New Orleans Pelicans medical staff grades poorly in comparison to NBA rivals

In yesterday's press conference, Alvin Gentry pointed to injuries first and foremost. They were a common theme, and towards the end of his speech he gave the medical staff a strong vote of confidence.

Should he have?

The Los Angeles Lakers set the NBA injury benchmarks in previous years, with personnel missing 338 games in 2015 and 320 in 2014. The New Orleans Pelicans exceeded both of those totals with a league-leading 351 missed games to injury or illness during the 2016 campaign, surpassing their aggregate from last year by 241 contests. From In Street Clothes, the franchise had lost approximately 1500 games in the prior 10 years.

If charting team injuries was a horse race, this graph from Man Games Lost wouldn't have been considered a photo finish. A total of 14 Pelicans missed games for 32 different reasons. Only 3, Luke Babbitt, Dante Cunningham and Alonzo Gee, managed to keep their number of absences in single digits. Here, have a look at each and every malady courtesy of the Pelicans final gamenotes edition.

Can one team be this unlucky, in an age where advancements in nutrition, injury prevention and technology are better understood and considered by the vast majority to be of utmost importance?

Back in 2002-03, the Toronto Raptors set an NBA record for the most games missed to injury with 519. Their fortunes were so awful that they failed to field 12 healthy players for a single contest of the 82-game schedule. Despite the crutch and having participated in the playoffs the prior three years, Lenny Wilkens, the winningest coach of all time, agreed to step aside the day after the conclusion of the regular season.

Fast forward to today and the Raptors are annually one of the healthiest squads around, having missed 95 (DeMarre Carroll missed 54), 61 and 68 games respectively the last three years. Many have credited changes to their philosophy, and at the forefront sits Alex McKechnie, Toronto's head of sports science, and the installation of his various prevention methods.

The Pelicans need to to find a way to undergo a similar metamorphosis, but do they possess the necessary tools?

Justin Verrier wrote extensively on the state of the injuries in New Orleans earlier this week and his story revealed a number of important details regarding the procedures of the team's medical staff. If you haven't taken the time to peruse it yet, I urge you to do so now because it's a great read and will serve as a valuable precursor to the rest of this article.

But as the paperwork began piling up in the training room, head trainer Duane Brooks says he tried to prepare his staff at one of their daily meetings for the backlash ahead.

"At some point," he told them, "the focus is going to be on us."

...So let's oblige Duane Brooks at this point because it's high time.

The best place to start is with team media guides in an attempt to decipher the number of medical resources utilized by the Pelicans in comparison to other franchises. Specifically, I want to contrast personnel to the San Antonio Spurs (Media Guide Link) and the Oklahoma City Thunder (Media Link Guide), two teams that sit on the opposite side of the injury spectrum -- having missed a mere combined 80 games to injury or illness in 2015-16.

Title	San Antonio Spurs	Title	New Orleans Pelicans
Director of Medical Systems	Phil Coles
Director of Rehabilitation	Marilyn Adams	Physical Therapist	Jared Lewis
Head Athletic Trainer	Will Sevening	Head Athletic Trainer	Duane Brooks
Athletic Trainer Assistant	Paul West	Athletic Training Assistant	Todd Hooks
Applied Sports Scientist	Xavi Schelling
Athletic Performance Coordinator	Anthony Falsone	Head Strength Coach	Jason Sumerlin
Physical Development Assistant	Kelly Forbes	Assistant Strength Coach	Michael Ruffin
Team Physician	Dr. David Schmidt	Team Physician	Dr. Scott Montgomery
Team Physician	Dr. Paul Saenz	Team Physician	Dr. Matthew McQueen
Team Physician	Dr. Richard Steffen

Title	Oklahoma City Thunder	Title	New Orleans Pelicans
Director of Medical Services	Dr. Donnie Strack
Medical Research Coordinator	Tony Katzenmeier	Physical Therapist	Jared Lewis
Head Athletic Trainer	Joe Sharpe	Head Athletic Trainer	Duane Brooks
Athletic Trainer	Sebastien Poirier	Athletic Training Assistant	Todd Hooks
Director of Performance Science	Mark Simpson
Athletic Performance Coordinator	David Howarth	Head Strength Coach	Jason Sumerlin
		Assistant Strength Coach	Michael Ruffin
Head Team Primary Care Physician	Dr. Daniel Clinkenbeard	Team Physician	Dr. Scott Montgomery
Head Team Orthopedic Physician	Dr. Carlan Yates	Team Physician	Dr. Matthew McQueen
Director of Team Wellness	Angela Charlton, Ph. D.

The first thing that should jump off the page is the lack of top tier executives on the New Orleans Pelicans payroll. Since Jon Ishop departed for the Detroit Pistons, New Orleans has not filled his vacant position of Director of Sports Medicine. In his stead, Dell Demps stated, "an organization decision was made to bring Brooks over from the Saints." Prior to joining the Pelicans before the 2014-15 season, Brooks was an assistant trainer for the New Orleans Saints.

In Justin's article, he defended his expertise at length.

"A torn ACL in basketball is a torn ACL in football. An AC contusion is an AC contusion. Injuries are injuries," Brooks says. "They have to be managed different because of the schedule or because of the different type of athlete or where we are in the schedule. It's different. But at the end of the day, I've never seen anything over here [with the Pelicans] that I've never seen before. I've never had an injury before that I said, 'I've never dealt with this before. What do I do?'"

Does it matter his previous experiences, a solid 13 years worth, all came in the National Football League? No one can say for sure, but I do know that the head athletic trainers with the Spurs and Thunder have a combined 38 years of NBA experience. Brooks has yet to make it a full deuce ...and his name is listed at the top of the Athletic Training section in the staff directory!

Next, notice the variety of titles quoted above: Oklahoma City and San Antonio have descriptions such as applied sports scientist and medical research coordinator. We've all heard don't judge a book by it's cover, but sitting atop of the NBA injury totem pole demands scrutiny. Why does the New Orleans physical care section of personnel read so blandly, bearing little difference from say an underfunded small college program?

On top of this, Brooks makes no effort to hide the fact that he's not cutting-edge.

"I'm a bit old-school," he says. "We have cryotherapy. But to me, hands are the best. You have to have a good set of hands. And I think the three of us, with the experience that I have and the experience Jared and Todd both have, I think it starts with that. Manual therapy -- putting your hands on a guy. That's how you get them to trust you. You can use Fusionetics, cold tubs, cryo, whatever. That's an extension of what we do.

Hands? A whole paragraph was dedicated to hands?? I don't know about you, but reading this doesn't put me at any kind of ease. I would have preferred hearing about the use of new techniques, on-going education, something ... anything to give hope that everything will be done to avoid future disastrous seasons!

Instead, Jason Summerlin, a recent hire hailing from San Antonio, dropped the following bombshell to ESPN.

"We're getting there," Sumerlin says. "We're definitely moving in the right direction. We're just in the process of getting to where the Spurs are. I think once we start winning some playoff games, start getting a bigger budget, we can start going that route."

Sumerlin, after reading his quote two weeks later, says that he regrets the comment, and Demps provided the following written statement in response:

Of course he regretted it, once he was reprimanded for giving an honest evaluation, which Dell Demps was required to throw on a few band-aids. However, does anyone doubt the truth was spoken? He had absolutely no reason to lie, and normally a first assessment is the correct one.

Did you know that after San Antonio knocked off the Miami Heat in the 2014 Finals they didn't sit pat at Max's Wine Dive and sip on some rather expensive wine for the rest of that summer? No, they didn't make significant changes to the coaching staff nor the roster. Rather, they revamped their medical services department. This forward-thinking franchise realized that their older core was going to need help in overcoming a disadvantageous offseason of rest.

Hey, look where the Spurs and their old guys stand today -- fresh off winning a franchise best 67 games and posing a legitimate threat to arguably the best regular season team of all time, the Golden State Warriors!

At the start of the 2016 campaign, Jeff Stotts of In Street Clothes predicted a worse case scenario was possible for the New Orleans Pelicans, based on all of their preseason issues.

The situation could set up a potential "death spiral" scenario that occurs when a medical team simply cannot keep up with the demands of the injured athletes. FanDuel injury analyst Will Carroll explained in a column for Bleacher Report that "There [are] only so many hours in the day, and at a certain point, the rehabilitation and maintenance programs [overtake] the preventative programs, leading to an increase in injury rate." As a result, multiple substantial injuries require extensive attention and ultimately divert focus away from the daily maintenance of healthy players.

Was this a contributing factor to a season-long bout with injuries? Was the existing staff so overwhelmed from the start that playing catch-up started some terrible domino effect? Would have additional key personnel made a notable difference?

A countless number of questions and no answers. Even the Jrue Holiday success story from this season should not sparkle as much in retrospect.

Brooks says the Pelicans knew Holiday might encounter some issues in the first season after he suffered the stress fracture in his right leg. What they didn't know was how much.

Holiday started the first 37 games of 2014-15, at an average of 32.6 minutes a game (one fewer than in 2013-14), before the January diagnosis of a stress reaction forced the team to shut him down again. Brooks concedes now that playing a normal minutes load was "probably" not the best idea.

"Knowing now, that's something we probably could have changed, but it was a collective effort," Brooks says. "This is the second year going into it. If this was his first year coming from it -- not last year -- he would probably have issues this year. I don't think him playing heavy minutes initially was the reason. I think that's part of it, but I don't think that's it."

Before the start of training camp last September, I interviewed Mike Guevara, Holiday's long-time personal trainer. He was not a fan of the high amount of minutes at the start of last season.

Early in the 2014-15 season, Mike remembers asking Holiday whether he was okay because he feared the minutes might have been too excessive so soon. He was aware that Holiday didn't enter the season in peak physical condition, and unfortunately, tragedy struck again.

The evidence suggests the Pelicans medical staff should have somehow been better prepared to handle Holiday and his allocation of minutes at the start of last season. If not, they should consulted with everyone in the business and followed the best recommendations, or better yet, made another hire or two to the staff. Instead the powers that be allowed Jared Lewis to attempt to solve Holiday's situation, admittedly his first mystery. #GuineaPig

Sigh.

So, who is to blame?

By all appearances, the team's approach to injuries seems quite old school, but does this suggest we should point a finger at Tom Benson? On the one side, his payrolls for the Saints and Pelicans have routinely been higher than average. The basketball team has the privileged use of one of the league's newest training facilities.

On the other hand, New Orleans sits in a small minority of organizations without exclusive ownership of a D-League team. The Pelicans have also made several deals the last several years for the sole purpose of raising capital (Jarnell Stokes, Tyshawn Taylor, the sale of multiple draft picks). #CashConsiderations

Perhaps, those entrusted with critical decision-making have failed. Mickey Loomis, the Saints general manger, is rightly considered a "football guy." However, he is also the head of basketball operations for the Pelicans. Does he and his immediate staff function with the same knowledge and wherewithal as others in the same position around the league?

Maybe the attention should focus on Dell Demps -- he has made his share of mistakes since the start of his tenure. Yet despite your opinion of him, don't forget he hails from San Antonio lineage, one of the most progressive front offices around. This same tree produced Sam Presti in OKC and has planted seeds elsewhere including the Atlanta Hawks, another team enjoying a lot of success this season on the injury front and possessing an enviable looking staff.

Title	Atlanta Hawks	Title	New Orleans Pelicans
Executive Director of Athletic Performance	Keke Lyles
Director of Rehabilitation	Michael Roncarati	Physical Therapist	Jared Lewis
Head Athletic Trainer	Art Horne	Head Athletic Trainer	Duane Brooks
Assistant Athletic Trainer	Scottie Parker	Athletic Training Assistant	Todd Hooks
Athletic Performance Coach	Chris Chase	Head Strength Coach	Jason Sumerlin
Athletic Performance Assistant	Zach Markowitz	Assistant Strength Coach	Michael Ruffin
Team Physician (Orthopedic)	Dr. Michael Bernot	Team Physician	Dr. Scott Montgomery
Team Physician (Orthopedic)	Dr. Ashok Reddy	Team Physician	Dr. Matthew McQueen
Team Physician (Internal Medicine)	Dr. Scott Kleber
Team Ophthalmology	Dr. Eugene Gabianelli
Team Ophthalmology	Dr. Andrew Feinberg
Team Ophthalmology	Dr. Parul Khator

It's odd the Pelicans do not possess a comprehensive medical staff as the Spurs, Thunder or Hawks. Has Demps overlooked certain aspects or have his hands been tied by those above?

To illustrate a point, does everyone remember when Anthony Davis underwent surgery? The New Orleans Pelicans, to the shock of many, publicly released the medical report from Dr. Neal ElAttrache. They (and who was they?) felt compelled to provide justification from an independent entity for what reason?

There is a chance the Pelicans suffered through some terrible luck this past season, at least in regards to several of their injuries (Holiday eye, Ajinca sternum). However, a number of others do not sit well with me including those involving Tyreke Evans, Quincy Pondexter, Bryce Dejean-Jones and Jrue Holiday's recovery from tibia surgery two years ago.

"I don't think we've done anything wrong," Brooks says. "I don't think the steps we take are bad steps. I'm not saying we're perfect, but we can get better."

The Pelicans can and should get a whole lot better. When other teams have added top level executives, key scientists and daily medical staff and have all seemingly relished lower injury rates, New Orleans should at the very least try to mimic those who have enjoyed such great success. The Warriors, Spurs, Heat and Mavericks, the last five NBA champions, averaged less than 102 missed games in their championship years due to injury/illness.

Unless, of course, if winning isn't a priority...