Tim Duncan has plantar fasciitis. While he can deal with the pain when he gets some rest, on back-to-backs, his feet don't have adequate time to recover, so he really can't move. As Tim goes, so goes the team, in most cases.
Luckily, during the playoffs, there are no back-to-backs, so Tim won't have these huge dropoffs. Also, in playoff games when there is more at stake, his pain tolerance will increase. Remember that he won Finals MVP with two sprained ankles last year. I guarantee they hurt and limited his movement.
The penalty is that the Spurs won't have HCA against Detroit, and may finish second to Dallas in the SW. The latter is not a huge problem, because the Spurs probably could beat Dallas in a best-of-7 even if all 7 were played at the AAC. The lack of HCA against Detroit may be fatal, but it's hardly reasonable to expect the Spurs to win 66+ games in a season as would be necessary to better Detroit in this special season the Pistons are having.

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