The Los Angeles Lakers season is becoming something like a Beckett play. Instead of a crossroads, the setting would be the training room. Perhaps Jerry and Jeanie Buss could be sitting outside the door, waiting for Kobe Bryant to come back. However, he's hardly the only key to winning. Steve Nash has missed the entire season and at the twilight of his career, this crossroads of the Lakers may affect whether he ever will return.
Steve Nash was expected to be the kind of ball-handling point guard that could play limited minutes, but important minutes. It was the missing piece to the Lakers last year. This year, Nash is yet another luxury for a team decimated by injuries and in the midst of a rebuild. With Nash sidelined due to chronic back issues, the team is looking more like a lottery team and less like "Hollywood Nights."
The back injury has become more than a localized problem. Nash has complained of pain and weakness in his legs, which is a common complaint. Even with surgery, it's often difficult to get back to full function or a pain-free life. Add in Nash's age and the demands of the position, and it's easy to understand why he's struggled to even practice at times.
While Dr. Neel Anand hasn't examined Nash, he is one of the top spine specialists in the country and has dealt with hundreds of similar cases. "While we don't know what the exact problem is," Dr. Anand explained, "what we do know are the symptoms, and that is important. The biggest worry is what appears to be severe radiculopathy."
Radiculopathy is a very tough diagnosis. In most cases, it's a chronic condition that is one of the leading causes of workplace disability. The pain radiates from the spine out to inflamed nerves, sending electric jolts that can bring the strongest men to their knees, literally. It's debilitating for mailmen and factory workers, so it's hard to imagine how someone like Nash could play through it.
The hope is not that they cure the issue, but that it's controlled and maintained. One of the strongest tools at the doctor's disposal is epidural injections. These are merely injections of anti-inflammatories and anaesthetic agents that go directly into the spine. Yes, it's as uncomfortable as it sounds.
"They can give a lot of relief, sometimes in seconds," Dr. Anand explained, "but they don't always last. You can only do so many in a period of time. Over a season, it's not going to be effective as a maintenance plan. It might help him get through pain enough to where other treatments work.
A realistic goal for Nash is not so much a cure, but a return to function. Over the next few weeks, that will be the key. If Nash can't do everything he was doing before, can he focus on the things he can do enough to not be exploited? The coaching staff will have to balance what he can do with how the opposition exploits this.
One NBA assistant coach told me that Nash would see a couple different tactics when he returns. "I'd put a fast point guard on him defensively and see if I could make him run. I'd also run him off screens or defend him with a more physical 'two.'"
A scout suggested a similar setup, though he focused more on working Nash. "There's a balance between trying to test a guy and being cruel," he said. "Sometimes you don't want to get the guy off the floor. Nash was pretty bad last year, so maybe keeping him on the floor isn't a bad thing. Let him get his minutes and his money."
The rehab has been extended and, thus far, unsuccessful. The idea that Nash is missing another month, as announced in late December, due to the catch-all "general soreness" certainly indicates that the rehab isn't working. That's not a reflection on the medical staff as much as the medical condition. Usually "general soreness" is used in getting someone up to speed, but this tends to get extended out, as we've seen in cases like Danny Granger and Andrew Bynum.
The chronic nature of Nash's problems, which some believe resulted from changes after Nash broke his leg last season, makes this more than just a maintenance issue, but that may be the key. The hope is not that they cure the issue, but find a way to get him productive and hold that over the course of as many games as possible.
In the process of the rehab, the Lakers medical staff is also going to be looking for what causes symptoms to recur and what can they do to get him ready from game to game. NBA teams have become more and more conscious of fatigue, with teams resting players, but the lesser-known maneuvers are becoming more noticeable with players like Dwyane Wade needing extra rest. The "pick and choose" method is becoming more common, matching up a player with need and schedule, and is likely to be used with Nash.
Of course, with Kobe Bryant out as well due to his fractured knee, the Lakers have a bigger talent gap than ever. Nash would likely directly replace Bryant if he were available, with Bryant shifting back to his more natural spot once he returns. How Nash, Bryant and Gasol interact will be a big factor in how Nash is dealt with (and if Gasol is dealt to assist with rebuilding.)
There's one other interesting tool the Lakers may be able to use in monitoring Nash's comeback. Once he gets back on the floor, Nash, like every player in the NBA, will have his movement tracked by the SportVU system. The Lakers will be able to compare his quickness and movements night over night to see if he's slowing or if there are any unusual things that are not readily apparent to the naked eye.
While it's in my nature to be positive, there's not really much I've found in researching this case to truly be optimistic. Nash is not going to be the Nash of old, and the drop-off may be even more dramatic. In fact, the most likely outcome is that he'll fail.
The best efforts and best hopes of the Lakers are fighting both time and chronic injury in search of that one last moment of glory. Given the team and what we know of Nash's medical condition, all we can do is hope that he gets to go out standing and not headed back to surgery.