There are injury risks in unprecedented NBA restart after four-month hiatus

If a high-performance athlete was a violin, Stuart Phillips says he or she would be a Stradivarius.

Famous for their rich quality of sound, Stradivarius violins perform at unparalleled levels. The precious instruments take special caring. They’re also worth millions.

“Pro athletes and NBA players in particular, they’re high end. . . and so you take away their supports and they become vulnerable,” said Phillips, director of the McMaster Physical Activity Centre of Excellence.

The NBA tips off its restart at Walt Disney World in Florida on July 30, a massive undertaking with myriad unknowns after an unprecedented four-month hiatus due to the COVID-19 global pandemic. After the longest layoff in most players’ careers, teams have had to jam preparations into just three weeks.

While it’s impossible to completely predict injury risk, the NBA has to hope it’ll fare better than the NFL’s return to play after the 2011 lockout. NFL players were sidelined for four months without access to their teams’ healthcare providers or coaching staff. Training camp opened two days after the lockout ended, with disastrous results.  

A typical NFL year sees between six and 10 ruptured Achilles tendons over the entire season, including training camp. In 2011, there were 10 ruptured Achilles in the first 12 days of training camp alone.

A player’s inability to properly care for their bodies during the break is a big concern, Phillips said.    

“If you’ve never climbed inside either a pro sport or a high-level amateur sport, to realize the amount of support that the athletes get, that they’re constantly surrounded by, that when it’s not there how quickly they would break down,” said Phillips, a kinesiology professor at McMaster University.

Like Formula 1 cars, athletes are always being serviced. The tiniest tweak after coming off the court sends a player immediately to the trainer’s table or into an ice bath.  

“When you’re out of the environment where you have your trainers and therapists and your nutritional support team, and your teammates who are all supporting you, and doing all the things that they do to make you better and push you and everything, they get into a phase where they just aren’t as finely-tuned,” Phillips said.

There’s already been a couple of injuries in the NBA bubble. Memphis will be without forward Justise Winslow for the rest of the NBA’s restarted season after he fell Monday and injured his hip. And Sacramento big man Marvin Bagley injured his right foot on Sunday.

The Toronto Raptors began practising at Disney World on July 11. They’d spent the previous two weeks in Naples, Fla., but had been limited by coronavirus protocols to four players per session, and only one-on-none drills.

Coach Nick Nurse asked his players to monitor themselves during practice, saying it was important — particularly for players like Marc Gasol who’d been plagued by a hamstring injury before the global pandemic — to pull themselves out when they’ve needed a break.

The coach works closely with the team’s sports science gurus to gauge the players’ fitness and fatigue levels.

“I always want the answer to where guys are and what they think the workload should look like, for each guy individually. . . I am a long ways away from using my gut instincts on that side of things,” Nurse said after Monday’s practice. “They tell me ‘Hey, it would be a good day to rest player X, Y, Z,’ and I’ll say ‘Why?’ and they’ll tell me why and then I’ll certainly take their information and use it.

“I lean on them heavily for a lot of that stuff.”

Led by Alex McKechnie, the Raptors’ head of sports science, the team famously perfected the nuances of load management with Kawhi Leonard last season, holding the superstar out of regular-season games so he’d be at his best for the post-season. They couldn’t have written a more successful ending: an NBA championship and an MVP performance from Leonard.

Clive Brewer, high performance director for the Columbus Crew of the MLS, formerly with the Toronto Blue Jays, compared athletes such as Leonard to F-14 fighter jets.

“They’ll fly right at the edge of physics,” Brewer told The Canadian Press during last season’s NBA playoffs. “They’ll do things that are incredibly agile and they’ll twist and they’ll turn. But if one thing goes wrong with them, they crash and burn.

“Compare that to a jumbo jet. It flies pretty high, pretty far, pretty fast,” Brewer said. “But it will fly on one engine. Jumbo jets, they’re not going to perform in the high-performance environments, but they’ll keep going.”

So while the weekend warrior might play slo-pitch this summer without suffering major injury, there are more factors to consider with elite athletes returning to sport.

Sport physiologist Trent Stellingwerff, who’s been a member of Canada’s high performance team for numerous Olympics and world championships, said there are some key scenarios that are high-risk for injury including a pre-existing injury, or a sudden change in training load — “So, at the start of the season, or coming out of COVID.”

Germany’s Bundesliga, one of the world’s top soccer leagues and first to restart, was ravaged by 12 soft-tissue injuries in its first weekend back in May.

Stellingwerff hopes that leagues have learned from the NFL’s disastrous return in 2011. While NBA players had been scattered across North America and Europe the past four months, some living in apartments with little access to gym or basketball facilities, he said players who were able to do high-intensity, specific movement patterns like cutting and jumping, will be better prepared.

“You don’t need a massive gymnasium to do that, you can get quite creative in terms of jumps and plyometrics and quick cuts and moves just even in a laneway,” he said.

Still, players normally play pick-up games in the off-season, and had no high-speed contact before arriving at Disney World. 

Athletes refer to being in game shape. Riding a stationary bike and shooting hoops in a gym is no substitute for getting game-ready — playing games at NBA speed is necessary.

Phillips said while there’s no magic formula for injury prediction, strength and fatigue both play big roles. Muscles and tissues are probably lacking a bit of resilience from the layoff, he said. 

“And then at the same time, it’s fatigue,” he said. “Towards the end of the game (especially), you’re going to see a few people make some poor decisions, and fatigue is the antithesis of skill, right? Instead of landing and having a bit of residual left in your muscle, you land slightly differently, and you step the wrong way, and something that you could usually recover from, you couldn’t.

“I don’t think that anybody should think that they’re going to see the top end game of these guys for a while.”

There’s added concern about players who’ve tested positive for COVID-19, and the league said it would implement heart monitoring for those individuals.

Each of the 22 teams in the restart will play three scrimmages beginning Wednesday. The Raptors play Houston on Friday in their first real action in more than four months. They tip off seeding round on Aug. 1 versus the Los Angeles Lakers in what will be Game 1 of eight games in 14 days before the playoffs.

The one benefit is the absence of a hectic travel schedule.

Stellingwerff said there’s a research paper to be written on pro sports’ return, and its relative success or failure.

Both he and Phillips are interested to watch how the next few months unfold. 

“I feel for some of the performance leads and directors of these teams because they’re in a challenging position to try and all of a sudden guide players to elite performance status, but you’ve got like two weeks to do it,” Stellingwerff said. “And then the owners are going to be like ‘And don’t get anyone injured.’ And ‘Oh, make sure no one gets COVID.’ So, it’s a challenging performance puzzle.”

This report by The Canadian Press was first published July 21, 2020.

Lori Ewing, The Canadian Press