Playing Injured

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Paul Rabil, Contributor - The Players' Tribune

Or, playing hurt. There’s a difference.

You’ve got bumps and bruises, you’ve sprained your ankle, you’ve got a gash on your forehead that requires stitches — that’s hurt. And at some point, we all play hurt. But injuries are something more severe — a concussion, a broken bone, or a muscle tear. Most injuries require a medical release to compete. When athletes play through injury, it’s at the risk of their long-term health.

I can’t express how frustrated I was when I found that I was injured, yet again.

As it was, 2014 had been a high-volume year for me in terms of games played. In the middle of Major League Lacrosse season, we took a break to participate in the World Championships, where I played seven games in ten days. Afterwards we jumped right back into MLL season, and late in the year I suffered a Jones fracture in my left foot. This is the same injury that’s recently afflicted the likes of Kevin Durant and Dez Bryant. I had to have season-ending surgery to repair it, and then immediately began rehab. Getting my foot back to where it needed to be was a tremendous challenge because with this type of fracture, you’re dealing with the smallest bone in your foot that happens to bear the most weight while getting the least amount of blood flow. For bones to heal, they need blood flow to the fracture site. Blood lends oxygen and oxygen promotes healing. My medical team’s plan was to do everything under the sun to promote the right healing, so I had a long process ahead of me.

I made it back in time for the start of the 2015 season. My foot had fully healed and I was medically cleared to play, but after the first game of the year, I could tell something was still off. I could feel pain from the 55mm screw. Doctors told me I would feel it and that “it was normal.” I was told I could get as many x-rays as I wanted, but I was reluctant to do so. Getting constant reminders of my injury would force me to over analyze my situation. which in turn would affect my mental repetitions. Out of sight, out of mind, I suppose.

HEMPSTEAD, NY - AUGUST 1: Paul Rabil #99 of the New York Lizards is announced prior to taking on the Boston Cannons at James M. Shuart Stadium on August 1, 2015 in Hempstead, New York. (Photo by Adam Hunger/Getty Images)

Shortly after I broke my foot, I was traded for the first time in my MLL career from Boston to New York. New York City — like I needed any additional motivation to come back. The franchise had a Miami Heat-like offseason where we’d compiled loads of talent. We had arguably the top attackman in the world, top draw man, best defender in the world, best midfielder in the world and best goalie in the world. I was part of a dream team, and the expectations couldn’t have been any higher. We got off to a blazing 8-0 start, and it seemed like everything was lining up.

But during the All-Star break, I got an 8-month post-op x-ray to see how the bone was doing. As it turns out, they located a fracture at the same site where I’d had the original surgery — calling it a “non-union.” It was devastating. I was confused. How was I able to manage playing with the same injury that sidelined me last year? It turns out that the 55mm titanium screw was actually holding my bone in-place. Much like what happened to Kevin Durant, this re-fracture presented us with some significant risk. If I kept playing, there was a chance I could manage everything well and get through the season. But there was also a real chance that I could break the screw. “What’s that like,” I asked. The doctor told me, “You know when you put an anchor in the wall and it breaks off? Having to get the anchor back out of the wall is tricky. It’s like that. If the screw broke, we’d have to dig it out, and really scrape around your bone.”

At that point, I had a decision to make.

Athletes usually are encouraged to portray a toughness standard that’s been around since the inception of sports. “An injury in your foot is the furthest place from your heart” type of coaching cliche. But the reality is there are some serious short and long-term risks associated with athletes wanting to prove their toughness. Playing injured happens more times than we care to count in sports, and is generally very widely accepted as an appropriate course of action. Seriously, how many times have you heard a prospect graded on “toughness” during the NFL combine?

The argument for not doing so is something we don’t hear too often because nobody celebrates the player who decides to put their health first. The “take one for the team” mentality has permeated sports so deeply that oftentimes athletes fear showing weakness more than any injury they could suffer.

HEMPSTEAD, NY - AUGUST 1: Paul Rabil #99 of the New York Lizards has the ball knocked away between Josh Hawkins #33 of the Boston Cannons and Brodie Merrill #17 also of the Cannons at James M. Shuart Stadium on August 1, 2015 in Hempstead, New York. (Photo by Adam Hunger/Getty Images)

Backtracking to the trade to the New York Lizards, the organization’s expectations for 2015, and the start we had to the year, I knew this would be a season to remember. And that was the ultimate hurdle for me in making a decision. Was the risk worth the reward? I went on a two-week IR to see if we could judge if there was going to be any healing when I laid off my foot. During that period, we dropped two games to the bottom two teams in the league. That gave me more to think about.

Athletes always have to weigh decisions relative to where they are in their careers. I’m 29 years old. In the general sense, 29 isn’t old. It’s a time when a lot of people are just getting settled into their careers. Across industries, there are laws in place to preserve your career when encountering injury. In professional sports, there’s rarely guaranteed money, and with every season that passes, there’s no guarantee you’ll play the following year. If you pass on an opportunity to be part of something special — like a championship — there’s no telling if the opportunity will come back around.

I look at players like Derek Jeter and Michael Jordan, and think of their journeys as the model to follow for success. But at the same time, I realize that’s a challenging benchmark. There are so few athletes that make it to the professional level, and among those who do, very few can play at an elite level well into their 30s. For the most part, the human body isn’t built to sustain high stress and impact movements for such a prolonged period. After awhile, injury isn’t happenstance, it’s the expectation. But there’s a deeper root in the cause/effect relationship. To get to the top, you have to train and compete harder and longer than your competition. That’s as real as it gets. But the wear and tear an athlete suffers over the course of a very long period of time is also very real. I think that’s one of the reasons you see so few players that are best-in-class late into their mid-30s. Injury is the Grim Reaper in sports.

I received several professional opinions on the re-injury so I could understand all associated risks and make a decision I was comfortable with. I wanted to win a championship with this group, and our opportunity was within reach. I think that’s where my 29-year-old maturity kicked in. A 22-year-old Paul Rabil would’ve be on a 1-6 team and said, “we’re gonna win the Championship, nothing will stop us. Not even this injury.” A 29-year-old Paul Rabil on a 1-6 team would have undergone surgery. But we were 8-0.

So I made the decision to play through the injury and get surgery after (hopefully) we won a championship.

Playing injured happens more times than we care to count in sports, and is generally very widely accepted as an appropriate course of action.

The pain was pretty constant. I’m a 220-pound athlete who needs to dodge hard and shoot from distance to build value. It’s the style I play. Every time I maneuvered towards the outside of my foot, I was testing that 55mm screw’s titanium strength. Each cut I made on the field was a risk. I just needed to make it six more weeks.

Because I wasn’t at 100 percent physically, I decided to do everything in my power to get myself in the right frame of mind mentally to play the game.

I announced to my teammates that I had re-fractured my foot, and then said it was the last time I wanted anyone to talk about it. I was going to finish the year no matter what it took, and I didn’t want the injury to creep into people’s mind as an excuse for bad play.

I was also very fortunate to have an incredible sports therapist, named John Eliot. We began working on different thinking and breathing techniques that helped me absorb and release the pain from injury. I began reading before games, writing quotes on ripped pieces of athletic tape posted to my locker, and frankly, spending more time doing things I previously wasn’t good at. Stuff like taking the rookies out to dinner, enjoying more time with my teammates and just generally appreciating the culture of a locker room, rather than being so focused on what I wanted to accomplish every time I stepped onto the field.

At halftime of games, our medical team would have stuff set up right away, so as soon as I came into the locker room I’d dunk my foot in ice, change out my orthotics and re-tape. During the week, I worked with Johns Hopkins Hospital physical therapy specialist, Ken Johnson, using shockwave systems, hawk grips and laser techniques to mend the fracture site and lessen the prior weekend’s blow. I knew by making the decision to play, it was on me to make sure I was in the best position possible to eliminate the distraction of my injury while also giving it the best care possible.

And in the end, it worked.

KENNESAW, GA - AUGUST 08:  Paul Rabil #99 of the New York Lizards celebrates after scoring a goal against the Rochester Rattlers during the 2015 Major League Lacrosse Championship Game at Fifth Third Bank Stadium on August 8, 2015 in Kennesaw, Georgia.  (Photo by Kevin C. Cox/Getty Images)

Our team pulled together to win the championship. Three days after the final game, I went down to Charlotte to see Dr. Bob Anderson, who’s widely recognized as the top foot and ankle sports surgeon in the world. He performed surgery, and now I’m rehabbing once again, preparing for next season and hopefully another run at the championship.

Was it worth the risk? That’s a difficult question to answer now because it happened to work out for me. But most athletes at all levels face the same type of decision I had to make at some point in their careers. What needs to be accepted is that there’s no right choice. The decision to play injured cannot be based on a desire to prove your toughness.

The pressure to play through pain and injury is ingrained in every athlete. The decision to do so is often simplified and glamorized by the outside world. But this decision wasn’t simple and it certainly wasn’t glamorous. So when we urge athletes to “tough it out” and “take one for the team,” let’s consider the full repercussions of what we’re asking them to do. Nobody wants to be on the field more than them.

It’s a difficult decision, but it’s theirs alone.

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