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Are the Warriors handling injuries correctly?

Amid heightened scrutiny, Andre Iguodala’s “so I’m fighting with the team” comment raises eyebrows as he terms old injury “a fracture” rather than bone bruise.

Golden State Warriors v Toronto Raptors - Game Five

“If you have to,” an emotional Bob Myers said. “You can blame me.”

The world had just watched all-star forward Kevin Durant collapse - and though they perhaps weren’t ready to voice it, were indeed looking for someone to blame. A blown Achilles tendon in what would end up being just the first shoe to drop on a calamitous stomping end to the Golden State Warriors’ pursuit of their third straight title.

Klay Thompson was next. An awkward landing after taking contact on a dunk attempt. Again, a catastrophic, surgery-requiring injury. Either one of these would be in the running for biggest Finals injuries. Taken together, it wasn’t a good look.

Both players had missed time for what the team described as unrelated injuries, but it was hard not to notice that both went down with leg injuries after sitting with a (you guessed it) leg injury. Speculation and side talk ran rampant as various people wondered aloud if the team was somehow at fault.

Obviously, the team has some strategic value associated with managing expectations around injuries, but after Kerr described the team’s medical advice as “no additional risk of serious injury” were the Warriors too cavalier, or are their professional medical staff just not good?

“When we gathered all of the information, our feeling was the worst that could happen would be a re-injury of the calf,” Kerr told reporters during Wednesday’s media availability. “That was the advice and the information that we had, and at that point, once Kevin was cleared to play, he was comfortable with that and we were comfortable with that, so the Achilles came as a complete shock. ... Had we known this was a possibility — that this was even in the realm of possibility — there’s no way we would’ve ever allowed Kevin to come back, so it’s devastating.”

Complicating this discussion, a doctor quoted by CBS Sports (h/t to GSOM member Spreeewell for drawing this to my attention) predicted a possible Achilles injury given what we publicly knew about Durant’s injury:

With a weakened calf, you’re worried about significant re-injury and even tearing the Achilles tendon further down…Durant just can’t play right now.

So there’s pretty clearly some medical uncertainty, but the team’s “no risk of injury” stance seems incongruent. But was it malicious, misdiagnosed, or just bad luck?

Andre Iguodala calls it a “fracture,” the Warriors called it a bone bruise

Hopefully you’ve already watched this, but one of the many interesting subjects Iguodala discussed during his interview with The Breakfast Club was injuries. It set off a renewed firestorm on the internet as people reacted to Iguodala describing his knee injury as a fracture, rather than a bone bruise (as per the team’s official announcements).

Here’s the relevant clip queued up with the right time stamp:

Watching this again now, I’m struck by Iguodala’s initially protective statement: “We have a really good training staff, credit where credit is due... I feel like they got our back. The tough thing being an athlete, everyone’s looking at you sideways.”

He goes on to talk about the pressure. From the media, fans, your teammates, your legacy. A player being “tough” is largely tied to how often they are available and thus how valuable. The NBA reinforced this just last season when they issued a memo essentially telling teams like the Warriors not to rest big stars during road games.

The main problem is over-simplification, not mismanagement

So? Was it a fracture, or a bone bruise for Iguodala? Was Durant’s calf muscle strained or had a tear already begun? Here’s the thing: it’s all actually the same thing.

According to my quick internet search, a strain is defined as follows: “a strain is the overstretching or tearing of a muscle or tendon.” So is it a strain or a tear? Either word describes the same medical condition. But rather then spend 10 minutes listening to a doctor nerd out, we tend to generally use “strain” as something more minor, and “tear” as something more severe - neither is more or less accurate than the other.

Similarly, when you talk about a bone bruise (which is what Iguodala went through last year), how do you think that blood gets out of the bone to cause the bruising?

An image showing that bones are not solid structures
from https://www.physio-pedia.com/Bone_bruise

The truth is that there must be some sort of fracturing there in order for a “bruise” to exist on the bone at all:

A bone bruise is thought to occur when there is a microscopic fracturing of the internal bone structure. While these microfractures don’t significantly weaken the bone, it can cause bleeding and inflammation within the bone. This can lead to pain and symptoms similar to a more familiar soft-tissue bruise.

2019 NBA Finals - Game Five

So is it a bone bruise or a fracture? The answer, unfortunately is “both.”

Injuries, uncertainty, and the blame game

We talk about this a lot in my line of work, but there’s no such thing as absolute assurance. Total assurance is an impossibility. Instead humans work towards a reasonable assurance that everything will be ok, and in the NBA that means you put the player back out there as soon as the risks are within acceptable parameters.

As Iguodala was saying above, it’s not the teams, or their doctors that are forcing players back onto the court before they’re ready. A doctor described the process in the NBA:

Remember, return to play is a joint decision between the medical staff, player and team. The “vote” has to be a unanimous “yes” to return to play. The medical staff decision is made jointly by the doctor/surgeon/consultants, athletic trainers and physical therapists. The player makes his call with input from his agent, advisors, personal doctors and family. The team position is formulated by the coaches, general manager, front office and ownership.

If you wait for absolute 100% health no one would play in the NBA Finals. People aren’t going to tune in for a Patrick McCaw versus Jonas Jerebko Game 7.

So please don’t blame the Warriors for sending these players out on to the court when they did. Medical issues are legitimately complicated and the main pressures to return to action aren’t because ownership is leaning on a player to return before they’re healthy.

If you need to blame someone, blame me, because I’m just about as much at fault here as the Warriors.