more difficult it is to make a full recovery.
So how did Porter manage to stay healthy this year?
The answer is surprising, and could have a profound impact on the treatment of chronic pain in the NBA.
The Challenge of Back Pain
Back injuries have affected the game’s biggest names, and can be stubbornly difficult to treat.
Dwight Howard had surgery for a herniated disc in 2012 and his performance was never the same.
Tracy McGrady’s ongoing back issues affected his career longevity.
Scottie Pippen’s revolving door between the locker room and the court in Game 6 of the 1998 NBA Finals left him on the bench for a large chunk of the game.
And surgical treatments for back injuries are often frustratingly ineffective.
Over 20% of NBA players with herniated discs do not successfully return to play the following season.
And among NBA players with disc herniations, those who undergo surgery play significantly fewer games and are less effective the following season compared to those who receive conservative care.
Surgery for other back issues, like nerve impingements and disc degeneration, can produce similar outcomes.
Take Ben Simmons. Having undergone two back surgeries in three years, Simmons has been limited to 57 games during that span.
The aim of surgery is to correct ‘abnormalities’ that are believed to be associated with the pain. And sometimes, surgery is necessary to relieve pain.
But surprising as it may be, there isn’t often a clear link between back abnormalities and pain.
Consider that 37 percent of 20 year-olds without any back pain have disc degeneration, like Porter has in his lumbar spine. The number increases to 52 percent by age 30.
So why is it that two players can have similar back ‘abnormalities’, while one is in immense pain and the other is pain-free?
The Science Behind Porter's Pain
Studies show that up to 75% of high-performance athletes have persistent pain, and according to the International Olympic Committee, there are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes.
Paradoxically, tissue damage has been proven to not be the main factor to explain persistent pain in athletes.
So what’s going on?
Well, physical injuries - like ankle sprains, hamstring pulls, and bone fractures - are inevitable in the NBA.
But cutting-edge science shows that athletes can suffer from persistent pain that mimics pain from a structural abnormality, yet is generated by the brain, called ‘primary’ or ‘neuroplastic’ pain.
Some studies show that up to 80 percent to 90 percent of all chronic, persistent pain in the general population falls into this category.
Surprisingly, this is true of elite athletes as well. Those with no pain or symptoms often have the exact same structural abnormalities as those who do.
For example, 40 percent of elite athletes whose sports require significant use of a shoulder have a partial or full rotator cuff tear without symptoms.
Approximately 64 percent of pro and college hockey players have degenerative hip changes without symptoms.
And even 49 percent of NBA players have damaged knee cartilage, yet have no symptoms at all.
This is why imaging, like with MRIs and x-rays, is notoriously unreliable in trying to explain persistent pain.
It also explains why Porter will tell you there’s never been anything ‘wrong’ with his back.
He said on a recent podcast, “Every single NBA player that they would MRI would have bulging discs, probably degenerative discs, herniated discs. Some players would be symptomatic, some players won’t. That’s not what’s causing your pain.”
What Was Causing Porter’s Pain, and How He Recovered
After his three surgeries, Porter realized he needed another way to heal. Or else his NBA career would be in serious jeopardy.
So what did Porter do? He started by picking up a book.
Healing Back Pain by Dr. John Sarno, a retired NYU physician, is a New York Times Bestseller. Dr. Sarno pioneered the concept that chronic back pain can result from internal emotional pressure, and can be successfully treated with a non-invasive, brain-focused approach. Sarno coined it Tension Myositis (or Myoneural) Syndrome.
Pressure is a key ingredient in chronic pain, and professional athletes are under enormous pressure to perform - from the time they’re scouted, sometimes as young as 12, through to the NBA.
Financial, familial, and external pressure steadily builds, stepping up with each successive achievement. Dealing with world-class competition, on top of the normal stressors of being human, can be a perfect storm for debilitating pain.
And even trauma from childhood can predispose someone to chronic pain.
So Porter began a regimen that did not involve surgery, stretching, or conditioning, but rather education on how pain is created in the brain.
He started responding to his symptoms with less fear.
He connected his pain with emotional issues and pressure, working with a specially-trained therapist named Nicole Sachs.
He made connections between the pressure to succeed on the court, and feeling loved.
And remarkably, his pain went away.
It may sound too good to be true, but the results are real - and not unique to MPJ.
Studies show that two-thirds of back pain sufferers - many of whom have been suffering for years - can become pain-free with the same brain-based approach that Porter used.
And it’s not just back pain. Knee pain, ankle pain, migraines, fibromyalgia and many more conditions have been successfully treated. Dr. Sarno reported a 88 percent pain-free rate amongst his patients, results that held up three years after treatment. Other studies show similar results.
While not right for everyone (it won’t help fractures, acute sprains, strains, etc.) this treatment is highly successful for those whose persistent pain has failed to respond to conservative treatment, and for those who have had non-ideal surgical outcomes.
It can also be used as a low risk, high-upside approach to test before going under the knife.
While only speculation, players like Ben Simmons and DeMarcus Cousins, could be strong candidates to benefit from this treatment.
The Opportunity
Michael Porter Jr. has proven that brain-focused treatments for chronic pain can be successfully applied to stars in the NBA.
He’s also spotlighted a massive opportunity.
Players can make full recoveries, avoid unnecessary surgeries, recover faster, and extend their careers.
Teams can keep players healthy and on the court, and find diamonds in the rough in free agency.
Even NBA retirees, almost half of whom have extreme day-to-day pain or discomfort, may benefit.
Programs already exist, doctors and therapists are available, and there is a mountain of research and success stories to support their use in professional athletics.
It wasn’t that long ago that Sport Psychology was frowned upon. Now virtually every team has a sport psychologist on staff.
Like the first teams and athletes that employed sports psychologists, those who are willing to be early adopters of brain-based treatments will gain a significant competitive advantage.
Just ask Michael Porter Jr. and the Nuggets.
About Us:
Dr. David Schechter is the most experienced mindbody sports medicine and chronic pain physician in the country, having published multiple works on the subject. With degrees from Princeton and NYU School of Medicine, Schechter has been practicing as a physician for over 35 years. He is on the medical staff of Cedars-Sinai Medical Center is Los Angeles, and is in private practice in Culver City, CA.
Alec Kassin is a former semi-professional cyclist and back pain sufferer, turned chronic pain coach for high-performance athletes. Now pain free, he’s helped numerous athletes make breakthroughs with their pain. He is the Co-Founder of Pain Free Comeback, the first mindbody treatment program specifically for athletes with chronic pain.
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