Koby Altman Reveals What 'Keeps Me Up at Night' About Cavaliers

The Cleveland Cavaliers used 41 different starting lineups during the 2025-26 regular season. On Friday, president of basketball operations Koby Altman said being healthy at the right time is the thing that keeps him up at night.

Cleveland still went 52-30 and finished fourth in the Eastern Conference. The Cavaliers hosted the Toronto Raptors in the first round and won in seven games, then came back from a 2-0 deficit to beat the top-seeded Detroit Pistons in seven. The New York Knicks swept them in the conference finals.

A year earlier, Cleveland won 64 games and entered the playoffs as the East's top seed. The Indiana Pacers eliminated the Cavaliers in five games in the second round.

Right knee tendinitis cost Jarrett Allen 10 games in March. Donovan Mitchell's ankle and Sam Merrill's hamstring put both of them on the injury report late in the regular season, and head coach Kenny Atkinson listed all three as full participants in practice before the Raptors series opened.

Atkinson said in April that he had to learn on the fly that season more than in any other year, according to Cleveland19.

"We've had so little reps with our group whole and you want to get stronger as the playoffs go," Atkinson said.

The roster turned over midseason as well. On Feb. 1, Cleveland acquired Dennis Schröder and Keon Ellis in a three-team trade with the Sacramento Kings and Chicago Bulls. Three days later, the Cavaliers sent Darius Garland to the LA Clippers for James Harden.

Every team is fighting the same problem, and the league's new draft rules have raised the stakes on each regular-season game.

"The challenge you bring up is the challenge for 30 teams," Altman said. "It's the hardest thing we have to do. Eighty-two games feel like meaningful games every night now, whether that's the in-season tournament or trying to avoid the play-in tournament. The East has gotten much more competitive. The league has changed around the draft rules, the 3-2-1 model, so tanking is not a thing or shouldn't be a thing. There's no incentive to lose games anymore."

Cleveland's answer starts with its performance staff.

"I love that we're going to have to compete every single night and be dialed in," Altman explained. "It's always been a focus of ours to figure this thing out. We've made tremendous investments in our performance group, diving into metrics, individual plans, recovery plans, diet plans, and everything that elevates the player and optimizes the athlete. Those studies continue to be ongoing, but the investments are massive."

Next year, the Cavaliers move into a new downtown practice facility built with the Cleveland Clinic. Altman said the team is done taking training camp on the road once it opens.

Ground was broken on the Cleveland Clinic Global Peak Performance Center on Oct. 14, 2024. The facility covers more than 210,000 square feet on the Cuyahoga River in downtown Cleveland and is expected to open in 2027, according to the Cleveland Clinic.

In April 2025, the Cavaliers and the Cleveland Clinic agreed to a 25-year extension of their partnership. The team currently practices at Cleveland Clinic Courts in Independence, Ohio.

Soft-tissue injuries are the target, and the Cleveland Clinic is part of the research.

"Someone could come down on [an] ankle or sprain something, but what we're trying to do better is evaluate the body as a whole, tone down soft-tissue injuries, and [get] better in this space," Altman said. "We're moving into a new facility downtown, the Global Peak Performance Center, led by the Cleveland Clinic. They're invested in figuring out injury prevention with us. There's a lot of R&D going into that, probably years ahead of where we are."

Altman said Atkinson and the performance staff sit in on those meetings, and each day starts with who came in not feeling great.

"It's one thing to invest infrastructure and bright minds in the back; it's another to have your head coach and performance staff entrenched in all the meetings," Altman said. "Before we do anything, we need the update: who came in today not feeling great? We need to be on the same page. Injuries are going to happen, unfortunately, but how do we eliminate or reduce the risk factors? How do we know when there's elevated risk as we study our athletes and become more sophisticated in decision-making? This is an organization led by Dan Gilbert and the Gilbert family. No investment is too small to keep our guys healthy and available."

Peyton Watson, acquired from the Denver Nuggets in an Aug. 19 sign-and-trade, strained his right hamstring on Feb. 4. He missed Denver's first-round series against the Minnesota Timberwolves with the same injury.

Altman said the conference finals run came once the roster finally got healthy.

"What keeps me up at night is that I love our talent, our process, and the momentum we're on," Altman said. "What keeps me up is not being healthy at the right time or peaking at the right time. Coach had to navigate 41 different starting lineups last year. Somehow we won 52 games and hosted a first round of the NBA playoffs. I don't want that to happen again."

"With the Gilbert family investing in our performance center and research, it's on us to create decision-making processes that keep our guys available," Altman continued. "The number one reason [we] went to the conference finals last year is because [we] were healthy. We made tweaks on when [we] were peaking and how we approached our minutes leading into the postseason. It wasn't perfect in the regular season, but we got to a point where [we] were healthy, and with the talent we have, that was the result."

The talent Cleveland added this summer comes on top of that spending.

"I'm excited about the talent we have and the talent we've added, as well as our investment in health and wellness," Altman said. "We've become a more sophisticated organization this offseason. We're trying to be at the forefront of this. It's complicated and complex, but we have the people and we're making the investments. Our players understand how important it is and are bought into it."

Atkinson's first two training camps in Cleveland were held at IMG Academy in Bradenton, Florida. This year's camp goes to Spain, with practices scheduled in the early morning Eastern time at The Embassy in Andalusia in Fuengirola.

The Cavaliers hold media day Monday with their 21-player training camp roster. Practice runs Sept. 30 through Oct. 5, with a scrimmage Oct. 4 at Martín Carpena Arena in Málaga.