Last week, San Francisco 49ers linebacker NaVorro Bowman went under the knife. Dr. James Andrews performed the surgery, which basically involved grafting a tendon from another part of his body to replace the torn ACL. From all accounts, including this from Pro Football Talk's Josh Alper, the surgery went well, and now the long process of rehabilitation begins.
The timing has actually worked out well for Bowman so far—the doctor had to wait to operate on the ACL because he had also torn his MCL. That injury needed two to three weeks to recover before Bowman was cleared; the ligament had swollen enough to be an additional complication for the surgeon.
The tears occurred on January 19, while the surgeries took place February 4, so that falls on the shorter end of the wait time needed. This is a good sign—the MCL wasn’t fully torn, so Bowman’s knee should be more stable during the ensuing rehab.
It’s always difficult to put an exact timeframe on recovery from injuries like this. It could take over a year for everything to fully return to full strength, or it can turn out like Adrian Peterson's experience, and a player can be at full form starting from Week 1 the next year.
The accepted recovery time is six to eight months, which, with the regular season seven months away, would leave open the possibility that Bowman could be in the starting lineup from the very beginning of the season. On the other hand, it also makes a stay on the PUP list, meaning he would miss the first six weeks, a distinct possibility.
How do you recover more like Peterson and less like Derrick Rose? A lot comes just from differing physical characteristics of the body in question—some people simply heal faster than others, regardless of how much work you put in. There is no magical formula, no set routine you can do to ensure a fast return.
We can, however, compare fairly typical recovery timelines, courtesy of Kelly Hansen of Gameready.com, with the offseason calendar and try to figure out how and when Bowman might be able to participate and get ready for the 2014 NFL season. It’s nothing more than a rough rule of thumb, but it’s a way to judge how Bowman’s doing and whether it will be a slow or fast recovery.
Throughout the first half of February, Bowman’s main goal will be to restore his ability to fully extend his knee, getting full range of motion back. We’re not talking about using the knee to actually support his weight at this point—it’s mostly trying to keep swelling down and preventing permanent loss of motion in the knee.
By the time the NFL Scouting Combine starts on February 19, Bowman should be doing some basic walking exercises and beginning to strengthen the new ligaments. If he’s still in crutches at this point, that’s a bad sign—it would indicate the knee isn’t ready to support his full weight. On the contrary, this is the point where he could start working out on treadmills and step machines and the like.
The first offseason workouts begin toward the end of April, and Bowman won’t be joining those. He won’t be able to do too much side-to-side motion or pivot very well, but straight-line work might well be possible—i.e. jogging.
One of the key steps here is mental, rather than physical—it’s learning to trust the knee once more. That’s an issue that you saw Robert Griffin III struggle with on his return in 2013—it took him some time to really be able to cut loose in the same way he did pre-injury.
The NFL draft comes up on May 8, and if Bowman has had serious problems by then, the 49ers could look for help with a later-round pick. By this point, Bowman might be able to begin jumping again—basically learning to transfer his weight on and off his knee quickly, without pain.
This is a difficult step, simply because there’s a natural competitive tendency to overwork the new tendons—the pain is gone, so why not go all out? It’s a tough instinct to overcome, as you have to slowly work the tendons back into shape.
The middle of July will see the 49ers training camp open, and by this point, Bowman will be hard at work in the middle of his rehab. Cornering and changing direction will be the key limiting factor at this point—the ACL keeps your knee stable when you rotate it, making that lateral movement the big limiting factor to seeing Bowman back on the field once more.
It’s far too early to make any solid predictions, as there are so many tiny variables that can significantly alter an athlete’s recovery time. Nevertheless, looking at previous recovery times, as well as the comparative lateness of this injury as compared to, say, Peterson’s injury in the regular season, can give you a brief picture.
Expecting Bowman to be back before October is probably wishful thinking—in an ideal world, he probably comes back sometime around Week 3 in a reserve capability, as he works his way back into full strength. That would be a major problem for most teams, but the 49ers have Patrick Willis on the other side, a luxury few teams can boast about.
When Willis went down this year, Bowman led the team in tackles and assists, and it looks like the beginning of the 2014 season will be Willis’ turn to return the favor. Directly replacing Bowman in the lineup will likely be Michael Wilhoite, who played solidly in two starts this season. Together, they hope to paper over Bowman’s absence.
The 49ers have the depth to absorb this injury, but they’ll still be hoping Bowman hurries back soon—and that their schedule is somewhat back-loaded, allowing Bowman to participate against their toughest matchups next season.