Purpose

There is growing concern of increasing injury rates among the recent generation of players in the National Basketball Association (NBA). Although these concerns are limited to anecdotal evidence, the current thought focuses on recent trends in youth player development including early single-sport specialization, increasingly rigorous training regimens, and the high volume of games played annually. In an effort to protect and promote safe player-development practices among youth basketball players, and ultimately those who continue on to the collegiate and professional levels, the purpose of this study is to determine the epidemiology and trends of specific overuse injuries in U.S.-raised NBA players over the past 15 years. Additionally, a comparative injury analysis was performed between U.S. and foreign-raised players. Our hypothesis is that, over the past 15 seasons, there has been 1) an increased risk of overuse injuries among more recently drafted U.S.-raised players, 2) a higher risk of overuse injuries among U.S.-raised players than foreign-raised players.

Methods

All overuse injuries sustained during players’ first 2 seasons were retrospectively analyzed between 2003-2019. Players were separated into cohorts based on whether they had spent the majority of their amateur careers playing in the U.S. (US) versus outside of the U.S. (OUS). Regression analysis was performed to analyze injury risk within the US cohort as well as between the US and OUS cohorts.

Results

Five-hundred forty-nine (80.9%) and 129 players (19.0%) were identified in the US and OUS cohorts, respectively. A significantly higher risk of ankle sprains (OR 1.18, p=0.047, CI [95%] 1.002-1.389), back strains (OR 1.79, p=0.010, CI [95%] 1.153-2.791), hip strains (OR 4.12, p<0.001, CI [95%] 1.937-8.775), toe sprains (OR 1.86, p<0.001, CI [95%] 1.024-3.380) and total injuries (OR 1.23, p<0.001, CI [95%] 1.061-1.446) was observed among more recently drafted US players. The OUS cohort did not show increased injury risk by body location or total injuries among recent draftees.
When comparing injury risk between the US and OUS cohorts, the US cohort showed a significantly higher risk of knee sprains (OR 8.26, p=0.038, CI [95%] 0.610-1.330), foot sprains (OR 9.34, p=0.031, CI [95%] 1.221-71.421), and total injuries (OR 4.25, p=<0.001, CI [95%] 2.374-7.600).

Conclusion

Our findings reflect the growing concern of increasing injury risk among the newer generation of U.S.-raised NBA players. Insight into increasing injury rates may be found in the training methods used to develop foreign-raised players, who appear to be less injury-prone based on our study. This is the first published study to our knowledge analyzing overuse injury trends during the early stages of NBA players’ careers. In an effort to mitigate injury risk among competitive youth basketball players, incorporating injury prevention measures into routine training regimens as well as adherence to safe training guidelines is recommended.