The NBA heads into the final week of the regular season trying to fight through the fatigue and injuries. The next ten slides of big name players like Derrick Rose, Metta World Peace and Dirk Nowitzki aren't all of the injuries in the Association, which should tell you how much players are wearing down. The success or failure of teams is measured in wins and playoff seeds, but how do we assess how medical staffs have done throughout the long NBA season?
That's an interesting question, with the easy answer being "wins and playoff seeds." At the heart, any medical staff's biggest task is to maximize the time a player is spending on the court versus on the inactive list. That's not always easy, since some measure of injuries is going to happen. The key is to minimize, to prevent where possible and to rehab as quickly as is prudent.
It's that last part that is the toughest to balance. We don't have wins, losses, plus/minus or tempo-adjusted stats for injuries. Jeff Stotts of Rotowire is doing the lord's work in putting together an injury database for the NBA the way I have for MLB and the NFL, but there's no realistic way to go back and put together an historical record. The information is not there in the same way we can check out a box from a game between the Ft. Wayne Pistons and the Minneapolis Lakers.
(Which reminds me ... why does "Lakers" not bother the discerning fan in the way that "Utah Jazz" does? Is it the alliteration?)
John Hollinger has moved from the press box to the front office, which is symbolic of the kind of statistical changes in the NBA. What we don't have is a Stotts in the front office, though there are some very forward thinking teams that take the medical side of the game seriously. You'll see some of those teams in the playoffs—the San Antonio Spurs, led by Will Sevening, or the Oklahoma City Thunder, who's Donnie Strack is a visionary—and some that will be soon and for a long time.
As NBA teams get ready to bring in the next generation of stars and millionaires, don't ignore the doctors, athletic trainers and other health personnel. The teams that do are about to start thinking about next year rather than the playoffs.
Let's look around the Association:
Someone has to be first. In some cases, that first one, or at least the first big name one, gets their name attached to the procedure. Ulnar collateral ligament reconstruction surgery in the elbow is widely known as Tommy John surgery, after the first pitcher to have the procedure.
Basketball watchers and medheads like me have long waited for something new to come in the management of knee injuries. The sheer amount of meniscal and cartilage injuries that happen and the cost of those in both time lost and careers ended have pushed doctors towards new research and techniques. Brandon Roy considered a meniscal transplant at a point, but didn't want to be the first.
Jason Richardson has become the first—or at least the first known pro athlete—to undergo a new type of knee procedure. Richardson had a DeNovo NT Graft, a surgical technique that fills in a cartilage defect with what the manufacturer calls "juvenile cartilage cells." While calls to the manufacturer were not returned, it does appear that the substance is exactly what it sounds like, coming from donors who are aged 13 and under.
The technique itself is not difficult or complex. The defect is filled in with the donor cells in a way not dissimilar to how you'd spackle over a hole in a wall. (I'm oversimplifying some, but not much.) The benefits are that the cartilage is repaired, not removed, and that there is no cutting or stitching inside the knee. While Richardson's quoted return time is six to nine months, the technique should see reduction in time, though it will not be on par with meniscectomy due to the need for the grafted tissue to mold into the existing tissue.
Medical staffs around the league will be watching Richardson's recovery slowly. If it works, we could see a big change in the long term management of cartilage in the knee which could impact the long term prospects of some players, especially those who are young—high school and college age players—that see problems develop years after meniscectomies. If this works, Dr. Jonathan Glashow will see a path beaten to his New York office.
Metta World Peace might change his name again after Kobe Bryant said he was channeling Wolverine in his comeback. The question now is whether the knee will hold up over the next week and perhaps into the playoffs. Peace's return helped the Los Angeles Lakers to a win and vaulted them back into the eight seed.
Peace showed none of the signs of ongoing problems. He wasn't perfect, lacking the "bounce" that helps him get back up for rebounds, but that's one of the last thing that returns. Peace showed acceleration and stopping off the leg, while also lacking any discernible limp. He backed that up with a good showing on Wednesday, playing in back to back games with only a slight reduction in playing time. That's impressive.
I'll leave the question of how he pulled this off to the speculators and focus on the fact that he had a top notch surgeon, top notch rehab and a great medical staff with the Lakers that facilitated this. I'll also watch closely since the last person to come back this fast was Brandon Roy and we know how that story ends.
For more info on Peace's return, click here now.
The Lakers have some Peace, but with Steve Nash, they're picking and choosing. With only a few games left, the Lakers sat Nash on Wednesday against the Blazers, but expect Nash back at the point for Friday's game. The team is trying to buy Nash's strained hamstring some rest more than picking who they think will be a lesser challenge.
Nash's hamstring strain is relatively minor, but he's not getting the time that it needs to fully heal up. It's the sports medicine equivalent of duct tape; you just hope it holds long enough and doesn't make things worse if it doesn't hold.
Nash is clearly limited on the floor, leaving the Lakers coaches to try and figure out if 80 percent of Nash at this stage in his career is better than their other options. They'll be making that decision for at least another week and maybe beyond, assuming they make the right ones.
The Chicago Bulls are staying patient. Joakim Noah missed his 11th game out of 12 this week as the Bulls try to get his feet up to the task of playing in the playoffs. The Bulls might be the five or six seed, but neither position is a huge problem for the Bulls, so getting Noah as healthy as possible is the smart play.
The worry here is that Noah's plantar fasciitis is only making small improvements with the rest and treatment. There's not going to be some miracle cure between now and the first round. If Noah's feet act up again, there's not going to be an extended rest that they can give him if they hope to win.
Plantar fasciitis is a painful and lingering injury. This could affect Noah for the rest of his career, but for now, the Bulls are just hoping that their emotional leader can get back on the floor to help them against a Brooklyn team that they have handled all season.
Derrick Rose dunked off his left foot this week. That was supposedly Rose's last hurdle, a somewhat arbitrary task that would prove to him and to others that his knee was fully healthy.
But he didn't come back.
At this point, Rose is looking less likely to return, unless the plan all along has been to pull a modern-day Wes Unseld move, coming back on the court just for the playoffs or maybe an even more dramatic move. The Bulls spent the week denying any problems between the team and their star, with Tom Thibodeau going as far as saying that this was the plan all along.
No, it wasn't.
Rose simply hasn't decided to come back and the Bulls don't seem inclined to alienate their star by pushing him for that return. Even the leaks to the media have been weak nudges rather than a frustrated push. Rose has full control here, all the leverage and even with the playoffs coming up, there's no indication that Rose has decided he's ready.
Dallas is out of the playoffs now for the first time since 2001. With Dirk Nowitzki aging and seeing increasing injuries, Mavericks fans are wondering whether Mark Cuban is about to shift this team into rebuilding mode, staying off what he once called the "treadmill of mediocrity."
(Wait! I was at the Sloan Sports Conference panel where the term was introduced and I remember Cuban saying this, though Henry Abbott claims it was Pacers GM Kevin Pritchard that used the term first.)
Nowitzki has played through chronic knee problems for the better part of three years and is playing through a mild ankle sprain that is much more acute. With the team out of the playoffs, the team is likely to shut Nowitzki down or at the very least cut into his minutes.
He showed on Tuesday that he could be effective playing through the injury, but there's really no need. The Mavs are playing a different game now, positioning for the lottery rather than the playoffs. Unless Nowitzki is walking away and needs a victory lap, there's no reason to push him to play.
It looked much worse than it turned out to be when Jonas Valanciunas hit the floor. After being taken off the floor and directly to the hospital, reports came back that the injury was not as serious:
Okay, #Raptors report Valanciunas sustained "flexion extension injury" to neck, tests negative, he's headed home today. Off to google we go— Doug Smith: Raptors (@SmithRaps) April 10, 2013
Of course, this tells us nothing. Flexion and extension are opposites. For the neck, extension is the equivalent of looking upwards while flexion is looking downwards. The injury is to his neck and is likely a muscular or ligamentous injury that is preventing free movement in both of those planes.
Valanciunas is headed back to Toronto for more tests, along with the Raptors' director of sports science. With the season almost over, it is unlikely that the big Lithuanian will return, though we don't yet know exactly how serious this injury may be.
The Hornets haven't gotten what they expected out of Anthony Davis. The number one overall pick hasn't been bad and he's actually been a lot better as the season's gone on, especially defensively, though he's hardly been the gamechanger many expected. That may end up affecting where Nerlens Noel goes, since he is basically the same player with a different haircut and eyebrows as Davis.
Now Davis and Noel have something else in common—an injured knee. Davis' injury was less dramatic than Noel's stomach-turning injury, but it will likely end his season a couple games early and could end up in the same place
Davis was diagnosed with a sprained knee and the team is hoping that the ACL is not significantly damaged. If the sprain is significant, Davis would need surgery and could miss as much as a year while he rehabs. It would be a devastating blow to the Hornets as they rebrand and rebuild. Images could come as soon as today and I will have updates as they come available.
So it's not the hand? Kevin Love has missed the bulk of the season with a fracture and a re-fracture of his hand. Now, Love's season is ended by a cleanup of scar tissue in his knee. It's a bit of a surprise, but with the team out of the playoff hunt, the timing is reasonable.
Of course, if this has been an ongoing issue, doing it in concert with his hand rehab would have been more reasonable. This is likely one of those things that teams regularly put off until the offseason and now, knowing that Love wouldn't be returning from the hand injury, it was as good a time as any to do the procedure.
As the Timberwolves stated, the recovery time is four to six weeks, which has Love ready far before camp opens (or quicker if he's Metta World Peace.) The Wolves have to hope that Love's health is better next season and that the off-season can focus on prepping for the next campaign more than this season's benchwarmer fashion show.
Denver is one of more exciting teams to watch in the NBA right now and has their playoff position locked in in the West. The downside is that they'll have to go through the playoffs without Danilo Gallinari and they'll also have to start next season without him. An ACL sprain has ended his season and will cost him the better part of twelve months as he recovers:
<blockquote class="twitter-tweet"><p>INJURY UPDATE: <a href="https://twitter.com/search/%23Nuggets">#Nuggets</a> F @<a href="https://twitter.com/gallinari8888">gallinari8888</a> will miss remainder of the season with torn ACL. <a href="http://t.co/PawxyHbjKE" title="http://on.nba.com/YY6H5C">on.nba.com/YY6H5C</a></p>— Denver Nuggets (@denvernuggets) <a href="https://twitter.com/denvernuggets/status/320261170038718464">April 5, 2013</a></blockquote><script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
Gallinari's injury is painful to watch, a non-contact injury that is becoming all too common in the NBA. There's no known cause for these injuries, but the more I watch them, the more I become convinced that there's a friction issue at the heart of this. The NFL used to have this problem with turf field, which had a much higher "stickiness" than grass or the newer turf solutions that have a longer, looser weave. Anyone that can remember Wendell Davis or the infamous "turf monster" at Philly's Veterans Stadium understands what I mean here.
With knees and ankles, it seems that players are stopping more quickly or in some cases, like Gallinari, that the friction between shoe and wood is more than the leg can handle, contributing to injuries. This hasn't been tested and I don't mean to impugn the fine people at Nike, Adidas or any other provider. We've come a long way since Chuck Taylors were overtaken by Air Jordans, but the human body hasn't changed. It's definitely something the NBA and shoe manufacturers should look into.