NBA Injuries, Part 2: The Injury EPIDEMIC in Young Players

Fourteen minutes into his NBA career, the Los Angeles Lakers' invaluable seventh overall pick, in the form of forward Julius Randle, sat grimacing on the baseline at the Staples Center. Although rather calm, the number of coaches, players, and athletic trainers surrounding Randle swiftly increased, until the nineteen-year-old was eerily carted off, with twenty-year veteran Kobe Bryant feeding valuable, but at the time difficult, insight to the somber rookie.

Following the 2014 NBA Draft, this scene became something of a formality. By the end of the season, eight of the top eleven picks had sustained serious injuries with four--Randle, Jabari Parker, Joel Embiid, and Aaron Gordon--forfeiting at least 35 games to significant injuries. 

While this "injury bug" is undoubtedly partially due to chance, injuries in the NBA have become more prominent in recent years, as we detailed in part one of this series. In fact, in the past five postseasons, 217 games were lost to injury, 105 more than the previous five (ESPN). While this indisputably places an almost unfair advantage on the teams with health and even removes some of the intrigue of the playoffs, a more serious problem exists: a new, but genuine inability to keep young players on the court early in their careers, and a difficulty preventing overuse and cumulative injuries. To what can we attribute this new phenomenon? Is it fixable? 

​Youth Roots
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The vast majority of NBA players discover their innate talent at a very young age. Likely originating as early as elementary school, these players are special, and in effect, most of them decide to specialize in basketball at least throughout their high school years, theoretically becoming the best they can in order to maximize the already slim (on a national scale) chance to advance to and succeed on the next level. Yet, what most adults do not realize at this stage in childhood is that this may ultimately facilitate negative byproducts. According to a study by Robert M. Malina, "overuse injuries are a consequence of repeated trauma in a tendon, muscle, or bone associated with chronic repetition of specific sport activities." In other words, the movement in a specific sport, even one as complex as basketball, when repeated, place stress on certain areas, and strengthen others, creating significant imbalances. As a result, playing only one sport can appreciably raise the risk of injury, both as a young player, and later in a career, when specialization may be even more profound.

​And, although the entire AAU hatred is probably overblown, it likely compounds this effect. Spring and summer basketball is centered around the obsession of playing as many games as possible for maximum exposure. As a result, no preparation is encouraged, and teams frequently hop out of a van following a three-hour road trip, and play two games 15 minutes later with a three-minute warmup period. Yes, it is unrealistic for all teams to perform a full dynamic warmup before each game, eat right, and sleep a sufficient amount throughout the course of the summer circuit, but this wear and tear, especially in the absence of preparation, does add up, especially when many players begin this lifestyle in elementary and middle school. While it is rare for the imbalances, overuse injuries, and more to manifest themselves in younger players in the form of serious injuries, the effects later in life are unarguably present.

In the locker room of the San Antonio Spurs, an organization known for their players' durability, a sign hangs that reads:

"Look at a stonecutter hammering away at his rock, perhaps a hundred times without as much as a crack showing in it. Yet at the hundred-and-first blow it will split in two, and I know it was not the last blow that did it, but all that had gone before."

This perfectly depicts the nature of this new era in basketball. The hammer--the early wear and tear of four to five games a weekend without proper preparation--continues to batter the bodies of these athletes, who are setting up their bodies for injury later in their careers.

Take Kobe Bryant, an unapologetic critic of the structure of youth basketball. "Looking back," he says, "when I grew up, I played soccer until I was about 14. And so when I came back from the States from Italy, that's when AAU was really starting to take off, and I literally played basketball all day, every day, every tournament, everywhere, which does nothing but wear the cartilage out--which explains why I didn't have much cartilage left in 2003."

Again, young players should not be discouraged from playing tons of basketball: it's what they do if they love the game. But, early-career NBA injuries are beginning to display the faults, at least physically, in the structure of organized youth basketball.

The Next Level

Similar to high school, the schedules of big-time college teams are becoming longer, condensed, and packed with travel. Just take a look at Duke's 1992 National Championship-winning team: before their conference schedule, the team played three away or neutral games, and six total in 36 days. Conversely, Duke's 2014 National Championship team traveled to five away/neutral games, and fourteen total contests in 58 days. That's an extra two trips, eight games, and 22 days of season for players who are still getting adjusted to an increased workload at the next level. 

And, a sudden spike in activity is arguably the most common cause of many overuse injuries, such as tendinitis, as well as more serious acute injuries. So, after a six-month break from games, it is tough for these young players' bodies to quickly acclimate to the faster, more demanding style of play. And, again, while this may not be expressed in their college careers, the stonecutter is hammering away...

​The Training Problem

For many high school players, there really is no clear-cut off-season. When they're not with their high school teams, they are--the majority of the time--playing in tournaments or showcases. 

And the most foolproof, definitive method of lowering the risk of injury is a proper strength program. Yet, because in-season is meant for maintenance work, and because there is no off-season for most players at that age, when can they correct movement patterns, fix imbalances, and strengthen their bodies to prevent injury? Plus, many young athletes do not have access to either a proper program, or the resources to get it done. 

And while strength training at the college level is fantastic at most schools, many professionals have noted a shift away from traditional heavy lifting, especially at the NBA level. Yes, great new methods of strength training and injury prevention are emerging, but heavy deadlifts, squats, and other compound movements are vital for any program that desires to limit injury. And, in the NBA, these are becoming more and more rare; most likely because the athletes simply do not like doing them, and have more power to control their workouts! (ESPN)

At the end of the day, there is no definitive reason for this spike in the injuries of young players. For all we know, it could be due to chance. Yet, it seems as though there exists a number of factors that are hammering away at many of these players' bodies... Let us know what you think about the issue in the comments or on Twitter, and we will continue to update with ways we believe this epidemic can be limited! 

Thanks to Baxter Holmes and Tom Haberstroh of ESPN for valuable statistics and information:
http://www.espn.com/nba/story/_/id/16009898/nba-injury-problem-scheduling-one
​http://www.espn.com/nba/story/_/id/13217004/the-four-injury-risks-today-young-nba-players-face