Why you can play basketball in 90-degree temperatures and LeBron James couldn’t

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LeBron James’ cramping in Game 1 of the NBA Finals is a medical issue that has been thoroughly analyzed by players, coaches, sports media and sports fans.

Maybe a medical professional can add a little more valuable insight to the discussion.

So, I reached out to Ben Wedro of MD direct. Wedro, who wrote more in depth about heat cramps here, was kind enough answer my questions. Here’s what he said:

Q: Eighteen players appeared in Game 1. LeBron was the only one to leave with cramps. Why was that, and what does that say about him?

A: It doesn’t say anything about him. It’s just the way it happened.

That’s not a medical question. That’s a philosophic question. Why do some people get sick and other people don’t? It just happened to him this time. So, if you’re ever on a plane and someone is sick and sneezes, a couple passengers are going to get sick in a couple days and a couple aren’t. Why those two instead of someone else?

Maybe that means he was working harder than someone else on the field. Maybe he was stressing his body more because he was more energetic and expended more energy and worked his muscles harder.

Q: Why couldn’t LeBron adjust to the temperature like so many non-elite athletes do?

A: He’s playing in great conditions all the time. He’s practicing in whatever they keep the arena at – 68 or 72. They tend to keep arenas a little cooler before the game because fans come in, and their body heat raises it a little bit. But he’s not playing on the playground.

“It’s 55 and then it’s 70 and then it’s 90, and you do that over the course of a month. Your body gets used to it. He went from playing in 70-degree weather then to 90. That’s tough. And his body’s not ready for that. He’s not acclimated. He can’t cool as well, and so he’s trying to cool his body, and he can’t, and he’s sweating. He’s not sweating as efficiently as he could and cooling as efficiently as he could.

Q: One LeBron left the game, could he or the Heat have done something differently to get him back on the court?

A: There’s really not enough time in that last four or five minutes of the game to get him better. It’s the equivalent of having an NFL player going in at halftime and getting IV fluids and getting back out there the second half.

What happens is the muscles become inflamed, and they go into spasm. It’s usually the large muscles that go into spasm, so a runner or basketball player, though they use their upper body, it’s going to be their legs and their quads and their hamstrings that get tight – their major jumping muscles.

So, you not only have to get the muscles stretched out and decrease the inflammation, but you also have to replace the fluids. If he’s not vomiting, he can take the fluids in by mouth, but a lot of times, if you want an elite athlete back quickly, you probably have to do IV fluids.

Is LeBron more susceptible to cramps because he’s so muscular?

A: No. He went into cramps, because he got dehydrated.

Q: LeBron has dealt with cramps before during games. Could there be something about his body that makes him more susceptible?

A: Not really.

Just the way it is, and that’s not a very satisfying answer.

Q: Is it possible he wasn’t hydrated enough entering the game?

A: I don’t know. He’s an elite athlete, and he knows his body well.

What we tell athletes who are both elite and non-elite is you have to let urine be your guide. When you’re body’s well hydrated, you’re kidneys make urine because there’s a lot of water in your body, so your urine comes out clear. When you become a little dehydrated, it becomes more concentrated, so it will come out a little bit more yellow.

Q: So any accusation LeBron didn’t properly hydrate before the game is baseless unless the accuser inspected LeBron’s urine first?

A: That’s right.

The big key is he’s an elite athlete. He knows his body. He was put in an unfair situation.

Let’s look at elite athletes who are in heat all the time – marathon runners. You get race days that go from 65 to 90 or 80, and all of a sudden, people are dropping on the course and pulling out in Olympic marathons. You wouldn’t say, “Well, they’re not prepared or they’re not elite.”

When you’re put into environments where you don’t know how to function and your body is not acclimated to it, you may not do well. And that’s not fair to blame the athlete for the environment.

Q: What does LeBron need to do before Game 2 Sunday, and is that enough time for him to fully recover?

A: It should be behind him by Sunday. And what should he do? Not play in an arena that’s 90 degrees.

Q: That’s it? He can go back to his normal training routine, and it will take care of itself?

A: That’s right. His muscles might be a little sorer than they would be, but no sorer than playing extra basketball. He should be ready to go and play well, but he may be more fatigued for a day or two. So, today and tomorrow, he may be a little bit more tired. He may have to work a harder at rest than he normally would.