Are NBA Stars Returning Too Early from Serious Injuries?

Will CarrollSports Injuries Lead WriterMay 18, 2013

May 16, 2013; New York, NY, USA; New York Knicks small forward Iman Shumpert (21) and point guard Raymond Felton (2) high five each other on the court against the Indiana Pacers during the second half in game five of the second round of the 2013 NBA Playoffs at Madison Square Garden. Knicks win 85-75. Mandatory Credit: Debby Wong-USA TODAY Sports

It would seem that the calendar has shrunk in sports.

Time has changed value. More and more, players who are out for injury seem to be coming back quicker. Is this a medical miracle or a new problem for players?

Seeing players like Amar'e Stoudemire, Iman Shumpert and David Lee return from once-devastating injuries not only helps their team (and career) but resets the expectations we have, setting the stage for the Derrick Rose backlash.

The change in the rehabilitation clock is difficult to understand for many, but most revolutions are. The difference we've seen over the last decade in terms of timeline is not one single factor, the way it was in the 1980s.

At that point, the introduction of the arthroscope changed the recovery timelines and allowed new surgical techniques to rapidly deploy. The reduced trauma to the damaged joints allowed for better results and quicker comebacks. 

Now, we're seeing a multi-factorial change that is not quite so clear, and a differential spread that has disguised the causations. Understanding what is going on behind the scenes is, by definition, not broadly explained in the mainstream.

Most fans can't name their team's athletic trainer, let alone the rehab professionals who are involved. While there are some recognizable names doing the surgery—Dr. James Andrews, Dr. Neal ElAttrache, Dr. Tim Kremcheck—fewer know the rehab geniuses who work with them, like Kevin Wilk or Mike Reinold

Wilk has been at the forefront for several decades, one of the "secret weapons" of Jim Andrews. Wilk's clinic in Birmingham, along with the biomechanics lab of Glenn Fleisig, has pushed Andrews forward, but without the notoriety.

Over the last decade, Wilk has made several changes to the rehab protocols, the schedule followed by the rehab professionals in guiding a player back from surgery.

The major change is an aggressive follow-on from those who came after the advent of arthroscopic surgery. Players are now pushed to work on range of motion and weight bearing almost as soon as they wake up from anesthesia. The quicker the body part is back to normal function, the quicker that athletic function can be worked on.

Nerlens Noel is a great example of this. His devastating knee injury in February not only hasn't hurt his draft stock, but he's been able to help his position by being, literally, a walking public-relations campaign. Noel is just three months post-surgery, but he has made a point of walking around ESPN's headquarters from interview to interview, where he is telling teams that he'll be ready to play by Christmas.

The technology of rehab and health maintenance has also changed greatly over the last decade. Trainers aren't magicians now, but technologists. While there's plenty of tape and Tiger Balm available, there are also things like cold lasers, high-tech rigs for electric stimulation, Swim-Ex pools for rehab and NASA-looking tubes for cryotherapy

New stadiums have brought big changes, but in the back, that increased room has also allowed for a better experience in the training room. The use of these new technologies as well as the wide availability, even on the road, has allowed the medical staffs to work more aggressively and more quickly on their injured players. 

There have also been some surgical changes.

While the basic techniques have remained the same, and, in some cases, things have reverted back to previous techniques, overall, the sheer amount of injuries have created opportunities for the doctors to refine the techniques. Use of new surgical tools (such as smaller anchors), jigs for drilling precisely aligned suture points and more all help reduce trauma and bring the athlete back more quickly.

Perhaps most importantly, the athletes themselves have changed. It just takes a simple look at some of these athletes to realize they are both genetic freaks and in top physical condition, even above the norm of their sport. Players with this type of conditioning will have advantages in the rehab process and on the court. 

In some situations, we're also seeing an increased acceptance of risk in coming back early, or even coming back at all, as best typified by the return of David Lee just days after a severe strain of his hip flexor.

Lee and the Golden State Warriors made an informed decision, knowing that the surgery he faced after the season would be the same, even if he exacerbated the condition by playing in the playoffs. Lee dealt with the pain and physical change, something more and more players are doing on a daily basis. 

There is a difference between accepted risk and the kind of macho, play-at-all-costs mentality that has led to many problems. Accepted risk is a more informed decision, allowing a player to change his game as much as possible while working in concert with the medical staff to keep the player's situation both functional and minimized in terms of risk. 

The changes that have occurred over the last decade may not be as visible as advancements in shoes or uniforms, but they're vastly more important to the fortunes of injured players and teams. The clock is still 24 hours and the calendar still flips 12 times, but the timeline for injury has shrunk. Living by the old timeline is the same as believing the earth is still flat.