Diving deep into data, the NBA, formally, says its numbers don’t back load management – The Athletic

The NBA’s 180-degree turn on its policy toward load management now has hard data to support its change of heart.

The league released a long-awaited report on load management that it first disseminated to its Competition Committee, and then to selected media this week, with a video call Thursday featuring two of the NBA’s top medical officials, along with senior epidemiologists from IQVIA, a health information technology and clinical research company that partners with the league.

Chief among the findings in the 57-page report, which the league says was culled from data over the last decade from teams through the league’s electronic medical records system, along with IQVIA’s Injury Surveillance and Analytics team, which has worked on data collection with the NBA and team medical and athletic training staffs since 2014-15: Resting healthy players for a game to help prevent future injuries doesn’t make those players less susceptible to future injury than players who aren’t rested for games.

“We have not, historically, seen evidence demonstrating that load management through reduced game participation reduces injuries,” said David Weiss, the NBA’s senior vice president of player matters. “To be clear, we also lack evidence that load management fails to reduce injuries. We just don’t have evidence that it does. And some members of the Competition Committee had taken it as the conventional wisdom that there is evidence, that it is proven, that within the NBA, load management reduces injuries. We just haven’t seen that in about 10 years’ worth of data.”

The report summarizes that missing games for rest or load management did not reduce future injury rates; that schedule density, including playing back-to-back games, does not impact future injury rates; and that cumulative game load — playing a high number of minutes or games, or playing more minutes than usual in games — did not impact future injury rates.

“Overall, what the analysis showed, and what’s reflected in the report, is that based on this league-wide injury and participation data, load management, in the form of missing regular-season games, has not reduced the risk of future injury for NBA players,” said Dr. Christina Mack, IQVIA’s chief science officer of epidemiology and clinical evidence head. “Again, as we did that analysis, we tested the results against assumptions. … (but) we consistently did not see load injury rates or injury risk when players rested more during the regular season.”

The NBA’s report says players defined as “star” players have, so far this decade, missed an average of 23.9 games total per season, which represents a large increase over the average number of games missed by stars in each of the previous five decades: 17.5 (2010s), 13.9 (2000s), 10.6 (1990s) and 10.4 (1980s). The league defines “stars” as the 150 players per season who were an All-Star in any of three prior seasons, a top-10 draft pick or the players with the most total minutes played in the prior season, if they’re not already in that group. The league says that increase in games missed is mostly because of actual injuries, but at the same time, the number of single-game absences has increased five-fold.

“Clearly, that’s happening more than at just the rate of injuries,” Weiss said.

The league’s new Player Performance Policy, implemented in September for this season, is not meant, alone, to address the issue of load management.

The PPP is one of “multiple aspects” of the league’s approach to encourage greater player participation, Weiss said, including NBA Draft Lottery reforms that reduced the incentive for teams to tank late in regular seasons, the implementation of the Play-In Tournament in 2020, this year’s In-Season Tournament and the 65-game minimum for players to be eligible for most of the league’s top awards: Most Valuable Player, the league’s three All-NBA teams, Defensive Player of the Year, the All-Defensive team or Most Improved Player. (Players who play in 62 regular-season games, then suffer a season-ending injury, also will remain eligible for the awards, provided they played in 85 percent of their team’s games before suffering the season-ending injury.)

The NBA’s about-face on the policy has come slowly, then all at once, over the last six months, including commissioner Adam Silver’s declaration in September that the data on load management was “inconclusive,” after insisting for years that the NBA would follow its teams’ leads and allow them to rest players as they saw fit. Joe Dumars, the league’s executive vice president of basketball operations and a Hall of Fame guard and a two-time NBA champion with the Detroit Pistons, said last October that the league wanted to re-establish a culture where “everyone should want to play 82 games.”

Some in the league have been skeptical about the change, with others wondering if the league’s switch is more about mollifying its national TV partners, who’ve chafed at the increasing number of marquee TV games over the years that star players have missed because of load management decisions by their teams and not because they were injured. The league fined the Brooklyn Nets $100,000 earlier this month after the Nets held out four players — even though none of them would fall under the “star” designation as defined under the PPP — in a late December game against the Milwaukee Bucks.

The report was reviewed with feedback from the NBA’s sports science committee, team health and performance staff, including team physicians and athletic trainers, medical leadership from the National Basketball Players Association and other medical experts.

The league pointed out that the report has limitations:

• It only covers regular-season games.
• It doesn’t account for players coming from the offseason and ramping up for play before the start of a regular season.
• It does not determine how much the fatigue of playing more minutes or games impacts players’ mental health, a major area of increased concern and care by the league in recent years.
• It does not account for individual intensity of play (how much does one player pace himself during a season, compared with another?)
• In addition, players over 35, who are eligible for exemptions from the PPP, are such a relatively small sample group that more data may be needed to see if they’re impacted differently.

“We want to be careful not to overstate the finding here,” Weiss said. “This doesn’t prove that load management doesn’t work, but it really calls into question the conventional wisdom that it does, to reduce injuries. That’s sort of why we wanted to put it on the table. Some teams have done deep studies of this; others less so, and relied on some of that conventional wisdom. And we wanted to make sure we were having a very, more medically- and scientifically-informed conversation around the league on this.”

Said Dr. John DiFiori, the NBA’s director of sports medicine: “Sometimes, the earlier data that comes out is very promising, but it’s not as rigorously performed. And it’s not until sort of higher-level, more methodologically sound studies are performed, that you begin to see what we can more reliably expect when it’s put into play. I think part of it is when the early information started coming out, it seemed like a great way to begin to try to prevent injuries, and manage training and performance. …

“This is just one aspect of load management that we’re looking at, which is the application of load management in the NBA, and also that it’s applied in the sense of missing games. When you’re missing a game load, and it doesn’t take into account all the other aspects of load management that might be going on that we can’t measure currently. …we don’t have data, consistent data, across teams, across the league, on what they do on other days that they’re not playing — other training and conditioning aspects. So all of that’s part of load management. This is specifically looking at whether missing a game makes a difference. … This is not the final determinant study, but it’s pretty good data for the world of basketball that shows we need to do some more work here to understand it.”

The report, though, contradicts what Silver, up through last year’s All-Star Weekend in Salt Lake City, insisted for years was strong data from teams that indicated load management did help prevent future injuries. If this data was being collected over the last decade, then, why was the league so adamant previously that it was following “the science” from its teams?

While deferring some of the answer to Silver, Weiss said, “I think it goes a little bit to that idea of the conventional wisdom, and the team data, that teams had shared with us, and our initial starting point around roster management and players participating in games and minutes. We think it’s appropriate to start from a point of being deferential to teams and to players on when they play. That’s historically been a realm of team and player decision making.

“We accepted that conventional wisdom, and some of the information that teams had shared with us over the years — which included some data, but never nearly as robust as what we’ve now shared back. And it hit a point where we said ‘You know, we have been looking at this for years, and we’re not seeing this effect.’ And so we think we need to get more formal and structured in terms of how we’re analyzing this and sharing it out with teams, and that’s really what kind of led to this.”

(Photo by Jason Miller / Getty Images)