Karthik’s Take: Why do NBA rookies keep getting hurt?


Lamelo Ball’s season-ending wrist injury is the latest example of one of the NBA’s most recent and disturbing trends. NBA rookies are getting hurt at an alarming rate. It has become far too common to hear that a highly anticipated draft prospect has to miss a full season before their NBA debut or fell victim to a season-ending injury during their first year in the league. This problem is not just impeding the career progressions of the most promising young talent but hurts the NBA’s viewership as basketball’s brand is built on fans following up on their favorite players.  

To address the issue, NBA owners and executives need to ask themselves three questions. 

  • How bad is the problem?  
  • Why is it happening?  
  • What can be done about it?  

Looking at the available empirical data, the extent of the problem becomes painfully clear. NBA rookies drafted in 2019 played in just 66.9% of regular season games. This availability percentage dipped to 61.4% in 2018, 61.2% in 2017, 53.4% in 2016, was relatively up at 65.8% in 2015 and an abysmal 46% in 2014. Juxtapose this playing rate to rookies from the 1984 through 1988 draft classes who played in 79.2%. 78.8%, 76.2%, 76.4% and 78.3% of their debut regular-season games respectively, and the timeframe of this problem’s development becomes apparent. Some notable NBA players that have been compromised by injury during their rookie campaigns include Zion Williamson, Ben Simmons, Joel Embiid, Julius Randle, Blake Griffin and Michael Porter Jr.  

Even with constant advancements in medical understanding, physical therapy and athletic training, the consistency of the injury data shows that the frequency of debilitating injuries happening to young players is not a fluke. Medical records from Jeff Stotts, a certified athletic trainer who has tracked the careers of over 1,100 players since the 2005-06 season, have stated that first-round picks now have the highest likelihood to miss time because of injury.  

The puzzling part of this issue is that the players are suffering injuries that previously only affected veteran players who had more mileage on their bodies. The majority of these season-ending injuries stem from structural weaknesses, something that should be more of a concern with age and attrition. NBA commissioner Adam Silver himself has acknowledged this fact. “What our orthopedics are telling us,” Silver says, “is they’re seeing wear-and-tear issues in young players that they didn’t used to see until players were much older. “Such regularity of these wear and tear injuries to young players means that player development has to be the first point of consideration in this multifaceted issue. 

The NBA originally banned the drafting of high school players and mandated that prospects complete a minimum of one year in college, the NBA G-League or play overseas during the same time span to let players mature physically and emotionally. The last player to get drafted straight from high school was Amir Johnson in the 2005 NBA draft. However, this has not dissuaded league franchises from scouting talent earlier and earlier. There is a vested interest in finding the next NBA superstar, regardless of how many tries it takes. In fact, the NBA has even considered bringing back the option to draft high school players by 2021 because of concerns regarding potentially exploitative practices by the NCAA.  

Nevertheless, athletes striving for professional basketball opportunities have responded to scouting interest by specializing earlier and training harder than ever before, much to the detriment of their health. Lakers head strength and conditioning coach Tim DiFrancesco said that young players are like “ticking time bombs” and that it is simply a matter of time before they get hurt based on how they are developed physically. After Julius Randle broke his leg 14 minutes into his rookie debut, DiFrancesco analyzed the injury, saying that “There is no clear culprit. No explanation. Randle’s leg simply snapped.” Randle’s physical anatomy simply could not take that level of pressure and it is no fault of his. The bigger and more athletic a player is, the more likely an injury like this can happen. 

Medical experts cite four key reasons for the uptick of injuries among young players: substandard sleep as a result of hectic schedules and technology use, frailer bones due to player diets being low in calcium and high sugar, specialization in basketball at early ages and weaker muscles as a result of substituting traditional weight training for more basketball optimized conditioning techniques. Players now have the ability to push their bodies to their limits thanks to modern science, resulting in the most athletic breed of NBA players seen in the league’s history. The downside is that if one misstep happens, players training at this peak intensity are way more likely to undergo gruesome injuries. A study from the Journal of Athletic Training analyzed the impacts of such specialized training and found that many lower body injuries can be directly attributed to bilateral isokinetic and functional asymmetries. In other words, the human body has limits and needs to be strengthened more evenly. Training cannot keep getting more intensive without prioritizing increasing general strength via a balanced approach that prioritizes rest and recovery. Dr. Charles Czeisler, the director of the Division of Sleep Medicine at Harvard Medical School who has been a consultant for several NBA teams echoed this sentiment, saying that “One night of lost sleep is 10 times more detrimental to those ages 18-25 than to those 60 and over because younger people’s sleep is much deeper, more restorative and the body’s “drive” to sleep is more intense”.   

Addressing the issue should be of interest to all involved parties. The players benefit for obvious reasons with a better chance to not sustain a severe injury, teams are able to make more efficient talent investments and the league gets a more exciting product to market to the fans. So what can be done?  

While the NBA has no direct power over youth basketball programs, upcoming athletes need to be made aware of the risks that the status quo NBA training entails. This can be most effectively achieved through NBA player outreach. Players like LeBron James who have highly touted children en route to the league can make a significant impact in helping kids train the right way. Basketball institutions can also more effectively regulate the diets of their athletes but ultimately, the issue comes down to awareness. These athletes are disciplined and highly motivated. They will do what it takes to be successful in the NBA. They just need to be empowered with the right information. This will encourage players to do their homework on what they are eating and how they are exercising, gradually lowering the risk of injury as they get closer to the NBA draft. The big change that the NBA can implement is finding a way to space games out more efficiently. While cutting games from the regular season is not an option for monetary reasons, eliminating back-to-back games may help the players maintain recovery and sleep cycles that greatly mitigate the risk of injury. Everybody wins with fewer players getting hurt.  

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