As the NBA season opens, we will see several top-level players come back. Derrick Rose will step back onto the regular-season court again after a controversial layoff. Kobe Bryant is closing in on his return from an Achilles strain. Russell Westbrook is a few weeks away after two knee surgeries since injuring himself in the playoffs. Rajon Rondo will come back later in the season from his own ACL tear.
However, the question remains on the lips of everyone from fan to general manager: Will they be the same? Each of these athletes was at the top of his game. They are elite-level NBA stars, freak athletes who now have to redirect their drive and focus to rehab. Is it harder for these players to return from injury?
While we all remember some of the signature moments of great athletes, such as Rose driving to the lane and soaring in, Westbrook's crossover or Kobe's fadeaway, there is a flip side—a moment where the crowd feels the air rush out of its collective chest. The knee bends in a way you know it shouldn't, and the scream of agony is so plaintive that we all feel it.
When these two moments collide—a freak athlete and a serious injury—it is more than a physical problem. In that moment and in the one just after it, we get a glimpse into the soul of a player and of a team. As the physical pain fades, we get a much different question: How does an athlete like Derrick Rose, Russell Westbrook, Rajon Rondo or Kobe Bryant come back from a devastating injury?
Variable Rate of Return
Sports medicine and sports science have led to a high rate of return for NBA players. Even devastating injuries like an Achilles rupture that would have been career-ending just a decade ago are now just career-altering. For a player like Kobe Bryant, who is on track to return at a rate ahead of the expected range, new techniques in rehab and surgery piggyback well with a drive to succeed and a solid physical conditioning base.
In some cases, however, it can be tougher for a freak athlete to come back than the "gym rat." Many so-called freaks (and I mean it as a compliment!) have gotten to the highest levels on sheer physical ability. Some react very poorly to the process and fear losing their athletic advantages. This is especially true for athletes who have been healthy for an extended period of time and then start to have minor injuries. Even minor injuries can build up. Having never had to deal with them before, the athlete simply doesn't know how to rehab or understand the process of "playing with pain."
Dr. Chris Carr, the coordinator of sports and performance psychology at St. Vincent Sports Performance in Indianapolis, has worked with athletes at every level, including the NBA and Olympics. He believes that much of the success comes down to whether an athlete has the proper support system.
"It's easy to call it mental toughness, because there is a lot of that," Carr explained, "but at its heart, it's about athletic identity. A lot of these players identify themselves by what they've accomplished and how they're seen. All of them have to go through a grieving process after an injury, but the ones with a good support system tend to make it through the process better and without losing that athletic identity."
That support system can be wide-ranging, but it often starts with the team's medical staff.
Role of Medical Staff
From the second that an athlete is injured, one of the key correlative factors in a normal return to play is the effectiveness of the medical staff. Throughout the NBA, hardworking athletic trainers, physical therapists and physicians are putting in countless hours to make sure that athletes are in peak physical condition.
When the injuries happen, the response is immediate. With injuries to Rose, Westbrook and Bryant, the response times were all under 20 seconds. Even in Westbrook and Bryant's cases, where the player attempted to keep moving and "walk it off," the athletic trainer responded quickly enough to prevent further damage. The rehab process begins that quickly.
Beyond the initial injury, there's a twofold value to the medical staff. First, there's almost always a trust factor. The player knows the athletic trainer and vice versa—a relationship that can be exceptionally valuable. Second, the medical staff is able to offer both guidance and support throughout the process.
Even in surgery, having this support system is key. In modern surgical centers like James Andrews' facilities in Birmingham and Pensacola, Kerlan-Jobe in Los Angeles or Tim Kremchek's Beacon in Cincinnati, operating rooms have a viewing lounge. A player's family, his agent and usually a trainer from the team can observe the surgery. In the past, athletes have told me that having people they know and trust helps them get through surgery.
Athletes often seek out "super surgeons" like Andrews, Kremchek, Neal ElAttrache and others largely because of confidence. It's a bit of a self-fulfilling prophecy, but past successes lead athletes to say they want the same doctor. When Rajon Rondo was told he had a torn ACL, he reportedly asked whom Adrian Peterson had seen.
Winning at Rehab
So often, any analysis of a rehab tries to separate things into two easy categories: physical and psychological. It's just not that easy. In each step of managing an injury, the two are so entwined as to be impossible to place in one bucket or the other. Is confidence psychological, as many would expect, or is it a response to a physiological issue like proprioception?
This dichotomy is best shown by how athletes handle their rehab. Many will spurt out unrealistic expectations, giving the media time frames that are well below accepted standards. Carr thinks this is healthy. "The best experiences usually start with this kind of unrealistic goal," Carr explained. He believes that athletes need to be very optimistic, especially at early stages. The medical staff is there to hold them back from doing anything that could be damaging.
"Unrealistic expectations aren't a bad thing," Carr continued. The type of goals that we've seen from both Rondo and Bryant are much more typical of a star athlete than the public lack of confidence that we saw when Rose spit the bit on his return after medical clearance. "Even when they're unrealistic, they're a manifestation of a positive spirit. To me, it shows that an athlete is recasting the experience and is finding a new way to win."
Athletes love to compete. Normally, they're on the court, and the scoreboard tells them everything they need to know. It's harder in rehab, and meeting goals and timetables is just one way of doing it. "We have to remember what is normal for them," Carr explained. "Elite athletes are used to winning." While the rehab process is the same for them, often a drudgery of repetitive exercises with slow progress, an elite athlete can re-focus his normal drive and feed off his ability to practice things that normal people or even lesser players don't.
"I like when an athlete lets the rehab become his training," Carr said. Athletes not only set time goals but like to be able to get out of the rehab side and back onto the court as early as possible. Even when an athlete can't do much, the positive reinforcement to his athletic identity is helped by being "part of the team again." Both Rondo and Rose exemplified this, getting back on the court very early in their rehab process and taking part in drills and shootarounds, even though there was no chance of them playing.
An NBA athletic trainer told me that one of the biggest advantages his team has in rehab is a physical therapist with a skill that's probably not on his resume. "[He] can turn anything into a game," the AT told me. "I think he doesn't even realize it. He's as competitive as these players. Whether it's saying something like 'so and so did more than you' or creating some crazy point system for a drill that's often drudgery, he gets them used to winning again."
There is another side to this, and that's the athlete that's losing at rehab. Athletes such as Greg Oden, Rudy Gay and Andrew Bynum all seem to be constantly fighting one injury or another, or worse, dealing with a chronic condition. At this point, it gets tougher for the athlete to maintain that identity. He's not part of the team, especially if he loses a team connection or shifts around as both Bynum and Oden have.
They are identified in the media as busts or has-beens. Mental toughness and a support system are key here, as we have seen with Oden, who focused his rehab at St. Vincent and bonded with another returning athlete, Austin Collie, now with the New England Patriots.
Better, Stronger, Faster
Many athletes will succeed through a rehab program and come back "better than ever." It's a common phrase, but there are cases for it going either way. Pitchers coming back from Tommy John surgery often believe they are throwing harder, though research has shown that this is seldom the case. If anything, there is a short burst from having been resting for six months or more. This same principle works in NBA athletes. "Fresh legs" can make them feel they are faster or jumping higher.
In other ways, they can be better. "Some get religion during rehab," said an NBA athletic trainer. "They work on conditioning as well as their rehab. They get focused on things. I had a player a couple years ago who had an injury on one arm. He could move and dribble and even shoot with his off hand and he got significantly better. When he came back, it was a weapon for him that no one had tape on."
Derrick Rose told the Los Angeles Times that he's increased his vertical leap by five inches after his knee reconstruction. Rose, of course, has had extra time to heal over a normal ACL rehab. Given the timing, it could be thought that he has been doing a summer of performance training rather than rehab. In that case, a study done by Vincent Nittoli, an athletic trainer with St. Vincent Sports Performance, gives us some idea whether this is possible.
SVSP is a top-tier location for athletes to both rehab injuries, such as Greg Oden, and to prepare for activities, whether that's the Olympics or the NFL combine. Some of the athletes that prepared in the months prior to the combine were monitored and measured, showing a 4.1-inch mean improvement in their vertical leap. If football players can increase their vertical significantly, it's certainly possible that a seasoned jumper like Rose could put on that much or more.
In Derrick Rose's first game back after 17 months, his physical ability was clear. Even though it was an early preseason game, Rose showed no signs that he was anything different. "He looked like Derrick Rose," said B/R NBA Lead Writer Howard Beck, who was at that game. "If you didn't know something had been wrong, were just some guy off the street, you'd say [Rose] looked like the best player out there. He was the fastest, drove strong, everything you want to see from a star point."
There was one play in the first quarter that stood out. Rose took the ball from half court and dribbled to the top of the key. He saw an opening to his right and dribbled quickly toward it, but George Hill came off a switch and stepped into the gap. Rose reacted with a quick stop, but there was something in him that didn't trust his knee on just that kind of jump-stop. Rose rolled over the knee and fell, turning the ball over. He didn't stay down at all, but it was a clear sign that he was still thinking about the knee.
Later in the game, Rose made a similar physical play. He was coming around a screen when a defender stepped into his path unexpectedly. Rose made a quick, hard and unanticipated cut off his knee to go around the defender. Given no chance to think, Rose's body didn't betray him.
In later games during the preseason, Rose has shown moments where it's possible the same kind of events are happening. Whether or not he's better physically, there's still the challenge of integrating the physical and mental back into the unconscious game flow that elite athletes need.
As fans, we see freak athletes differently. They fly, not jump. They blaze, not run. Calling it worship is hardly a misnomer in many cases. Seeing that very athlete felled by an injury, seeing that his knee is just as human as our own, can cause a cognitive dissonance. It's even worse for that athlete, dealing with the physical consequences as well as the psychological ones. While fans share their pain, they never carry it.
These elite athletes aren't made of adamantium and don't get their power from a yellow sun. They are, at some level, human in makeup. They bleed and break like the rest of us, but that's where the comparison stops. A significant injury is an inflection point, where an elite athlete can either fall apart or rise up.
The same traits that made great athletes great are the same that can make them great again. An integration of the mental and physical aspects helps return these athletes to the game, sometimes in an even better place to be able to amaze those same fans once again. Even Superman has his Kryptonite, but with the right process, elite athletes like Derrick Rose, Kobe Bryant and more can put their cape back on and fly again.
All quotes in this article were obtained first-hand unless otherwise noted.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Football Outsiders.