The NBA’s Conflicting Catch-All of ‘Load Management’

It was January in Denver, and Duncan Roth needed something to look forward to. Roth had moved to Colorado five months earlier from Philadelphia, and his first winter under the Rocky Mountains was about to be warmed by having some old friends in town — two from Sweden and a few others who were more than six feet tall and played for the Philadelphia 76ers.

A long-suffering Sixers fan, Roth wasn’t going to miss the chance to see Joel Embiid and Nikola Jokic duke it out under the basket, and he was excited to bring his friends from abroad to their first National Basketball Association game. The Sixers were on the first game of four in a West Coast road trip, and while Embiid had played 37 minutes the game prior, the team had two days off before getting to Denver. Roth figured he and his friends would get to see the twin engines of Embiid and Ben Simmons in full bore. But that wasn’t to be.

Embiid rested, and the Nuggets made short work of the Sixers, with Jokic feasting on all the rebounds Philly’s big man wasn’t there to contest. It wasn’t the game Roth had pictured by any stretch, but the silver lining turned out to be a surprising one: Corey Brewer, who was with the Sixers for only that 2018-19 season, went off for 20 points, six rebounds, four steals, and two assists, “which was surprising fun,” Roth recalls, and Roth’s friends went home to Sweden with a new appreciation for this relatively anonymous athlete.

Load management, as familiar now to an NBA fan as its athletes, is the practice of monitoring and restricting a player’s physical activity to reduce injury risk. The load refers to minutes, games, and specific physical actions, and the management could be imposing a minutes restriction or having a player sit out a game. Essentially, it’s precautionary rest.

It’s become something of a trigger word within the NBA, whether for fans who feel cheated when they miss out on seeing a player or a previous generation’s athletes criticizing the practice itself as coddling. Team to team, there’s no set definition of what it can entail. And for those who study the wear and tear on an athlete’s body, load management as a term and as a practice is equally as frustratingly vague. The rules implemented by the league around the practice are centered on optics over science, such as no healthy player being sat during nationally televised games or teams not sitting multiple players at once, hefty fines being the main consequence.

What Roth experienced is what thousands of fans see on any given night, and his decision to take disappointment in stride, while positive, was also practical. Through greater player autonomy and our now-colloquial use of the practice as a term, load management is fixed firmly in the NBA – so much so that the league got stuck in a load management loop. It became a catch-all. We know it’s not going anywhere, which is why, rather than stay stuck, many around the sport are thinking about how to move beyond.

The History of ‘Load Management’

“‘Load management’ is something relatively new as a term,” Dr. Franco Impellizzeri, a professor in Sport and Exercise Science and Medicine at the University of Technology Sydney says over Zoom. “It’s really an old training principle and concept.”

Impellizzeri has been studying sports science and medicine, and orthopaedics, with a focus on training load and performance for 25 years, in a range of disciplines including soccer, track, cycling, combat sports and basketball. Recently, his work has shifted towards training load and injury from an epidemiological perspective, as well as meta-research.

“The reality is that there are no benchmarks, no numbers, no metrics, nothing that can tell you if your players are really at higher risk,” Impellizzeri continues, “And even less literature suggesting what to do in those situations.”

The introduction of load management within the NBA was gradual. The Sixers used it in the 2017-2018 season with Embiid, and the Toronto Raptors would popularize it in their 2018-19 NBA championship season by structuring regular rest periods for eventual Finals MVP Kawhi Leonard. When asked about his rest routine during his first season with the Los Angeles Clippers, Leonard said that “My health is no. 1 and that’s gonna make us a better team."

From there, some franchises adopted it as needed while others, whether skewing younger or within rigorous “no days off”-style systems, barely used it at all. While its initial amorphousness gave teams flexibility when deploying it, it also lent to what experts find so problematic about the practice and likely pushed the league toward implementing rules to curb it.

Big names resting was what Commissioner Adam Silver’s NBA aimed to crack down on, but Impellizzeri points out that the NBA also faces a unique problem of celebrity when it comes to high-profile injuries and the resulting spike of concern they typically generate.

“Normally people are impressed when there are famous players that are injured,” Impellizzeri says, “So when you have two, three famous players with injuries, you say, ‘Oh, wow, injuries are spiking.’ In reality, it can be just bias in our perception.”

“As scientists, we have to have proof that something actually works. And there are only associations to this that are weak associations,” Dr. Martino Franchi, an assistant professor in skeletal muscle physiology at Padova University, adds on the same call. “If you have a player that genuinely comes to you and says, ‘It’s better if I don’t play tonight I don’t feel well. I feel tired.’ In some sense, it’s down to the medical staff or the athletic trainers to understand, ‘OK, what is the problem here? Where do you feel pain, or what is it that you cannot perform as usual?’ Instead of having benchmarks that are actually very vague.

“If somebody cannot perform a muscle task up to a certain degree of force, then I have to know if it’s a tendon problem, if it’s a muscle problem, and I have to know if it’s tiredness, maybe psychological.”

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The problem with the data available, both Impellizzeri and Franchi say, is that what exists already can be manipulated – “You can play with the numbers as you like,” Impellizzeri says, “It’s like reading tarots”– inaccurate given the way in which it was collected, or incomplete. To gain the necessary data would require athletes, like NBA players, to be studied in a lab setting over a long and consistent period of time.

“If we talk about the NBA,” Franchi says, “how do you have the time to take these players down and tell them, you don’t have free time, but you have you come down here and make an assessment? You can’t do it every day.”

Impellizzeri stresses, “We don’t have validated prognostic models. There’s a lot of commercial interest. Unless the teams are developing something internally that they don’t publish as a competitive advantage, in the literature there’s nothing strong that can be used to predict injuries or to stratify the risk. There are a lot of studies just finding associations. Associations are like shark attacks and ice cream.”

Because of these imperfect methods of surveillance and a general desire to have a ready, blanket explanation, incomplete studies on load management proliferate. But, as Impellizzeri points out, this can be dangerous for athletes.

“People focus on the amount of training. I would instead focus on what kind of training they can do. There are studies suggesting there are context or factors which can affect injuries: psychological, sociological, nutrition. There are a lot of other factors,” Impellizzeri says. “It’s not just the training load. And most players are really robust; they are strong. So I don’t think [training] is really a problem.”

Impellizzeri and Franchi each recognize factors where load management is important, but never as a hard-and-fast rule. For example, an athlete’s age comes into account, but so does the condition the athlete is in. Hall of Famer Kevin Garnett has said that if load management had been a popularized practice in his era, he’d “still be playing.” And although LeBron James may be slowing down, slowing down for him is relative. Think of a sedan speeding toward a freight engine. Which one better represents James?

There are studies to support the argument that athletes face a higher risk of injury when held out for longer periods and when they aren’t properly reintroduced, or geared up, toward periods of intense performance. This was the case before and after the NBA’s “Bubble” in Orlando.

Accounting for Mental Health

But the main concerns about load management, beyond bad data, are the psychological implications on players’ training if they aren’t advocating for themselves.

“There is a risk in these kinds of decisions,” Impellizzeri says, noting he finds it disappointing when an athlete’s mental health is touted as top of mind but the psychological impact of limiting the games of the player is not considered.

“It’s not just a question of the next game you don’t play. There are consequences, and the consequences are in terms of mental health, and also in terms of business and impact with the media,” Impellizzeri stresses. “So if they really care about mental health, they should involve the players in these kinds of decisions. And if the players prefer to run the risk of playing, it’s his or her responsibility. They aren’t passive actors in the process.”

There is a more immediate adjustment NBA teams can make, beyond collecting physiological data, when it comes to caring for an athlete’s mental health in tandem with the physical demands on their bodies.

“Psychologists are not really part of the team, or sometimes the psychological support is outsourced and is not someone within the teams,” Impellizzeri says, citing the lack of attention to the mental health side of an athlete’s whole-body well-being as a cultural problem. “It’s very common to have a lot of data analysts. It’s much less common to have other professions that can help in the process.”

Where Franchi and Impellizzeri are heartened is where they see the game, and the doctors and trainers involved in it, keeping ahead of buzzwords. They note that it’s rare for NBA teams to run rigorous practices on off-days between games, and teams now focus on recovery methods instead.

‘Load Management’ in Pandemic Times

It would be an oversight to examine the unforeseen effects of load management on fandom without folding in the impact of COVID-19. While the NBA did attempt to guard players throughout the pandemic’s first wave, namely by spending $180 million to create the Orlando Bubble, the sudden start to the 2020-2021 season less than two months later featured several canceled games as well as public outcry from many star players. Silver oscillated between start dates in a rising wave of the coronavirus, initially looking to late January or beyond, but with more revenue loss for the league’s billionaire owners bearing down on him, the season’s tip-off was accelerated to mid-December.

Players bore the brunt of that decision. Last January alone, 21 games were postponed due to team rosters riddled with athletes entering into health and safety protocols. Daily injury reports, typically offering explanations for player absences in muscular-skeletal shorthand like “Achilles” and “hamstring,” began to return only “COVID-19” in a grim and uniform list, a distillation of the outside world finally creeping in.

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Franchises were at the behest of varying restrictions when it came to arena attendance, some at full capacity while others were barred from hosting fans at all. The Toronto Raptors, most notably, shuttled their entire organization to Tampa, Florida, for the duration of the season. Most fans, navigating the pandemic in their lives outside of basketball, were supportive, and when it came time to return in person to watch games, many were eager to be back.

Sasha Podzorov, a Rochester, New York-born Raptors fan, was attending college in Long Island and asked a friend of his from home if they’d want to meet him for a game in Brooklyn in April 2021. Expecting a star-studded lineup of Jayson Tatum, Jaylen Brown, James Harden, Kyrie Irving, and Kevin Durant, the two were excited. They’d bought tickets ahead of time for that game in particular.

Tatum and Irving were the only two players who ended up taking the floor.

While Podzorov acknowledges it was a “huge disappointment,” especially for his friend’s first NBA game, “to actually go to a sporting event at that time was the highlight of it all.” Even from their seats in the nosebleeds, he says it was a “terrific game and a blessing to even be there.”

In life, as in NBA fandom, it’s helpful to take small joys where you can. Even more so in a pandemic. Podzorov’s approach shows how resiliency plays an important role in fandom and the league at large. But as new money funnels into the NBA that is connected directly to the outcomes of the same regular-season games that athletes are increasingly sitting out, the chatter around load management is becoming increasingly tenuous and high-stakes.

‘You Don’t Wake Up and Assume Everybody Is Playing an NBA Game’

“Load management, or the resting of NBA players, it’s just not something that happened in the early 2000s or 1990s. Whether the teams are calling it rest or calling it injury, it has a massive impact on betting markets,” Julian Edlow, lead NBA analyst at DraftKings Nation, says over the phone.

While Edlow notes that the NBA is unique in its league-wide practice of resting players (the only close, pro sports comparison in terms of betting impact being Major League Baseball pitchers getting scratched) and that load management has made betting on the NBA trickier in the timing of bets, the practice has also generated novel responses in the betting space.

“There’s definitely interest in, now that this guy is out, these are the player prop markets I want to be looking for,” Edlow says, when asked whether he’s seeing the types of bets NBA fans are making change, given their familiarity with load management or resting practices. “Bettors and casual fans are certainly more aware. You don’t wake up and assume everybody is playing an NBA game the way that you used to.”

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Overall, the change Edlow is seeing in the NBA betting space is one of adaptation. Even casual fans are paying closer attention, becoming more nimble in the way they consume, and process, news of resting players.

“I’m sure there are people that aren’t taking advantage of the news like this, but the people that are actually betting on the NBA that I’ve talked to are saying things before an injury report comes out like, ‘These guys played last night and the game went to double OT, player X played 52 minutes. I don’t think they’re going to play tonight,’” Edlow says, referencing instances of fans growing familiar with resting patterns of certain teams, such as the Sixers and their tendency to rest a player like Embiid on back-to-back games.

Fans are “looking ahead of the schedule, looking behind recent games,” Edlow says, all to gain a slight advantage and, in a roundabout way, becoming more engaged fans in the process.

“People are paying attention to that news all day,” Edlow adds. “I do think that it has people’s interests. If they feel like they can get an edge following injury news and get a good number, that keeps the bettor interested.”

In this way, the sports betting space inverts the traditional complaint that fans have made when it comes to taking financial hits on games where they’ve spent a substantial amount on tickets only to find the person they’ve gone to see is out. A fan can now, in theory, stand to make that amount back, or more, under the same circumstances. There is still the lingering moral caveat of how someone should feel betting on the well-being of another person, but Edlow sees that as succinctly separate and straightforward: “If you can get an edge in anything, why not take it? The sports books are all doing fine.”

The NBA’s rise in the sports betting space has been substantial, and there were bound to be growing pains. Similarly, COVID-19’s impact on the league was effective at showcasing its shortcomings, not all of which the NBA has or should rush to rebound from quickly.

For all of the studies, recommendations, and loose data surrounding the debate on the importance of resting a player, the voices of players aren’t always included. It’s that glaring absence that makes some scientific researchers, whose academic careers are focused on improving and prolonging the careers of professional athletes, dubious when it comes to the catch-all quality a term like “load management” has gained.

Moving beyond load management, whether as a too-broad term, in fandom a lucrative incentive, or in melding physical and mental health for a more balanced and scientifically grounded approach, requires us to square our expectations with reality. The gaps apparent in the league today present opportunities for growth and adaptation for the NBA as a business and for fans in their own expectations. Whether the game is approached as a product or as entertainment, both perspectives tend to share a glaring oversight: humanizing people at the heart of it.