By Jay Busbee
Originally appeared on Yahoo! Sports
Tiger Woods has triumphed over the greatest challenges possible on a golf course. But he has never faced a test like the one that’s before him now.
Woods suffered severe injuries to his legs in a one-car rollover on a Los Angeles area street Tuesday morning. He was driving on a winding residential road when his SUV hit a sign, a curb, crossed over two lanes of oncoming traffic, traveled down into a gully and ended up driver’s-side down. The fact that Woods survived that initial impact was the first good sign.
Woods was conscious when first responders arrived on the scene, and “awake” and “responsive,” according to his team, late Tuesday evening. Between those times, though, he underwent hours of extensive surgery, the first steps in what will be a long and arduous recovery.
Two questions face Woods, one immediate and crucial, the other long-term and aspirational. First, can Woods have a normal life, with typical mobility and freedom from pain? Second, can one of the world’s best-known athletes ever return to competitive golf?
Yahoo Sports spoke to several surgeons with extensive experience in treating injuries similar to those Woods suffered. Without having reviewed Woods’ specific case file — and with the caveat that there may be undisclosed elements of Woods’ case that could impact any prognosis — all agreed that a return to a normal life is highly likely, and a return to elite-level golf isn’t out of the question.
“Tiger has a very, very, very long road to recovery ahead,” said Dr. Kirk Campbell, an orthopedic surgeon at NYU Langone Health, “and based on the information we have, returning to being an elite golfer would be very challenging. But I would not root against him.”
The extent of Woods’ injuries
The simple fact that Woods is in treatment at all, given the way his SUV left the road and came to rest, is good news.
“Any time there is a rollover accident where the car gets off four wheels, you can die,” said Dr. Brian Polsky, an orthopedic surgeon at the Centers for Advanced Orthopaedics in Washington, D.C. “The trauma involved in that is very unpredictable, even with seatbelts and airbags. From that standpoint alone, he’s fortunate.”
Late Tuesday evening, Woods’ team released a statement documenting the extent of his injuries. Dr. Anish Mahajan, CMO and interim CEO at Harbor-UCLA Medical Center, indicated that Woods suffered “significant orthopaedic injuries to his right lower extremity.” In detail, those known injuries and treatments included:
- Comminuted open fractures on both the tibia and fibula. “Comminuted” means Woods’ bones broke into more than two pieces. “Open” means the bones broke through the skin. “The bone saw the outside world, which is very bad,” Polsky said. “That means there’s a significant increase of infection.”
- Insertion of a rod to stabilize the tibia. Doctors inserted an intramedullary nail in Woods’ tibia, running it from his knee toward his ankle. The nail is 12 to 16 inches long, depending on the length of the patient’s tibia, and will remain in place. This is a standard procedure in cases of this type, and long bones typically heal well.
- Insertion of screws and pins to stabilize the foot and ankle. “This may be the bigger issue,” said Dr. James Gladstone, chief of sports medicine at The Mount Sinai Health System in New York. “If it’s a simple ankle fracture, those can get fixed, and people do very well. If it’s complex or severe, the risk is that the ankle gets stiff during the course of the healing process.”
- Surgical release of the covering of muscles of the leg. “Any muscle has a covering over it like skin,” Gladstone said. “If you’ve had trauma, the muscle swells, and you may have to do a fasciotomy, where you cut that covering to keep the muscle from being strangled.” Fasciotomies often require the wound to be left open in order to let the muscle subside, which in turn increases the risk of infection.
All of these procedures will require a minimum of several days in the hospital, and possibly much more once the trauma team sees how Woods responds to initial treatment. Antibiotics will be a necessity, and likely additional surgical treatments.
“Open fractures can require multiple debridements, which is a fancy word for cleanups,” Polsky said. “That’s not uncommon. He could potentially require additional procedures for skin coverages, skin grafts and muscle grafts, depending on how bad it is.”
Then Woods will leave the hospital, and the real work will begin.
Rehab and recovery
This won’t be the first rehab session for Woods — or the second, third, fourth or fifth. Woods has undergone multiple surgical procedures all over his body, most recently his fifth back surgery just before last Christmas. Each time, Woods rebounded, sometimes slowly, sometimes triumphantly.
“Unfortunately, it’s very possible that he may not physically be back to 100 percent, ever,” Polsky said. “But the person you’re dealing with, someone of that athletic level, that amount of mental strength, that focus he has, definitely adds to the potential of him returning.”
The mental aspect of Woods’ recovery will be a crucial one, but given his well-established tenacity, that aspect of his treatment isn’t as much of a concern. Take it from the people who’ve seen that up close: the players he has competed against, and beaten, for the past two decades.
“We all know he’s a strong cookie physically, mentally,” Tony Finau said Tuesday while practicing for the WGC-Workday Classic in Florida, “so if someone’s going to get through this, he will, and be back for the better, I’m sure.”
That’s a hopeful diagnosis, not a medical one. Before Woods walks up another fairway, he’ll need to walk out his front door. That alone will require months of physical therapy.
“I would imagine that when all is said and done, he’s in very good hands, so he has a very good chance of having a basically normal life,” Polsky said, “being able to walk, be a father, maybe even to some extent be athletic, depending on recovery.”
What about his day job? That’s another matter entirely.
Can Woods ever play competitive golf again?
Golf fans with an eye toward history have noted the similarities between Woods’ accident and that of Ben Hogan, who lived through a devastating wreck in 1949, suffering a fractured pelvis, blood clots and a range of other injuries. Hogan recovered and went on to win six more majors. Could Woods enjoy a similar resurgence?
Again, that’s probably more optimistic than realistic. Woods, 45, is 12 years older than Hogan was at the time of his accident. Even before Tuesday, Woods’ career was on a slow decline. Since his landmark Masters win in 2019, he has missed the cut in three majors and hasn’t cracked the top 20 in any of the others. He’s slipped out of the world top 50 for the first time since 2018. On Sunday at the Genesis Invitational — in which he did not play because of his back — he was tentative, at best, about his prospects for the Masters. Now? Who knows?
“That’s the $10 million question,” Polsky said. “There are fairly simple compound fractures that are open that are treated effectively with one procedure, and that individual can return to whatever their pre-injury status was.” He cites the example of one of his patients, an Olympic athlete who suffered a similar open compound fracture and later returned to the Olympics.
Campbell pointed to Alex Smith, the Washington Football Team quarterback who suffered a similar injury to Woods — broken tibia and fibula, along with nerve damage — but still returned to the field two seasons later and kept Washington in the playoff hunt.
“It all depends on concomitant [associated] injuries,” Campbell said. “Right now we don’t know the details of his foot and ankle injury. And we’re not even speaking about his lower back. He’s still rehabbing from the recent surgery on that.”
Worth noting: Woods’ team focused on trauma to the right leg, although initial reports indicated that he had broken bones in both legs. Whether that means his left leg was not as severely damaged, or whether Woods’ team is keeping that information private, remains unknown. But if the primary injury is to Woods’ right leg, that carries some small glimmer of hope for his golf game.
“For a right-handed golfer, a lot of the power and torque goes through the left leg at the hip, the knee, the ankle,” Polsky said. “If the right leg got to 90 percent, he probably could be playing potentially competitive golf. If the worst of [the trauma] was to the right leg, that’s mildly positive.”
Assuming Woods recovers at a projected rate, he won’t be able to return to a golf course for months. Given that his focus now is on winning majors, it’s likely he’ll miss the entire 2021 major season, which runs from mid-April to mid-July. That could mean we won’t see Woods tee it up in any tournament until 2022.
“It can really cover the spectrum,” Gladstone said. “It can be he returns without any problem, or he can’t return at all. Without knowing more about his specific injury and how he’s responding, we just don’t know yet.”
“We all know Tiger is such a tremendous athlete, and he’s proven time and time again that he’s super-dedicated in terms of rehab,” Campbell said. “But the injury that he had will need several months before he’ll be back to functioning at a reasonable level.”
Whenever he’s ready, the game will be waiting for him.
“I have no doubt in my mind he’ll be back,” Bryson DeChambeau said. “Take him a little longer, I’m sure, but from my perspective he’s one of the most impressive human beings I’ve ever met and I think that he’ll come back just fine.”
Rory McIlroy, one of Woods’ heirs in the game, offered a more philosophical perspective. “He’s not Superman,” McIlroy said Wednesday. “He’s a human being at the end of the day. And he’s already been through so much. At this stage, I think everyone should just be grateful that he’s here, that he’s alive, that his kids haven’t lost their dad. That’s the most important thing. Golf is so far from the equation right now, it’s not even on the map at this point.”