What is a ‘ramp-up’ process? Here’s how the Sixers gradually prepare players to return from injuries

While awaiting his next NBA destination as January turned to February, Kyle Lowry’s personal trainer put him through daily at-home cardio workouts. But the veteran guard acknowledged it was impossible to “emulate actual game play,” from sprinting back on defense to executing offensive sets.

So when Lowry made his 76ers debut on Feb. 22 against the New York Knicks and then rested the following night against the Cleveland Cavaliers, coach Nick Nurse described the approach as the “initial ramp-up thing.” When that phrase was repeated back to him in a follow-up question, Nurse quickly quipped that he was simply using the terminology used by the athlete care staff.

Because, to outsiders, it can feel a bit abstract. What is this mysterious ramp? How long is it? And where exactly does it lead?

» READ MORE: With Tyrese Maxey’s concussion, the Sixers are creeping closer to the point of no return

“Ramping up” refers to a deliberate, gradual, personalized course of action for a player — based on data and an array of benchmarks they must meet before moving on to the next phase — to most logically determine when they are ready to return to playing in games.

“That’s their job,” said veteran forward Nico Batum, who recently completed his ramp-up following what he called the first hamstring injury of his career. “I know my body, so it’s constant communication.

“They’re good at what they do, so it’s just finding a good plan for me to get back on the court.”

Some followers of the Sixers may have initially caught on to the phrase when it was applied to James Harden, who, after stepping away from the team during the preseason, seemingly was “ramping up” until he was traded to the Los Angeles Clippers. Yet the phrase is still relevant months later, with multiple Sixers currently at different stages of their ramps.

The 37-year-old Lowry is reconditioning after not playing from Jan. 22-Feb. 22, when he was traded from the Miami Heat to the Charlotte Hornets and then bought out of his contract. Reserve wing Robert Covington, who has been nursing a knee bone bruise since early January, has a goal of returning to on-court activities in the next 7-10 days, according to an official update from the Sixers on Wednesday. Guard De’Anthony Melton — who exemplifies that even the most thoughtfully executed plans can hit setbacks — has instead begun an “offloading” period before restarting a ramp-up. A spine issue that had sidelined him for the better part of two months resurfaced three games into his return last week. And Joel Embiid is now one month post-meniscus surgery and soon hopes to be on that path to return before the end of the season.

» READ MORE: Sixers turn to patchwork backcourt with Tyrese Maxey and Kyle Lowry sidelined

The Sixers’ ramp-up programs are helmed by Simon Rice, vice president of athlete care, who did not speak to The Inquirer on the record for this story.

In general terms, however, a plan is tailored to the type of injury and to a player’s specific demands during a game. NBA teams constantly measure players’ average and maximum physical metrics — such as how many feet they run, or how much power they exert while jumping — during on-court minutes. The overall ramp-up goal is to exceed those numbers before fully returning to live action, making predicting success more objective than guesswork.

The initial expected timeline is crafted based on experience with similar ailments, and player factors including age or injury history. That estimate also can be affected by the point of the season — like if the injury occurred in the middle of January or the middle of the playoffs. But certain criteria also must be hit before advancing to the next step. A calf injury, for example, may require a player to hit close to their personal marks in jumping power — and body symmetry — before shifting to on-court work. For a hamstring, it might be getting up to their maximum velocity while running in straight line.

The more basketball-centric drills also typically are a progression. Melton, for instance, said he tested his back by going from spot shooting to firing attempts on the move. Individual contact drills typically evolve into full one-on-one work, then three-on-three, then five-on-five scrimmaging. Melton added that his final step before being cleared just after the All-Star break was checking how his back responded to a full practice.

Communication between all parties throughout the process also is critical. Strength and conditioning and sports science staffs are involved in the initial planning, as is player input. Front-office executives and coaches are kept in the loop. Nurse described constant daily updates on players going through that process at meetings in the morning, as well as before and after practice.

That consistent dialogue also originates from players. Even though Lowry is new to the Sixers, he said familiarity with the staff because of his Philly roots made it easy to be “open and honest” about how he is feeling. When Melton initially tried to come back from his spine issue in early January, he felt empowered to candidly express a message of, “I don’t feel good.”

“You’ve got to be honest with yourself,” Melton said last week before the Sixers’ game in Boston, before his latest injury hiccup. “You’ve got to be honest with your body. At the same time, it’s tough when you’re trying to help your team. But you’ve got to think about longevity of your situation and your career.”

» READ MORE: The Sixers had a chance to prove themselves without their stars. They hit rock bottom instead.

As they return to game action, players might be put on a minutes restriction to better align with those ramp-up numbers. Batum and Lowry, for instance, were kept around 20 minutes, Nurse said. Within that, the coach kept a keen eye on how those players looked “rhythm-wise and confidence-wise” while regaining conditioning during their rotation stints.

“As soon as I see them [trailing] way behind a play or two,” Nurse said, “it’s probably like, you kind of look down and say, ‘What has that been five minutes? Six minutes?’ Then hopefully the next time, that’s creeping up to seven or eight.

“And then hopefully, it’s not an issue. If they’re rolling, they can roll. If we can get them a rest through a timeout or get them a rest through a quarter break, if they’re rolling, [then] you’re not thinking about how long the stint is.”

And sometimes, that work briefly shifts to behind the scenes.

When Lowry and Batum did not play in a Feb. 23 game against Cleveland (other than Batum delivering a late inbound pass in a down-to-the-wire Sixers victory), they still participated in cardio and weightlifting sessions. That night, Covington walked into the pregame locker room dripping sweat and breathing heavily, before adjusting a device attached to his healing knee.

Then, after playing 36 minutes during Tuesday’s loss at the Brooklyn Nets, Lowry was back to resting for Wednesday’s loss to the Memphis Grizzlies on the second night of a back-to-back.

Consider that the latest step in his personalized ramp.