Is Heavy Workload Burning out the NBA's Elite Point Guards?

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Is Heavy Workload Burning out the NBA's Elite Point Guards?
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The biggest subplot of this NBA season is the regularity with which the game’s best point guards are going down. It’s happening with such frequency the question needs to be asked: Is a heavy workload causing the injuries?

In particular, the lower extremities of point guards are getting pummeled. Derrick Rose, Russell Westbrook, Rajon Rondo and Eric Bledsoe are among those out with knee injuries. Jrue Holiday has a fractured tibia. Deron Williams has a never-ending battle with ankle injuries. Why?

In investigating this, I asked three questions:

  1. Is there something about the modern style of point guard play which is more conducive to injury?
  2. What is the financial cost to teams?
  3. What can the NBA do to reduce the number of injuries?

Modern Style More Conducive to Injury?

The modern point guard is asked to do more than his peers of the past. With the advent of the rule changes which occurred at the turn of the millennium, the game is faster, and that increased speed may be related to the injuries.

The rule changes, detailed here, were predominantly designed to open up the middle, allowing for quicker, more exciting players to drive the lane. They included things like defensive three seconds and removing the hand-check.

Accordingly, the offenses adapted to take advantage of the new rules and drive-and-kick offenses were born. Quick, explosive point guards who could both penetrate and pass became a premium commodity.

Simultaneously, advanced stats started coming more in vogue, and the importance of the three-point shot grew with it. In 1999, the Houston Rockets led the NBA in three-point makes per game at 6.7. That same total would place them 24th this year.

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Again, this impacts the point guards, the drive-and-kick offense and, in turn, the knee. By design, point guards drive into the paint, collapse the defense and kick the ball out to their open three-point shooters. 

Thus a series of actions the player routinely takes: bursting forward, accelerating, stopping suddenly, twisting to pass the ball and pushing off with the feet to generate force for the pass. Sometimes, jumping and landing would seem to put extra torque on the knee. 

All those can add stresses to that important joint which are different from mostly passing the ball ahead, the way point guards of old did. 

I asked Will Carroll, Bleacher Report’s resident injury expert, about that. He answered:

Yes. They're adding rotation to it, which taxes the ACL. Most non-contact injuries for ACL involve leg plant and rotation of the femur. Do that, add in the element of jumping or contact causing an awkward landing, and it’s a wonder you don't see more.

Again, just by my own non-medical observation, it seemed that a lot of these injuries are not “traumatic”: They don’t seem to be coming off of some kind of severe collision. For example, both of Derrick Rose’s knee injuries came from normal activity.

That led me to wonder if it’s possible that there can be a kind of “gradual” injury where the ligaments weaken before tearing. Carroll’s response affirms that:

The term is "insidious." What you're looking at is that there is trauma that is not total failure. Microtears are common, then it eventually breaks. There still has to be an event that causes the rupture, but the threshold can be lowered.

So, medically, my theory holds up well enough, but how about historically? Do the theory and practice suggest that there’s a change in the injury pattern since the rule changes came into effect? Do the smaller players with heavy demands have a tendency to get injured?

Below is the list of every player under 6'3" since 1978 (as far back as can be measured) who has had a usage percentage (the percent of team possession a player uses) of 28 percent and an assist percentage (the percentage of teammates' field goals on which a player assists) of 30 percent for a season. Also noted is how many total games each player missed in the high-usage season and the year after. (Note: As Kyrie Irving and Stephen Curry's high-usage seasons are currently in progress, they've been left out of the data.)

Two-Year Missed-Game Fallout of High-Usage and -Percentage Point Guards
Player Season Tm USG% AST% Games Missed Percent Missed
Gus Williams 1981-82 SEA 28.5 31 4 2%
Michael Adams 1990-91 DEN 28.5 39.4 20 12%
Allen Iverson 1996-97 PHI 28.9 33.6 8 5%
Terrell Brandon 1996-97 CLE 28.3 35.6 36 22%
Stephon Marbury 1999-00 NJN 28.2 39 23 14%
Stephon Marbury 2000-01 NJN 29.7 40.8 15 9%
Baron Davis 2003-04 NOH 30.1 37.9 51 31%
Allen Iverson 2004-05 PHI 35 37.6 17 10%
Steve Francis 2004-05 ORL 28 31.6 16 10%
Allen Iverson 2005-06 PHI 35.8 34.9 27 16%
Tony Parker 2007-08 SAS 28.2 34.1 23 14%
Tony Parker 2008-09 SAS 31.7 40.1 36 22%
Devin Harris 2008-09 NJN 28.4 34.4 31 19%
Derrick Rose 2010-11 CHI 32.2 38.7 109 74%
Russell Westbrook 2010-11 OKC 31.6 42.7 0 0%
Deron Williams 2011-12 NJN 30.1 46.6 15 10%
Russell Westbrook 2012-13 OKC 32.8 38.4 12 10%

These players missed an average of 26.1 games over that span, which works out to 16 percent of two 82-game seasons.

Furthermore, the hand-check rules first started to go into effect in 1998, and all but four of the qualified seasons have occurred since then. What was once rare is now becoming commonplace, suggesting that might be why the injuries are also becoming so.

Both medically and historically, there is reason to believe that the modern style of point guard play is related to the injuries.

What Is the Financial Cost?

The reason the NBA instituted the rule changes is no secret. They were specifically designed to do what they did: open up the game and make it more exciting. Making it more exciting made it more marketable, and more marketable meant more profitable.

But how much more exciting is it when some of the most exciting players are getting injured? Certainly that starts cutting into the profits?

Not to mention, the dollar value on wasted salary is getting enormous. The following table shows the 11 point guards who have missed significant time this year or last, how many games they’ve lost and what it’s cost the team in terms of paying a player to be in rehab.

Key Point Guard Injuries 2013, 2014 and Salary Hit (in Millions)
Player Name Team Games Missed 2013 Salary Cost 2013 Games Missed 2014 Salary Cost 2014 Total Salary Cost
Derrick Rose* CHI 82 16.4 25 5.4 21.8
Jrue Holiday* PHI, NOP 4 0.1 2 0.2 0.3
Rajon Rondo* BOS 44 5.9 38 5.6 11.5
Steve Nash* LAL 32 3.5 31 3.5 7.0
Deron Williams* BRK 4 0.8 15 3.4 4.2
Russell Westbrook* OKC 0 0.0 12 2.2 2.2
Eric Bledsoe* LAC, PHO 6 0.1 12 0.4 0.5
Chris Paul* LAC 12 2.6 5 1.1 3.7
Kyrie Irving CLE 23 1.5 3 0.2 1.7
John Wall WAS 43 3.1 0 0.0 3.1
Ricky Rubio MIN 25 1.1 0 0.0 1.1
275 35.2 143 22 57.1

*Player is currently injured. Only games missed as of Jan. 12, 2014, are counted, although the number is expected to climb.

If every one of them returned their next game, it would mean that the lost contests from just these 11 players would still be 418 games over two years, and the total cost to their respective teams would be over $57 million!

That is a lot of games and a lot of money. And both of those numbers are extremely conservative. It doesn’t count the other point guards. It doesn’t count playoff games. It doesn’t count other injured, non-point guard superstars like Brook Lopez and Kobe Bryant. It doesn’t count the tax on the pay of the players who aren’t playing. It doesn’t count the medical costs associated with the injury.

Andrew D. Bernstein/Getty Images

Most importantly, it doesn’t count the hidden cost to the teams individually or to the NBA. It doesn’t include the cost of having exciting games between two of the most popular franchises bumped from ESPN because they’re now meaningless. 

It doesn’t count lost merchandising, concession sales or ticket sales to fans who would pay to see Derrick Rose, Russell Westbrook or Chris Paul on the road. For example, the Chicago Bulls’ road ticket sales were 96.1 percent in his MVP season. That’s down to 92.5 percent this year. People pay to see superstars, not just other people wearing uniforms.

It is conservative to estimate that money lost will climb to well over $100 million, just from the last two seasons, and just in regards to those 11 players. Of course, that’s in comparison to a league that generates over $5 billion per year, so maybe $100 million doesn’t mean that much to the owners. (But it probably does.)

What Can the NBA Do to Reduce the Number of Injuries?

So what can the NBA do to mitigate the issue at hand?

I asked Carroll if there were exercises that players could do to strengthen their ligaments.

Yes. Mostly they strengthen the secondary stabilizers rather than the ligaments themselves. There are hundreds of programs out there for ACL prevention, some good, some dubious.

Teams try to be on top of this, and on top of their players. Yet, it always baffles me when I hear about players not stretching sufficiently or not doing adequate exercises to maintain health. Why aren’t they?

Part of the problem there may be insufficient training staffs. Carroll has an outstanding piece on that which I highly recommend.

Mark D. Smith-USA TODAY Sports

By investing more money in training staffs and equipment, teams could help stem the flow of injuries preemptively, as well as help their players recover from minor issues before they become more severe compensation injuries.

If you buy a $100,000 car, you don’t take it to the discount mechanic. And if you have a $100 million player, you shouldn’t cut costs on the training staff.

Wondering whether routine screening for microtears could help catch them before become season-ending injuries, I asked Carroll about whether MRIs can see them, and whether they could be healed through rest or surgery.

(MRIs will) not consistently (see microtears). MRIs are advanced and getting better, but it's tough to see these.

Rest yes, surgery no. The tears aren't big or to point of failure, but certainly aren't good. Rest heals them, but not back to a pristine state. It’s those little stresses that build and build until it doesn't take as big a stress to rupture.

So, while it seems there’s no guarantee, it’s possible that some injuries could be curtailed by maintenance, proper exercise, training and perhaps routine screening for microtears (though that does seem iffy). While not every injury would be prevented, how many need to be before it becomes worthwhile?

It’s also important how players develop. As Bleacher Report's Assistant NBA Editor, Joel C. Cordes, points out:

A question for me, that I've also heard asked an awful lot over the years, especially in the NFL is this: Are players training themselves to become too fast and too strong for their own bodies? Did we have ACL injuries with this much frequency in the pre-weightlifting era?

Sure, they happened, but the lithe, natural bodies flowed versus exploded like now. Instead, we have muscle-bound guys (largely packing the glamour muscles, not all the small, stabilizing and fast-twitch ones) who start, stop and turn quicker than their joints and ligaments were meant to.

Carroll concurs with that assessment, saying:

I agree. Bigger, stronger, faster is only good if they can control it. They do need to shield because other guys are bigger, but I want functional strong, not "pose on the beach" strong. They are well beyond the normal physical capacities (today) and showing it.

So, the game has opened up in a way which allows the players to be more explosive. That’s coupled with them having developed their bodies to such an extreme that they can play at a level where they actually hurt themselves.

Does the league have an obligation to protect them from themselves?

You can’t put standard radial tires on a NASCAR and expect it to hold up. The explosive NBA point guard has become so big, strong and fast that the rest of the machine is just too much for the framework to handle. The most logical solution then is to slow the game back down by rules, as pointed out by Cordes:

There are some folks out there who have suggested that the return of hand-checking could actually improve the injury situation since it slows the game down, especially in the paint. I think it would increase the bruise factor an awful lot though, haha.

Cordes jests, but it’s true. Reinstituting the hand-check might mean some minor injuries, but would you rather have your starting point guard out two games with a thigh bruise or for the season with a torn ACL?

Carroll agrees with the hand-check suggestion, noting that they "might slow the game down a bit.” 


We don't have many answers yet, just more questions. The NBA needs to seriously evaluate the issues here.

Should the NBA revert to the slower rules?

Submit Vote vote to see results

At a certain point it’s not just about money; it’s about players. The NFL brushed aside the concussion question for years, and it ultimately had to pay a much larger price.

While the long-term ramifications of the knee injuries aren’t the same, it’s still an issue of player vs. profits. It shouldn’t always come down to just money. The NBA owners have as much of a responsibility to their players’ health as they do to maximize their own profits.

At the very least, the NBA needs to initiate a serious study, conducted by an objective, outside expert to investigate what solutions in terms of rule changes and training standards can be implemented to promote player safety while keeping the game profitable and exciting.

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