Scar tissue: Behind the curtain of the Pelicans' training operations

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Ask virtually anyone within the New Orleans Pelicans organization about the mass of injuries the team has endured this season, and they'll tell you the same thing: They've never been part of anything like this in their NBA careers.

"I say this is a Job season," says Alvin Gentry, who is in his first season as Pelicans head coach. "If you know the book from the Bible, he got tested in every way."

Executives, coaches and players are adamant that no fingers are being pointed.

"Nobody's really complaining about, 'I don't want this guy here, he's not doing this, he doesn't know what he's doing,'" says Anthony Davis, who missed a career-high 21 games to injury this season and has missed 68 in his first four seasons. "Nobody's doing that whatsoever."

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."

Even before the surgical procedure that made him a literal iron man, Jrue Holiday felt almost untouchable.

"Maybe I'm saying this because I was young at the time, but 19 to 21, 22, I felt like I can go out and do anything," he says. "I can play a basketball game and then go out and still feel like I can play after. That's how much energy I had. I guess my recovery time was a lot faster and all that."

Holiday was 23 when he arrived in New Orleans in the summer of 2013, with his first All-Star season just behind him and not a single major injury during his ascent from an elite-level prep player. The draft-day trade that sent him from Philadelphia for two first-round picks came as a surprise, sure, but summer days spent with Davis, Ryan Anderson and then-Pelicans trainer Carlos Daniel in the weight room at Team USA minicamp opened his mind to the possibilities ahead.

Then, sometime during the 2013-14 season, the pain started. And it wouldn't go away.

"I don't know if it started out as a shin splint or whatever," Holiday says. "I've had shin splints before and played through them and done all that. But I guess this one just kept on getting worse and worse."

On Jan. 8, 2014, during a home game against the Washington Wizards, Holiday went up for a layup and felt something was wrong. Later, X-rays showed a crack in Holiday's shin -- the "dreaded black line."

"Your bone's supposed to be solid," he says. "It's supposed to look the same all the way through. But when you see a crack, that kind of tells you. I guess you have some options. You can keep playing with it. It'll hurt, but there's a chance that your leg might snap. I guess I kind of felt like, 'Yeah, I should probably stop.'"

Nearly two months later, a titanium rod was surgically implanted from the bottom of Holiday's knee to the top of his ankle to correct the stress fracture. His first season in New Orleans was over after 34 games.

One year and four days after that game, he was sidelined again. This time it was a stress reaction, a weakening of a bone that is often a precursor to a stress fracture.

"I know the rod's in there to be able to protect my bone, and it's supposed to take pressure off my shin so that with that rod in there, my leg will never break," Holiday says. "But to have the reaction kind of on the side, it was weird and frustrating because I thought the hardest part was over. Being injured and having to sit out, not knowing why this is happening, and then this kind of hit. It was ... yeah, it was frustrating."

The feeling has become all too familiar in New Orleans.

In the past six seasons, the Pelicans have finished above league average in games lost to injury more than they have finished above average in games won, according to InStreetClothes.com. This season, the number of DNPs on their injury list has become as prolific as the Warriors' win total.

The diagnoses ran the gamut, from the chronic (Quincy Pondexter undergoing two left-knee surgeries since May, Tyreke Evans with three procedures to his right knee) to the uncontrollable (Bryce Dejean-Jones breaking his wrist a week after signing his first long-term NBA contact) and from the familiar (broken finger) to the femoris (right quad).

New Orleans has lost 340 games to injuries and illness, the most in the NBA, and is on pace to finish with 349, the most in at least the past six seasons. The team's 41 different starting lineups are tied for third most in a single season in the past decade, according to Elias Sports Bureau.

"It's been disappointing," vice president and general manager Dell Demps says. "We had a lot of high hopes coming into the season. And, obviously, not being at full strength has really ... it's been tough. It's been tough on us. It's been tough on the organization."

Jason Sumerlin's chart is simple, elementary even: Days of the week run horizontal across the top, and players' names are listed on the left. A blue dot is added to a given day's box each time a player completes a routine that falls under the category of "injury prevention." A red dot represents conditioning, and a dot made to look like a basketball is for weight training. A gold dot was recently added for recovery techniques.

"I'm trying to hold guys accountable by showing what they're doing on the board," says Sumerlin, the Pelicans' head strength and conditioning coach.

A San Antonio Spurs staffer for five years, who was hired as Daniel's assistant last season before ascending to the head job this season, Sumerlin says the "bread and butter" of his program is rather traditional: Olympic-style lifts, which he says emphasize "power and hips," done at least two times a week.

But Sumerlin's short tenure is tinged with modern approaches, including a new dietitian and a yoga coach for team sessions. Pizza has been replaced on the postgame menu with the health-conscious trifecta of a protein, vegetable and carbohydrate. The 34-year-old even lifts weights alongside the players, which Davis says creates a more fun environment. The 23-year-old superstar spent last offseason sculpting his physique under Sumerlin's watchful eye.

"I try to bring the same thing they do with the Spurs over here, by doing all the small things consistently and efficiently," Sumerlin says. "Foam-rolling, simple stuff. Taking the right protein drink, eating the right food, sleeping habits. Just trying to educate the guys with what I learned there because we've got a young group here."

There has also been an effort, team officials say, to continue updating the $15 million training facility opened in 2013. The Pelicans purchased a cryotherapy chamber on Sumerlin's recommendation to accelerate the recovery process. This season, they became one of 19 NBA teams to invest in wearable GPS tracking technology from Catapult Sports -- which began showing up on Spurs summer-leaguers in 2013 -- to monitor the workload, force and fatigue of players at practice. Fusionetics, a movement assessment tool to track bodily changes through the season, which Kobe Bryant says he has used to great success for four or five years, was added this season. There's also Optojump Next, which measures a series of jumps, and Normatec, which aids recovery.

"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:

"Mr. and Mrs. Benson have spared no expense, and have gone above and beyond in providing all the resources for the Pelicans to be successful. Our practice facility is one of the top five facilities in the league, if not the best.

"As I have repeatedly explained, our first year strength coach was promoted to his position after all of our equipment for this season was purchased and ordered.

"After each season, we evaluate our facilities and equipment, research what is the optimal equipment for our players and then we attain it. There is no budget."

Success requires fitting resources, and in the Pelicans' case, the whole operation works in conjunction with the NFL's Saints', as that team's facility shares the Pelicans' campus space in suburban Metairie, Louisiana.

Duane Brooks, for one, is quite familiar with the football branch of Tom Benson's New Orleans pro-sports monolith. When Jon Ishop, a former Houston Texans assistant trainer who spent four seasons as the Pelicans' director of sports medicine and head athletic trainer, departed two summers ago to take a similar position on Stan Van Gundy's staff in Detroit, Demps said an "organizational decision" was made to bring Brooks over from the Saints, with whom he had spent 13 seasons as an assistant trainer.

"I'm a bit old-school. We have cryotherapy. But to me, hands are the best. You have to have a good set of hands." Duane Brooks, head athletic trainer for the New Orleans Pelicans

Brooks, who also worked at Florida State, said he has had to adjust with the Pelicans -- to a basketball player's schedule, to an increase in administrative duties and to a staff that has replaced all five of its medical professionals in the past two years -- but overall, he feels comfortable in his new role in a different sport.

"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?'"

The Pelicans do not employ a department head for their medical staff or a head of sports science, like the Spurs or Philadelphia 76ers do. Brooks runs the training room and Sumerlin the weight room, and daily meetings are used to organize and trade ideas. The team takes a collaborative approach to technology too.

Brooks says he was researching Catapult for the Saints when he was hired by the Pelicans in the 2014 offseason, but the team was unable to purchase it in time for that season. Whereas Sumerlin cultivated his professional worldview in the cutting-edge environs of San Antonio, Brooks says he skews toward a wait-and-see approach to technology.

"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.

"But if they're not trusting us or believing in what we're doing, everything else is a moot point. It's there. It's window dressing. I'm not saying it doesn't work -- it does. A lot of that stuff is good stuff. But I think it starts with us three. And having good hands to put our hands on these guys every day, and for them to gain our trust because of what we're doing manually -- that's where it starts."

Jared Lewis is officially a medical practitioner, but his station of physical therapist often places him more in the role of investigator. His first big case? The mystery of Holiday's aching knee.

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."

Holiday was shut down and evaluated daily for nearly three months after he suffered the January stress reaction, but he returned in three of the final four regular-season games to help the Pelicans' playoff push. Although he didn't practice between games to maximize his playing time, he logged 15 minutes in the first two games and 25 in the victorious, decisive finale. Holiday played in three of four games in the first round against the Warriors, at an 18.3-minute average. He missed Game 2 because of shin pain.

"Nothing was worse than it had been," says Lewis, who is in his second season with the Pelicans. "It was more just playing through some discomfort. But it was determined he wasn't at risk for further injury, and that was confirmed by imaging as well."

Soon thereafter, the Philadelphia Inquirer reported that the 76ers were ordered to pay the Pelicans $3 million for not fully disclosing Holiday's injury history before their 2013 trade. Holiday says the report is based on osteochondroma -- extra bone growth -- found on his left leg during a physical in his rookie season, but he says it has not caused any issues in his career.

As Holiday recovered from May surgery to remove a screw implanted during the initial procedure on his right leg, Lewis, after consultation with Holiday's doctor and surgeon, developed a plan to find a solution, once and for all. Holiday would be on an established minutes limit -- first 10 minutes, then 15, then 25 -- that would keep him from playing in back-to-back games until late December. Holiday wouldn't get to play again until September, and he couldn't do consecutive days of on-the-court work until October.

"Bone responds to the stress you put on it," Lewis says. "Our thing was we didn't want that stress to be like a piano falling on him. We wanted to gradually build it up so that the bone could respond and get used to that and then progress."

Tracking the load placed on Holidays' knee during a baseline set from preseason testing, the Pelicans continued allocating Holiday's practice time based on his weekly and monthly load, even after the minutes restriction was lifted.

This season, Holiday, now almost 26, didn't miss a single game because of his right leg, except for six planned rest days. He sat out two games in March because of an unrelated left toe injury and was shut down for the Pelicans' final nine games, after he received an unintentional elbow to the face from Kristaps Porzingis that caused a fracture to his right inferior orbital wall.

In 65 games played, Holiday finished with averages of 16.8 points, 6.0 assists and 3.0 rebounds in 28.2 minutes a game and a career-high 19.8 player efficiency rating.

"He's happy," Lewis says. "We're obviously happy."

As Holiday was put on the path that would finally keep him upright and on two healthy knees for almost a whole season, Quincy Pondexter and Tyreke Evans began their own season-long battles with knee issues.

Shooting a career-low 36 percent from the field with Memphis in the first half of 2014-15, Pondexter found everything he was looking for in a midseason trade with New Orleans. And he wasn't going to give it up, even though he says he knew "100 percent that something was wrong" after last year's All-Star break.

"To finally be a starter on an NBA team like I was and playing for Monty Williams last year, I didn't feel ... I couldn't sit out," he says. "There was no part of me, no matter what pain I was going through, that I was going to sit out -- especially after finally earning a starting spot in a place I really love."

In July, Pondexter told the Times-Picayune that he "begged" the medical staff to not administer an MRI until after the postseason, out of fear that the results would take him off the court, but the Pelicans provided documentation to ESPN that shows the 28-year-old underwent MRIs on March 16 and April 15 of last year. Pondexter says the scans showed swelling and "little bits of things floating around," but the team wouldn't know the issue until a scope was performed.

"It was something that was there all along," Brooks says. "The actual injury itself, I'm not going to say it was worse, but the symptoms were."

"There was no part of me, no matter what pain I was going through, that I was going to sit out -- especially after finally earning a starting spot in a place I really love." Quincy Pondexter

Pondexter had offseason surgery to repair the cartilage in his right knee, but he says it "didn't really work the way we wanted it to." After holding out hope of playing into January, the self-professed "stubborn" swingman conceded and had a cartilage-replacement procedure that sidelined him for the entirety of the 2015-16 season.

"I can tell the difference, even walking around as a normal person and being able to go up and down stairs -- the little things," he says. "It feels 10 times better than it did the day before the last surgery."

Evans, meanwhile, played in a career-high 79 games last season, but his offseason surgery -- a debridement to remove loose particles in his right knee, per Brooks -- was the result of wear and tear brought on by past issues. Brooks says Evans has a history of bilateral knee cartilage wear and trace of fusion on both knees that dates back to before the 2013 sign-and-trade that brought him to New Orleans.

"Even if he probably hadn't had surgery, I'm sure some maintenance work was being done on the side, just to get him through the season to possibly prevent surgery," Brooks says. "Both knees are tied to a prior history."

The 26-year-old former rookie of the year returned for the preseason but bumped knees in practice with Kendrick Perkins. That led to a chip in his right knee and surgery in October. Evans returned Dec. 1, but persistent knee swelling -- despite the draining of fluid "several times," per Brooks -- led to a third procedure in nine months. Evans underwent an osteochondral autograft transfer system (OATS) procedure in February to replace cartilage in three areas of his knee, Brooks says.

"Maybe it had something to do with the piece that was chipped off, maybe a little bit of a history, and then maybe a little bit of the wear and tear," Brooks says. "Possibly a player not really doing everything he should do -- maybe, maybe not. All of those things kind of play into him having to have season-ending surgery."

The Pelicans are expecting both Pondexter and Evans to be back by next season, with the latter more likely to return by late preseason.

As their injury-marred season crawls to a close, the wounded Pelicans have started to resurface on the home bench. Davis, Dejean-Jones and Pondexter. Ryan Anderson, Norris Cole and Alonzo Gee. Evans and Eric Gordon.

The core that was supposed to lead the Pelicans into contention now looks on in suit jackets as reserve Luke Babbitt leads an offense Gentry brought in to bring out the best of the team's once-in-a-generation big man.

Everyone is ready to turn the page on 2015-16.

"I already have," Gentry says. "We've got one more game, in Minnesota, and I'm thinking about what we're going to do from that day forward."

Holiday has recently been in New Orleans too, but he is currently recovering from surgery to fix the fracture of his right eye. For the first time in two years, he's looking ahead and not seeing more pain awaiting him.

"I think once [the stress reaction] happened, I started to accept that if I can't play, or if I don't play the same way, or if I have to, like, limit minutes, or if I have to play half the season, or whatever it is, then that's OK," he says. "But I'm blessed to play this game, and I will cherish that every time I step on the court."

The Pelicans have done their own self-examination.

"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."