Dealing with the coronavirus was the priority for the NBA in 2020-21, but as the end of the season nears, data suggests the league saw a dramatic increase in injuries not related to COVID-19.
Some team health officials said the effects will drive how they manage player health for next season.
The average number of players sidelined per game due to injury, non-COVID-19 illness or rest this season was 5.1 (includes both teams), according to ESPN's Kevin Pelton, the highest since he started tracking it in 2009-10. That does not include games missed by players in the health and safety protocols. The next highest season was 4.8, so 2020-21 was 5% higher.
The increase was even more pronounced when focusing on the league's stars. This season's All-Stars missed 370 of a possible 1,944 games (19%), the highest percentage in a season in NBA history, according to Elias Sports Bureau research. They missed an average of 13.7 regular-season games each this year.
Throughout the season, team health officials and executives internally feared a spate of soft-tissue injuries, such as hamstring strains. Earlier this week, Brooklyn Nets star guard James Harden exited Game 1 of the second-round series against the Milwaukee Bucks because of right hamstring aggravation. Similarly, Jazz point guard Mike Conley missed Tuesday's Game 1 vs. the LA Clippers because of a mild right hamstring strain. In the regular season, the same injuries caused Harden to miss more than a month and Conley to miss six games in February and nine games in April and May.
These types of injuries can be tied to fatigue and stress. Fear of an increase in these injuries grew more pronounced when the schedule condensed late in the season as teams made up games postponed due to COVID-19 issues.
There were 2,909 games lost to soft-tissue injuries this regular season, according to certified athletic trainer Jeff Stotts, who maintains the most authoritative public injury-tracking database that covers the NBA. It's the second-highest figure Stotts has recorded since he began tracking in 2005-06. The most was 3,038 in the 2017-18 season, which was played in 82 games vs. the 72-game campaign this year.
One Western Conference athletic training official said it was difficult leaguewide to properly train players during the season, both because of the rigorous daily COVID-19 protocols and because players were increasingly deprived of sleep, leading to more player rest and canceled shootarounds and practices.
"When you can't train, you get soft-tissue injuries," the athletic training official said. "It's a known fact."
Several team athletic-training officials said they were more cautious than in recent years with players who seemed fatigued or were nursing minor injuries, leading to many being sidelined or playing reduced minutes for precautionary purposes. These training officials said they're expecting to operate under the same circumstances next season, especially because the league is facing a second consecutive short offseason, furthering the cumulative effects of fatigue, stress and sleep loss from the past two seasons for players.
Said a second Western Conference playoff team's athletic-training official: "[We] still have a contracted offseason [rest period] and just had a very high density of games; can't imagine we are in the clear. I do have to think it will be better next year with a more normal schedule, but we can't be sure the amount of load these players will be carrying into the start of camp next season."
"It's brutal in the aggregate," added an NBA general manager.
Just in the past week, multiple NBA stars and coaches have discussed publicly the toll the season has taken.
"I always think from the moment we entered the bubble to now, it's been draining," Los Angeles Lakers star LeBron James, 36, said after his team's first-ever first-round playoff exit last week. "Mentally, physically, spiritually, emotionally draining.
"Every team has to deal with it, obviously. But with us and Miami going the long haul in the bubble and then coming right back on short notice to this season, it's been draining."
The Lakers and Miami Heat, last year's NBA finalists, faced a 71-day offseason, marking the shortest turnaround in the history of the NBA, NFL, NHL or MLB, according to research by Elias.
James and Anthony Davis battled injuries all season for the Lakers and appeared in only 27 games together. Davis missed two months of the regular season with a strained calf and suffered a groin strain in the Lakers' first-round playoff series. James missed 26 games because of a sprained ankle in March and said after the season that it was still bothering him.
"We've been at this for a while, so where we're headed first is rest," Heat president Pat Riley said after his team was swept by the Bucks in the first round. "Our players, our staff, the people that have been here every day, every single day, they're mentally worn out more so than physically. And I think they just need to rest for a couple of weeks, a month."
Added Denver Nuggets coach Michael Malone: "I think this year has been the hardest year in my 20 years in the NBA. It's the mental toll, the physical toll, the emotional toll."
And an Eastern Conference GM said: "There will be a lot of stress pouring out after this season, too."
Citing internal data, the league says injuries rate similarly to last season. Officials note that in a normal calendar year, teams play 82 games and return after 14 weeks off. Over this two-year period, the average team played 20 fewer games than it would've played in such a stretch and had an additional two months off. Of course, those numbers don't take into account the complicating factors wrought by the pandemic, such as early testing times or other elements tied to COVID-19 protocols.
"Injuries rates this season were virtually the same as last season, and any suggestion to the contrary is inaccurate," NBA senior vice president David Weiss told ESPN. "The number of serious injuries was lower this season than last season. Although more players this season missed a single game because of an injury or rest, injuries resulting in many games missed were in line with normal historical trends. To operate this season safely in a pandemic has been physically and mentally challenging for everyone involved, and players and teams have risen to the challenge and avoided an increase in serious injuries."
In late April, Golden State Warriors coach Steve Kerr said it has been "an exhausting season for everybody, for every team, every player."
"The COVID protocols, the lack of emotional connection. Not being able to see family or friends on the road, go out to dinner, all the normal things that you do to kind of fill up your cup and complete your social life," Kerr said. "You don't have any of those things, so this season has been extremely draining."
Sources said the league is expected to engage general managers and other team staffers on all manner of competitive issues, including the schedule, in a more formal manner in the near future, which will help inform how next season's schedule is impacted.
"Everyone is a fan of less travel," an NBA GM of a playoff team said.
But the prospect of a second consecutive short offseason is a topic that many around the league noted even as this season unfolded. The NBA Finals are scheduled to end July 22, with Summer League slated for August and teams potentially resuming training camp in late September before commencing a new season in October.
In talks between the players' union, the league and network partners, the decision was collectively made to return the league's schedule to normalcy as quickly as possible -- a full 82-game slate that starts in October with the Finals ending in June -- rather than over a period of several years, league sources said.
"These two years have certainly been stressful from a lifestyle and mental health standpoint, and we shouldn't overlook that," NBA executive vice president of basketball strategy and analytics Evan Wasch told ESPN. "But from the standpoint of the actual basketball competition, when considering the reduced number of games in each of the last two seasons, and the aggregate amount of time away from the court players will end up having had between the hiatus and the two offseasons, we are not in a worse place in terms of overall wear-and-tear and rest and recovery time than we would have been over a normal two-year stretch."
"The one thing that plays into this is just how fatigued everybody feels, which as we all know, is not unique to the NBA," Weiss told ESPN. "We're so appreciative of the work that the athletic trainers and the doctors and the contact tracers and everybody who partnered in the health and safety effort of this season. It's unbelievable how hard they had to work this year."
ESPN's Kevin Pelton contributed to this report