Public injury timelines could be harmful to NBA athletes

Last week, ESPN published, arguably, some of the most important sports writing to ever exist. The five-part series, which was penned by Hall of Famer Jackie MacMullan, focused on the current state of mental health and wellness in the NBA and was a truly exquisite display of journalism whose importance and general need cannot be overstated.

Each individual piece brought something new to the conversation around mental health and player/coach/referee/etc. well-being, but one passage, in particular, burrowed itself into my mind and has stuck with me since. It can be found in the piece entitled The courageous fight to fix the NBA’s mental health problem, the inaugural entry in the series. I’ve included it below:

"“…There’s unrelenting scrutiny and pressure to perform. Then there’s the expectation to exude an aura of toughness and invincibility.The curious case of the Sixers’ Markelle Fultz, the No. 1 pick in the 2017 NBA draft, left many scratching their heads. A prolific scorer at Washington, Fultz suffered a shoulder injury, developed a mysterious hitch in his shot and missed most of his rookie season. Was it physical? Mental? A combination of both? Fultz’s mindset became clearer after he posted this on Instagram in July: “Depression, anxiety and panic attacks are not a sign of weakness. They are signs of having tried to remain strong for so long. 1 in 3 of us go through depression, anxiety or panic attacks at least once in our lifetime. Would you share this on your wall for at least one day? Most people won’t. To those who do — thanks for sharing the support. Let those who struggle know they are not alone.”"

I work in the sector of healthcare and well-being that primarily focuses on the neuromusculoskeletal — I’m a doctor of physical therapy by day — but the profound effect the mental has on the physical rears its head every day with nearly every patient I see.

Markelle Fultz’s highly documented — and scrutinized — battle with his injured shoulder during his rookie campaign was one of the most discussed topics around the NBA and NBA-adjacent circles last season. Much the same can be said in regards to ex-Spur and current Raptor Kawhi Leonard’s enigmatic quadriceps injury. Seemingly lost in — many, though certainly not all — conversations regarding how a player’s injury will affect the team’s place in the playoff standings or how many weeks/games they’ll ultimately miss is the fact that each injury involves a human-being dealing with the emotional, psychological, and spiritual — however you wish to define it — side of injury that accompanies the physical.

It may not seem as though conversations had by fans, bloggers, and/or journalists on the Internet or at the stadium bar hold that much weight, but a recent systematic review published in the British Journal of Sports Medicine, which aimed to answer “which psychosocial factors are associated with sports injury rehabilitation outcomes in competitive athletes”, found that in professional rugby players who suffered “serious injuries”, “perceptions of social support network provided by multiple agents [eds. note: including crowd] were particularly salient on returning to sport. Trust in the rehabilitation provider, feeling wanted by others, and satisfaction of social support were associated with psychological return to sport.”

One of the takeaways the researchers of the study — in which the data of 25 studies involving 942 injured athletes — came away with was that it seems as though perceived crowd (i.e. fan) support plays an integral role in the success of the player’s ultimate rehabilitation outcome. Therefore, it wouldn’t be farfetched to say that every time a conversation about a player’s injury devolves from talking about it’s potential impact on the team to questioning the motives of the player and his/her work ethic, it has a deleterious effect on the player’s final rehab outcome.

Now, I don’t mean to portray that ultimately players who are going through the rehabilitation process should be kept out of the media and national conversation, but I do think that there are adjustments that could be made to keep the questioning of motives to a minimum, or at least less than the current dialogue. I propose one simple adjustment here: no longer report or discuss the number of weeks a player is expected to miss due to injury.

This is something that I am guilty of doing on multiple occasions in the past, but, at the end of the day, every player is human and every human undergoes the healing process differently. Each person has a multitude of factors that affect their return to play — including the physical, psychological, and social — and each factor effects them in different ways. It wouldn’t necessarily be abnormal for Player A to miss more time than Player B despite having the same injury on paper.

Reporting and having the conversation revolve around the player’s expected return to play could, and likely does, place unneeded stress and pressure onto the player, pushing them into returning to game action before they are physically, psychologically, and socially ready to. If the timeline is kept between player, teammates, coaching staff, and medical staff it may, at least theoretically, help ensure that the player is truly 100 percent before returning, which in turn may, again theoretically, cut down on further injuries.

If the conversation and reporting must involve some sort of timeline, whether to keep fans at bay or to maintain journalistic integrity, then may I suggest the following non-specific return to play breakdown: days, weeks, and months. Categorizing injuries as ones that the player will recover from in days, weeks, or months gives fans and journalists a general idea for when the player will return — so as to minimize impact on ticket sales, etc. — while not holding a player’s toes to the fire for a specific date of when to return.

So, the next time you find yourself questioning a player’s motives as they return from injury or wondering when they’ll return to play, at least remember that injuries are more than physical, and you never truly know what someone may be going through.