The Cruel, Unrelenting, Back-Breaking, Knee-Busting Anti-Logic of the NBA Schedule

ByTOM HABERSTROH
March 11, 2016, 1:22 PM

— -- This story appears in ESPN The Magazine's Feb. 29 NBA Body Analytics Issue. Subscribe today!

TO THE UNTRAINED EYE, Kristaps Porzingis looked fresh and rested as he walked into the Quicken Loans Arena for a late-December game in Cleveland. And for the first three quarters, he played that way.

But even if the 20-year-old rookie phenom looked good on the outside, on the inside his body was surely a mess. For the past three months, it had been systematically trashed by the NBA's silent killer: its grueling 82-game schedule. New York had just come off a three-games-in-four-nights stretch, which had come on the heels of a three-games-in-four-nights swing through Utah, Sacramento and Portland. Not surprisingly, Carmelo Anthony had rolled his ankle late in a game two nights earlier and was now out.

Sure enough, by the fourth quarter, the hormonal, mental and physical aftershock of the Knicks' schedule emerged into full view. With a minute left, Porzingis, who had scored 23 points in the first three quarters, had yet to score in the fourth and was visibly dragging. The Knicks trailed by four and needed a stop. And with the entire arena on its feet, LeBron James -- coming off a luxurious, if rare, two days of rest -- made his move. From the left corner, LeBron darted toward Porzingis before rising up for a sky-high one-handed slam. Instead of challenging James at the rim, Porzingis ducked away, like a matador. The Cavs would win by seven, with the Knicks mustering just 12 points in the fourth, tying their then-season low.

For the NBA, LeBron's slam was the stuff of dreams: A superstar soaring for a game-clinching dunk is the very thing that sells tickets, spikes ratings and launches Vines. But here's the thing: It almost never happens, and for reasons most people don't realize.

As it turns out, the fourth-quarter dunk is a rare phenomenon. From the 2005-06 season through 2014-15, there were nearly 5,000 fewer dunks in the fourth quarter compared with the first, a decline of 20 percent. In fact, dunks become rarer with each passing quarter: from an average of 1.98 in the first to 1.59 in the fourth. More fascinating: The overall frequency falls 24 percent when teams play on zero days' rest versus one day off, dropping from 5.5 dunks per game to 4.2. The upshot: It took a dog-tired Knicks team on the road against a fresh Cavs squad to produce that James highlight.

It's merely one of a hundred signals that NBA players are exhausted and sleep-deprived. In this case it was to the benefit of the highlight makers. But the evidence suggests that, over the course of a season, all players -- and fans -- end up losing.

"It makes no sense to me," says Dr. Charles Czeisler, director of sleep medicine at Harvard Medical School. "These guys are so extraordinarily talented, and it's a shame that they're being impaired. It'd be like the NBA saying, 'OK, let's see how they do if we starve the players. OK, let's see how they do if we make them all drunk before they play, so everybody has to do six shots before they do the game.' Would anyone in their right minds consider that?"

STEVE MAGNESS IS one of the world's top running coaches -- his middle- distance and marathon runners are prepping for the Olympics now -- and a leading authority on athlete exhaustion. There are disagreements among experts in his world about how hard to push athletes, but nobody recommends anything like what the NBA prescribes: four contests in five nights, say -- or 82 in 169 days.

"It's almost ludicrous how often they play," says Magness, who has a master's in exercise science and wrote the book The Science of Running. With so few days off, the restorative faculties of the human body start to shut down. And it's a problem the NBA knows it has. Commissioner Adam Silver recently told reporters in London that "we're becoming more sophisticated about the impact of fatigue on our players and the direct correlation between fatigue and injuries."

But even with a new push by the league to reduce back-to-backs and four-in-fives to all-time lows, there are still 533 back-to-backs in the NBA schedule, far too many in the eyes of Magness, who advises his top Olympic athletes to race no more than once a week.

The problem is mounting. Research from ESPN's Kevin Pelton indicates that stars are more injury-prone than ever. Incumbent All-Stars from 2013-14 missed 19 games on average last season, or about a quarter of the season. Compare that with 2009-10, when incumbent All-Stars missed just 10.8 percent of their games -- or one of every 10 games. The plague of the injured star was evident in the 2015 Finals, when James shot 38 percent sans Kyrie Irving and Kevin Love. And Jimmy Butler, the NBA leader in minutes per game, just suffered a knee injury on the second night of a back-to-back that will keep him out for three to four weeks.

If you survey doctors and sports scientists around the world, the NBA's problem stems in large part from chronic lack of sleep, the body's natural performance-enhancing drug. How important is it? A recent Stanford University study found that shooting accuracy improved by 9 percent and 3-point percentage by 9.2 percent after basketball players spent at least 10 hours in bed for nocturnal sleep during a five-to-seven-week period. "We get this nice big surge of testosterone and human growth hormone when we get into deep sleep," Magness says. "The longer the deep sleep phase gets, the more HGH and testosterone you produce."

Magness describes a war between two biomarkers in the body: testosterone and cortisol. The more testosterone, the better; it's the anabolic steroid that promotes muscle growth and recovery. Cortisol, though, is a stress hormone that parachutes in when the body is breaking down. As cortisol levels rise, the body signals that it's in distress and dispatches ambulances and firetrucks to fix the damage. In October and November, he says, NBA athletes show strong testosterone-to-cortisol levels. But as the season grinds on, the ratio flips: "As your body flip-flops into 'not being able to repair itself' state, your immune system can't keep up; it eventually taps out."

Magness has seen this firsthand: It's common for marathoners to stay healthy all during training and then get sick a week or two before the race. "Because they cooked it just a little too hard."

In early January, the NBA's ironman, Clippers center DeAndre Jordan, missed his first game since 2011. The DNP was due to a bout with, of all things, pneumonia, to which Magness quips, "Yeah, exactly."

There's a reason, after all, teams play three points per 100 possessions worse on the second day of back-to-backs. And even worse when they play four games in five days. "Basically, it makes the body a mess," Magness says. "What happens when you play 82 games in a 160-day stretch is you don't give your body time to repair itself and get ready for the next go-round. It just kicks into this stage where it can't keep up with the demands."

IT'S BEEN ALMOST A YEAR since Chris Bosh's diagnosis of a pulmonary embolism -- a blood clot in his lungs that forced him to miss much of last season. Fresh off scoring 18 points in a win over the Hawks, the 6-foot-11 Bosh is slumped deep in the red leather chair in front of his locker, trying to illustrate what air travel is like for him. He says the constant flying contributed to the life-threatening clot that migrated from his calf to his lungs: "You sit so much. You're like this for two hours. If you get kicked, blood just pools up somewhere and you don't move it, it just sits there."