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What’s It Like to Return from a Major Injury?

Alex Kennedy talked to players about the physical and mental stress of returning from a significant injury.

Alex Kennedy

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Entering the 2016-17 NBA campaign, a number of notable players are returning to the court after suffering a significant injury last season. This includes big-name stars such as Anthony Davis (left knee), Blake Griffin (left quad), Chris Paul (right hand), John Wall (both knees) and Marc Gasol (right foot).

Every step of an injury is difficult on a player, and their eventual return is no exception. While it’s the culmination of a ton of hard work and they’re thrilled to return to the game that they love, there’s always the possibility that the individual will be limited (physically and/or mentally) at least initially.

When a player goes through an intense rehab regimen, it can drastically change their body. This forces them to make adjustments once they’re healthy enough to play again. Dan Barto, who has trained over 100 NBA players as the Head Skills Trainer at the famed IMG Academy in Florida, has seen this happen many times as a player makes a comeback.

“Any time an athlete misses an extended period of time, they typically come back and work extremely hard, but they’re working with a new body and an old mind,” Barto explained to Basketball Insiders. “When they get back on the court, these ultra-athletic guys have a bunch of very strong muscles from the rehab they’ve done, so their old movement patterns and old reactionary on-court moves put pressure on different areas that their body isn’t used to. Sometimes they try to avoid the pain by moving too hard to one side. Sometimes their muscles are so strong, but their body and joints aren’t ready for the hard cutting and reactionary movements they’re doing. This can lead to an overuse injury or a tear because you’re basically putting a different engine into a car. In some cases, a player has to change the way that they play or work out after an injury to avoid wearing that area of their body out.”

Barto stressed that the key for a player to return to full strength is taking the rehab process slowly. Many NBA players are extremely hard workers who want to be in the gym as much as possible and push to return earlier than expected. While the player thinks they’re doing what’s best for themselves and their team, that kind of mentality can cause problems.

“I think sometimes a player will be cleared and then they think, ‘I’m ready to do everything again,’ but they need to ease back,” Barto said. “In baseball, you have minor league rehab assignments and simulated games for players to test themselves. But in basketball, you hardly see that method used. Rarely do teams send a guy to the D-League for a rehab assignment, but that could help ease them back.”

Jodie Meeks appeared in just three games for the Detroit Pistons last season due to a non-displaced fracture of the fifth metatarsal in his right foot. The veteran shooting guard was traded to the Orlando Magic this summer, but was recently ruled out indefinitely due to another surgery to stabilize the same metatarsal.

“You want to get back as soon as possible, while not rushing it,” Meeks told Basketball Insiders. “It’s real tough to balance those things.”

Barto has a strict order he follows as he eases a player back from an injury.

“What we do when a player is cleared – and I’ve even done this for players who are overweight and trying to get back into shape – is we do a lot of shooting first,” Barto said. “Then, we do jogging. Then, we add some ball-handling and moves. Then, we add jumping and, finally, some contact. If a doctor says you’re going to be out eight months due to an ACL injury, I’ve always said, ‘You need to take nine or 10 months before returning.’ You need time for athletic foundation build-up and then planned contact followed by actual reactive basketball simulation. The best order when a player is coming back is shooting and conditioning, then cutting and moving with the ball, then planned contact and basketball simulation.”

It’s also important to note that every injury is different, which is something Barto was quick to point out.

“Shoulder and ACL injuries are tough to rush back from,” Barto said. “And with ACL injuries, the player needs to slowly get back onto the court and build back up their athletic foundation or they’ll be more at risk for re-injury.”

Then, there’s the mental side of recovering from a serious injury. Not every player can be like Adrian Peterson or Paul George, putting their serious injury behind them and having an amazing bounce-back season right away. Some players struggle with the fear of re-injury. Others are hesitant to duplicate their pre-injury style of play (consciously or not). Mental hurdles are extremely common for a player who is trying to return to form.

BillupsInsideInjury1In fact, when talking to current and former NBA players, the majority said that recovering mentally was the toughest part of their comeback.

“Physically it’s hard, but through rehab you regain the strength and stability that was lost; however, the biggest obstacles are mental,” NBA champion Chauncey Billups told Basketball Insiders. “You have to rebuild your confidence. You not only have to prove to the team and the fans that you’re back but, more importantly, you have to prove it to yourself. Being injured has a way of chipping away at one’s confidence. When you cross that bridge [and regain your confidence], you’re back.”

“You have to get over the mental aspect, the thought of re-injuring yourself, and just trust your hard work and dedication to get back,” Meeks said. “You have to focus on what you can control – things like your effort and mental focus.”

“Coming back from my season-ending back surgery in 2014 was one of the toughest things I have dealt with in my life,” Phoenix Suns guard John Jenkins told Basketball Insiders. “Mentally and physically, I was drained for the first two-to-three months. You hate not playing the game you love for that long, but you learn to embrace the challenge and attack your rehab the same way you would attack a game or practice. Getting back on the court felt different and it takes a while to get back in playing shape. I would say that the hardest part for me was getting my conditioning where I wanted it and getting back into playing rhythm. I missed almost seven months. But after a good two to three weeks on the court, I started to see positives and regain confidence in my back and my game.”

“I was worried about whether I was going to be the same player after the injury,” said forward Adonis Thomas, who suffered a season-ending wrist injury in December. “After returning, I didn’t do anything to change my game though; I played with confidence immediately. But I was worried at first. [My goal became] to be better than I was before being injured. And I wanted to be in the best possible shape, that way I could prevent any other injuries in the future.”

When it comes to helping players with the mental aspects of their recovery, Barto has several methods that he uses.

“I think visualization is important,” Barto said. “You can’t go back and watch highlights of your old self. Using someone like Derrick Rose as an example, I wouldn’t advise him to watch his old film. I’d tell him to close his eyes and imagine himself playing in a Knicks uniform as opposed to dwelling on the past. And, ideally, you want everyone around the organization helping him with this and being on-board with this approach.”

The ease-back strategy also helps the player mentally, since it gradually increases their confidence and they start to feel like themselves again as they go through the progressions.

“In addition to visualization, a player should have a four-to-six week window once they’re cleared where they’re psychologically advancing,” Barto said. “They’re thinking, ‘Okay, I can make some shots now. Next, I can do sprints. Okay, my handle feels sharp and back up to speed. Okay, now they’re leaning on me, but I know they’re going to lean on me and play dummy defense.’ Then, with the simulated basketball, you’re being defended at 75 percent. It’s basically AAA level. By easing them back this way, they advancing physically and mentally.”

As the players quoted above pointed out, getting the body and mind right are equally important.

Returning from an injury is one of those things that players typically do behind the scenes. Outsiders rarely get to see the hard work that an individual is putting in or hear what issues they are dealing as they go through the process. Instead, very little information is disseminated between the point the injury occurs and the eventual comeback. Hopefully, pulling back the curtain on this process gives everyone a better idea of what a player may be feeling and thinking during that important recovery period.

Alex Kennedy is the Managing Editor of Basketball Insiders and this is his 10th season covering the NBA. He is a member of the Professional Basketball Writers Association.

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NBA

NBA Daily: They Guessed Wrong

Matt John reflects on some of the key decisions that were made last summer, and how their disappointing results hurt both team outlooks and players’ legacies.

Matt John

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It doesn’t sound possible, but did you know that the crazy NBA summer of 2019 was, in fact, over a year ago? Wildly, in any normal, non-pandemic season, it all would have been over three months ago and, usually, media days would be right around the corner, but not this time. The 2019-20 NBA season is slated to end sometime in early to mid-October, so the fact that the last NBA off-season was over a year ago hasn’t really dawned on anyone yet. Craziest of all, even though there will still be an offseason, there technically won’t be any summer.

Coronavirus has really messed up the NBA’s order. Of course, there are much worse horrors that COVID-19 has inflicted upon the world – but because of what it’s done to the NBA, let’s focus on that and go back to the summer of 2019. It felt like an eternity, but the Golden State Warriors’ three-year reign had finally reached its end. The Toronto Raptors’ victory over the tyranny that was the Hamptons Five – as battered as they were – made it feel like order had been restored to the NBA. There was more to it than that though.

Klay Thompson’s and Kevin Durant’s season-ending injuries, along with the latter skipping town to join Kyrie Irving in Brooklyn meant two things.

1. Golden State was down for the count
2. Brooklyn’s time wasn’t coming until next year.

A one-year window was open. Even if neither Golden State nor Brooklyn posed the same threat that the former did when it had Kevin Durant, those were two contenders out of commission. If there was a time to go all in, it was in 2019.

Milwaukee certainly seemed to go all in. For the most part.  Malcolm Brogdon’s departure seemed a little odd since he was arguably their best non-Giannis playmaker when they were in crunch time. Not to mention there was nothing really stopping the Bucks from keeping him except for money. Detractors will call out Milwaukee for electing to cheap out by not keeping Brogdon and hence, avoiding the luxury tax. However, there’s more to it than that.

Milwaukee thought it had enough with the core it had on its roster. Coming off the best season they had put up since the eighties, they believed the franchise built the right team to contend. There was an argument that keeping Brogdon may have been overkill with their guard depth – let’s not forget that Donte DiVincenzo did a solid job in Brogdon’s role as the backup facilitator. This would have been more defensible had it not been for Milwaukee picking the wrong guy to let go. That was the indefensible part- electing to keep Eric Bledsoe over Brogdon.

Bledsoe wasn’t necessarily a bad investment. No one’s complaining about an almost 15 point average on 47/34/79 splits or playing individual defense tight enough to get named on the All-Defensive second team. By all accounts, Bledsoe earns his keep. That is until the playoffs. Bledsoe’s postseason woes have been a weight ever since he first entered Milwaukee, and this postseason was more of the same.

Bledsoe’s numbers dwindled to just 11.7 points on 39/25/81 splits, and Milwaukee getting ousted in five games at the hands of Miami made his struggles stand out even more than it had ever been. Bledsoe may be the better athlete and the better defender, but Brogdon’s all-around offensive savvy and his only slight dropoff defensively from Brogdon would have made him a bit more reliable.

Milwaukee guessed wrong when they opted to extend Bledsoe before the postseason last year when they could have waited until that very time to evaluate who to keep around. Now they face a hell of a lot more questions than they did at the end of last season – questions that may have been avoided had they made the right choice.

Now they could have kept both of them, yes, but it’s not totally unreasonable to think that maybe their approach with the luxury tax would have worked and maybe they would still be in the postseason right now had they gone with the homegrown talent. And just maybe, there wouldn’t be nearly as much of this Greek Freak uncertainty.

The Houston Rockets can relate. They got bruised up by a team that everyone thought Houston had the edge on going into the series and then crushed by the Lakers. Now, Mike D’Antoni is gone. The full-time small ball experiment likely did not work out. Since the Rockets emptied most of their assets to bring in Russell Westbrook and Robert Covington, there may not be a route in which they can become better than they presently are.

The mistake wasn’t trading for Russell Westbrook. The mistake was trading Chris Paul.

To be fair, most everybody severely overestimated Chris Paul’s decline. He’s not among the best of the best anymore, but he’s still pretty darn close. He deserved his All-NBA second team selection as well as finishing No. 7 overall in MVP voting. OKC had no business being as good as they were this season, and Paul was the driving force as to why.

For all we know, the previously-assumed tension between Chris Paul and James Harden would have made its way onto the court no matter what. Even so, Houston’s biggest obstacle in the Bay Area had crumbled. If they had just stayed the course, maybe they’re still in the postseason too.

To their credit, none of this may have happened had it not been for the Kawhi Leonard decision. Had he chosen differently, the Thunder never blow it up, and Houston might have very well been the favorite in the Western Conference. Instead, the Rockets took a step back from being in the title discussion to dark horse. But at least they can take pride knowing that they weren’t expected to win it all – the Clippers can’t.

Seeing the Clippers fall well short expectations begs the question if they too got it wrong. The answer is, naturally: of course not. They may have paid a hefty price for Paul George, but the only way they were getting Kawhi Leonard – one of the best players of his generation – was if PG-13 came in the package. As lofty as it was, anyone would have done the same thing if they were in their shoes. They didn’t get it wrong. Kawhi did.

On paper, the Clippers had the most talented roster in the entire league. It seemed like they had every hole filled imaginable. Surrounding Leonard and George was three-point shooting, versatility, a productive second unit, an experienced coach – you name it. There was nothing stopping them from breaking the franchise’s long-lasting curse. Except themselves.

Something felt off about them. They alienated opponents. They alienated each other. At times, they played rather lackadaisically, like the title had already been signed, sealed, and delivered to them. The media all assumed they’d cut the malarkey and get their act together – but that moment never really came. They had their chances to put Denver away, but even if they had, after seeing their struggles to beat them – and to be fair Dallas too – would their day of destiny with the Lakers have really lived up to the hype?

Even if it was never in the cards, one can’t help but wonder what could have happened had Kawhi chosen to stay with the team he won his second title with.

Toronto was the most impressive team in this league this season. They still managed to stay at the top of the east in spite of losing an all-timer like Leonard. That team had every component of a winner except a superstar. They had the right culture for a championship team. Just not the right talent. The Clippers were the exact opposite. They had the right talent for a championship team but not the right culture. That’s why the Raptors walked away from the postseason feeling proud of themselves for playing to their full potential while the Clippers writhed in disappointment and angst over their future.

In the end, everyone mentioned here may ultimately blame what happened to their season on the extenuating circumstances from the pandemic. The Bucks’ chemistry never fully returned when the Bubble started. Contracting COVID and dealing with quad problems prevented Westbrook from reviving the MVP-type player he was before the hiatus. As troubling as the Clippers had played, the extra time they would have had to work things out in a normal season was taken away from them.

For all we know, next year will be a completely different story. The Rockets, Bucks, and Kawhi may ultimately have their faith rewarded for what they did in the summer of 2019 – but that will only be mere speculation until the trio can change the story.

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NBA

Looking Toward The Draft: Power Forwards

Basketball Insiders continues their NBA Draft watch, this time with the power forwards.

David Yapkowitz

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We got some updated NBA draft news this week when the league announced that several key dates have been pushed back including the draft, the start of free agency and the beginning of the 2020-21 season.

The 2020 draft was originally scheduled for Oct. 16, but it will now likely occur sometime in November. Obviously, with the COVID-19 pandemic still wildly out of control in the United States, all of these potential deadlines are fluid and subject to change.

With that said, we’re continuing our position by position breakdown here at Basketball Insiders of some of the top 2020 draft prospects. We looked at the point guards and shooting guards last week, and this week we’re covering the small forwards and power forwards.

The power forward crop, like the draft overall, doesn’t appear to be as strong as recent years, that doesn’t mean there aren’t potential contributors and high-level NBA players available, as well as one who might just turn out to be a star-caliber player.

Onyeka Okongwu, USC – 19 years old

Okongwu is the player who just might develop into a star on some level. He was actually underrated in high school and was snubbed for a McDonald’s All-American selection his senior year. He established himself early on at USC as the team’s best player as a freshman and now appears to have turned some heads.

He’s been mentioned as a lottery pick and in some mock drafts, he’s top 4-5. He possesses a great all-around skill-set; he can score in the post, he can put the ball on the floor and attack and he can shoot. But perhaps his biggest attribute is his versatility on the defensive end. He’s got quick feet and mobility and can guard multiple positions.

Okongwu might actually play center in the NBA, especially in small-ball lineups, but he’s mostly played power forward and so he’ll probably see time there in the league. His skill-set fits perfectly with today’s game.

Obi Toppin, Dayton – 22 years old

Toppin is one of the older players in the draft, and in recent history, players that age tend to slip on draft boards. In Toppin’s case, it looks like the reverse might actually be true. He’s been projected as a lottery pick, and even going in the top 3.

He’s an incredibly athletic player who thrives in the open court. He looks like he’ll do well in an up-tempo offensive system that has capable playmakers who can find him in transition. He’s extremely active around the rim and he can finish strong. A decent shooter too, something he’ll need at the next level.

Toppin has the physical tools to be an effective defensive player, but that’s where the questions marks on him have been. In the NBA, he’s likely going to have to play and guard multiple positions. Whether or not he can adapt to that likely will answer the question as to what his ceiling can be.

Precious Achiuwa, Memphis – 20 years old

Achiuwa is another intriguing prospect. this writer actually got to watch him play in person while he was in high school and he was very impressive. He looked like a man among boys. He’s projected to be a late lottery pick.

He has an NBA-ready body and he’s got some toughness around the rim and in the paint. He was a double-double threat during his one season at Memphis and his knack for rebounding is something that should translate to the NBA. He’s a very good defender too, in particular, as a rim protector. He’s very quick and has the ability to guard multiple positions.

One of the main knocks on Achiuwa is his shooting ability. He didn’t shoot that well in college and power forwards being able to space the floor is almost a requirement in today’s NBA game. It’s something he can certainly work on and improve on though.

Honorable Mentions:
Paul Reed, DePaul – 21 years old
Xavier Tillman, Michigan State – 21 years old
Killian Tillie, Gonzaga – 22 years old

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NBA

Looking Toward the Draft: Small Forwards

Basketball Insiders’ examination of the 2020 draft class continues with a look at the small forwards.

Drew Maresca

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It was announced on Wednesday that the NBA Draft would be delayed from Oct. 16 to Nov. 18. The rationale is that the extra month gives the league and its players association more time to negotiate changes to the CBA. It also grants teams additional time to procure information on prospects and allows the NBA to establish regional virtual combines. But nothing is set in stone.

Still, draft prep must continue. This year’s draft class has more question marks than usual – which was complicated by the cancellation of the NCAA tournament (along with the NIT and a number of conference tournaments). There are incredibly skilled offensive players with limited offensive upside and jaw-droppingly talented defenders with incomplete offensive packages. But if (recent) history serves as a guide, there will be a few guys who make an immediate impact – and some of them very well could be small forwards.

The small forward position is key for the modern NBA. Want proof? Survey the league and you’ll find that most – if not all – contenders have an elite small forward – Milwaukee, Los Angeles (both), Boston, Miami, Toronto.

But the list of can’t miss small forward prospects feels smaller than usual. Scanning the numerous legitimate mock drafts (including our own by Steve Kyler), it becomes apparent that we lack a consensus on which small forwards will be selected (and in what order) after the top 3 or 4. Can any of them grow into a star? Maybe. Maybe not. But before we get too far ahead of ourselves, let’s identify what the top few bring to the table.

Deni Avdija, Israel – 19 years old

Avdija is a relatively well-rounded prospect who’s played professionally since he was 16. He boasts good height (6-foot-9) and uses it effectively to shoot over and pass around opposing defenses. Further, Avdija is an exceptional playmaker and he’s incredibly confident, enabling him to take chances many players would be apprehensive trying. Avdija is a high-IQ player. And what’s more, he’s a surprisingly strong defender. His height and above-average athleticism allow him to block shots, and he’s more physical than you’d expect him to be.

But there are drawbacks to Avdija, too. His main issue is around shooting. Avdija shot only 28% in the EuroLeague last season, and he shot only 60% from the free-throw line. Further, while he’s a decent athlete, he’ll struggle to secure a role in the NBA. He’s going to need to add speed to stay with modern wings, and he’ll also have to bulk up to bang with power forwards.

Still, Avdija’s upside is alluring. He’s only 19, and his smarts, confidence and grittiness should provide him cover for much of his rookie season. Avdija should be the first small forward off of the board.

Isaac Okoro, Auburn – 19 years old

Avdija might be the flashier name currently, but Okoro will give him a run for his money in terms of which small forward is first off the board. Okoro is built like a traditional NBA wing; he’s 6-foot-6 with good strength packed in his muscular frame (215 lbs). Okoro finishes well around the rim and he converts well through contact. He’s an exceptional athlete who excels catching the ball on the move. Like Avdija, Okoro has the poise and composure of a more experienced player. Also, like Avdija, Okoro looked the part of a high IQ player in his lone season at Auburn.

And while all that is great, the main allure of Okoro is his defense. He’s a fairly advanced defender given his age, and his athleticism and timing make him an effective weak side help defender.

While Okoro’s raw abilities are exquisite, his refined offensive skills leave something to be desired. Okoro shot 28 percent on three-point field goals and he struggled from the free-throw line (67.2 percent). His mid-range jump shot also needs work, and he struggles in isolation situations.

If Okoro can hone his offensive game, he could grow into an All-Star. He has the ability to guard multiple positions, and his strength and athleticism give him a leg up on most prospects. But even if he doesn’t become an All-Star, he possesses a fairly high floor given his defensive abilities — and the guy definitely fills the state sheet (12.9 points, 4.4 rebounds, 2.0 assists, .9 steals and .9 blocks). He has lockdown defender potential and he’ll put his stamp on the game beginning on night one.

Devin Vassell, Florida State – 20 years old

Vassell played two seasons at Florida State, but he came into his own in his Sophomore season. He averaged 12.7 points, 5.1 rebounds, 1.6 assists, 1.4 steals and 1.0 blocks per game. He shot a more than respectable 41.5% on three-point attempts, and he demonstrated a strong stroke from the free-throw line (73.8 percent) and on two-point field goal attempts (53.2).

Vassell is an extremely athletic leaper, who can rise up for a highlight dunk and sprint down the floor with ease. He has good body control and demonstrated a strong mid-range game, especially his step-back jump shot. But Vassell must generate more free throws through decisive moves to the hoop, which would be bolstered by a more muscular frame. Additionally, he must improve his ball-handling to get more from isolations.

Vassell will have an adjustment period in terms of scoring the ball at the next level. Fortunately, his defense and shooting should get him by. If he can bulk up and improve his handling, Vassell could grow into a serious player.

Aaron Nesmith, Vanderbilt – 20 years old

Nesmith probably has a lower floor than any of the other top small forward prospects given that he’ll be 21 by the draft. Still, he looked quite good in his Junior year, averaging 23 points, 4.9 rebounds and 1.4 steals per game on a scorching 52.2 percent shooting from deep. Nesmith is an incredibly gifted shooter who has impressive range. His ability to catch-and-shoot and create space with fakes makes him a promising prospect – for the right team.

Nesmith is a high IQ player who uses his smarts on the defensive end. He’s also quite strong, can get buckets in the open floor and demonstrates above average ball-handling skills, as long as he’s not taking the ball to the hoop.

But there are inherent limitations in Nesmith’s game. He’s doesn’t create for his teammates too effectively and he turns the ball over more frequently than one would like with. Further, Nesmith is plagued by robotic movements that limit his athleticism. His ball-handling breaks down when taking the ball to the rack – something he’ll certainly have to work on in the NBA if he wants to be a versatile scoring threat against the bigger and stronger competition.

Still, Nesmith’s positives give him an excellent chance at being selected in the first round. His range alone will intrigue teams in need of a shooter.

Honorable Mentions:

Saddiq Bey, Villanova – 21 years old

Jaden McDaniels, Washington – 19 years old

Robert Woodard II, Mississippi State – 20 years old

With the uncertainty around small forward prospects, expect to see a revolving door of names enter the discussion after the first four wing prospects are off the board prior to Nov. 16 – assuming the draft is held then. But regardless of how you have them ranked, all of the aforementioned prospects have question marks. But all have had far more time to improve than they would have in years’ past. Let’s hope that shows come next season.

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