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Load Management on Display

A lot of questions swirling around game 5 of the NBA Finals: The Raptors had a chance (lost by only 1 point) to win their first NBA championship. Why did coach Nurse take a timeout with 3 minutes remaining when his team was rolling? Why didn’t coach Nurse take a timeout with 15 seconds left and last shot to strategize the best options for the championship winning shot? But, I don’t have the basketball acumen to answer these questions.

The biggest question of the night, though, has nothing to do with the basketball game itself, but rather everything to do with professional sports at large. It’s almost fitting that a season that saw the term ‘Load Management’ reverberate in basketball fans’ minds all season will end with it representing the highs and lows of doing it right (and wrong). The Toronto Raptors traded for injured superstar Kawhi Leonard before this season began. He was a disgruntled athlete who felt that his former team, the San Antonio Spurs, hadn’t listened to him clearly enough when describing his leg injury (his quadriceps muscle injury). The Spurs allegedly did not listen when he spoke about needing more recovery time, rehabilitation, and rest. His frustration led to the trade. The Raptors medical staff then began the process of strategizing his rehabilitation, including the emergent ‘Load Management’.

But, what exactly does load management mean? It is not simply about taking games off. All injuries are subjected to the same mathematical formula: INJURY = LOAD > Tissue CAPACITY. I site this equation everyday with my patients and explain that the best model of rehabilitation marries the right amount of DECREASED LOAD with INCREASING CAPACITY until the injury is rehabilitated. Many details, too many for this article, shape a rehab plan for any individual, especially one that intends to compete in the highest level of athletics. Once the individual is feeling ready to return to sport, scientifically tested battery of tests are employed to determine a player’s eligibility to ‘return to sport’. Kawhi Leonard not only successfully rehabilitated his injured quadriceps muscle, he played at an elite level all season, and has the Raptors on the cusp of a championship. Yes, he skipped some regular season games, in the interest of decreased load, but has been working hard all year to increase his capacity.

His opponent, the Golden State Warriors, feature another elite superstar player: Kevin Durant. Kevin has been injured for the past month, recovering from a significant strain of his right calf muscle. Unless the public has been purposely deceived about Kevin’s recovery, his practice schedule, etc., all signs pointed to his injury being too serious to return this season. And yet, as the Warriors season got pushed to the brink, down 3 games to 1, fans and teammates urged him to play. So, he played.

Who’s decision is it to play an injured athlete in the highest level of athletics, in the biggest moment? Medical Staff? Coach? President of Team? Or, the player himself? These are relevant questions. These are questions we may never know the answer to. But, on the notion that he had only had one basketball practice prior to playing in game 5 of the NBA Finals, there is no way that he had progressively trained his injured calf to the readiness it would require to play elite level basketball. We don’t even know if he was recovered, let alone progressively trained back up to elite athletic levels. But, again, with one practice, there is no way he could have been medically cleared to play (in my opinion). But, he played. And, he played a lot. Instead of short bursts of playing time, followed by rest, he played until he tore (likely) his Achilles tendon (where the injured calf muscle attaches to the heel bone). Depending on the severity, this is a basketball player’s worst nightmare – a potentially career ending injury – an injury that requires potentially months, if not a full year, to rehabilitate.

And, this, coming just days from him becoming a free agent, on the verge of signing a four year, $150 million dollar contract with any team that wants him. And who wouldn’t want him? He’s the best player in the world. Now what is he? So, now he enters rehabilitation mode again. Surgery, rest, rehab, including treatment and training for months. Then comes playing basketball and getting back to an elite athletic level. This is ‘Load Management’. The Raptors’ medical staff have orchestrated it to perfection with Kawhi Leonard. With the information I have (minimal), it’s easy to say the Warriors failed. Who wins the championship is still a question to be answered, but who won the ‘load management’ game? Kawhi Leonard and the Toronto Raptors.

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