Nerlens Noel could not be contained at the Champion Sports Medicine complex in Birmingham, Ala., where orthopedic surgeon Dr. James Andrews' physical therapy chief, Kevin Wilk, treated the Philadelphia 76ers rookie after his left ACL was repaired.
At one point during Noel's March-to-September rehabilitation program last year with Wilk, the 19-year-old was introduced to a rigorous workout where he had to crouch and swing heavy ropes up and down to build up his shoulder and leg muscles. A few times, Noel could barely lift his arms the following day.
But Noel never complained and wanted to go at it again later in the afternoon—a mindset that he brought to every exercise during his recovery process.
"He would go back to the conditioning area of the clinic and he would never tell the conditioning people (if he was hurting)," Wilk said. "I would be like, 'Tell them you're sore.' And he's like, 'Nah, nah, nah. I'm going to do my work.' And he would just power through it all the time. He would never give in. That speaks to his motivation but also speaks to his competitiveness."
Wilk said Noel did not miss a single rep in any workout during those six months.
"If he did two sets of 10 and the eighth, ninth, 10th rep wasn't good—he didn't like the quality of it—he would just do the whole set over," Wilk said. "Sometimes young guys can get a little flippant with it and they won't give max effort. But he quickly (gained) momentum in that second and third week, and really sailed from that point on."
After Noel declared for the 2013 draft in mid-April, his agency, Decus Sports Management, decided that him moving to Birmingham for the summer full-time to work with Wilk was "worth it for him to be with the best," said Noel's manager, Chris Driscoll.
Wilk, who first made a name for himself treating White Sox players in Chicago, has been working since 1989 in Birmingham with Andrews. Wilk's roster of NBA stars has included Scottie Pippen, Chris Webber and Vince Carter, and he led Shaun Livingston's rehab after injuring almost every part of his knee in February 2007.
"(We) spoke with Dr. Stephen O'Brien, one of the top surgeons in (SI.com's) 2012 rankings, and he said that Kevin Wilk is the best in the country, and that nobody is even close," Driscoll said.
"Stephen said Kevin never misses a beat—that he's so reliable and thorough. NBA trainers, in fact, go by what he publishes. (We) wanted to go to the guy who wrote those books (more than 155 journal articles, 98 book chapters and 685 lectures at professional and scientific meetings, according to Wilk's website)."
Noel's schedule with Wilk last summer consisted of two-a-days Monday through Friday. His first session from 8:30 a.m. to 12:30 p.m. involved the "most intense work," Noel said, which included agility or muscle-building exercises with squats and paddles. After lunch, Noel would engage in smaller drills and treatment from 2 to 5 p.m., and the final hour from 5 to 6 p.m. consisted of upper-body lifting. Saturday involved a condensed workout program for about three hours, and Noel had Sunday off.
Working with Noel, like other ACL patients, Wilk divided the recovery process into what he calls "four blocks." The first involves reducing swelling and re-learning the knee's motion, while enabling the overall leg muscles to get working again to prevent any atrophy. The second deals with building initial strength in the hip, core and hamstrings to develop even more control of the leg, so it doesn't feel weak or like it's going to give out.
The third block features "more functional-type stuff," such as agility and balance, and the final block involves on-court shooting and game-like movement to prepare for a return.
Wilk also implemented the latest technology he uses for ACL recovery. This includes newer cold and compression methods to decrease swelling; light sources to stimulate muscle cells; laser therapy to reduce inflammation; stimulation devices to help muscles fire to a higher degree and with a greater contraction; and underwater and anti-gravity treadmills, where you can run at 25 or 30 percent of your body weight.
The innovation extends to computerized, video game-like devices that show how much force you're generating. Wilk, who said the Andrews facility looks to create an "uplifting and stimulating environment" for players, described one such system that involves the leg press:
"You would be laying on your back and your feet are up on the platform, with whatever weight is on, and you do it for time—30-40 seconds of leg press," he said. "Looking at the screen, these balls are coming toward you and you have to dodge the balls. Every time you get hit, you get points taken away. Every time you dodge one, you get points. So each set you do it, you get a score.
"What happens is athletes being athletes and they want to beat their score or another, it gets competitive. We have a white board and we write the person's name on there. We have names like Adrian Peterson and other top athletes."
Noel said that kind of state-of-the-art machine helped him stay motivated through his recovery.
"Even with Kevin's personality and (equipment), he always keeps me engaged and not really getting bored of rehab," he said. "And I think that was a big thing as well, which helped me a lot through the whole process. I always had a great mindset, just definitely working as hard as I could to get back. But there were definitely times where you just don't feel the hard work and you have to really bring yourself together mentally—(not just) physically."
During the recovery, Wilk shared Noel's progress with the Sixers head athletic trainer Kevin Johnson. "We try to make it a collaborative effort with teams," Wilk said. When Noel returned to Philadelphia in mid-September, he had gained 21 pounds of muscle, felt more explosive and improved his outside shooting.
"When we were on the court, I'd say, 'Take 10 shots each at one of these points around the arc,'" Wilk said. "And 10 would turn into 30 because he didn't like the way they were going or he didn't like the feel or he wasn't making them."
Wilk, who said most ACL injuries occur to athletes between ages 16 and 26 because athletes are exercising in more of a competitive manner during that time, is aware of the latest trend in the NBA where teams are not rushing players back. While Wilk understands the "long-term investment" in a potential franchise player like Noel, he doesn't buy into the new strategy. He said he's always been more "criteria-based" than "time-based," and if a player responds to the treatments well in six months or 12, he's ready to play at that time.
However, because Wilk sometimes had to rein in Noel, he can see why the Sixers have held him out longer than usual. The mentality could be to prevent him from pushing himself too much too soon on the court.
"That certainly makes sense to me," said Wilk, who pointed out that a team's management has the ultimate say in when a player returns or not. "But his knee is totally healed."
Wilk noted that Noel's strong work ethic early in the rehab was a significant key for the entire process.
"A lot of individuals who are playing competitive sports don't make it back because they have a fear of reinjury," he said. "They kind of hold back and they don't quite get as aggressive with (their recovery), and it hurts their performance later on."
Many times in pro sports, fans read about a player having a "successful" surgery and his timetable for playing again, and stop there. There is an overall lack of awareness about what comes in between, which is where the actual recovery happens. The true measure of surgical "success" is usually a player's rehab process and how quickly and effectively he returns to game action.
Working with Wilk, Noel is well aware of the importance of that behind-the-scenes work.
"Kevin just really taught me the work of how you have to be diligent with the whole process, and just making sure you take your time with everything and just work progressively," he said. "Hard work is always the main thing, but you never want to overwork. You always want to be just smart, and get better and better."