LeBron James has had his body under scrutiny before. Last season, sciatica kept him out for the Lakers’ first 14 games, although he still managed to return and play 60 games at 41. Now, settling into a new city and a new jersey, James is carrying familiar lingering issues into Year 24. But this time he is keeping a close eye on his body.

“There is special attention paid to his left foot, which has chronic arthritis, sources told ESPN, and his lower back, which caused him to miss the first month of last season because of sciatica,” insider Dave McMenamin reported.

That attention is already built into James’ routine in Philadelphia. His day starts at the Sixers’ facility around 7:45 AM, well before team practice. He meets longtime trainer Mike Mancias for stretching, activation work, and treatment modalities to stabilize his joints and back before he touches a basketball.

Neither issue appears new. James’ biggest flare-up occurred around the same time last year, after the symptoms developed by late July. The only difference between now and then was that by October 2025, James hadn’t touched a basketball for months. The pain affected his right side (the sciatic nerve runs from the tailbone down the leg to the feet), and James had no choice but to wait until he was close to pain-free to shake off any rust.

But in 2026, James has been pictured participating in intense scrimmages alongside Joel Embiid, Tyrese Maxey, and Jaylen Brown, focusing on spacing, rhythm, and passing sequences. And that’s been going on since late September. So, it is safe to say that he is well ahead of where he was a year ago.

James also wouldn’t want to take his recurring health condition for granted, as he described how frustratingly slow his recovery was in 2025. In fact, even though it took him until mid-November just to return to practicing 5-on-5, he still couldn’t be sure he was fully fit. Here’s why.

“We’ve been taking it literally one minute, one hour, one step at a time throughout this whole process,” James told ESPN. “See how I feel this afternoon, see how I feel tonight. When I wake up in the morning, we’ll probably have shootaround. Just got to see how the body responds over the next 24 hours-plus.”

James ultimately returned to game action against the Utah Jazz, but there was no gradual uptick in his availability status, as there usually is when other injuries heal. Head coach JJ Redick had no choice but to keep his former biggest star listed as “TBD” or “questionable” before every game for nearly a month.

It was the second time James had suffered from the nerve condition since the summer of 2023, and he openly said, “If you ain’t never had it, and people are making jokes about it, I pray you never get it,” concluding, “It’s not fun.”

Mind you, these were the words of someone who spends about $1.5 million a year on soft-tissue treatments, such as massages, hyperbaric chambers, and ice baths, to keep his body in peak athletic condition.

“You wake up one day, and you hope that when you step down from the bed that you don’t feel it,” James said on his sciatica issue. “You go to bed at night, and you hope that when you’re in the bed that you don’t feel it.

“There’s a lot of exercises and a lot of mobility things and a lot of things you can do to help it. So, I’m just keeping a positive mindset.”

Understandably, James is taking every possible precaution this time so that his health conditions don’t affect why he joined the 76ers. Meanwhile, the Philly franchise didn’t sign James without accounting for this.

Head coach Nick Nurse recently indicated he was developing a “grab-and-go” system, which means reduced roles and equal responsibility for the bigger names. For instance, if James, Brown, or VJ Edgecombe grab a rebound and see an opening, they have the license to push for it themselves rather than finding the initiator. Meanwhile, Nurse has something planned for James too.

“LeBron, I consider him a great offense creator,” Nurse said. “I don’t necessarily mean scorer. I just mean creator and a table setter and all that kind of stuff. That’s where I could see, if it isn’t bringing it up and starting, it’s probably going to be first pass anyway to the wing, and then we get into our actions, and he’s kind of seeing what’s there, and he’s creating offense for others.”

It is important to note that James played a lot off the ball last season, handing over offensive control to Luka Doncic and Austin Reaves. Now, the 76ers coach wants James to use his playmaking skills all over again.

James, for his part, has said he intends to adjust to “whatever” the team needs him for. On Media Day, the 41-year-old said he would bring his experience, knowledge and winning blueprint to the 76ers game while keeping an open mind.

The stakes are straightforward. Philadelphia has built a roster around Joel Embiid, Tyrese Maxey, Jaylen Brown and James specifically to contend now, and a championship-or-bust season puts real pressure on keeping its oldest star available in the spring, not just the fall.

Embiid himself has a long injury history, meaning the Sixers can’t simply plan around one fragile star while assuming the other will stay healthy.

None of this is James hiding an injury or making excuses in advance. It’s the opposite: a level of transparency about chronic arthritis and recurring sciatica that comes from a team trying to get ahead of a problem rather than react to it mid-season, the way the Lakers had to a year ago.

Whether that planning holds up will say as much about Philadelphia’s title chances as anything that happens on the court.