LeBron going to the Lakers wasn’t that big of a surprise once he opted out of his Cavaliers contract, since doing that narrowed his possibilities considerably. A much bigger surprise transpired not much later: DeMarcus Cousins signed with the Golden State Warriors.
In a cool market that was projected to be even more tepid for centers, Cousins reportedly was left with no offers Monday morning and had his agent call around the league. With few teams with cap space (and those that had more than the non-taxpayer midlevel to offer not interested), Cousins took a one-year, $5.3-million deal that seems paltry.
Cousins famously saw his 2017-2018 season end January 26 due to an Achilles tendon rupture. Therefore, there are some questions as to when he can come back and, if he does, whether he can be effective.
Still, is this a case of the rich getting richer as it appears on the surface?
The Achilles Injury
On January 26, 2018, with his Pelicans playing the Rockets, Cousins tore his left Achilles tendon when rushing down the lane after a missed free throw.
The play seems innocuous enough at first blush. However there is a shot or two in the above video that provide clues to the mechanism of his injury.
First, you should understand what the Achilles tendon is.
A tendon connects muscle to bone. For our purposes, the muscles in this case are two calf muscles: the gastrocnemius and the soleus. The Achilles tendon essentially attaches these two muscles to the calcaneus.
This allows the gastrocnemius and soleus to exert their function at the ankle. This function is plantarflexion (bending down) of the foot.
Achilles tendon ruptures occur when there is sudden plantarflexion or dorsiflexion in the foot. It can also occur due to direct trauma.
At 0:48 of the video above you can see Cousins land on his left foot. If you slow it down enough, or look at it a couple times, you can see he lands with the front part of his foot first. In other words, his foot is plantarflexed upon landing as it is bent down.
With that said, it is possible it also occurred when his heel landed, causing direct force to the tendon.
With Achilles ruptures, you would be naturally inclined to think that they require surgery. That’s what Cousins underwent after all. However, an increasing number of physicians and their patients are opting for non-surgical intervention.
As far back as 2010, there were multiple small-scale studies that concluded that outcomes were similar in non-operative and operative intervention. Why is non-operative treatment even an option? This quote from Dr. Kevin Willits, an associate professor of orthopedic surgery, from this article explains the general concept well:
“People think that when [an Achilles] ruptures, it’s like a meat cleaver hitting a rope, and it just goes flying apart with this huge gap in the middle…But in reality the tear is like mop ends, and there are usually strands of tendon still in continuity.”
Traditionally, plaster casts were applied with the foot in plantarflexion in non-operative treatment. There has been more of a drive to use orthotics, synthetic casts, and splints.
Early range-of-motion and weightbearing is key for non-operative treatment and newer orthotics and casts allow this.
According to a 2018 review of current literature, Aujla et al. found that re-rupture rates were similar in non-operative treatment with early mobilization and range-of-motion when compared to surgery.
Perhaps most tantalizing right now is the potential of using platelet-rich plasma (PRP) injections to promote healing (you might recall hearing recently that Lonzo Ball received one in his knee for a torn meniscus, and athletes like Tiger Woods have prominently used them). PRP is essentially blood with a higher concentration of platelets than normal blood. Platelets contain growth factors that promote healing. It is receiving increased attention and use in the sports medicine community.
There have been a few studies assessing the efficacy of PRP injections in Achilles tendon ruptures. According to the Aujla study, studies suggest an earlier return to work with no adverse outcomes and that a study by De Carli et al. found that there was actually increased tendon remodeling. Stem cell injection therapy shows similar promise.
What about time lost, which is imperative in sports? It has been generally acknowledged that, though outcomes may be similar, it takes a few weeks longer to return when treated non-operatively compared to operative treatment. The aforementioned article that quoted Willits stated subjects took nearly three weeks longer to return to work. However, Aujla et al. recommends 8-10 weeks is enough to achieve good functional outcomes. Of course, this is “functional” in terms of the general population. It takes a lot longer to be strong enough to return to the pro game.
The Willits article also goes on to state that surgery is generally the preferred option for younger athletes, while older patients tend to try the non-operative route.
However, Dr. Lowell Weill, former team podiatrist of the Chicago Bears, mentions in the same article that he treated an athlete non-operatively at one point.
There is some awareness in the professional athlete world. If non-operative treatment catches on in this realm, it will be interesting to measure outcomes. This method of treatment is becoming more prominent.
When Will Cousins Return?
Cousins told Marc Spears of The Undefeated that he is hoping to be back by training camp, which would mean he would not miss any regular season action.
Is this realistic?
Training camp starts at the end of September this year. That would give Cousins eight months to return to the court in some fashion. Sources told ESPN’s Zach Lowe that a Christmas start date wouldn’t be a surprise.
So what can we really expect?
SBNation compiled a list of notable players that suffered Achilles ruptures. Let’s see how many days it took for these players to return to game action.
Notable NBA Players Days Lost to Achilles Rupture
Age = Age at time of Rupture
*Elton Brand and Maurice Taylor injuries occurred in offseason, so only days missed starting that season included
Obviously, the data is slightly skewed given NBA lockouts and timing of regular season. But on the whole, the players that suffered these injuries in January returned by the start of the following season.
For Cousins, using 260 days as a rough estimate, this places him at an October 13th start date. So it’s not quite as optimistic as Cousins hopes, but given that the regular season starts at the end of October, there’s a chance he could be ready by the opener.
However, these are also the Warriors. They don’t really need him to rush back and it’s likely they’ll bring along his rehab slowly so that he is ready for the playoffs.
Of course, coming back onto the court and staying on the court are two different stories.
In the above example, for instance, though Kobe Bryant returned in relatively short order, he actually only played six total games that year and 35 the subsequent season.
Perhaps a more important question, then, is how many total games can they expect from Cousins to play on the year?
Many studies have investigated the implications of Achilles ruptures in NBA athletes. They are all pretty much devastating.
A 2017 study by Trofa et al. evaluated athletes across the NBA, NFL, MLB, and NHL. The athletes that were able to return to game action the season after surgery played about 75% of the games they played the season before the injury. While acknowledging that all four sports have varying requirements for conditioning and movement (though the study states that NBA players fared the worst), if we apply this percentage to Cousins, it would project him at 54 games played. If we assume the Warriors will bring him along slowly and that NBA players are usually at the low end of that projection, we are probably looking at around 40 regular season games.
Will Cousins Be Effective?
Kevin Pelton of ESPN used his SCHOENE projection system to determine that players’ performance on average decline about 8 percent the following season after a rupture when compared to their injury-free projection.
This is supported by other studies. A 2013 study by Amin et al. showed that players suffered a dramatic decline in their Player Efficiency Rating (PER) when compared to controls. The PER was reduced by 4.57 in the first season after injury.
But Cousins is such a good player to begin with that even such a drop would lower his PER to about a 21, which is still borderline All-Star level.
Once a tendon is ruptured, it is never as quite as strong again. This is attributed by the fact that you commonly hear players state they don’t feel as explosive or as fast as they used to be.
Is this objectively true?
Since we have Second Spectrum tracking data going back to the 2013-2014 season, let’s take a look at the above players for which we have data and examine statistics that may conceivably be influenced by explosiveness and speed: Average Speed, Drives, Contested Rebound Percentage, and Block Rate.
Explosiveness/Speed Before and After Achilles Rupture
|Name||Pre-Average Speed||Post-Average Speed||Pre-Drives per 48 Mins||Post-Drives per 48 Mins||Pre-Contested Reb%||Post-Contested Reb%||Pre-Block%||Post-Block%|
The Drives per Game data provided by Second Spectrum was calculated to per 48 mins for this table
There are two takeaways here. One is that Rudy Gay seems to defy the odds in that he hasn’t seemed to have lost any explosiveness after his injury. The other is that Anderson Varejao categorically fell off a cliff.
Because the sample size is so small, it is tough to draw any other conclusions that we could apply to Cousins case. Except for this: Jennings seems to have a major uptick in his speed, and though his Drives per 48 minutes declined, he still featured them heavily in his game. Jennings also played nearly half as many minutes per game the season after his injury as before, so perhaps he was able to preserve that explosiveness because he played in shorter spurts. Maybe the extra rest helped. This is a similar case for Gay, who played about 13 minutes less per game after his injury, as well.
It is also worth pointing out that Jennings and Matthews significantly increased their amount of passing out of drives after the injury (Gay stayed about the same). Perhaps Jennings and Matthews were willing to defer more rather than to rely on their perceived diminished athleticism to finish at the rim. And given that Gay seemed to exceed expectations after his injury (his PER improved and he actually outperformed Pelton’s SCHOENE projection) maybe it makes sense that Gay didn’t increase his deferring.
However, it’s important to note that of the players mentioned, Varejao is the closest physically to Cousins. There’s really no other player that’s much of a physical comparison. This could temper expectations bit.
If there’s anything to take away, it’s that monitoring Cousins’ game workload seems to offer him the best chance of preserving some of his explosiveness, speed, and athleticism.
The Bottom Line
In a vacuum, here is what the Warriors can expect from Cousins individually this upcoming season: 40 games of high-quality starter to borderline All-Star level of play if given a limited workload during games.
Of course, nothing in this world occurs in a vacuum. First of all, each injury is an individual case. Trends are nice, but there are factors regarding a player and his specific injury that may be unique, so expectations should be adjusted accordingly.
Also, there are fit questions. Cousins frequently loafs back on defense, especially when he throws a tantrum at the other end if he doesn’t get a call (which happens a lot), usually not appearing on your screen until well after the opposing offense has set things up. That won’t be tolerated on the Warriors. He also loves to post-up, which would be out of place in a free flowing Warriors offense (though he could use his passing ability to be effective in these situations). He turns over the ball at an alarmingly high rate, which does not mesh well with the Warriors as turnovers is their one weakness.
Can he play in a fast-paced offense? Can he switch on defense? Can he defer the ball much more than he has done in the past? As Kevin Pelton wrote, Cousins holds the ball much longer than the Warrriors’ current centers and will have to speed up his decision-making.
And none of that mentions Cousin’s reputation as a locker room malcontent.
All this makes Cousins a high-variance play. As Pelton mentioned on Twitter, if you’re the favorite, you want to limit your variance, not increase it. This is a sentiment I agree with.
However, Cousins at this price is a no-brainer. He’s essentially replacing Javale McGee and Zaza Pachulia, which is an enormous upgrade talent-wise. He gives them yet another high-level option to counter switch-heavy schemes like the Rockets that gave the Warriors some trouble last season. He provides Stephen Curry an elite pick-and-roll partner and improves their rebounding.
And remember— these are the Warriors. They don’t need Cousins. At best, he’s their third-best player; at worst, he’ll be their fifth-best on the court.
If Cousins doesn’t fit well or proves disruptive in the locker room, the Warriors don’t have to take any of his crap. They can easily cut bait with this low-level investment and keep humming.
When you combine the amount of impact he is likely to make after his Achilles injury as outlined above, his necessity (or lack thereof) to the Warriors, and the ease with which the Warriors can move on if necessary, the biggest takeaway from this signing is that it is likely not as significant as people think it is.
Thanks to basketball-reference.com for statistical information.