L.A. Lakers Injuries: It's Fair to Question Training Staff's Effectiveness

Will Carroll@injuryexpertSports Injuries Lead WriterApril 26, 2013

EAST RUTHERFORD, NJ - MARCH 27:  Kobe Bryant #24 of the Los Angeles Lakers is attended to by athletic trainer Gary Vitti during the game against the New Jersey Nets during the game on March 27, 2009 at the Izod Center in East Rutherford, New Jersey. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and/or using this Photograph, User is consenting to the terms and conditions of the Getty Images License Agreement.  (Photo by Chris McGrath/Getty Images)
Chris McGrath/Getty Images

Kobe Bryant's Achilles' heel might have been the downfall of the Los Angeles Lakers, but their metaphoric Achilles' heel this season has been injuries. Jeff Stotts of Rotowire was kind enough to supply me with a list, from his database of NBA injuries:

Kobe Bryantankle sprain, Achilles strain

Dwight Howard—torn shoulder labrum

Pau Gasol—plantar fasciitis, concussion

Steve Nash—broken leg, strained hip

Ron Artest—post-surgical knee

Steve Blake—strained abdominal

Earl Clark—strained groin

Chris Duhon—back spasms

Devin Ebanks—flu

Jordan Hill—post-surgical hip

Yes, 10 of the expected, active 12 missed games. Some missed a handful, some missed much of the season. In total, Lakers players missed 175 man-games or just over 17 percent. It looks and sounds like a lot, so let's take a deeper look to see what went wrong and well.

No seriously, it's OK to at least suggest the IDEA we should examine if the Lakers' staff is as good as its reputation, right? Right?

— Hardwood Paroxysm (@HPbasketball) April 25, 2013

OK, HP. Challenge accepted. 

Many are taking the easy route and looking at Gary Vitti and the Lakers medical staff.

Vitti is one of the longest tenured and best thought of athletic trainers in the NBA, so he'd likely welcome the scrutiny. If you want to go further than that, the Lakers have long been associated with the world-famous Kerlan-Jobe Clinic, home of some of the top orthopaedists in sports and in the country. 

Anyone doing an objective task of evaluating the job the medical staff is doing will have to consider not just the results and the body of work but another simple question.

If they fired the staff, could they find better?

It's possible but not very likely and certainly not very practical. Vitti's relationship with Bryant alone and the need for consistency in his rehab is likely to keep him around regardless.

The simplest answer is a quick perusal of the numbers. That 17 percent lost time sounds like a lot, but in fact, it's about the equivalent of losing two players for the season. Look around the league and see how many teams did not have a season-long injury. 

A deeper look at the timing of the injuries brings up what I think is the real problem.

Take a quick look at this staff roster for the Lakers.

That's right, Vitti is a staff of one.

There are of course associated health personnel, team doctors and others that will assist Vitti, but there is not even an assistant for him on a full-time basis. With only 24 man-hours available, assuming that Vitti never sleeps or visits his family, there's still not enough time to deal with all the things a medical staff must handle.

The timing of the injuries exacerbates this issue.

If Vitti is dealing with a player's emergent injury, he's not dealing with another situation. If he's in the training room doing maintenance on a series of players, he's not monitoring the preventative work another player is doing. If he's doing pregame work to get someone functional, he's not checking the rehab work of someone coming off an injury.

There's only so much time and clearly a lot of work. 

The way that the Lakers spaced out the injuries—completely unintentionally, of course—also added to the issues. There was never a time when there weren't at least two missing players and at least one emergent situation in any 10-day period.

Vitti's juggling act of prevention, maintenance and reactive care piled up and no matter how good (or bad) he was, he was facing a phenomenon I termed the "death spiral" nearly a decade ago.

The death spiral is an issue first encountered with the late-stage Montreal Expos in the mid-2000s and most clearly seen in the 2008 New York Mets.

The Mets, in what appears to be the worst injury season in the history of baseball, lost over 1,600 days and had 23 different injuries. The reactive care simply overtook the maintenance and preventative care, likely leading to more injuries. That leads to more reactive care and so on, which led me to call it a death spiral. 

There's commonalities between those teams and the Lakers, but just on the numbers, this is a very apt comparison. A baseball season has about double the games, double the players and the Mets' medical staff is double the size. While the number of injuries is comparable, the days are not, indicating that the Lakers somehow kept the injury days down.

Part of this is the timing of some of the injuries.

Bryant's torn Achilles may only cost him four games, but the true cost is clearly much higher.

But looking at the rest of the injury list, it appears that the Lakers did not lose their edge in rehab time. Almost every player came back early, including a ridiculously quick return for Metta World Peace, a quick return from a foot injury for Pau Gasol and a Dwight Howard season that many thought was over when he reinjured his shoulder but was maintained.

Minimizing the impact of three traumatic injuries, incidents that no medical staff could prevent, should be counted as something of a win for Vitti.

Once we dig through the long list of injuries and the possible reasons, we now must do what the Lakers front office and ownership simply must do in the coming weeks. We must ask whether the team can do better next year.

The simple answer is yes.

By doing nothing though, the Lakers can expect some improvement. Luck does tend to even out in terms of traumatic injuries, which means that on average, the Lakers should see about a five percent improvement just on that.

That's not an answer though.

The simplest solution would also be cost effective. Vitti should have at least one assistant, as he did for much of his tenure with the Lakers. Given the relative cost, the Lakers (and other teams) would be smart to hire a couple of these. It will come at a fraction of the cost of the players and dollars lost to injuries and would prevent Vitti from becoming overwhelmed if there's another rash of injuries. 

From the outside, it is difficult to make specific suggestions. Things like roster construction, accepted risk and injury management are easy enough to talk about in abstract terms but harder to put into any concrete plan affecting the medical realities of an NBA team.

Even things like the training room, workout facilities and treatment modalities are things that aren't visible to the outside but are very apparent to the Lakers. If they need to be upgraded, again, it is a very cost-effective solution. 

How cost effective you ask? Given Bryant's current salary, the cost of his four missed games is about $1.35 million. All the suggestions I put forward for consideration above could be done for that amount of money...with about $1 million left over. 

While it is fair, even necessary, to question the effectiveness of Vitti and the Lakers medical staff, the facts show that any wrath, snark or disappointment with the team's injury-riddled season should be pointed elsewhere.

Perhaps the Lakers front office over-relied on its ability to keep some injury-prone players healthy, but that's hardly any excuse. In the end, a lack of help, quick returns and simple math help show that the Lakers medical staff deserves praise, not scorn, and at least another season to show that this season was a fluke.


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