Wade missed his third straight game, his longest consecutive stretch of the season, Tuesday night against Boston with what the team continues to say is general soreness and part of a proactive maintenance program. Wade has missed 12 of 42 games so far and has had issues with both knees in recent years.
But Wade's current stretch of absences has been related to an ongoing recovery process from his offseason shock-wave therapy treatment on his right kneecap, which was bruised last spring and hampered him throughout the Heat's run to a second straight championship.
Wade is one of several rotation players who missed time this season, and James said Tuesday that the lack of continuity has been weighing on the team more in recent weeks.
"With some of the guys being in and out, and with the concern with D-Wade, it's been tough on all of us trying to fill that," James said. "We've just got to be able to do a little bit more consistently, and go in with the mindset sometimes that he's not playing instead of [he is] playing."
The Heat entered Tuesday's game having lost four of their past six games and are just 5-5 in January. Wade has not played since he struggled through Friday's victory in Philadelphia, where he finished with just eight points in 25 minutes. After that game, Wade immediately told reporters he would not play in Saturday's game at Charlotte, which was the second game of a back-to-back set.
Wade also struggled during the Heat's 114-97 loss in Washington on Wednesday, when he missed 7 of 11 shots and also scored just eight points.
He was also sluggish defensively against both the 76ers and the Wizards.
James has supported the team's approach to periodically rest Wade during the first half of the season. But on Tuesday, James seemed at a loss for words as he described Wade's predicament.
"I'm not a doctor. I'm only a player, man," James said. "I don't know the [therapy] program he's on. I do know that his knee, if he's feeling good, he's going to play. If he's not feeling good, he doesn't play. For me as one of the leaders on this team, I've got to make sure the guys that are prepared to play are ready to play. When D-Wade is ready to come back, then that's what it is."
The Heat have started more than a dozen different lineups this season as coach Erik Spoelstra has had to sort through injuries. Only reserve point guard Norris Cole has played in every game this season. James has missed one game with a strained groin. But there have been games when Miami has been without as many as three starters because of injuries.
Spoelstra insisted Tuesday that Wade's recent absences are part of the training staff's proactive approach. Wade told reporters in Atlanta on Monday that he wanted to play, but that he was instead instructed by the staff to sit out of the 121-114 loss to the Hawks.
Wade did not speak to reporters before Tuesday night's game against Boston.
"It's just part of the process; you can't predict it," Spoelstra said. "You're going to have some good days and some days where you don't feel great. What we try to do is not predetermine or have expectations about it. We know as long as we stick to the routine, he should get better, quicker and stronger."
Veteran guard Ray Allen started Tuesday night for Wade against his former team. Allen said Tuesday he hasn't lost confidence that Wade will eventually get his health in order and return to his elite form. Wade has averaged 18.9 points, 4.8 rebounds and 4.7 assists in 33.3 minutes a game this season.
His overall production is down from recent seasons, but Wade is shooting a career-high 54.0 percent from the field, and has largely been effective in games when he returns from taking time off to rest.
"If you look at his situation, he's not injured [and] nothing has happened where it's sidelined him for a long period of time," Allen said. "It's management of his body. We were fortunate last year that he wasn't sidelined more. It's a matter of us being aware and staying ahead of it, making sure that we don't overdo it and put ourselves in a bad situation."
Wade's health is one of the biggest questions facing the Heat in their quest to become the fourth franchise in NBA history to win three consecutive titles. It's also an issue that could impact how Miami addresses its roster moving into the future. Wade, 32, could opt out of his contract after the season and test free agency or look for a long-term contract from the Heat.
Both James and center Chris Bosh also could opt out of their contracts after this season, and Wade's ongoing health is widely viewed as at least one determining factor in James' looming decision. For now, James is simply concerned with finding a way to get the Heat back on track amid the injury concerns.
"I can say from a rhythm standpoint, it's kind of hurt us," James said. "And we're a team that's built on rhythm, built on chemistry, and we've had so many lineup changes, so many different guys in and out with injuries that it's kind of hurt our performance. We don't like to use it as a crutch or as an excuse."
Instead, it's just a reality.
"It's tough, it's tough," James said. "And guys think it's easy, but it's tough."