Joel Embiid is questionable with back tightness— Keith Pompey (@PompeyOnSixers) January 17, 2019
It was back on January 17th when Keith Pompey of the Philadelphia Inquirer reported this seemingly innocuous update. Before then, Philadelphia 76ers’ star Joel Embiid had been on the injury report plenty of times with knee soreness, ankle soreness, migraines, or hand swelling. Most of the time he would not only play but he would dominate.
But this back issue has gone on for a couple of weeks now. And after being given a full 6 days off (he skipped the game in Denver) Embiid returned to action on Tuesday night at Staples Center against the L.A. Lakers. He seemed healthy enough except when early in the 4th he gave fans a pretty big scare trying to one-hand this lob from Ben Simmons:
Joel Embiid, already dealing with back issues this season, went down awkwardly after this alley-oop and came up clutching his back pic.twitter.com/UAp7DJhEDg— Def Pen Hoops (@DefPenHoops) January 30, 2019
Thankfully, he was healthy enough to return to the game and whether or not that was a wise decision, it’s certainly better than some alternatives.
Some encouraging news, Brett Brown does not seem concerned about Joel Embiid’s back, said he’s fine.— Serena Winters (@SerenaWinters) January 30, 2019
But a back injury should not be taken lightly. Not for a player of his size, (he’s listed at 7 feet and 249 lbs. but... well you’ve seen him) not for a player with his injury history. Here is what Embiid said after the game per Rich Hofmann of The Athletic:
“I felt like I was going into a hyperextension but I got caught up and ended up, you know, putting it back in place,” he said of his back. “But I’m fine.”
I don’t know what he means by that. But the Sixers should now try and nip this nagging injury in the bud even if it means him missing a chunk of games before the All-Star break.
It’s probably not a big deal. Embiid finished with a healthy 28-11-6 stat line. But what if they don’t let it fully heal and it becomes one?
When Joel was at Kansas he was diagnosed with Spondylolysis, a stress fracture in his lower back. Like the stress fracture in the navicular bone of his foot Embiid suffered before his rookie season, Spondylolysis is classified as an overuse injury.
While there is no reason to believe Embiid’s back soreness now is related to that condition, it is to the same region of his body where he once had a career-threatening injury. That’s worth monitoring.
The Sixers were once concerned enough to negotiate some insurance related to the Cameroon native’s back in the max extension he signed in October of 2017. Embiid himself even references his back from time to time:
So what can the team do to prevent this from getting worse? Allowing a superstar to play a lot when hurt and fatigued seems particularly risky.
Much has been made this season of Embiid’s 1st and 2nd half splits:
Been some talk recently about Embiid's production difference between first and second halves (re: https://t.co/Nu3d0HVyDm)— senthil s. n. (@SENTH1S) December 27, 2018
Of the top 10 in the NBA in points-per-game, Embiid and Lillard have the starkest differences in scoring from half to half, but in very different directions. pic.twitter.com/nxaUtAt0fg
Head coach Brett Brown admitted that Embiid was feeling “fatigued” back in mid December.
Here’s some updated data courtesy of NBA.com that could lend support to this type of narrative:
- In 8 games with 0 days rest this year Embiid has a net rating of -5.8.
- In 25 games with one day of rest his net rating jumps to +10.2.
- Last season in 2017-2018 his net rating with 0 rest days was +5.7 in 6 games. It jumps to a +8.2 in 34 games with one rest day and rockets up to +10.4 in 16 games with two days off.
- Embiid in the first half of games in 2018-2019:
16.7 minutes, 15.8 points, 7 rebounds, 1.9 assists, 52.6 FG%, net rating +8.4, TS% 59.7, offensive rating: 110.5, defensive rating: 102.1
- Embiid in the 2nd half of games in 2018-2019:
16.2 minutes, 11.2 points, 6.1 rebounds, 1.6 assists, 44.9 FG%, net rating +0.3, TS% 56.4, offensive rating: 106.7 defensive rating: 106.6 def rating
There is a noticeable difference here. 
If Embiid is effected by fatigue, and now dealing with a back injury that has lingered for a couple of weeks, it’s time to ramp up efforts to prevent this form worsening. There are a couple of different but nonetheless important recent examples to look at; examples where fatigue possibly contributed to major injuries suffered by bigger players trying to keep up with the fast-paced modern NBA.
Last year, then with the New Orleans Pelicans, DeMarcus Cousins ruptured his achilles tendon, a catastrophic injury.
According to Tom Haberstroh, “Fatigue Likely Contributed to DeMarcus Cousins’ Achilles Injury.”
Haberstroh writes per Bleacher Report:
That it occurred at the end of the fourth quarter isn’t a total surprise. According to a 2015 study by Jeff Stotts of InStreetClothes.com, a site specializing in sports injuries, 64 percent of in-game ruptures in the NBA since 2005 happened in the second half of games....
Cousins was coming off the best stretch of his career, but his minutes totals indicate it was also perhaps the most taxing.... But minutes only tell half the story. Tim Duncan averaged 40.6 minutes per game in 2001-02 for a Spurs team that averaged 92.6 possessions per game. When you do the math using the NBA’s official data, Duncan played an estimated 78.3 possessions per game. Cousins this month? He was playing approximately 80.2 possessions a night when you factor in that the Pelicans have averaged 101.5 possessions, one of the speediest in the league.
Of course, the injury that Cousins suffered has nothing to do with Embiid’s sore back. But that he did suffer a severe injury that fatigue could have contributed to is at least worth considering.
In a related example, Kristaps Porzingis of the New York Knicks last year came out of the gate full steam ahead. He was playing elite two-way basketball. But by early January of 2018, he said “I’m tired. I’m so tired right now” per ESPN’s Ian Begley.
On Twitter an account called @Bbiomechanics founded by Tommy Tempesta noted that Porzingis’ knees were touching as he ran back around Christmas of last season. A month after KP said he was feeling tired, he tore the ACL in his knee. His timetable for a return is still uncertain nearly a year later because of his size according to the Latvian phenom himself.
Per BBiomechanic’s Youtube channel there were actually warning signs for the tear:
The same account noted earlier in this season back in November, there might be some things Joel Embiid could do to lessen the load on his spine upon landing from dunks. You can click into the tweet below and scroll up for the relevant example:
He diffuses the load that must be dealt with by the knee by flexing his trunk, so for this instance, yes it can be considered ok for his knee stress. We’d prefer other landing strategies to be implemented as well, to variable protect his spine & achilles— BBiomechanics (@BBiomechanics) November 11, 2018
Fly unicorns fly on the road to victory
The NBA is faster than ever now. In fact, the 2017-2018 Pelicans Haberstroh referenced above averaged the most possessions per contest in the NBA last season with 104. This year’s Sixers play at an even faster tempo than that at 106.3. And that’s only good for 6th quickest pace in the league.
Embiid is playing more minutes and more games than he has in the past. And he’s doing it at a time the league itself is playing at a record pace. This years Sixers average more team possessions in a game than coach Mike D’Antoni’s “7 seconds or less” Phoenix Suns used to. There are only 5 teams over the past 16 seasons who average more possessions per game than Philadelphia does now and they’re all from this 2019 season (Hawks, Thunder, Lakers, Kings, Wizards).
The NBA is running like never before and big men are being asked to cover more ground than ever.
Can big players keep up? Sometimes it seems like the answer is a resounding yes:
This sequence was crazy. Embiid stuffs Brown on the chase down block, runs the floor and Ben Simmons hits him between the legs for the flush. pic.twitter.com/NQw5eoei8E— Paul Headley NBA (@PaulHeadleyNBA) October 17, 2018
Paradoxically, a unique player like Embiid is perhaps better suited and yet more susceptible to the rigors of the modern game because he frequently makes plays like the one above.
The Process and the Hare
Philadelphia has a colorful history when it comes to handling injuries and has not exactly earned the fanbase’s trust:
The Indiana/Dipo injury means the 4 seed is a fairly nice spot. They should try to buy Joel some time to get the back right and prioritize that over seeding. It won’t happen, but it should.— Jimmy (@_JimmyMcCormick) January 30, 2019
The fans don’t expect the team to limit Embiid. But it would not only be smart, it might be irresponsible and detrimental to their championship odds if they don’t.
A severe injury to Indiana Pacers’ star Victor Oladipo gives the Sixers a chance to win home-court in the first round of the playoffs without pushing themselves too hard.
They might take note of how the Toronto Raptors manage their star Kawhi Leonard. Leonard has a lengthy injury history. He’s missed 165 games out of a career possible 602, the vast majority related to the quad/knee tendon that cost him almost all of his age 26 season. Now Leonard sits roughly every four games for the Raptors. He expects to be rested so it’s not a surprise and when he suits up he’s fresh and looks terrific.
It’s time to transition from proving Embiid can remain healthy during the regular season grind to proving the team can win a championship wit him as their catalyst.
In an NBA that is playing at a break-neck pace and occasionally asking players as large as Embiid to guard a high screen-n-roll it’s more important than ever to prioritize winning in spring than winning in winter. And it’s also important to take something that might not be a big deal pretty seriously anyway. Just in case, because he’s that special.
 As my esteemed colleague Andrew Patton has wondered on our Liberty Ballers’ Slack chat, if this trend were reversed, would we be calling him “clutch” instead of “tired?” It’s fair and calls into the question the seemingly arbitrary nature of chronology as it shapes our narratives.