I don't believe what we have seen happen to the Chicago Bulls over the past six seasons from a health perspective is pure coincidence.
As a whole, injuries are inherently unpredictable. Human error simply allows for too many unforeseeable mistakes to be able to appropriately predict when a player is going to get injured over the course of an athletic season. Some teams experience more of these health setbacks than others, and most of the time these additional complications get attributed to bad luck. However, what often gets lost in this equation is that while what happens to these players' bodies can't be entirely prevented, the treatment response frequently ends up determining both the length and effectiveness of the recovery. Subsequently, the Chicago Bulls have found themselves consistently plagued by injuries for the entirety of the previous half-decade while operating with a mentality that favors quick returns over preventative treatment.
Fans ask themselves what went wrong or why the basketball gods hate the Bulls so much, but one can only see so many "grind-it-out" tweets from players over the years before beginning to question if the Bulls as a whole are looking at their injury issues from an appropriate perspective.
The Bulls' trainers and medical staff are not solely responsible for this unbelievably unfortunate run of bad injury luck. Nor are the players, GarPax, Fred Hoiberg, or even Tom Thibodeau. All of the parties involved played a role in creating an organizational culture that emphasizes faster recovery from injury as the method of choice for handling injuries. The results clearly indicate that such a strategy is failing, and has been for some time.
A Half-Decade of Injury-Plagued Seasons
A little under five years ago, Jacob Grinyer of BrewHoop put together a comprehensive list of NBA injury data from the first eleven seasons of the new millennium. His findings indicated that from 2000-2011, teams would typically average about 78.5 games per year lost due to injury across nine rotation players. The Bulls in particular averaged just under this average for the entirety of this stretch, with about 75 games per year lost.
But their fortunes began to change for the worse during Derrick Rose's MVP season. You may recall this was the season that featured Carlos Boozer breaking his hand by tripping over his gym bag prior to playing his first game as a Bull, and that season ultimately saw the Bulls' rotation forfeit 89 games to injury. Yet, the Bulls went on to win 62 games, a truly remarkable feat that Thibodeau perhaps didn't get enough credit for when examining the team's performance in a historical context.
From there, as many of you know, it only got worse. Here are the Bulls' games lost to injury totals from every season following 2010-11:
2011-12: 145 Games Lost (adjusted for the 66 game season)
2012-13: 188 Games Lost (106 Games not including Derrick Rose)
2013-14: 113 Games Lost
2014-15: 124 Games Lost
2015-16: 168 Games Lost Through 78 Contests (will be at least 172 at end of season, projected ~177 at current rate)
Taking this season's projection with the previous five seasons indicates that the Bulls have averaged 139 games per year lost due to injury across their core rotation over the last six seasons. For reference, in Grinyer's entire analysis, the highest team average for games lost per season during the 2000s was the Washington Wizards with 125. At this point, we can say with pretty great confidence that this run of injuries by the Bulls has been one of the worst we have seen thus far in the 21st century. If not the worst. In fact, the only other team in Grinyer's analysis that managed to string together five straight seasons of 100+ games lost to injury were the Milwaukee Bucks from 2006-07 to 2010-11 (the team the analysis was originally intended for).
Pre-Thibs Problems & The Wrath of Tom
Now, one could easily point out that this ferocious spike in injuries perfectly correlates with the start of the Tom Thibodeau era in Chicago. Thus, one could likely conclude that Thibodeau's departure means that the Bulls are destined to fall back towards the NBA's average injury rate. However, there are a few key pieces of information that contradict this.
Even if the entire roster remains healthy the rest of the way, the Bulls are going to close out the first year of the Fred Hoiberg regime by losing at least 172 games to injury across their rotation. This would be a higher total than any Thibodeau team, other than the season following Rose's ACL injury.
But such thinking would imply that the Bulls had no history prior to Thibodeau of poorly managing injuries, and this simply couldn't be further from the truth. Long before the now infamous spinal tap fiasco (more on that later), Luol Deng found himself at the center of a different Bulls injury controversy when, in 2009, then and current team physician Dr. Brian Cole said this regarding Deng's lower leg stress fracture:
"He has been restricted from high-level activity since [Feb. 28]," team physician Brian Cole was quoted as saying. "At this point, he will undergo 'active rest,' meaning that he will be encouraged to challenge himself physically, and if symptoms remain minimal, he will be allowed an expeditious return to play." --Rick Morrissey, Chicago Tribune, 2009
There are various concerning elements at play here, but let's focus on those that showcase the "recovery time" emphasis the Bulls have when handling injuries. My favorite in particular is the concept of "active rest." Those two words have to be the best oxymoron created since "happy Monday!" Asking an injured athlete to engage in "active rest" is like asking an obese person to go on a cake diet. It makes literally no sense. It made even less sense when Cole attempted to rationalize this concept by explaining that Deng could make an "expeditious return" when "symptoms are minimal" (you know, instead of gone altogether).
Of course, then Deng did the smart thing and sought a second opinion on the injury, thankfully going with the doctor that told him to avoid putting as much weight on his leg as possible. Essentially, he told Deng to do the exact opposite of what the Bulls' team physician recommended because all of the movements required of a basketball player (run, cut, jump, etc.) are counter-productive to the recovery of a stress fracture. Deng would sit out the rest of the season and wouldn't be cleared for basketball activities again until July, four months after the initial diagnosis.
So, because the organization already had an emphasis on "expeditious" injury returns regardless of injury severity, Thibodeau cannot be entirely blamed for this unprecedented streak of unhealthy rosters. However, most Bulls fans will acknowledge that the relentless commitment to working hard that Thibs attempted to permeate throughout the organization had some sort of malignant effect on the team's health. Some people would even argue that Rose's ACL tear was the fault of Thibodeau for how unnecessarily leaving him in a Game 1 against the 76ers that had already been decided. Go back and read the BaB post-game thread from that night and you will find countless examples of people calling for Thibodeau's head for that very reason alone. But there's also the team-wide direction given to Rose's litany of minor injuries leading up to that event that were brought into question.
And then there was that time Luol Deng led the NBA in minutes per game playing with a torn wrist ligament and a fractured thumb, to only then suffer a botched spinal tap when trying to recover from an illness in time for the playoffs. While the latter is more of a medical staff issue, the former was completely preventable by anybody in this scenario. Deng could have requested a lighter workload or opted for surgery, but instead chose to grind through the season to the tune of 41.2% shooting from the field. He also elected not to get wrist surgery after the season so that he could play for the UK's national basketball team. Thibs could have taken note of Deng playing through multiple injuries and decreased his workload, but instead played him more than anyone else in the association in what was already a lost season. GarPax could have explicitly stated they wanted Deng on a minutes restriction if they were aware something was wrong, but they instead praised (PRAISED!!!) Thibs for the way he managed the entire team's minutes. (And then they fired him two years later! Are you kidding me?!?)
That's enough on the Thibodeau era, though there are certainly other horror stories from that time. Today, however, things are perhaps worse than they ever have been in the context of health. Much of that has to do with the Bulls' attempting to make expedited returns from their various injuries, something that was a problem from the very first day of practice.
Orbital fractures aside, Joakim Noah is the most egregious example from this season so far. It simply cannot be a coincidence that Noah sprained his shoulder, got cleared for action two weeks later (the bare minimum for sprains), and then promptly injured the very same shoulder after a couple games back. Yes, hindsight is 20/20, but everybody and their grandmother should be in agreement that at least one additional week lost to recovery is nothing compared to potentially a season-ending re-injury. This is perhaps something that Rose did not receive enough credit for when evaluating how he handled recovering from his own injuries, something highlighted by the fact that he's now playing some of the most efficient basketball of his entire career. Then again, he tried to play through a hyper-extended elbow against the Rockets, missed the second half, and hasn't looked right since, so "who knows" with Derrick.
Then we get to Jimmy Butler, a situation that for a while appeared as if it was going to play out in the worst fashion possible. There is perhaps no better showcasing of the grotesque strategy the Bulls as an organization have when it comes to managing injuries than this one if the end result is Butler needing knee surgery. Stephen Noh provided an excellent timeline of Butler's injury history this season a few days ago that's worth checking out. The biggest takeaway is that, since returning from an injury incurred via returning too early from his previous injury, Butler is averagine 36 mpg and played 39 minutes on the second night of a back to back versus the Knicks two weeks ago. After the second Knicks game, he admitted he may need offseason knee surgery, and directly said that his knee is not the same as it was prior to the original injury. Though he would later retract his statement about potentially needing offseason knee surgery, it still makes you wonder why he was cleared to begin with. Just this week, the Bulls completed a 3-games-in-4-nights stretch where Butler played 39, 39, and 38 minutes.
Most recently, Taj Gibson has served has the best example of the faulty "grind-it-out" approach in action. Gibson complained of sore ribs prior to a game against the Hawks, then found out following the game that he had a fracture in one of them. Motivated by the admiration he has for his coach and teammates, Gibson elected to play through the injury rather than rest and recover. He only made it through the first half of the next game before being declared out for the remainder with a "rib contusion." Since then, Gibson has not played a single minute of action due to aggravating an injury he previously had clear knowledge of. In fact, Gibson himself admitted that the medical staff easily picked up the fracture on the x-ray, and they cleared him anyway at his insistence!
As Gibson's revelation further showcases, perhaps the worst part of all of this is that the Bulls' players seem to be ignorantly bringing these injury issues upon themselves. Butler's "you gotta risk it to get the biscuit" quote sounds even worse now than it did when he first said it, and other key players such as Pau Gasol have been peddling a similar narrative all season with comments like "I like to push it until the wheels fall off. Hopefully, it won't get worse." Hope is a terrible strategy, and it is even worse medical insurance.
A Guiding Light in... the Phoenix Suns
So how do the Bulls go about making changes? One would think that the keen businessmen throughout an organization led by hall of famer Jerry Reinsdorf would be wise to what successful NBA teams do, and would attempt to adopt these trends accordingly to maximize
profits probability of success. But what franchise has a universally acclaimed medical staff worth examining at length?
Look no further than the Phoenix Suns.
Hall of Famer Shaquille O'Neal prefers referring to the Suns' trainers and medical personnel as the YUMS (Young Unorthodox Medical Staff). Some of their accomplishments range from getting Steve Nash to the All-Star game at age 38, maximizing the play of a notoriously-brittle Grant Hill at age 39, and getting 36-year-old Shaq to play 75 games in a season, the most he would play in any season of his career in the new millennium. They attribute their success to focusing on three health-science fields: kinesiology, physiology, and functional anatomy.
This article from Valley of the Suns is truly a gem and well worth a full read, but here is a summary of their methods to success as detailed by the article's author, Michael Schwartz:
"In a nutshell, the Suns aim to ensure that a weakness in one area does not compromise other parts of the body. For example, if a player injures his right ankle he will start compensating by putting more stress on his healthy side, so the training staff treats the entire athlete and not just the injured part to ensure "there is no movement dysfunction," as Nelson put it.
More specifically, the Suns chart an abundance of information on each player. This process starts with an overall assessment in the preseason that's used as a baseline, and then rotation players are continually reassessed at least four times a week, if not daily.
These assessments can include the following:
Utilizing a goniometer to evaluate players' flexibility in eight different areas, including the big toe, the foot and ankle, the knee, the hips, internal and external rotations, and shoulder flexibility.
Manual muscle testing to evaluate the strength of particular muscles. The trainers will also look for differences in the measurements of the legs, ankles and hips to see if they've deviated from game to game.
Visual and movement assessments involving leg squats. The training staff will have players squat down a few times and watch for deviations. "Do the feet turn out, do the feet cave in, do the knees come in, do they come out, does the low back arch, does it round, all that kind of stuff, do they fall forward in their motion?" Nelson said.
From there Nelson and his staff can determine which muscles are tight or weak, which joints aren't moving properly, and if there's any neurological component that may be eliciting pain and causing dysfunction.
Then the trainers put together a program to counteract the issue, often involving manual therapy techniques that "either inhibit the muscle, stop it from being overactive or to lengthen the muscle and create that greater flexibility pattern," Nelson said.
Each player is also given a corrective exercise program based off his frequent evaluations. Nelson said many of these plans are similar because they see many of the same patterns. In fact the head trainer said when the Suns fix issues corresponding with the TFL (Tensor Fascia Latae) overactive and glute medius underactive â this controls the femur and if it's weak it wants to cave in, which can cause a variety of issues in the hip, back, knee and ankle â they eliminate 80 percent of their problems.
From there corrective exercises are the key for that particular player to get his body firing at optimum levels once again."
Now, I've no definitive way of knowing if the Bulls employ a goniometer or how they go about evaluating muscles of various players. However, Nikola Mirotic gave us a glimpse into how the Bulls' trainers evaluate leg movement on lifts when he posted a video of him working out following his appendicitis/hematoma debacle. Notice how Mirotic fully extends his knees when finishing the rise on the lift. Here's what can happen when you do that. If they aren't even looking for locked knees, I doubt they are evaluating the movement of the feet, knees, back, etc. on various other lifts and exercises involving the legs in the fashion that the Suns do.
There's one person that hasn't been mentioned yet, and that's Jen Swanson. In October 2013, Gar Forman brought Swanson on to staff after her work with Derrick Rose... and not much has happened since. It's interesting that someone so hastily named director of sports performance that oversees at least six different health departments as they apply to the team has kept such a low profile in recent seasons, at least until you realize that Swanson hasn't been doing a very good job. By her own admission, she rates her performance on "decreasing injuries" and "getting athletes on the court" as most important metrics, in contrast to performance enhancement and preventative treatment. And in her time with the Bulls, they have never finished with less than 113 games lost to injury across their core rotation. On the other hand, Swanson does deserve credit for introducing individualized training programs for players, something other teams have utilized for years and something the Bulls did not, so she has helped Chicago take at least one step in the right direction.
It's Not Just Bad Luck
To conclude, the responsibility for this unprecedented streak of injuries to Bulls' players over the last six years has blame throughout the organization. Players grind themselves through injuries they often choose to return too early from, coaches (not just Thibs) mismanage the workloads of players that they should know are hurt, and the trainers/medical staff frequently misdiagnose expected recovery times. This all relates back to the organizational culture created by those in charge that favors expedited recovery over preventative treatment, usually in the pursuit of making the playoffs regardless of whether or not they are truly contenders. Though some instances have simply been a series of unfortunate events, the consistent injury issues plaguing this team for the past six years have to make one wonder if a change in approach is justified. The success of other trainers/medical staff's approaches in the NBA, such as that of the Suns would suggest that is most certainly the case.
If I were management, I would shut Jimmy Butler down today and make him get knee surgery if it's warranted. This isn't unprecedented or controversial, as the New Orleans' Pelicans already shut down Anthony Davis for the season to allow him the chance to get surgery and play fully healthy for the first time in three years. But if the Bulls continue to grind one of their core players into dust for the sole purpose of making a playoffs they have no shot at ultimately winning, then their negative injury narrative is never going to end.
At some point, all of the people responsible for making these health decisions are going to have to examine the events that have consistently transpired over the past six seasons. They must collectively realize that relentlessly fighting through injuries is not a successful strategy for any team that desires to label itself as a championship contender. To not do so will ensure that the door is left open for this cycle of "bad luck" to continue.