What is load management and why do the Raptors use it on Kawhi Leonard?

NBA analyst Michael Grange joins Sportsnet’s Starting Lineup to discuss the Raptors’ potential first-round playoff opponents.

Just a few hours before the Toronto Raptors were scheduled to play the Washington Wizards on Oct. 20, the team’s public relations department sent out an intriguing injury update.

“Out: Rest – Kawhi Leonard, load management.”

Wait, “load management?” Was this just some fancy way of saying Leonard needed some rest?

The Oct. 20 game would be Toronto’s first time playing the second game of a back-to-back. Since then, “load management” has become one of the defining terms of the Raptors 2018-19 season, with Leonard sitting out 12 additional games under the designation. Additionally, Leonard hasn’t played in both ends of a back-to-back all year, resulting in him having played just 59 of a possible 81 games, heading into Tuesday night’s regular-season finale against the Minnesota Timberwolves.

But when you factor in how effective he’s been when he’s been on the court, it’s hard to argue with the results to date.

So what exactly is load management?

According to an IOC Consensus statement on load management published in the British Journal of Sports Medicine in 2016, “the aim of load management is to optimally configure training, competition and other load to maximise adaptation and performance with a minimal risk of injury. Load management therefore comprises the appropriate prescription, monitoring and adjustment of external and internal loads.”

In other words, load management isn’t just about minimizing injury risk in a player. It’s about optimizing that player’s effectiveness over the long-term.

As it relates to Leonard and the Raptors, it’s important to remember Leonard played just nine games last season due to a quad injury and an alleged breakdown in trust between he and the San Antonio Spurs over his rehabilitation.

So when the Raptors traded for the two-time defensive player of the year last summer, building trust with Leonard and managing his health became a top priority for the team. Not only to keep him happy and help the team’s chances to re-sign him when he becomes a free agent this summer, but to keep him on the floor for what the Raptors hope will be a deep playoff beginning this weekend.

As far as the NBA league office is concerned, “load management” is as legitimate a reason to miss a game as a sprained ankle or a back spasm.

“In certain cases, load management – a common phrase in the sports medicine community – is an accepted term under the league’s injury reporting and player resting policies,” the NBA told Sportsnet via email.

In order to get permission to sit Leonard — or anyone else for that matter — for load management reasons, Toronto must first provide medical documentation to the league. It should also be noted that not all requests are necessarily granted.

“Teams must contact the League Office when they are considering sitting a player in circumstances that might violate the Player Resting Policy,” the league said in an email to Sportsnet. “In limited circumstances, load management may provide a legitimate basis for a team not to play a player without violating the Player Resting Policy including, for example, a player who plays in most games but is restricted from playing in back-to-back games or in other unusual circumstances for legitimate medical reasons that have been documented and shared with the League Office.

“Based on this review process, a player’s health or injury history may impact the application of the Player Resting Policy and/or the explanation associated with that player’s participation status in a particular game.”

Prior to the start of the 2017-18 season, the league enacted The Player Resting Policy, to help address a growing trend of otherwise healthy star players sitting out nationally televised games.

Doug Richards, medical director of the MacIntosh Sport Medicine Clinic at the University of Toronto, said research shows that when it comes to load management, the key to avoiding injury and optimizing performance has more to do with managing the pace of workload buildups, than the amount of work itself.

“What people have shown is the probability of injury is more related to your acute-to-chronic workload ratio then it is by the total amount of workload that you do,” Richards explained. “In other words, people can achieve very high levels of workload if they build up to it slowly and sustain it.”

The specifics of a load management program can vary wildly depending on the athlete and their sport, especially when dealing with a pre-existing injury.

“If someone’s got an injury, load management becomes a different thing because then it’s not about building up slowly,” said Richards. “They reach a certain limit where if they play more than 150 minutes a week of basketball, their knee swells up and it’s a problem. So you’ve gotta keep them under that.

“In general, if someone has an injury, an underlying chronic injury that is incurable, then you get the most out of them by managing their minutes by not letting them get to their threshold triggers for their injuries.”

It’s unknown if the load management the Raptors have been placing Leonard under this season has to do with a pre-existing injury or if they have just been building him up to be at his absolute best for the playoffs.

And while it’s presumed the load management program Leonard has been operating under all season is designed to have him available for every playoff game, if this season has taught us anything it’s that when it comes to Kawhi Leonard’s playing time, we should assume nothing.

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