Kevin Love returned to the Cleveland Cavaliers’ lineup on Saturday evening, putting up 23 points and 15 rebounds in the Cavs’ win over the Knicks. It was Love’s best game since the Suns game on January 8th, when he had 25 points in a close Cavs win. In between, Love missed three games, and struggled mightily in two others - Love scored just three points in the Warriors blowout. He also played just 12 minutes, scoring one point in the Cavs’ win over the Thunder. The reason for Love’s ups and downs? The back injury that has bothered him throughout the last three seasons.
Love has six missed games throughout his three Cavaliers seasons due to his recurrent back issues, and has clearly been affected by them for longer stretches. “Kevin Love questionable vs. [insert team]” has become a familiar headline at this site, and it’s become almost predictable that Love will be bothered by back spasms every couple of months or so.
But at the same time, Love’s long-term play hasn’t been affected by the injury. Despite missing more time this season than he has previously, Love has looked better than he ever has as a Cav. His 19.9 points and 11.0 rebounds per game, as well as his 37.5 percent three-point shooting, are all the highest he’s posted since he was with the Minnesota Timberwolves. His rebound rates are the highest they’ve been since 2012-2013. How can this be? And the even more perplexing question - How can he bounce back so quickly when he returns, as he did on Saturday after missing two games?
Back injuries are more difficult to deal with than injury to other parts of the body, due to the complexity of the anatomy of the spine. The spine is made up for 24 individual vertebrae, each with a cartilage disc in between to provide flexibility and shock absorption. These individual segments work together to both provide movement and stability for the column, and are supported by both large ligaments that run up and down the column, and smaller ones that support and connect the individual segments. Likewise, the spine is moved by both a large muscle group, called the erector spine, that runs from the neck all the way down to the hips, and several sets of smaller muscles that move the individual segments or groups of vertebrae. That’s a lot of moving parts, and breakdown of any of those parts can cause the entire structure to lock up in an erector spinae strain or spasm. That’s because this musculature is the ultimate protector of the spinal column - responsible for allowing, or if needed restricting, movement of the spine as a whole.
This is one reason back injuries are so difficult to manage. The number of moving parts and the somewhat uniform presentation of symptoms (the back muscles tightening up and causing pain and limited movement) causes diagnosis to be very difficult. And if you don’t know what exactly you’re treating, it can be difficult to actually cause the symptoms to go away. This is why Love got an MRI last week. More serious issues, such as a stress fracture or disc bulge, can be masked by the appearance of a back strain, and you can spend weeks unsuccessfully attempting to treat the symptom (muscle pain) while it covers up the real issue.
The other problem with back injuries is that it’s an area that’s nearly impossible to rest completely. Think about it - your back is involved in pretty much every task you do throughout the day! It supports your trunk and upper limbs while standing, walking, and sitting. When you bend over to reach for something, your back is allowing that movement. Similarly, the back provides stability as you reach for something above your head. Muscles that control upper body and lower body movements also assist with supporting the spinal column. Everything you do, the spine has a role in - and that's why a back injury makes doing these mundane tasks so difficult.
Now, imagine attempting to body up Andre Drummond on a box-out with back spasms. That's the goal of Love's back treatments - to get back to doing some of the most physical work in the NBA. That is part of the reason Love's injury has been a recurrent one. It is very difficult to get rest with a back injury, even if the player is not playing. When they do get back to the court, the high stresses placed on the back by running, jumping, and attempting to box out 7-foot tall men can trigger recurrence of the injury. These flare-ups after the initial back injury are most commonly caused by muscle tightness, as the muscles are still tight and vulnerable, and able to be set off by even a small overload of stress. Even when the back is pain-free, that doesn't mean it's healed completely.
This is why Love has had on and off issues with his back, and why these issues are unlikely to ever fully resolve. Many players who suffer these injuries, such as Dwight Howard and Andrew Bogut, have had flare-ups years after their initial injury. But these injuries can be manageable. The Cavs and Love have done a great job of this over the past three years. They have continued to treat Love's symptoms, focusing on flexibility and hip mobility through yoga. They take a cautious approach when it gets bad, resting him for short stints while they get things calmed down, and they will get him a night off when they can afford it, making sure he isn’t overworked.
Love’s back issues are likely to continue throughout the rest of his career, and management through stretching and scheduled rest is going to be paramount to his long-term longevity in the league. But this doesn’t mean he will be missing games once a month for the rest of his career. Love and the Cavs have done a great job of managing his symptoms, and he’s returned to playing at an All-Star level this season because of the work he’s put in. Moving forward, the hope is that Love’s back becomes like LeBron’s in 2014-2015 - something to monitor, but not something that is obviously limiting him night-to-night on the court.