The NBA will soon begin its 2024-25 season with questions that go beyond Xs and Os. Plenty of them involve what happens in the trainer’s room.
Can LA Clippers forward Kawhi Leonard overcome his extensive injury history?
Can Los Angeles Lakers forward LeBron James’ defy Father Time again?
Will the NBA see an increase in load management amid various stars nursing various injuries to enter the season? Or will the NBA’s player participation policy and fan pressure lead to players becoming more available?
Three independent medical expects spoke to Sportskeeda about these topics and more.
The panel included:
Dr. Alan Beyer, executive medical director of Hoag Orthopedic Institute
Jonathan Kaplan, a foot and ankle surgeon with the Hoag Orthopedic Institute
Shaheen Jadidi, primary care sports medicine physician at Endeavor Health
Editor’s note: The following one-on-one conversations took place separately and have been condensed and edited.
Among the currently injured players, which injuries concern you the most?
Beyer: “Kawhi is the oldest of the bunch and has been injured the most. But he should be healed from his issues. The key is going to be how they use him during the season. When a guy that has a history of having an injury shows me that something is hurt again, you just have to sit him down. There’s no alternative. You have to let the guy get his rest and sit him down.”
Jadidi: “With a player like Kawhi, when you have an ACL injury, your knee is never really the same after that. That’s one of those false pretenses. I’m saying this as a physician that takes care of these injuries and have gone through it myself. The mechanics of your knee are never quite the same. It’s very common to have interior knee pain afterwards. So I’m worried about Kawhi’s trajectory. After he got back the following season, he had a meniscus injury [during the 2023 playoffs]. So it seems like he’s having repeated bouts of exploratory surgeries and taking more cartilage out of his knee. That can really affect an athlete.
I predict that Kawhi will have shorter playing-time bursts so that he doesn’t have an injury or flare-ups with his knee. Then during the shorter times on the court, he will probably focus more on an assisted role. But that’s going to be tough with Paul George gone. He’s seen as a leader on that team. This is a time for somebody on the team to step up and take the mantle. But I don’t know who it would be.”
Kaplan: “It’s a great question. Just because of history, I would say Kawhi. He’s a guy, when healthy, is able to be a superstar. But he has a history of having recurring knee issues that cause him to miss extensive time. Reports suggest that he’s on a program where he’s trying to maintain the knee and keep it from getting inflammation. But given the history that he has had, Kawhi would be the biggest concern. The fact that he’s limited in training camp is a red flag. Clearly his knee continues to cause him issues without a full NBA schedule starting. He’s at the point in his career, given his age and mileage, that they’re probably always going to have keep an eye on minutes, do cross training and come up with ways for him from overexerting and flaring up his knee.”
Among the players that are healthy but had injuries last season, which injuries concern you the most?
Beyer: “They had five months to let those injuries settle down and heal. Hopefully they had access to the best training staffs available and could rehabilitate. There’s always a mindset that players come to training camp in great shape and did all the great things in the months they had off. Others don’t. So it’s hard to generalize on a player that had injury that kept him out of the playoffs or limited him. It depends on what they did in the five months they were off. It’s very individual. Some players rehab faster than others. Some of that is their body makeup. We can’t control that. But management should know what that it is. I hate to be vague on this, but we’ll have to wait and see. The younger guys have more propensity to heal. They have less mileage on their odometer and can heal better and more reliably. So you approach them differently.”
Kaplan: “The Ball brothers are comiing back from two different things. Lonzo, because of the uniqueness of his situation, we just don’t have data on his specific injury. I’ll be watching him closely. LaMelo’s ankles are another one because he’s had recurring ankle issues. That’s really affected his ability to play. It’ll be interesting to see how he plays given the nature of his style being so agile and explosive. My gut reaction tells me they give me reason for pause. With Lonzo, we just don’t know how players can come back from a meniscus transplant and a cartilage transplant. It’s not a common procedure among high-level athletes. So we don’t have the data that predicts the likelihood of it. I have pause with LaMelo because ankles are so pivotal for basketball with having good stability and strength. Especially given the nature of how he plays, I have some pause on if he can continue to play the way he does.
Jadidi: “I’m not too worried about Ja [Morant], especially with how young he is. Morant had an ankle sprain [in preseason], but that looks mild. With his shoulder injury [that required surgery in January], he’s been strengthening it for the past year. He’s had time to strengthen it and then do sports-specific movements. I wouldn’t be worried about him. Embiid had a meniscus repair. That’s better for the longevity. This far out, he’s likely to do really, really well. He probably can feel what he did with his knee before the injury.
The nice thing about training camp is that the pressure is off a little bit. Even though players go through rehab protocols in the offseason, spending the preseason doing sports-specific movement is part of rehab. As they’re doing drills or scrimmaging with other players, even if they’re in a recovery phase, it still will enhance their recovery. Ja is technically not a year removed from surgery. But the fact that he is playing in training camp will enhance his recovery. Even if they’re not 100% recovered, training camp is the one of the best things for recovery.”
Given how well LeBron James and Kevin Durant played last season and in the Olympics, what is your outlook that they can delay Father Time and maintain their elite play?
Beyer: “The guy that I’m most worried about is LeBron. You can fool Mother Nature. But you can’t fool Father Time. LeBron has a lot of mileage on his odometer. There have been so many seasons that he’s played where he’s gone deep in the playoffs. That probably concerns me more about than just anybody else. As a guy like LeBron gets older and older, he’s not going to rebound as quickly from these wear-and-tear injuries that he sustained from 21 seasons playing in the NBA. They will definitely have to load manage him significantly. With LeBron, you have to go easy and gentle. During the season, they’re going to have to really monitor his minutes. LeBron is very much like Kobe and is a one-of-a-kind guy. He defies logic and everything we know about players. He still has another year or two in him. But I think his minutes will be significantly less this year and next year.”
Kevin (36 years old) has come back from his Achilles well and is certainly a lot younger than LeBron (39 years old). But like LeBron, Kevin has a lot of mileage on the odometer. But I still think there’s a reasonable expectation for Kevin to have a level of performance. As much time as he has been in the league, Kevin has lost a little bit physically, but he sure has gained a lot mentally with his knowledge of the game, game flow and how to manage the five guys on the court. That makes up for a little bit with what he loses on the physical end when he was younger. Like LeBron, Kevin needs to be time managed considering the number of injuries he’s had. But I still expect him to play at a high level. He did pretty well in the Olympics. I think that he can continue to be a very significant contributor.”
Kaplan: “As every year goes on, especially with LeBron, we continue to wonder if this is the year that he’ll have a major injury that will start the end of his career. But he has done a tremendous job in avoiding that. I think that is in part because of the amount of time, effort and money that he invests in his health. I would always be apprehensive with someone at his age and the years that he played that they’re going to have an injury. But if anyone can continue to avoid it, LeBron would be the person that could do it.
Kevin Durant is on the other end of the spectrum. He’s had some major injuries. The Achilles rupture itself is an injury that something that notoriously players couldn’t come back from, but he’s proven that he can do it. He has come back at a high level. But each year that goes on, you start to wonder. if he’s going to continue to play at a high level or if his body will develop an injury that will set him back. Or if small little changes like power and speed will affect his game. But he has adapted very well over time with his game.
Both of them have concerns on how long they can last, but in a different way. They both pass the eye test. You watch them play, and it doesn’t look like they lost a step, accuracy or precision in their games. Both played at an extremely high level last season and in the Olympics. Looking at them, I’m highly optimistic they’ll both have a tremendous year and lead their team in statistics and to the playoffs.”
Jadidi: “The body has a harder time keeping up with the same load as it had when they were younger. But KD and LeBron aren’t just defying the odds. They’ve been doing this for over a decade now. Your ability to recover from a workout session isn’t usually as strong as it was. But between the flexibility and cross training, nutrition and hydration, they’ve got it down to a science. I’m not sure how much longer it will last. It can’t be forever. Watching them as a fan, both of those players aren’t the same they were 10 years ago. They’re not single handedly carrying a team. But I definitely think both of them have another season in them where they’re playing at a high level. I don’t think KD or LeBron will retire when their body gives out. I think they’ll retire when they don’t have a ‘why’ anymore. For a lot of professional athletes, it’s not that championship trophy. I’m sure they still want it. But that drive has to wane year after year.”
To what extent do you think load management increases or decreases across the league?
Beyer: “I think we’re going to see more emphasis on the concept of load management this season than ever before. We’re seeing more and more of these chronic, repetitive-use injuries in the NBA. The level of competition is far harder. But you have a lot more aging superstars than you used to have. Kawhi is a great example. This goes way back to when he was in San Antonio and nursed the quad injury forever where he was being accused by his teammates of dogging it. He has a history with not rushing back from injury. Maybe he’s right and everybody else is wrong. But I think he’s certainly someone that I’d watch carefully.
For these guys, the pressure for them to play and perform is so huge because their window of opportunity is so small in terms of the number of years they’re able to play in the NBA. It’s a real crapshoot that you play in terms of who do we keep out, who do we keep in and and sit on the bench. Teams are finding it more and more difficult to make those decisions and do it the right way.”
Kaplan: “That’s a great question. I feel like for the vast majority of players that there is probably going to be less load management because of that player participation policy. I still think you’ll see some load management for the top-tier stars with LeBron, Durant, Kawhi and Embiid. The teams will be a little bit more cognizant of the amount of minutes they’re getting and how many games they are playing. For them, it will continue. But for most of the league, I think you will see less load management because of the incentives the league built into it. Being able to get certain bonuses with All-Star appearances, awards and financial incentives based in their contracts with all-pro teams, I think those things will entice players to want to play.”
Jadidi: “It’ll be interesting to see. Load management has come a far way with understanding the science behind sports and longevity. KD and LeBron are amazing examples. They have sports scientists and sports docs that are on the cutting edge of things with helping them and understanding their bodies so that they can stay in shape and have great recoveries. They’re still competing at a really high level. So there’s reason to be conscious of these. But there is backlash. It sounds like the fans and the league think these guys are sitting out way too many games here. I don’t know what the right answer is. Obviously, there has to be some balance.”
What do you think of the NBA’s new player participation policy that entails having to play at least 65 games to be eligible for regular-season awards?
Beyer: “I think that any player that rushes himself back before he is really ready just to participate in an ancillary revenue stream is being very penny-wise and pound-foolish. I think putting incentives out there is a negative thing. I don’t agree with it. I think you have to let the medical team, the training staff and the player himself make with the decisions as to when I’m ready to go back and play and not be driven by an alternative payment scheme that could pay him more money if he comes back to play sooner. [Joel] Embiid is one of those players that is like the ‘Mike Trout of basketball.’ He gets injured a lot. Maybe we talk about that concept of injury prone and is there really such a thing. I think there is not. Most of the players that have repetitive injuries are training the wrong way for their body. I don’t think their body tissues are defective in any way. I think with the grind of the NBA season that they should increase the size of the squad. I really think that in most sports. I think that in the NFL. I think that in baseball. You have to increase the number of eligible players. You are putting too much pressure on too few guys.
We’re better than ever in terms of our training pathways, what we know medically, how to treat the players and deal with their injuries. From a medical standpoint, we’re ahead from where we’ve ever been. The problem is, as always and everything else in sports, follow the money. The pressure is there more than ever to get them back sooner and put fans in the seats and put eyeballs on the TV set. That pressure sometimes goes against the better judgement of physicians and trainers and of owners, managers and coaches. I think it’s a constant tight rope that they’re walking. But as physicians, we have to put the players first. Unfortunately, that’s sometimes a distinction between what management and coaches feel. They want to know what they can do for them this season. It’s going to be a constant battle.”
Kaplan: “I think it’s important to have a balance with a players’ health and also prioritizing the fans. In theory, the sport is for the fans. It is for the players. These are players that love the game of basketball and they dedicated their careers to that game. But the fans are the ones who spend their money and time. They’re dedicated from childhood, and they raise their children to be passionate fans as well. So I think it’s important. Going to an NBA game is not cheap. A lot of fans will spend their hard-earned money so they can go to a game with their kids. It’s important that the fans are able to see their favorite players play in games throughout the season. With how expanded the playoffs are, I don’t know if regular season game matters as much. So I think you have to find ways to incentivize players to play in those games. I support those incentives.
The player participation policy may be not perfect. But I think it’s a step in the right direction that entices and encourages players to play in games. If they want to earn those accolades and get bonuses from that, they can play in those games. At the same time, it gives them the opportunity if they’re unhealthy, they can choose not to play. They can focus on their health as well. At the same time, Adam Silver, the league and the front offices have a responsibility to reevaluate it. They need to keep an eye on player health and make sure that if they are seeing a detrimental effect with player health, then there is consideration to adjust the schedule and find a policy in the middle. But I endorse it, and think it’s a good start.”
Jadidi: “It’s a really tough question to ask a doctor. As a physician, we declare an oath in medical school to do no harm and keep our patients healthy and happy and keep them in the game. These are things that resonate with a physician and every health care provider. But at the same time, these guys are getting paid millions of dollars to entertain. The league is a business. I get that part. Whether you like it or not, it’s not a good thing. These are human beings. But you’re trying to keep in the game to keep fans happy and keep the business running. I’m conflicted because I’m also an NBA fan. It’s not great to take your kid to a game and expect him to see a superstar, and they’re not there. But I’m also a physician. If that superstar is playing on an injury, I totally get it.”
Mark Medina is an NBA insider for Sportskeeda. Follow him on X, Instagram, Facebook and Threads.
