In July this year, 22 NBA teams descended upon Disney World in an elaborate bid to salvage a basketball season that, like most things, came to a grinding halt in March. Against the odds, it was a success – a completed season, reportedly zero positive corona tests, and a platform for players to take a stand on the social justice issues sweeping the country. But now, the NBA bubble has burst, and a fresh new season awaits under more conventional circumstances. Opening night falls on Tuesday, just 71-days after the Los Angeles Lakers overcame the Miami Heat to win an emotional title, and a series of season-defining questions remain unanswered: How long will James Harden remain in Houston? Will Jayson Tatum be listed as a 7-footer by the end of the season? And will Giannis’ free throw percentage dip below his field goal percentage? One aspect in particular that seems to be troubling the league’s staff is the risk of injury. These concerns have been amplified by another season-ending injury to Klay Thompson paired with observations in other sports, including a number of key NFL injuries and a sharp increase in hamstring injuries in the Australian Football League. European football is under particular scrutiny - at various stages of the English Premier League season so far, muscle injuries have been anywhere between 16% to 42% higher than the same point of the previous season. Injuries can pretty quickly turn championship aspirations into lottery draft picks. So, using the factors that are driving European football’s injury problems as reference points, let’s take a look at what’s in store for the looming NBA season.
Contributor 1: The Pre-Season
The period between seasons should serve two basic functions: 1) recovery from the rigours of the previous season, and 2) adequate preparation for the rigours of the upcoming season. The recovery part is self-explanatory – spend some time away from the court to unload before reloading. Once the legs are fresh again, pre-season presents the perfect opportunity to bank some physical development and injury prevention currency in order to stay afloat during a long season.
Inevitably, when the length of pre-season is eaten into, recovery and preparation are compromised, which may explain why elite football teams who complete fewer pre-season training sessions lose more time to injury in the subsequent season. For teams involved in the late stages of the Champions League this year, the writing was on the wall. Paris Saint-Germain’s injured XI for this season almost resembles their optimal starting squad. And, while most of their compatriots were in vacation mode, German giants Bayern Munich won the Champions League final on August 23rd, returned to team training on September 9th and had their first game of the new season on September 18th. That’s 17 days to recover from a campaign where they conquered all of Europe, and a further 9 days to prepare to do it all again.
A similar scenario is brewing in the NBA. For the Lakers and Heat, their reward for going deep last season is the shortest pre-season in modern history across all four of the USA’s major sporting leagues, which left none other than LeBron James expressing his disapproval. For teams not involved in the NBA’s bubble experiment, it’s the opposite – the Cavs, for example, played their last competitive game 289 days ago, which can also present injury complications due to a lack of recent game exposure. Regardless of a long or short off-season, the timeline has radically shifted for everyone, and the scenario for rookies is particularly interesting. In 2019, NBA freshmen had 123 days between draft night and the start of the season to participate in the Summer League, team training camps and pre-season games. This year rookies have just 34 days between draft day and the season tipping off, with no summer league and just four pre-season games to rise to the demands of NBA basketball. For number two pick in the draft James Wiseman, the timeline is especially challenging, given that he played just three games of college basketball in 2019 before his season was cut short, and has played no pre-season games courtesy of a positive corona test upon joining the Warriors. It’s a fascinating scenario amongst a class of rookies facing the double-edged sword of more time to physically prepare for the demands of NBA basketball, but less time in the NBA system to gain direct exposure to those demands.
Contributor 2: The Fixture
Even in the pre-pandemic era of global sport, scheduling issues were a contentious topic. Thanks to broadcasting pressure, the fixtures in European football appeared to be expanding with each season despite evidence that players with a higher match density are at a higher risk of injury. This year, match congestion has escalated substantially, which is likely driving the injury increase, and explains why teams with extra game load via European league duties currently sit atop the EPL injury list (despite what Jose says). As the congestion continues, it inhibits teams from implementing meaningful in-season training load, which potentially feeds back into the injury risk later on in the season.
But the European football fixture schedule is not as frightening as the NBA’s. Traditionally, teams contest 82 regular season games, with routine clashes on consecutive nights, all culminating in lengthy playoff series for the top eight teams in each conference. Despite the ridiculous schedule, there is no compelling evidence to suggest that NBA injuries are higher on the second night of back-to-back games (there is some evidence, but it’s far from convincing thanks to statistical flaws). However, this doesn’t mean that back-to-back games and game congestion don’t contribute to injuries through overload over time. With this in mind, the league dropped ten games from the schedule, meaning teams will average a game every 2.01 days for the period of the upcoming regular season, including around 13.94 back-to-back sequences. It’s certainly demanding, and it is indeed an uptick on what was slated for last season before you-know-what happened - one game every 2.15 days, with 12.4 back-to-back sequences per team. But on closer inspection, things could have been a lot worse. Following the 2011 lockout, the NBA crammed a 66-game regular season into a 123-day period, for a game every 1.86 days. To achieve this rate of play, each team had least one set of back-to-back-to-backs (yep, that’s three games in three nights, often on the road). Combined, there were 42 sets of three games in three nights, and 29 sequences where teams played five games in six days. It’s little surprise that teams suffered injuries to big-name players deep in the season.
The scheduling all boils down to the league’s priorities – broadcasting dollars or player welfare? It’s not much of a secret which one wins out most of the time, and it became even less of secret when broadcasters were exposed for allegedly censoring Liverpool boss Jürgen Klopp when he spoke out about the impact the TV schedule is having on his team. It wouldn’t have been a surprise to see the NBA go down the same path. But instead, NBA commissioner Adam Silver and the Players Association combined to reach a relatively sensible middle ground which doesn’t involve exorbitant increases in player load compared to previous years. Teams involved late in the bubble even have a more favourable schedule in the first half of the season to make up for their abbreviated pre-season.
Contributor 3: The Training
‘Injury prevention’ training programs have been demonstrated to reduce injury incidence in professional football players, which is a promising development. But most of these programs, including the FIFA 11+ program, simply include elements that should already be a staple in strength and conditioning program anyway, like eccentric strength development, exposure to maximal velocity sprinting, and proprioception training. It begs the question – what were some teams previously doing for training if the inclusion of basic strength and conditioning significantly reduces injury rates? This issue of training methods isn’t unique to this season, but this unique season is certainly exposing it a new extent. Simply put, some teams are years behind in terms of their willingness (or ability) to implement evidence-based methods, especially outside of England. Whether it’s because their fitness trainer is handcuffed by an old-school coach, or because a former player waltzed his way into a position he’s supremely underqualified for, there remains a certain aversion to modern strength and conditioning in some dusty corners of the European football community which ultimately results in some players spending more time in the physio treatment room than the weight room.
Like the top football leagues, the NBA is stacked with highly skilled practitioners who are on the cutting edge of applied sport science – Lorena Torres (76ers), Jace Delaney (Celtics) Blake McLean (Thunder), Xavi Schelling (Spurs), Cory Schlesinger (Suns)… The list goes on. But a major problem is that NBA players spend their off-seasons away from the team, often with their own personal trainers. Unfortunately, the off-season personal training market often rewards clout and confidence over competence. My favourite example is a training facility responsible for the off-season preparation of some high-profile NBA athletes whose social media presence is riddled with red flags, including a trainer recommending an ‘alkaline diet’, a future Hall of Famer running in an altitude mask, and most recently, a handful of anti-vax stories. Ironically, this is all coming from the co-founder of an institution that sells online seminars where they teach personal trainers to access and interpret scientific information. On the complete opposite end of the spectrum exists P3 Performance. There’s a very good reason Luka Doncic has spent his summers with them since he was 15, and why more than 45% of current NBA players have visited their premises to undergo biomechanical assessment. As a bonus, they’re publishing some of their findings along the way. At the highest levels, the value of a trainer is not simply in improving already elite physical performance. Instead, their value lies more in ensuring that players are available to express their elite physical performance night after night over the course of a long campaign.
The Forecast
NBA staff are well aware of the unique elements underlying this season, and so we can expect players to be rested at record rates. Even though Kawhi Leonard load-managed his way to the Raptors’ first ever championship in 2019, there remain non-believers in the load management movement – when questioned about the game load for his highly-touted draft prospect Cole Anthony last year, decorated North Carolina coach Roy Williams stated that he “doesn’t believe in this load management crap”. Fast forward a month, and Anthony underwent surgery on a partially torn meniscus that “did not occur in one play” and apparently just built up over time. So, while some continue to waste time debating the Kawhis and Kawhi nots of load management, the favourable evidence is accumulating. Resting for back-to-back games can reduce the probability of an injury by around 16% for the average player, and the leading culprits on the NBA injury list, including lateral ankle sprains and patellofemoral ailments, can be influenced by frequency of exposure to high external loads and fatigue, among other risk factors. Accordingly, teams are already making plans to put this evidence to good use. After all, molehills can pretty quickly become mountains if left unattended for too long, which is exactly how Kawhi has become the face of load management in the first place. And once an athlete sustains an injury, they can be at a higher risk of subsequent injuries, even if it’s seemingly unrelated – Klay Thompson, DeMarcus Cousins, Derrick Rose and Kristaps Porzingis can attest to this. Finally, reducing game load allows more time for recovery and for microdosing some season training load - exactly the same pieces of the puzzle that were compromised by the abbreviated off-season. In fact, the NBA has even relaxed their load management policy for this season, seemingly opening the door for players to rest with more freedom than previous seasons. All things considered, is it any surprise that LeBron, Anthony Davis, Russell Westbrook, Kevin Durant and many others will be sitting out some back-to-backs and dropping some minutes to increase the chances that they’ll be available when the playoffs arrive?
The NBA and European football undeniably share some common ground this season – an abnormal pre-season, a tight schedule and an ensuing uphill battle to avoid injuries. While the circumstances have manifested in more injuries for the EPL, this isn’t an automatic uptick guarantee for the NBA. In fact, our first taste of post-pandemic basketball in the bubble actually saw a reduction in injuries compared with previous years. But inevitably, layering back in the complications of travel and the associated sleep struggles will be costly, and despite the proactive attempts by the league to limit the damage, it’s likely that medical and performance departments will have their hands full this season.
