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Is the International Injury Effect Real?

NBA Statistical Analyst Kevin Pelton

by Kevin Pelton, 9/11/06

When Memphis Grizzlies star Pau Gasol fractured the fifth metatarsal in his left foot during this month's FIBA World Championship, likely sidelining him for the next four months, it served as a dramatic reminder of the dangers of summer. With Tony Parker also suffering a less serious fracture (his right index finger) while representing his country, an injury during international competition remains a realistic fear for NBA teams when their players play competitive basketball during their supposed "off" seasons.

Even those players who do not actually suffer an injury during international competition end up working harder than they typically would in preparing for the season. Miami Heat star Dwyane Wade - already coming off a grueling run to the NBA title - expressed his fatigue recently to ESPN Insider's Chris Sheridan.

"I'm not the Dwyane Wade that was in the Finals," Wade told Sheridan. "I'm not 100 percent physically healthy or in shape the way I want to be, but I'm good enough where I can help my team win, go out there and play 20-25 minutes, then go back after this and get some rest."

Not exactly what you want to hear if you're Pat Riley, right?

A prevalent theory is that playing international basketball increases a player's likelihood of being injured the following season, particularly for Americans who aren't as used to the summer work as foreign players who have more likely been representing their country for years. The 2003 FIBA Americas Olympic Qualifying Tournament provided backers of this theory with solid evidence: Of the 12 players on the U.S. roster, only four played even 70 games in 2003-04. Ray Allen underwent ankle surgery, Allen Iverson missed a career-worst 34 games and Nick Collison missed the entire season after having surgery on both shoulders.

Still, when Sheridan's fellow Insider John Hollinger was asked about a possible carry-over injury effect in a recent chat, he was dubious:

"It's funny," replied Hollinger, "as soon as one of these guys get injured everyone blames fatigue, but I think if you did a comprehensive study you'd find little impact."

Well, with sincere apologies to Hollinger if he was planning to do a study at some point, here's my look at the issue - focusing specifically on the U.S., though not for xenophobic reasons. Because other countries tend to play more frequently (the U.S. did not have to qualify for the 2002 World Championships as the defending Olympic Gold Medalists and sent a team of non-NBA players to qualify last summer) and have less roster turnover, it would be more difficult to isolate any carry-over injury effect.

Since 2000, there have been four U.S. teams featuring NBA players - the 2000 and 2004 Olympic squads, the 2002 World Championship team and the group that played in the aforementioned 2003 Olympic Qualifying Tournament. Ignoring the three collegians in the group (including Collison) who had yet to play an NBA game, I recorded each player's games played the year before their international stint, the year after and the year after that. Did players play less following their summer with USA Basketball?

        Yr0   Yr1   Yr2
Games  74.8  70.1  68.5
full   0.69  0.44  0.53
major  0.04  0.09  0.13

(Full indicates the percentage of players that played a full season - five games missed or fewer. Major means a major injury - fewer than 50 games played.)

There you have it - indisputable proof that players tend to be injured more frequently the year after playing with USA Basketball. Obviously this indicates that ...

Wait, do you see some problems here? There are a couple critical ones. First, it's unlikely a player coming off of a major injury would be chosen for the U.S. team - witness Amaré Stoudemire this year. Indeed, no player who had played fewer than 43 games the previous season made any of the four teams in the study. Second, players tend to get injured more frequently as they age, so we would expect players to play fewer games going forward.

What we need, then, is a control group of players with similar attributes to those who played for the U.S. This isn't as easy as it sounds, particularly in the case of super-young players like Carmelo Anthony and LeBron James. I chose only players of the same age, looking for comparables that played similar numbers of games in the season preceding the international competition and with relatively similar styles of play to the USA Basketball players. Sometimes, like with Tim Duncan and Kevin Garnett, who alternated offering their MVP skills to the U.S., this works better than others - Ricky Davis was the best I could do for 2002 Baron Davis.

I threw out four players entirely for a total lack of comparable players: 2000 Alonzo Mourning (who subsequently missed most of the following season because of his kidney), 2003 Jermaine O'Neal (who missed 15 games in 2004-05 because of NBA suspension, which I'm not sure how to deal with anyway), 2003 Mike Bibby and 2004 Stoudemire (who missed almost all of last year after knee surgery).

Without those four, here's how the two groups compare:

    USA BASKETBALL                 CONTROL
        Yr0   Yr1   Yr2           Yr0   Yr1   Yr2
-----------------------   -----------------------
Games  75.6  70.7  70.2   Games  76.5  70.8  69.5
-----------------------   -----------------------
full   0.71  0.41  0.56   full   0.66  0.51  0.46
major  0.05  0.07  0.10   major  0.00  0.10  0.12

For the most part, the two groups show up as virtually identical. There does seem to be a slightly higher probability of minor, nagging injuries for the players who participated on USA Basketball, but this effect is mild at best.

In his answer I referenced earlier, Hollinger did add a second half of his theory - if playing over the summer does have any injury effect, it shows up for players like Wade who already saw their summers shortened by a lengthy playoff run:

"[T]he only players who did this coming off long playoff runs are Wade, Dirk, Diaw and Barbosa," Hollinger wrote. "So if you're looking for impacts, look to those guys first."

Defining a long playoff run as advancing at least to the conference finals, six players in my study qualify: Allan Houston and Steve Smith in 2000, Paul Pierce in 2002 and Tim Duncan, Richard Jefferson and Jason Kidd in 2003. Kidd missed 15 games in 2003-04 and would undergo microfracture knee surgery in the summer of 2004, while Duncan missed 13 games. However, the other four players missed just eight games combined.

Six players isn't really a big enough sample to say anything remotely definitive about whether a long playoff run plus international play means trouble, but I think we can confidently say that in general playing over the summer doesn't mean more injuries down the road.

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Kevin Pelton formerly wrote the "Page 23" column for He provides original content for both SUPERSONICS.COM and, where you can find more of his analysis of both the NBA and the WNBA. He can be reached at

Also see Kevin's previous columns for
The Year in Stats
Why I'm an APBRmetrician
Wanted: Open Minds
Investigating Dwyane Wade's Injury Risk
The Similarity of Eddy Curry and Mike Sweetney
Rating the Rookies: Projected Fantasy Stats
Valuing the Preseason
Every Play Counts: Kobe Bryant
Comparing the 50 Greatest
Every Play Counts: The Phoenix Pick-and-Roll
Every Play Counts: Antonio Daniels
Every Play Counts: Detroit-San Antonio
The Value of Kobe Bryant
Every Play Counts: The Phoenix Suns D
The Value of Steve Nash
The Curious Case of Darko Milicic
The 2005-06 Every Play Counts All-Defensive Teams
Playoff Predictions
Playoff Thoughts
Every Play Counts: Kobe Bryant v. Raja Bell
The Evolution of the NBA
The Evolution of the NBA: Part Two
Everybody Into the Free Agent Pool?
Review: Wages of Wins

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