Twenty-four hours in a day. Sixty minutes in an hour. Forty-eight minutes in a game. Every second counts.
Yet there's often only one athletic trainer on the sidelines of an NBA game. With 15 men and millions of dollars on the line, the athletic trainer is hardly an entire crew, but there are times when the short full-time staff of an NBA team might act against the best interests of the team itself.
The Los Angeles Lakers seem to be in one of those situations. With Kobe Bryant and Steve Nash injured, along with Jordan Farmar, Steve Blake and Xavier Henry dealing with various physical ailments, it seems that the Lakers medical staff has lost control.
Over the past five seasons, the Lakers have lost over $45 million to games missed due to injury, including $18 million last season in a year described by trainer Gary Vitti as his worst season in 29 years, according to Mike Bresnahan of the Los Angeles Times.
Sadly the nightmare continues, as the club has already lost $14 million due to injury and will easily pass last year’s total with Nash and Bryant expected to miss several more weeks recovering. (All data on injuries and salary courtesy of Jeff Stotts of Rotowire.com.)
In fact, it's become a joke. "Did the Lakers somehow get the Timberwolves' luck from last year?" I was asked by one of B/R's smart basketball minds. Rather than blaming this on luck, I think there's actually a much different cause and a much simpler solution.
Back in 2004, while I was at Baseball Prospectus, I came across what looked like a line in the data. Above a certain point of injuries, the season seemed to get away from a medical staff, and there was a rapid acceleration in overuse and traumatic injuries.
It seemed there was a breaking point where the medical staff simply couldn't handle the workload.
After extensive discussions with athletic trainers around the league, it became clear that this was not a competence or luck issue. Instead, it was very simply a man-hour problem.
There were only so many hours in the day, and at a certain point, the rehabilitation and maintenance programs overtook the preventative programs, leading to an increase in injury rate.
That quickly became a vicious cycle.
More injuries would occur, adding to a workload that was already too great. I termed this a "death spiral," though on the other side, there's another point beyond which a team doesn't go. Healthy players don't suddenly become injured outside the scope of probabilities, so the death spiral never speeds to the terminal.
Being nearly a pure man-hour issue, though one that is individual to each team and staff, there's a simple cure: add more men (or women).
The medical staff for most teams is one or two athletic trainers. These highly qualified, hardworking medical professionals are simply overworked. While they have help, most of it is part-time.
Obviously, there is a team doctor as well as an on-call network of specialists, surgeons, dentists and chiropractors. On a more day-to-day level, there is usually a conditioning coach, a rehab specialist and massage therapists that come in.
A quick look through NBA.com pages shows there's about an even split between teams that list one or two full-time athletic trainers. Only one team, the Oklahoma City Thunder, listed three. It should be noted that most of the top-rated staffs, such as the Thunder, Phoenix Suns, Indiana Pacers and San Antonio Spurs, all listed two.
(UPDATE: The Suns actually have three ATs, as well as a rehab coordinator. A call to the Suns on Friday to confirm the one they have listed on their website gave me the two I originally listed here.)
So why do any teams still have one or even two athletic trainers on staff? The usual answer is cost. An athletic trainer isn't cheap, but in the grand scheme, investing $100,000 on health for a roster that costs upward of $50 million seems to be a good strategy.
It's also an expense that improves productivity. A team gains a full day of man-hours and they can better leverage the equipment and modalities already in place.
Division of labor can expand efficiency.
One team I spoke with on this piece said, while they couldn't add a third athletic trainer, they did hire someone to handle the paperwork where possible, which freed their trainers to do more medical work. It's a smart strategy.
One front office type I spoke with said there was a point at which inertia was an issue, that there had always been only one head trainer, and that adding another would lead to a point where each player would have his own athletic trainer.
And that's not the worst idea. American sports, and the NBA in particular, have been very paternalistic. The team knows best and the player will usually deal only with team physicians, as opposed to baseball or football where the super-surgeons have a much larger market share.
In a player-first world where stars have their own chefs, drivers and personal conditioning coaches, it's hardly a stretch to think they might end up with their own medical staff.
Coordination of care would be tough, but at some point, the basis of American health care is personal choice. If LeBron James decided he was going to hire his own athletic trainer to focus on him, the Miami Heat would not have much of an objection.
It's easy to imagine Kobe Bryant or any NBA player doing the same. Bryant was monitored closely throughout his rehab from Achilles surgery. Extending that out to deal with the day-to-day maintenance could free up Los Angeles' staff to work on other players or more acute situations.
Another possibility that could be raised is creating a division between tasks. Rehab and maintenance are more closely related than prevention and performance, so why is the same staff—or in many cases the same man—expected to do both?
Every athletic trainer knows that there are some out there that love and excel at acute care and have every trick in the book inside their kit to help a player get back out on the floor. Separating them to different members would make sense.
Baseball is also shifting to a model where more medical directors are in place. Several teams elevated their athletic trainer to a more supervisory role, focused on the overall care and taking a "30,000-foot view" of the situation. An NBA team could do much the same thing. This type of system is used by a few teams already, most notably Oklahoma City.
The NBA isn't at that point yet, but the Lakers do show an interesting crossroads. They've seemingly hit the point where no matter how good Vitti is—and he's universally considered an excellent professional—either the Lakers or the players will have to make the next move.
It's a matter of who adds staff, not whether it's needed.
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