The Sixers have been getting crushed by the public thanks to a series of public relations fiascoes and puzzling decision-making from higher-ups in the organization. They have been a disaster at controlling the message despite putting a new GM in place to do almost exactly that. For an organization that likes to call themselves world class whenever a shiny new toy is unveiled -- whether that’s a a dominant rookie, an eSports team, or a new practice facility -- they have looked anything but.

Much of the ire has been placed on the public figures in Philadelphia, and rightfully so. They are forward-facing employees for a reason. But a central figure lurking in all the recent calamities, the Sixers’ medical staff, has skirted by and remained out of focus despite a troubling history.

This is to be expected on some level. They exist without any real checks and balances from the basketball decision-makers, and by virtue of their medical certifications are handed full trust to take care of the team’s most important people. Colangelo can quibble with Brett Brown on rotations and offensive philosophy, but he’s not really qualified to second guess treatment options suggested by doctors on staff.

Trainers are the proverbial first line of defense for player health and safety. They have their hands in prevention, identification, evaluation, and rehabilitation of injuries to their players. Players often develop close bonds with the training staff because they rely partially on their guidance to stay healthy.

The Sixers made several changes to what can more broadly be referred to as the health department under Sam Hinkie. Within a two week span in the summer of 2015, the team hired Dr. David T Martin to be the “Director of Performance Research & Development” and Todd Wright as “Head of Strength and Conditioning”. These are important hires with implications long and short term.

But we need to go much further back than that to identify the OG of the Sixers’ medical staff. The Sixers have had the same Head Athletic Trainer, Kevin Johnson, entrenched in his position since the 2003-04 season. For some perspective on how long ago that was, the team’s coaching duties were split by Chris Ford and Randy Ayers that season. The second-leading scorer behind Allen Iverson on the 03-04 Sixers was Glenn Robinson II, whose then 13-year-old son has won an NBA Dunk Contest and completed a Sixers stint of his own in the time since.

Johnson’s authority as the head trainer enduring through eight coaches, several GMs, and an ownership change is significant because so much of the organization has been stripped to the nails in the time since he was hired. To last that long indicates a level of trust and respect from members of the organization.

One doesn’t need to paint him as a fall guy or ascribe all blame to him to wonder what the role of the training staff has been in a long series of medical misfires.

Acquiring known problems

Critique of the organization in recent years zeroed in on Hinkie’s drafting of injured big men, but the Sixers have routinely acquired damaged goods in every market there is to search through.

Look at some of their biggest acquisitions of the last 15 years for proof. In 2004-05, the Sixers searched for a big name and a sidekick for Iverson when they traded for the post-knee injury version of Chris Webber. In the summer of 2008, they signed Elton Brand to a max contract to make a splash in free agency, just months after the power forward suffered an Achilles tear. 2012’s blockbuster trade for Andrew Bynum and his shoddy knees represents the worst of it all, since the salsa-dancing fiend never ended up playing for the Sixers.

The initial confusion over Bynum’s knees looks in hindsight like a precursor to the team’s woes of the last couple years. The Sixers originally diagnosed Bynum with a “bone bruise” when he was dealing with knee trouble in September 2012. That issue quickly spiraled out of control, thanks to pre-existing problems following Bynum to Philadelphia.

“Pre-existing problems” connects the trio of Webber-Brand-Bynum, an impressive feat given they otherwise don’t share a lot in common. In all three cases, the team prioritized different percentages of talent, name recognition, and cost effectiveness to get a player they otherwise probably had no path to acquiring.

In all three cases, the Sixers’ medical team had to sign off on consummating the deal, regardless of whether it was completed via trade or free agency. In the case of a trade (relevant for both Brand and Bynum) NBA deals are typically only completed in principle when the exchange of contracts, insurance, and medical records takes place between two franchises. To get to the “phone it in to the league” stage, that means a review of those pieces of information by trusted staff.

When players repeatedly exceed the high-end of recovery windows, often in the absence of previous injury histories, it’s a lot more difficult to believe PR is the central cause for concern.

The best you could say about those players is that Brand’s work ethic never faltered after his athleticism departed. But in the case of all three players, the team took chances on players with a notable injury history, and those problems limited the success of their tenure in Philadelphia.

These problems would be bad in isolation, and they get worse when you consider the long-term ramifications of such big misses. Selecting the wrong sidekick for Iverson, a free agent past his best days, and a center with crumbling knees caused resets of various degrees for the franchise. On some level, the medical team helped make decisions (and many others) that went awry, forcing management to try to dig themselves out from under bad contracts, a dearth of picks, and a general state of disrepair.

Refusal (or inability) to put their foot down

In Brand’s first season with the team, he suffered a shoulder injury against the Bucks on December 17. After missing nearly a month of time, he returned to play limited minutes in six games toward the end of January, until the team announced a need for season-ending surgery on February 5. Then GM Ed Stefanski stressed Brand’s desire to stay on the court as a decisive factor:

Elton wanted to do whatever he could to get back on the court and initially elected to forgo surgery in order to help his teammates. He worked as hard as he could over the past six weeks to return, however the scope the injury would not allow it.

The Jerryd Bayless saga is a more recent example of this phenomenon. After initial uncertainty regarding the the nature of his wrist injury, news came in October that he would miss the season’s first month while trying recover from a torn ligament. He made his debut for his new team on November 21st, and expressed a public disinterest in surgery that would knock him out for the year:

I'm going to try to play. I want to play. I want to get to the point where I can play and not worry about it. I think [playing basketball is] more of an outlet for myself and most of us in here. So if that was taken away for a year, I would struggle. Luckily, I do have other interests. But at the same time, I really love doing this.

The Sixers’ own release on his season-ending surgery suggested a partnership in toughing it out. Sources indicated to Liberty Ballers this is not an accurate representation of the dynamic, and said Bayless pushed for the team to let him play early on despite the team preferring for him to have it taken care of sooner rather than later.

Disregard for their advice was spelled out directly by Embiid after he played in the team’s national television matchup against the Houston Rockets. Embiid described the timeline the team somehow allowed him to ignore in order to have a go, despite knowing at the time he was carrying both a bone bruise and a slight tear in his meniscus:

My knee is a little bit sore. It was a little bit sore after [the game]. But that's what to be expected like the doctor told me. It's a bone bruise. It supposed to take two or three weeks to heal. I only missed a week.

In his post-game comments to reporters, he also described the appeal process he had to go through to play that night:

‘They didn’t want me to push it, they didn’t want me to play at all,’ Embiid said of the Sixers medical staff. ‘I had to convince them. There’s a trust between me and them.’

Athletes are not livestock, and they will always have (and deserve) agency in deciding whether to play through pain or not. It would be demented to allow doctors to assume total control and authority over their bodies.

But there’s a difference between trying to maintain a level of trust between players and medical staff and allowing them to be reckless. The Sixers want fans to accept the premise that Embiid shouldn't play back-to-backs or over a certain minutes count, and that's fair enough. If you're going to be strict and selective in your broader plan, giving Embiid authority in whether he can play because the game is on ESPN doesn't make any sense.

When you let a big-money signing play through it, nobody is likely to complain. When a potential franchise anchor who has faced career-threatening ailments is able to talk you out of recommended procedure, people are going to take notice.

Timelines not even a mother could love

Bynum represents an inflection point for the franchise, both because it led to the hiring of Hinkie (who warned Sixers owners about the move) and constant radio silence on the injury front. The Sixers, to put it lightly, got burned by several different public timeframes for Bynum’s Sixers debut that never happened.

Former beat writer Chris Vito, god bless him, compiled a detailed timeline of the saga at the end of the 2012-13 season. The shenanigans are in plain ink: the team originally stated on October 1st he’d be ready for the season opener, only to hold off on ruling him out “indefinitely” until November 24th. Bynum would announce on January 29th he expected to debut after the All-Star break, and things continued to get worse from there.

Since then, the Sixers have tried much harder to control the message (or at least suppress it) as it pertains to when players are able to return to the court. All they’ve accomplished by doing so is to allow the public to fill in blanks, question their methods, and watch players continue to overshoot conventional expectations for recovery time frames.

Michael Carter-Williams underwent surgery to repair the labrum in his right shoulder early in May of 2014, and the team declined to comment on a timetable in their release on the matter. Conventional recovery suggests somewhere in the neighborhood of 2-4 months, but MCW ended up missing the first seven games of the 2014-15 season, putting him around six months from surgery to return.

We previously covered the mysterious, conflicting comments on Jahlil Okafor’s recovery from meniscus surgery, and it’s worth emphasizing a few things again. Okafor continued to battle knee soreness to the point of missing games in February of this year, nearly 11 months clear of surgery for an injury that typically carries a six-week recovery. He initially experienced discomfort in the knee prior to a game against the Magic in February 2016, but a shin collision got him removed from the contest in question and initially kept him shelved until they reevaluated and decided on meniscus surgery in March.

It was the Ben Simmons timeline (or lack thereof) that inspired a new wave of scrutiny on the team’s communication and recovery process. In a post on the Sixers’ own website addressing what was supposed to be Simmons’ final scan in January, the team stressed things had come back “clean” for the young forward:

Just in case they scrub it, the Sixers' own website on Jan. 24th said Simmons scan was "clean" and he'd go about rehab "as planned" pic.twitter.com/318n4W1rRo — Kyle Neubeck (@KyleNeubeck) February 16, 2017

While previous examples leaned more toward conservatism or slow recovery, this was a purposeful attempt to project better news than the team was able to earnestly provide at the time.

Colangelo has since stressed that healing occurs at different speeds for different people, but he failed to give a justifiable explanation for a lack of action in the time between that scan and ruling him out for the season. Unless the scan went from clean to broken again — and they haven’t suggested that’s the case — the team chose to hold off on a marrow injection they claim will help stimulate recovery until this past week. If they knew he wasn’t where they needed him to be at any point, steps to best aid his healing should have been taken as soon as trouble signs were spotted.

Timelines pushing past their expected expiration date don’t necessarily suggest a medical team problem on first glance. But when players repeatedly exceed the high-end of recovery windows, often in the absence of previous injury histories for the players involved, it’s a lot more difficult to believe PR is the central cause for concern.

The unknown isn’t inspiring, either

The aforementioned issues are just some of the high profile cases the Sixers have bungled, and there are likely plenty of under-the-radar misfires the public will never know about. Philadelphia’s negligence handling Embiid’s recent knee issue calls into question their broader tactics, and makes it fair to suggest the day-to-day treatment protocol is worth questioning.

What’s also worth questioning is their role in some of the team’s messiest situations of The Process era.

In the summer of 2015, the Sixers were forced to pay the New Orleans Pelicans $3 million as a penalty for allegedly not disclosing the extent of Jrue Holiday’s injury history. This was attributed to Hinkie and his secretive tactics when it happened despite denials from the team on the matter. While he continues to carry blame whether out of malice or ignorance, the fact is the medical staff played at least some part in making the organization look abysmal in that moment.

Nerlens Noel took a lot of heat for his lack of visibility around the team last summer, and the Sixers made sure to note the procedure he had done on his knee in late October was “elective” in nature. Noel also chose to have his rehab done away from the team, with the same guy (Dr. James Andrews’ therapy chief, Kevin Wilk) he worked with to recover from the ACL tear he suffered in college.

Though you can connect Noel’s desire to get out of this situation with his willingness to distance himself from the organization — ditto the Sixers’ subsequent press release shade — it’s also worth questioning how much he and other players trust the team to properly handle injuries and recovery if they’re content to head elsewhere in times of need.

Could bad intel from the medical staff be the reason Hinkie had the misguided belief that Kendall Marshall would be ready to start the season in 2015? It’s hard to say where to draw the line.

This isn’t a call for specific parties to be fired, or even a suggestion you can attribute all these things to failings by doctors and/or trainers. A lot of the bigger moves (including drafting Embiid) were made on the basis of significant upside, and each of those moves were an odds play on some level. If even one of the big risks broke in favor of the team, history looks much kinder to all parties involved. Red flags aren’t enough to talk a GM out of a move if he’s convinced the reward can be great enough.

But this is the equivalent of watching a player who ends up on the minus-side of the ledger game after game, creating a trend that seems impossible to ignore. Luck is a much bigger factor than people realize in staying healthy, but organizations like the Sixers pay people a lot of money to extract and protect every ounce of luck they can. You can only chalk it up to the difficulty of reading MRI results so many times before people are tired of excuses.

Whether it’s because of holdovers from a bygone Sixers era, new hires from Hinkie’s tenure, or a combination of factors and personnel, a scan of the franchise’s medical decision-making looks anything but clean. Maybe it’s time for a second opinion.