SAN ANTONIO -- LeBron James walked into the Spurs' practice facility at 1 p.m. CT on Friday, about 13 hours after he'd received 2 1/2 bags of intravenous fluid to combat debilitating muscle cramps that became the story of the NBA Finals in Game 1 and beyond.
His accessories included sunglasses, white headphones, sandals and camouflage shorts. Despite the attire, James would not be hiding from the questions about being rendered incapable of finishing the first game of his fifth Finals on Thursday night.
"Feel like my body failed me last night," he said.
In a championship series that had been about so many pure basketball storylines, the days between Games 1 and 2 are now about James' repeated bouts with dehydration. What causes them? Why couldn't they be prevented? When 18 players competed in the same 89-degree temperatures in the air conditioning-challenged AT&T Center, why was James -- the most imposing physical specimen in a league of 450 players -- the only one to succumb?
There are those who have taken to trolling James on social media over this, and we won't waste any time here on their ignorance. But James' muscles seizing up with four minutes left Thursday night under sweltering conditions has opened the door to intelligent discussion about issues that modern professional athletes like James must confront every day.
For one, James is an endorser of Powerade, a sports recovery drink that’s used for hydration and recovery. The fact that he became debilitated by cramping under adverse conditions would seem to raise a question about whether James should be drinking something else -- such as Gatorade, an official sponsor of the NBA, or something completely different.
Amid the social media onslaught Thursday night, a fan tweeted at Gatorade to suggest that perhaps its product was substandard if its "No. 1 client" succumbed to dehydration during an NBA Finals game. Gatorade responded with, "The person cramping wasn't our client. Our athletes can take the heat."
Gatorade apologized for the tweet on Friday, but did little to reconcile an inconvenient truth: Images of James drinking what appeared to be Gatorade on the bench Thursday night were screen-grabbed and posted all over the internet.
A league executive confirmed that players on every NBA bench are provided ample supplies of water and Gatorade during games since the sports drink manufacturer is a lucrative league sponsor -- one that pays upwards of $36-$40 million a year for that relationship, according to industry sources. There is Gatorade on every NBA sideline regardless of the brand affiliations of individual players.
James said he did all the right things to prepare for and get through Thursday night's conditions, which he described as "extreme." This included drinking what he thought was the right thing to drink.
"I've never played an NBA game like it was last night as far as the heat," James said. "Not an excuse, but it was an extreme condition."
James said he pre-filled with lots of fluids, toweled off on the sideline with cold towels, came out of the game more frequently than usual and even changed his sweaty uniform at halftime. When asked if his treatment protocol for dehydration was constrained by his endorsement contract with Powerade, James said, "I'm conscious about the things that I endorse, but that's not in the forefront of my mind when I'm trying to win a championship. Whatever it takes for us to win at this point, that's what I'm going to do."
But maybe it's not a matter of Gatorade vs. Powerade. Maybe it's neither.
Maybe there's a better way.
Kelly Starrett, a renowned body mechanics coach and physical therapist, has worked with hundreds of extreme athletes -- from triathletes to marathoners to endurance cyclists to CrossFitters. He's consulted with the New Orleans Saints about recovery and injury prevention and has worked with the U.S. military to help prolong careers, reduce lost service time and improve the quality of post-service life for military men and women.
Some of the methods still used in mainstream sports for hydration, recovery and injury prevention, he said, are "old-school, bad sports medicine."
"We basically just throw out there, 'Drink a gallon of water a day,’" Starrett said. "The problem is, you’re actually not absorbing the water you’re drinking. What you end up doing is losing your sodium and all of your essential electrolytes. We talk all the time to athletes who are blowing out their electrolytes and then when they get to that place, they start to cramp."
Regardless of the brand, the typical retail sports recovery drink "has so much sugar in it that it actually pulls water out of the system into the gut to digest it," Starrett said. "So it actually makes the process much, much worse."
If athletes are drinking so much fluid that they're constantly going to the bathroom, it's a sure sign that they're not absorbing the fluids they're ingesting, Starrett said. On Friday, James said that after receiving his IV fluids, he got up to use the bathroom "six or seven times" between 2 a.m. and 11 a.m. CT. What James most likely was experiencing Thursday night, Starrett said, was a condition called hyponatremia -- the rapid decline of sodium in the blood. Starrett believes there’s a better way to replenish it -- and to prevent it from happening again. James also had to leave a game during the 2012 Finals against Oklahoma City due to muscle cramping.
"He starts running a deficit and tries to drink to catch up but he never really catches up because he’s not absorbing the water he’s drinking," Starrett said.
The Heat declined to make anyone from their medical staff available to comment on James’ cramping incident. Attempts to reach spokespeople for Gatorade and its parent company, PepsiCo, as well as Powerade’s parent company, Coca-Cola, were not successful Friday.
Citing the research of Dr. Stacy Sims of Stanford University, an expert on hydration in athletes, Starrett said a better approach would be to increase James’ pre-competition consumption of essential salts by mixing them with his drinking water. There are numerous brands, but they all amount to some form of salt and electrolyte tablets that also contain potassium, and in some cases, magnesium. Many of them fizz like Alka-Seltzer when you drop them in water. One brand, CamelBak, makes a special line of hydration products for the U.S. military.
“This can be as simple as adding like a pinch of salt to your water,” Starrett said. “That alone can change the game.”
Once James is on the floor and losing fluids rapidly, Starrett recommends an alternative to the mainstream sports drinks. It would look like this: a concoction loaded with electrolytes with a small amount of glucose to promote absorption, as opposed to sugary recovery drinks that are designed for the body to use as fuel.
“With a little bit of sugar, you can trick the body into up-taking water when you’re losing it radically,” Starrett said. “So with the right mix of sugar, you can shuttle the fluids into your stomach at a much faster rate. You use the sugar as basically a vehicle. But it’s a small amount of sugar; it’s not a fuel source.”
Another remedy that is gaining popularity among endurance athletes suffering from cramping: pickle juice. No kidding.
“The tartness shocks your system and then you get the sodium dump in there,” Starrett said. “That’s why pickle juice stops cramping.”
Starrett, featured this week on Showtime’s 60 Minutes Sports for his global campaign to help athletes move and recover better, isn’t some witch doctor. He said his goal is to help people fix themselves, not quibble with traditional training and recovery techniques.
“I am on the side of the athlete,” Starrett said. “I don’t think we can pay these guys enough or support them enough.”
He’s also the founder of San Francisco CrossFit and author of the New York Times best seller, “Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury and Optimizing Athletic Performance.” This brings us to the next couple of areas that may have influenced James’ adverse response to the sweltering conditions in Game 1.
The first movement deficiency a physical therapist such as Starrett would look for in a cramping athlete is overextension in the joints and stiffness in the supporting muscles around the back. Either one could cause James’ 6-foot-8, approximately 270-pound body to seize up under the extreme demands of an NBA Finals game -- especially under the added stress of 90-degree heat.
“Stiffness around his spine can trigger cramping as a neural defense mechanism,” Starrett said. “We see that all the time with hamstring pulls and calf muscle soreness. The nervous system makes the musculature tight to try to protect the nervous tissue excursion at the back.”
That sounds a lot like what James was explaining when he said Friday, “My body just shut down. Basically, my body said, ‘OK, enough jumping for you for the night. You've had enough.’ Nothing I could do about it.”
Then, there’s the issue of James’ accessories -- not the sunglasses, headphones and sandals he wore Friday, but the full body armor he wears in every game he plays. As is his custom, James was wearing full-length compression tights in Game 1, along with a compression shirt. I’ve seen him with padding sewn into some of his undershirts to protect him against the violent collisions he often encounters on the floor.
“I actually don't wear a lot of it,” James said. “I wear a pair of tights, underwear, jersey and shorts, socks and shoes and a headband, arm sleeve. Compared to my teammate D-Wade, he looks like a football player compared to me.”
Dwyane Wade and James are among a growing number of NBA players who cover their bodies with all manner of padding, sleeves and compression gear. Grant Hill, an 18-year veteran who retired in 2013, said he believes it started with Allen Iverson wearing a shooting sleeve to protect swelling in his elbow but that it has since become more of a fashion statement.
“It’s just sort of the evolution of where the league is and it’s about the look,” Hill said Friday. “If you look good and feel good, you play good.”
Starrett said there’s something to the placebo effect. “You can’t ever negate that piece, when the athlete feels like an athlete,” he said. But compression gear often gets misused. It’s an effective tool for recovery, he said, but not so much during competition.
“All the light fabrics that we wear are designed to wick and keep us cool,” Starrett said. “If you’re trapping any of that heat at all, you see core temperatures go up. And once the core temperature goes up, you see a whole bunch of problems. Your body basically goes haywire and that throws off everything. You’re toast because all of your energy is going into that sweat mechanism, you start to overheat and it’s a disaster.
“So unequivocally, why the hell is that guy wearing so much compression when he’s 270 pounds and it’s 90 degrees? It’s just a no-brainer.”
Wade, one of the most physically imposing shooting guards ever to play, said protective gear is “very important. I've been wearing it for many, many years, so it is needed.”
But Hill said he always preferred to be lighter and quicker, rather than weighed down by so much gear. And if the gear caused James to retain more heat, Hill said, “You’d think the training staff would’ve addressed that and taken it off.”
As James prepares for Game 2 in the hunt for his third straight championship, his round-the-clock recovery will be the most important strategic issue in the Finals. If anything is clear, it’s that James thinks he’s been doing all the right things and wants nothing more than to get back on the floor at 100 percent.
“Don’t worry, you guys can talk about me as much as you want,” James said. “I’ll be there on Sunday as well. I’m not hiding.”
There’s nowhere to hide when you’re the most prominent player in the NBA. The way around that is simple: The Heat should send someone else to the store before Game 2 with a grocery list that includes one item.