Ja Morant sprained his ankle. Karl-Anthony Towns partially dislocated a bone in his wrist. Spencer Dinwiddie partially tore his ACL. These are just a few of the seemingly ever-mounting early season soft tissue injuries suffered in the NBA.
Injury occurrence becomes a frequent topic of conversation at the beginning of every sports season as we forget the injuries that occurred in the past and are enamored with the return of seeing our favorite players back on the court, pitch, or field.
The conversation almost always begins as such:
The thing is: It may be.
The science of rehabilitation and injury prevention is relatively young compared to other medical fields and constantly evolving; as such, not much is known with 100% certainty.
This uncertainty exists for a number of reasons - the entire depth of which is beyond the scope of this article - but perhaps the main reason is that it is difficult to produce high-level studies.
The gold standard method of conducting studies in medical scientific research is the double-blind randomized control trial. In short, this type of study is set up in a way so that the researchers and the participants are completely unaware of what treatment - the medication or a placebo, for instance - they prescribe and receive, respectively. That’s very difficult in the rehab and injury prevention world as, well, it isn’t really possible for a participant to not know what exercise they are performing or for an athletic trainer or physical therapist to not know what exercise they prescribed.
This is just one example, but suffice it to say that a double-blind randomized control trial cannot be conducted to determine which NBA athletes get injured. As such, a good chunk of the research looking into this topic utilizes retrospective data.
Retrospective data are numbers that are collected after the statistical events occur. For example, a player’s career statistics are retrospective data; they scored a ton of points and past box scores show exactly how many points were scored. Retrospective data is easy to collect, but the interpretation of the data has great potential to be smudged by bias. It is easier to selectively pick and choose data points to bend the dataset to fit a preconceived narrative.
Retrospective studies don’t hold a ton of weight within the research community. They are often seen as intriguing and reseason for more research to be conducted, but they are never seen as being able to firmly conclude reality.
In essence, we can look back at all the data from the conception of the NBA until now and perhaps say that the injury occurred in the NBA through the first week of the season is increased compared to previous seasons, but that would merely be an indication, not a scientific fact.
Additionally, the sheer amount of variables that exist from season to season - not to mention one extended (2019-20) and pushed back (2020-21) due to a global pandemic - make it difficult to draw 1:1 comparisons. Each season in and of itself is a unique case study of sorts.
Going back to the whole “injury prevention science is an uncertain” idea, two things seem to pop up in the research time and time again: 1. Injuries - particularly those of the soft tissue variety - are most likely to occur when an athlete goes from relatively little activity to relatively a lot of activity and 2. Injuries are multifactorial.
In regard to the first, the term “relative” carries a ton of weight and adds a layer of obscurity to what otherwise seems logical. Each individual athlete carries their own unique workload; one of the more well-known workloads is the acute:chronic workload ratio, which takes into account how much “work” - practice, games, off-time. etc. - a player does over the course of a week and compares that to their monthly totals. This ratio was developed in part to help athletic trainers and other team medical providers determine when an athlete needs some extended rest; to put it simply, the higher the ratio, the more likely the athlete is to suffer an injury.
However, this ratio is - again - merely a suggestion rather than a fact. Each athlete has an inherent ability to overcome their workload. For example, LeBron James may be better able to tolerate a chronically high workload and not suffer an injury than another player. The trouble is, it isn’t completely known why that is. Is it genetics? The athlete’s overall mentality? Body composition? Treatments received? Amount of sleep per night? Or - more than likely - some combination of all the above?
To put it bluntly: relatively little activity for LeBron may be relatively a lot of activity for someone else and vice versa. (It should also be noted that many of these studies are not conducted on athletes competing at the NBA or a commensurate level. They are usually conducted on those at the high school, college, or international level.)
In regard to the second, it is nearly impossible to say what the “cause” of an injury is. There is the mechanism - the roll of an ankle or the twist of the knee - but not all athletes who roll their ankle will suffer an ankle sprain. Muscle strength, fatigue level, sleep quality and quantity, diet, injury history, all these factors - and many more - play a role in injury occurrence. Many of these factors can be addressed in a variety of ways, but even still injuries will occur.
Injury occurrence is a topic of conversation that arises at the beginning of nearly every season - no matter the sports league - and it will continue to come up until the heat death of the universe. However, it is virtually impossible to know with any amount of certainty if an increase in injury occurrence is due to something other than coincidence. That conclusion does not seem logical, but logic isn’t always the stout defender of truth we want it to be; the human body is too complex and the variables too many.