Kawhi Are You Still Getting Hurt? The Effect of Load Management on Long Distance Running

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If you had any interest in the previous basketball season, or at least the Toronto Raptors colossal 2019 NBA championship run, you may have heard a thing or two about our beloved (and, sadly, now departed) Kawhi Leonard who managed his injuries with a ‘load management program’. Conceptually load management is fairly easy to explain as a dosage plan to manage, or better yet control, the amount of load placed on an injured area over a specific time-frame with incremental changes in load as load tolerance increases. For Kawhi, his dosage plan involved specific days off leading up to the playoffs which is why he played only 60 games during the Raptor’s 2018-2019 season. On top of that, but this is only speculation, the Raptor’s training staff were likely controlling and curating his workouts to, again, manage the load on his injured right leg. From the sounds of it, he likely suffered a quadriceps tendinopathy, so check out this blog for more learning on that topic.


So if you DID watch the playoff run, you know the result of the load management program. If you DIDN’T, here’s a quick recap: IT WORKED. Yes, there were other injuries bogging him down at times in the playoffs, but the fact that the previous season he played 9 games and this season with playoffs he exceeded 80 is a huge accomplishment for him AND the Raptor’s training staff. Okay, so now to the overarching message of this blog: load management is critical and applies to EVERYONE, injured and non-injured alike.  


We the North are in the midst of our long-distance running season. This might be the year you complete your first half- or full marathon, or maybe you are a seasoned vet, but regardless we do know that load management is key in preparing for race day. A recent study followed 161 runners over a 16-week period prior to running a half- or full marathon found out the following information from their study cohort (1):

  1. About 90% of runners reported at least one running related injury over the 16-week study (injuries include lower body muscular or joint injuries, but also excessive sneezing and/or coughing issues since the training time was around the peak of influenza season)
  2. About 20% of the injuries were specific to either the lower leg or knee
  3. Every 2 weeks there would be a new injury reported in 1 in 7 runners


So if we read between the lines, we can start to see the effect of load management NOT ONLY on musculoskeletal injury management and prevention (joint and muscle injuries, for example), but also on full body wellness. Physical stressors like long-distance running are likely to create a spike in a stress hormone known as cortisol (2). An increase in cortisol has been shown time and again to be detrimental to immune function which we need to fight disease and illness (3). Therefore, knowing how to PLAN AND ADJUST your mileage is critical to staying healthy for more than one reason. Depending on your current running ability, your overall health and conditioning level, and your race goals, this can be a very complex problem to navigate despite its simplistic explanation. That being said, here are a few simple ideas to get you started from home:


  1. Build in appropriate rest days: maybe you COULD run 7 days a week, but your body probably needs rest. This will minimize the repeated spikes in cortisol in your blood, keep your immune system happier, and most likely lead to improved performance on your next training run. How many rest days are needed? Really rough to answer but it may come down to my next point…
  2. Listen to your body: your body will tell you when it needs a break or when it is ready for more. Sometimes we get stuck in this thought that we MUST exercise ‘x’ number of days per week. If you can’t shake that feeling of a missed workout, ensure you stress a different system (strength training over cardio). Afraid to put on muscle mass in preparation for your run? This is likely not a real concern unless you strength train a specific way, so I would recommend consulting a physiotherapist or strength and conditioning specialist for more information.
  3. Cross-train: see above. Don’t just run. Running is very repetitive. If you only run, your risk for tendinopathy injuries will very likely increase.
  4. Increase your mileage slowly: to complete a successful half- or full marathon, you need to expose your body to further running distances. There are people out there that complete their first 10 km training run 1 week before a half-marathon and go on to finish the half-marathon… you don’t want to be this person post-race (trust me, I’ve seen it in the clinic). You need to build up your tolerance to load which includes increasing your mileage. A general rule-of-thumb of 10% increase in mileage per week is appropriate for most people (but again, listen to your body).
  5. Recovery (on top of rest days): there is more to recovery than just days off from running. Consider factors such as sleep, nutrition (pre- and post-run), quality of life (consider stress from running compounded with emotional stress from day-to-day events), and muscle/joint soreness management (hello massage therapy!). Some of these factors are difficult to change in the short-term so consider seeking out professional services to guide you in the long run, such as a registered massage therapist, physiotherapist, naturopath, or osteopath (weird, I think we have all of those at Body Co…).


There are certainly additional factors we could consider, but let’s keep it simple and digestible today. If you have questions or concerns of your own it is best to contact your most trusted healthcare provider so that they can further guide you towards a successful full or half-marathon! Consider consulting a professional early and before injuries happen. Remember that you are likely dedicating 3-6 months of your time towards one goal, so it is probably worth consulting a professional regarding preparation. 


Thanks for reading and have fun outside!

Jordan Fortuna, Manager of Clinical Services

Jordan is a graduate of the University of Toronto Physiotherapy program and has since been practicing in orthopaedic settings. He has developed an interest in sports physiotherapy through his many years as an athlete, participating in baseball, golf, snowboarding, and more recently rock-climbing, cycling, and strength training. He has worked with a variety of clientele including athletes from disciplines such as competitive dancing, running, rock-climbing, and mixed-martial arts, as well as non-athletes of a wide age range and ability. Regardless of activity level, he is dedicated to improving mobility, optimizing function, and strengthening to help achieve your goals through the use of an individualized exercise prescription and manual therapy. He also has additional training in acupuncture and sports taping.


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  1. Frank, T., Backx, F., and Huisstede, B.. Running themselves into the ground? Incidence, prevalence, and impact of injury and illness in runners preparing for a half or full marathon. J Ortho & Sports Phys Ther. 2019; 49 (7): 518-528.
  2. Cardoso, C., Ellenbogen, M., Orlando, M., Bacon, S., and Joober, R. Intranasal oxytocin attenuates the cortisol response to physical stress: a dose-response study. Psychoneuroendocrinology. 2013; 38(3): 399-407.
  3. Webster Marketon, J., and Glaser, R. Stress hormones and immune function. Cellular Immunology. 2008; 252(1-2): 16-26.


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