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Anatomy Of An ACL Injury

The number of devastating knee injuries in sports has been off the charts recently. They've been tough to watch, especially for Dan Grunfeld, because he knows exactly how it feels.

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It was the first night of the 2012 NBA Playoffs, and my stomach turned as I watched Derrick Rose, the reigning MVP of the league, crumble to the floor, wincing in pain and grabbing his knee after a routine jump-stop in the lane went terribly wrong.

Then, a few hours later, when stand-out Knicks rookie Iman Shumpert executed a simple crossover dribble, only to have his left leg buckle, dropping him to the ground in obvious agony, I grew even more distressed.

I thought back to how it had felt a few months earlier when Spanish phenom Ricky Rubio tore his ACL in a random collision with Kobe Bryant, just as he was captivating the basketball world, and I considered grabbing my comfiest blankie and hitting the couch for a Tom Hanks rom-com marathon.

Ultimately, I reconsidered my coping strategy, but the sudden rash of devastating knee injuries was taking its toll on me, and that was before Mariano Rivera (ACL) and Baron Davis (dislocated patella) also hit the deck in dramatic fashion. To deal with what I'd witnessed, I decided to take the manly route: I called my sister to commiserate.

"It must be really scary," she said, "to lay on the ground like that, in a lot of pain, in front of all those people, without knowing exactly what's wrong with you."

I paused for a second, still affected by what I'd seen. Obviously, it's difficult for any fan to watch a supremely talented athlete fall to the floor in a heap and not be upset by it. That's normal, but it's especially true for me when the athlete is a basketball player, and even more so when it's an ACL injury.

The reason: I've been there before.

I've felt a knee give out on the court. I've been the one on the ground, panicking, grabbing my leg and writhing in pain, with television cameras fixed on me and with my family and friends watching from home. I've been in that position, and I know how it feels.

"Truthfully," I told my sister, "it's not scary because you don't know what's wrong with you. It's scary because you do."

Yes, I actually said that. And yes, it sounded quite after-school-special-y, but since I own and operate a few very snazzy Mr. Rogers-inspired cardigan sweaters, I'm cool with that. And besides, it also happens to be true, at least in my case. I can't speak for these other guys, but when I went down with an ACL, I knew right away that it was bad.

What I had no way of knowing at the time, however, was what would come after a debilitating injury like the one I'd just suffered. I'd learn all about that soon enough, but at the moment of impact, I knew that something was wrong. Of course, all injuries are different and personal in their own ways, and mine was no exception, though it certainly can provide a glimpse into what it's like -- physically and emotionally -- to be the athlete who crashes to the floor when it's least expected, your worst fear realized in the blink of an eye.

My injury happened near the end of my junior season at Stanford. We were playing our biggest rivals, Cal, in a nationally-televised game on our home court. Like Rose, Shumpert and Rubio, I was doing something that I'd done countless times before. My head was down, my arms were pumping, and I was charging forward on the fast break, filling the lanes with gusto while my point guard pushed the ball up the floor. I was trying to run a little bit harder than everyone else because -- since I wasn't the most athletic, dynamic, or gifted -- I needed that extra effort to be a good basketball player.

I played the game with purpose, and that was why, at that very moment, I was the second-leading scorer in the Pac-10 Conference, ahead of guys like Brandon Roy, Nate Robinson and Channing Frye. I also happened to be the most improved player in college basketball that season, sporting the highest scoring increase in the entire nation from the previous year.

My hard work was finally paying off, and I basically would have run through a wall on any play if it meant a bucket for my team.

So there I was, barreling down the right side of the court like I was hopped up on Mountain Dew, headed straight toward the rim, when the pass came. It was the type of play that I could finish in my sleep, but as I caught the ball with my right hand and planted my right foot into the ground to stop my sprint and lift toward the basket, I felt the dreaded "pop" familiar to those who have suffered ACL injuries. It was like nothing I'd ever experienced before. It's a difficult feeling to put into words, except to say that it's a very, very unnatural sensation to occur inside of a knee. It definitely hurt, but more than anything, it just felt weird.

Too weird to be good.

Instantly, the ball flew out of my hands, and I was face down on the baseline, grabbing my knee, with my teammates looking on and my head trainer kneeling beside me.

"Did you hear a pop?" I remember him asking once he'd reached me.

"I think so," I said in a voice that could have either been a scream or a whisper.

There were other questions, too, but in that convoluted moment that every athlete fears, I don't recall much. Eventually, my trainers peeled me off the floor, put my arms around their shoulders and led me to the training room.

As we reached the back of the arena, having hobbled out of everyone's view, I asked our medical staff to stop moving for a second. They propped me up in the hallway, and almost instantly, the tears came. Not out of pain, obviously, because a rugged fella like me would never cry from pain, especially since I'd recently started wearing Brut Cologne. Instead, the waterworks were from pure emotion. For a motivated kid who had just turned 21 a few days earlier, my future as a ballplayer had just been turned upside down. The situation was so much more painful emotionally than it was physically, and all I could do was let it out.

It happened naturally, and after I told everyone in the hallway that I'd give them a Hulk Hogan boot to the face if they ever told anyone, I was examined in the training room. Our team doctor suspected it, and an MRI would later confirm it: I had a torn ACL. My breakout season had come to an abrupt end and I would need surgery as soon as the swelling subsided.

Immediately, I had two questions for the doc, and I'm pretty sure they were the same ones that Derrick Rose, Iman Shumpert, Ricky Rubio, or any other athlete would ask after an ACL injury: how long will it take to get back, and will I ever be the same again? Our team doctor estimated the recovery time to be between six and eight months, and he assured me that it was possible, and even probable, that I would come back better and stronger than ever.

On a Wednesday morning, 10 days later, I had the operation. By that time, I had realized that while I couldn't control getting injured, how I responded to it was completely up to me, so I made it my mission to attack my rehab with positivity and enthusiasm. That was my mindset as I entered the recovery stage, the same one that Rubio is in right now, and that Rose and Shumpert (and Rivera and Davis, for that matter) will enter shortly.

And though I can't say exactly what their respective ACL rehabs will be like, because everyone's is different, what I can say is that each recovery will be long, tough, and ultimately, will offer important learning experiences throughout.

At its core, the physical journey to get back to basketball after ACL surgery is grueling. In my case, it meant spending six hours a day for the first few weeks after the operation in a machine that bends and straightens your leg for you, at a preset angle, in order to regain range of motion in your knee. It meant relearning how to fire my quad muscle, which had become so atrophied from inactivity that I couldn't even access it anymore. It meant schlepping myself around on crutches for a month, much to the chagrin of my very delicate armpits.

It meant learning to walk again, which I did by limping laps around my grandma's apartment while she watched Wheel of Fortune.

It meant having to gain back the 20 pounds of muscle I had lost, something that required me to rebuild both my upper and lower body. It meant hours on the underwater treadmill, hours on the stationary bike and intense walks at an incline, backwards, on the regular treadmill. It meant four days a week of squats, step-ups, box jumps, balance work, hamstring curls, cone drills, calf raises, and any other leg strengthening exercises you can think of in addition to cardio. It meant icing my knee, every day and every night, non-stop, with no excuses.

And eventually, it meant jogging again, then running, then sprinting, then cutting and, finally, working out on the basketball court.

Seven-and-a-half months post-op, our team ran our annual pre-season mile, and I participated wearing a knee brace, winning the race with a time of 5:10, only five seconds slower than I had run it the previous fall. I had maintained my faith and focus throughout the process, and as a result, I made it back in time for my senior season. I'd proven that I could still run a good mile, and I managed to play that whole year without missing a game, but was my doctor right? Did it take six to eight months to recover, and did I come back better than ever?

Well, I started playing five-on-five basketball games eight months after surgery, so my doctor was right in that regard, but when I returned, I wasn't anywhere close to where I'd been before. Physically, I could move around well enough, but I didn't have the same type of force that I'd had the previous year. My explosiveness, balance, and timing were all off, and while I was a step slow physically, I was even further behind mentally. I was scared. I was timid. I wasn't confident with my knee. I started to doubt myself, and as a result, my production dropped off dramatically. It wasn't until the season ended that I really started playing like myself again.

That year-plus duration might seem disappointing, especially for fans of Rose, Shumpert, and Rubio, but it also proves that my doctor answered the second question correctly: despite the long process of ACL recovery, eventually, it all comes together again. The legs acclimate themselves. The mind remembers what it's like to make moves without thinking. The athleticism reappears. The comfort-level rises. The confidence returns.

And, just as importantly, the heart and soul move on from the injury, equipped with the added patience and resiliency gained along the way, so that you start to think of yourself not as a player recovering from an injury, but rather as a player with an enhanced set of experiences, one who very well might be better than he was before.

Obviously, I can't say for sure what the NBA's most recent ACL sufferers will be like when they come back, but my money is on all of them to make full and impressive recoveries. They're young, they're hungry, and I know firsthand that it's possible to emerge from an ACL injury as a more complete version of the player you once were. Even though it might take some time, it's worth the wait.

When I got hurt, I had just turned 21, not unlike Shumpert and Rubio. Now, at 28, I still remember a lot from that day, but it's not at all painful to talk about. Actually, I enjoy discussing it, because it's a formative event in my life. As with all serious injuries, experiencing an ACL tear and the subsequent recovery teaches you so much about hard work and perseverance, but more than anything, it makes you live through a situation that proves the extreme importance of attitude in life. It forces you to learn to take the bad things that happen along with the good, to not feel sorry for yourself about it and to embrace the process with a positive attitude, no matter how hard it may be.

I felt pretty low when I was lying on that floor holding my knee ... and when my bedpan aim was not as true as it needed to be after surgery ... and when I struggled through my senior season wearing a bulky knee brace ... but I got through the adversity with positivity. I'm glad I did because I'm still a pro player today, and I've had zero knee problems since those days.

For sports fans, it was terrible to see Rose, Shumpert and Rubio go down when they did (Rivera and Davis, too), and I guarantee it was even worse for them. But, as I learned from my own ordeal, it's not about going down, it's about getting up.

When it comes to ACLs, I've been through it, and I have no doubt that sports' most recent ACL-sufferers will get back up too. It won't be easy, but when they do turn the corner toward recovery, I'm sure they'll find that this unfortunate experience will prove extremely rewarding for them, both as players and as people.

Personally, I can't wait to see them back in action. I'll be rooting for them.