Was Joel Embiid’s work-load mismanaged and what do we know about his knee?

It’s hard to get excited reading all of the Sixers-Nets content when you’re probably wondering more about if Joel Embiid will be out there or how healthy he is. First Elton Brand shocks everyone by saying he’s merely “optimistic” Embiid will be ready to play. Then Joel himself is talking about having had scans and how the pain has recently escalated. Is this all gamesmanship? Do they really think Nets Coach Kenny Atkinson will spend a chunk of his time preparing to stop Boban Marjanović instead, or is something very wrong?

According to Embiid himself, the pain level has recently gotten worse over the last couple of days. He was asked about gutting through the pain in big games matching up against Giannis Antetokounmpo but he revealed that he may not have been dealing with the new level of pain in those recent stellar performances.

A somber version of the often confident and affable superstar said the following today, per Per Dave Uram of WFAN:

“...the past couple of days it’s been different.... Everything looks good, the scans and everything, but it’s just the pain level has just changed and it just got worse.”

It certainly doesn’t sound like the Joel who reminds us that he’s a warrior and is going to go out there and steal some real estate in people’s minds. To me he sounds very disappointed and possibly exasperated.

For those of us on the outside trying to infer what version of the team’s best player we may get (if any) this series it’s all pretty alarming.

Let’s go through a bit of his injury timeline this season.

Joel’s Injury Report

Joel Embiid sprinted out of the gate this season. He was plowing through his competition, shattering his former minutes or games restrictions, and even leading the league in minutes played through the first few weeks of the year. Some fans loved that he seemed to be fully healthy and without restriction. Others worried the team was playing with fire, given his history.

By December 7th, the coaching staff was openly discussing how it is their responsibility to preserve the players, and Joel got an evening off to rest after appearing run down.

The knee issue begins

Recall, it was just after a grueling 40 minute overtime performance on Christmas (a loss to Boston) when Embiid would miss a game with knee soreness (his first due to this malady) on December 30th. Per Keith Pompey of The Inquirer:

He would pop up on the injury report with the sore knee around 6 times in early January until the designation eventually changed to a sore ankle which cost him one game vs. Atlanta.

The back

By mid January, the designation of sore knee then morphed into a sore back. Joel would play through (often apparent) back pain through the end of January.

More and more people were beginning to question his work load following the knee and back issues even though he still played so well.

This Twitter account @BBiomechanics noted early in the season the way Jo was landing was placing a sizable load on his trunk, possibly to diffuse the load absorbed by his knees. An ailment or sensitivity in one area can lead to compensation injuries - which was the obvious concern since Joel did tear the meniscus in his left knee in 2017 and once dealt with a stress-fracture in his lower back during his days in Kansas:

Embiid would play in the second night of a back to back in New York and make headlines by diving into the stands. He’d play in the All-Star game. And then the team would declare him out for at least a week with left knee tendinitis.

He has only played in 10 out of the last 24 games since this point. It does not seem unfair now to say that he and the team pushed too hard in the first half of the season and are now paying for it.

This isn’t just Monday morning quarterbacking. Lots of people insisted upon it throughout the year, even while Joel was demolishing his opponents. It seems plausible that a few involved were a bit eager to erase the memory and stigma of “The Process” or Embiid’s injury history.

When he first returned to the lineup on March 10th his conditioning was a concern. The strategy was to play him in short bursts, as detailed here by NBCSP’s Serena Winters:

It seems likely this will be coach Brown’s strategy if/when Embiid is active: short bursts and see how the knee responds. With an overuse injury like tendinitis, sometimes it’s about getting the tendons warmed up. Then you ice and rest and pray they recover in time for the next battle.

But now they won’t have the luxury that they enjoyed recently when Embiid would play hard and then take lots of rest time to sit out.

So wait, was there a recent setback?

Rewind to a week or two ago. Things felt pretty good for a bit when they were winning against Boston and Milwaukee and heading towards clinching a 3 seed while also (apparently) resting Embiid in order to be 100 percent for the playoffs.

On April 4th, after leaving him home for a road trip, the team signed another big man insurance policy in Greg Monroe. Was this a signal that they were more concerned than they were letting on?

It was also head scratching when Joel would be a “game time decision” for Milwaukee or Chicago. If this was just load management, why does he need to “test it out?” What the heck is Monroe doing here?

Things got even scarier last Saturday. He didn’t look like a player who had been resting since the All-Star break in order to peak in time for the playoffs. He looked visibly uncomfortable:

The team won the game but Embiid did not want to speak with the media afterwards:

Now what?

Since this is the Sixers the one thing we can count on is lots of misinformation or overly rosy updates when it comes to injuries. Embiid mentioned today that he’s at least happy his “scans” look good, but we didn’t hear from the team he had had any.

Coach Brett Brown suggested he doesn’t want to be the one giving the medical updates anymore. And that’s fair. But if he won’t, who will? Weird and confusing injury reports from the team are now the norm through the last 3 different GMs. The smoke, mirrors and confusion regarding medical issues has been one of the team’s defining traits for years now.

It’s fair to at least prepare for the possibility that Embiid might be more hurt than they have let on and could even need some type of off-season procedure, even if this is truly just tendinitis.

(Sometimes players will undergo a scope just to look around and/or clean up scar tissue or voluntarily opt for things like platelet rich plasma therapy, blood spinning, stem cell treatments, or other non-traditional procedures for overuse injuries).

Kawhi Leonard’s cautionary tale

Kawhi Leonard once spent a season on the injury report with “jumpers knee” or “quad-knee tendinitis” (overuse injuries in the tendon where the quad meets the knee) and it’s been something that he’s largely managed or dealt with in some way over the last 7 seasons. It has cost him lots of games and some summer USA competition. There are lessons here for Embiid and the Sixers.

If Philadelphia loses to the Nets, it will be because Embiid isn’t healthy. If they win that and move on and then lose to the Raptors, it will be disappointing but it’s something that possibly/probably would have happened even if Joel was fine. The Raptors have earned home court and were the better regular season team. It wouldn’t be the end of the world. Keeping the band healthy and together again will be the much bigger issue.

But losing to a team who features Kawhi Leonard would be a reminder for Embiid and everyone in the Sixers organization. One year after Brett Brown left San Antonio, in Leonard’s 3rd season Leonard was the NBA Finals MVP and yet he averaged less minutes per game (at just 22 and with less of an injury history) than Embiid did this year.

Brett Brown’s mentor Gregg Popovich is well known for his conservative rest program. He knew his most explosive athlete had an overuse injury that couldn’t be taken for granted. He had to conserve and channel Leonard’s energy. He did, Leonard accepted it and they won a ring together.

But eventually the relationship deteriorated. A large part of that stemmed from disagreements about his quad and how it should be treated and managed. Brett Brown makes no secret that he models coach Pop.

Embiid can take note of Leonard’s career trajectory and how often he sits; this year, around every 3-4 contests. And if Elton Brand or coach Brown are lucky enough to stick around with the team after this season, they should have a long talk with Pop about load-management and what he’s learned from both winning a ring with Leonard and then what he learned from losing a top 5 player with major injury concerns.

A more diligent load management could be the key to both Embiid, Brand and Brown’s future successes or failures. Jo is a very very special player, and like Leonard, one that needs to be managed more carefully than he was earlier this season. Is it possible that he would be healthier today if he played less and rested more frequently back in November, December and January? It’s a very long season. In my opinion, too long. What’s the old Spider-Man phrase about great power...?