The Sixers were struggling and down their two biggest stars due to injury management out of the gate, which put the early onus on Tyrese Maxey to carry the weight.
Then injury came for him, too.
Against the Clippers on November 6 in LA, Maxey entered the night leading the NBA in minutes played per game, and the wear from it appeared to have caught up to him.
The contest fell out of the Sixers' reach, 110-98, and the 24-year-old guard was pulled in the second half for what the team designated as "right hamstring soreness."
Immediately afterward, Sixers head coach Nick Nurse tried to dispel any concern that Maxey would miss time, but the next day, word broke that the leading guard was set to miss a couple of weeks with a hamstring strain pending further evaluation, the team added soon after.
It was another tough break for a Sixers team that already had and seemingly can't stop getting enough of them. But, even in light of any and everything going wrong for them of late, the Sixers might have at least gotten the best-case scenario out of Maxey's injury, with hope for a return near the end of this week.
Dr. Dinesh Dhanaraj, the chief orthopedic surgeon at St. Mary Medical Center in Langhorne, offered his outside perspective on Maxey's injury and the probable path taken to getting him back on the court soon.
Before getting fully into it though, a note: The views and opinions expressed in this article are those of the author and guest authors and do not reflect any official policy or position of any NBA team or a team's athletic physicians.
The severity of hamstring injuries and how they occur goes back to Eagles receiver A.J. Brown's own ailment from back in September, which caused him to miss three games and four weeks in total.
The hamstring is made up of a group of muscles that runs down the back of the thigh and plays a part in every kind of athletic movement.
So an injury like that for a receiver, who's sprinting, cutting, and shifting direction all the time, that's a tough draw. The same goes for a guard in basketball.
"Explosion cutting, change of direction, acceleration, deceleration, it's key," Dr. Dhanaraj said. "The hamstring is involved in all of those, and it's tough for a guard. He's not posting up and hanging out. He's bringing the ball across the court."
Where and how also factor into how bad the injury is and how long it will take to recover, along with determining the process of rehab.
Hamstring injuries come in three grades, Dr. Dhanaraj explained. Grade 1 is a strain or a stretch of a muscle, Grade 2 is a partial tear, and Grade 3 is a full avulsion off of the bone.
There's been an array of those types of injuries over the past month or so – mostly across football – which each exhibited the different levels of severity.
So going back to the Eagles, for example, Brown, offensive tackle Jordan Mailata, and tight end Dallas Goedert each had hamstring injuries that sidelined them for a 4-6 week window, but only required rest to make their way back from, whereas Cowboys quarterback Dak Prescott suffered a tear in the tendon that ripped off the bone, which required surgery and thus ended his season.
Given that Maxey's injury was only reported with a recovery window of a couple of weeks, that was a good sign that his strain fell on the more minor end of the spectrum with a probable hint that the issue was in the muscle rather than in a tendon.
"The ones in the muscle, the ones lower down in the actual hamstring muscle, they heal better," Dr. Dhanaraj said. "There's more blood supply."
"It just depends on where that grade of strain is and how early they catch it," Dr. Dhanaraj added. "[The Sixers and Maxey] can rehab it, just like A.J. Brown did in 3-4 weeks getting back, even Mailata."
The process to getting back though just has to be taken one day at a time, with proper rest and gradual testing of what the muscles can handle again.
Maxey has been sidelined just shy of a full two weeks now, and while the Sixers have gotten new star Paul George and MVP center Joel Embiid on the floor, their struggles haven't gone anywhere, and they're still waiting for the moment when they do finally have their All-Star trio of Maxey, George, and Embiid playing together all at once.
The Sixers are keeping their fingers crossed that the moment will arrive later this week. Their season might depend on it now, and so will their ability to keep all three of them as healthy as possible the rest of the way.
"That's the thing about these seasons, it's attritional," Dr. Dhanaraj said. "Early in the season, sometimes you see them, but you do see a lot of these injuries later on. The athlete has to rest, stay conditioned, and stretch."
"It's a time-based attritional war," Dr. Dhanaraj noted on the possibility of re-injury for Maxey once he does return. "So it is something that you have to keep an eye on, I hate to say. I wish I could say either one and done, but a lot of times it's repetitive."
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