The mental and physical grind of rehabilitating an anterior cruciate ligament injury is about small victories. Full extension of the leg. Achieving time thresholds on the stationary bike and treadmill. Less and less post-workout soreness. Re-learning to trust your body.
“Get 1% better every day,” has been the mantra of Broncos receiver Courtland Sutton.
But Jan. 14 felt different. Under sunny skies, Sutton jogged for the first time. It was two sideline-to-sideline lengths measuring 100 yards, a fraction of the distance he will cover in a practice or game. But it felt like his Super Bowl.
In a process of minor wins, this was a significant.
For just a few minutes, Sutton felt like a football player again.
“It was such a surreal moment,” he said in an interview with The Denver Post last week, his first since being injured in the Broncos’ Sept. 20 loss at Pittsburgh. “I stood there, looked at my cleats, looked at the grass and just took in the moment. The last time I had cleats on was the day I got hurt.
“To jog like I did, 50 yards down and back, it was humbling and puts everything into perspective of how precious the day-to-day things are, like waking up and walking, like getting out of bed and your knee isn’t hurting, like being able to go up and down the stairs. It makes you appreciate all those little things even more.”
The Broncos’ appreciation for Sutton only grew in his absence. The passing game was projected to go through him last year, but once their best offensive player was lost after 20 snaps and three catches, the offense scuffled during a 5-11 season.
After his workout last Tuesday, Sutton, who now has jogging as a regular part of his routine, detailed his injury, the rehabilitation process and how he wants to “dominate” when he returns in September. Every day — every single day — is a step forward and being on the field two weeks ago was monumental.
“It’s so important,” said Dr. Burt Mandelbaum, an orthopedic surgeon and co-chair of medical affairs at Cedars-Sinai’s Kerlan-Job Institute in Los Angeles who specializes in ACL surgery and recovery. “To smell the grass, to put your practice gear on, to move around and feel the wind — it’s such an important motivating and emotional and inspiring step in their rehabilitation.”
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”Oh No Moment”
Sutton’s first injury adversity came in a Sept. 10 practice, four days before the season opener against Tennessee. During a routine drill, Sutton went up to catch an off-target pass and landed on his shoulder, sustaining an AC joint separation. The Broncos’ loss to the Titans was the first missed game of his career.
“I feel like I have to catch everything; I should have let it go,” he said. “I tried to catch it and tried to tuck-and-roll like we’re taught and I didn’t tuck all the way. I felt something pop. I knew something wasn’t right, but I didn’t know exactly what it was. I was able to get it to a spot that I felt semi-comfortable to go out and play (at Pittsburgh). I felt at my 70%, I could contribute.”
Sutton debuted against the Steelers and offensive coordinator Pat Shurmur dialed up the opening play for him, which resulted in a 29-yard catch. After Drew Lock left the game because of an injured shoulder, Sutton caught passes from Jeff Driskel for gains of one yard and 45 yards. He looked like the same exciting Sutton.
But then it was all over.
Sutton lined up on the right side of the formation, ran forward 10 yards and broke toward the middle of the field. Driskel’s pass was slightly high but catchable. Sutton jumped but the ball went through his hands and was intercepted by Joe Haden.
Sutton never gave up on the play, missing the initial tackle, but still chasing Haden and eventually pulling him to the turf. In the pile of bodies, he immediately grabbed his left knee.
“I caught a cramp at the same exact time so when (it was reported in-game) as a cramp, it really was,” he said. “I had no idea I had torn my ACL. I thought the cramp was really severe and once it went away, it would stop pulling on my knee and it would start to feel better.”
Sutton didn’t want to go to the locker room to get an IV (“I’m not a big fan of needles”) to treat the cramp, but acquiesced and only then did he become concerned.
“Things didn’t feel right, but I said, ‘It will go away eventually,’” he said. “We get back outside to the front of the tunnel and our trainers said, ‘Jog to the goal-post to see how it feels.’ I literally took two steps and that was definitely my, ‘Oh No Moment.’”
Season over.
Sutton has watched a replay of the injury “maybe twice. I guess you could say it’s a freak thing, how my body was, how many people were around me. It was just an uncontrolled situation.”
What Sutton could control: His return-to-play mindset. There was no time to be depressed, no time to think about the future, no time to ask, “Why me?”
“I gave myself a very small window to sulk,” he said.
A really small window.
“Maybe three minutes,” he said. “They told me I had torn my ACL and obviously my season was over so there was a moment when it hurt and I knew I wouldn’t be able to play the game I love and be around my boys and do something I’m really good at. I let myself have a little pity, but then I pulled myself out of that hole because I’m a big believer in positivity and if you can even trick yourself into perceiving things are OK even when they aren’t and have an attack mindset, I feel like you put yourself in a better situation.”
In the Heinz Field locker room, receiver coach Zach Azzanni delivered his first post-injury message.
“Listen, this is a different challenge for you. This isn’t going out and game-planning and playing, this is having a game plan and attacking the rehab and your strength and conditioning — you have to flip your mind into, ‘This is my new season,’” he told Sutton.
Sutton underwent surgery a month after the injury. His new kind of season was underway.
“How Can I Get Better Today?”
Mandelbaum, who has served as chief medical officer for Major League Soccer, said ACL surgery is put on hold for 2-5 weeks so the capsule containing the cartilage and ligaments gets “sealed up and that makes the surgery easier and allows for some of the meniscal tears to start healing. You have a slower start, but come out of the blocks faster.”
The reality of the rehabilitation road for Sutton hit him with a thud when he started light mobility training.
“Having to learn how to walk again was the most humbling thing,” he said. “And then it was learning how to walk normally.”
Mandelbaum said the rehab process begins with leg lifts and gentle squats and advances to walking (2-6 weeks post-surgery) and riding the stationary bike to build strength in the hip and lower-extremity muscles. The workouts generally last around an hour so as to not overstress the knee, but also the hip, quadriceps and hamstring.
An important landmark for Sutton was jogging on the Alter-G, an anti-gravity treadmill in which his lower body is in a pressurized air chamber that reduces the pounding. He started at 60% of his body weight (he is listed at 216 pounds).
“It’s a fantastic way to begin running and just such a great tool,” Mandelbaum said. “We couple that with cycling and a couple of rehab exercises like blood-flow restriction and we put it all together. It’s an orchestra of things we put together and it is one step at a time.”
Sutton’s process was led by Matthew Kee, the Broncos’ director of rehabilitation and assistant trainer.
“It’s fun because Matt pushes me,” Sutton said. “I know where I want to get to and he helps me understand by saying, ‘You may not be able to get this on Monday, but keep working and come Thursday, when you do the workout again, it will be easier.’”
Azzanni witnessed one example last week.
“He said, ‘Look at this, Coach,’ and he moves his leg completely straight out and he says, ‘I couldn’t do this two weeks ago,’” Azzanni said. “You can see his face just light up. Little goals are huge landmarks.”
Kee served as Sutton’s top teammate because players with season-ending injuries are detached from their position group and coaches, especially under the league’s COVID-19 rules which called for virtual meetings. When the receivers were going over the game plan, Sutton was doing his morning rehabilitation. When they were walking onto the practice field, he was driving home, his day completed. And when they were on the road for games, he was watching on television.
Thus the mental gymnastics for player and training staff.
“Optimism and positivity are so essential for these athletes because that’s what makes them great in the first place,” Mandelbaum said.
As the day, weeks and months clicked off the calendar, Sutton’s goal remained a constant.
“It was, ‘How can I get better today?’” he said. “I’ve been attacking each day ferociously and pushing myself to different limits and making sure I don’t stop when I feel comfortable. When they give me the go-ahead-and-play call, I want to look back and say I gave it everything that I possibly could every single day to go out and perform at a high level whenever that time rolls back around.”
Not sweating contract
If the coronavirus pandemic allows for any kind of offseason program this spring, that time will arrive in brief spurts. Sutton said his participation will be “something we dip our toe into. The biggest focus is getting me to the season. They’re going to baby-step me into it and let me do some position stuff.”
By the spring, Sutton will be at the seven-month mark post-injury. Mandelbaum said an ACL recovery entails six “basic maneuvers” — stepping down, cutting, shuttling side to side, deceleration, triple jump and jumping down.
“They have to check the box on each,” he said. “They need to have it all together — the biomechanics, the strength, the moving patterns and, coupled with the emotional part, it’s a very complex grid.”
The rehabilitation is complex. Each day of progress feels like a touchdown, each jog up and down the field feels like a victory. Sutton hopes his future is less complicated.
Had he matched his 2019 season (72 catches-six touchdowns) with a similarly productive 2020, he might have been in-line to receive a contract extension from new general manager George Paton. But now? Sutton is back in prove-it mode.
He is scheduled to be a free agent in March 2022, but is confident he can compartmentalize the on-field and business aspects of his professional life. The last four months have hardened his already tough resolve and the next seven months will be testing, but he is embracing the grind.
“I’m not going to sweat about it,” he said. “The contract is controllable to an extent, but what I can really control is how I meet, how I practice, how I play. I’m going to continue to dominate this rehab and come back next season and dominate every practice and dominate every game. I’ll make sure to do those things so when it’s time to have a conversation, I’ll know I’ve done everything I can to put me in a position to get the best out of that next contract.”
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