On Injury Front, the Macho Tough-Guy Mentality is Fading Fast

Chicago Bulls All-Star point guard Derrick Rose had no intention of returning from a torn knee ligament until he was ready, regardless of the timetables offered by doctors, the team or fans.

New England Patriots tight end Rob Gronkowski, who had numerous offseason surgeries on his forearm and another on his back, was cleared to play last week by team doctors, but he did not take the field -- his independent physician did not agree.

South Carolina Gamecocks defensive end Jadeveon Clowney has been bothered by injuries and sat out a game, prompting accusations that Clowney, projected as a top draft choice, doesn't want to risk further injury and jeopardize his NFL career.

Injured players still want to play, but fading fast is the macho, tough-guy mentality that dictates athletes should play through injury whenever possible. With increased attention on player safety and greater access to doctors and medical information -- as well as athletes' awareness of the relatively narrow window for them to earn significant money -- the trend is for players to take a longer look at how soon they return.

For others, the old-school mentality persists. Los Angeles Dodgers infielder Michael Young keeps his pains silent and said a big-time salary comes with a responsibility.

"We all understand we're in a very fortunate situation in this game, being able to make money," Young said. "But if you do make a lot of money, you owe greater responsibility. You've got to be out on the field. Your teammates have to know you're accountable (and) you're going to be out there hurt.

"There's something that comes with that money. If you're going to get an off day, it shouldn't be against a team's ace. The guy subbing in for you shouldn't have to face Clayton Kershaw."

Said Matthew Matava, team physician for the St. Louis Rams and president of the NFL Physicians Society: "They don't want to come off the field. They're afraid of losing their job. They're afraid of their teammates thinking they're not tough. There's lots of dynamics that go on as to when a player goes back to play."

Former NFL Pro Bowl safety John Lynch, a Fox Sports analyst, says he was that type of tough guy but might do things differently now.

"There is a great amount of money involved," Lynch told USA TODAY Sports. "My perspective has changed a whole lot. When I was playing and when I was in that world, I was always to a fault -- I would come back too soon. Ultimately, people have to clear you, but you have some influence on that."

What's different these days, though, is the number of people who determine whether an injured player is fully healed. In the past, it was the team doctor, team trainer and athlete making decisions -- if they all agreed a player was ready, he played. These days, it is common for a player to seek second and third medical opinions and work with a personal trainer. While Gronkowski drew criticism for sitting out after his medical team declined to clear him, Dodgers President Stan Kasten says his club welcomes outside help.

"That's something we didn't do as much of in past years. We want to make sure we have the best information we can possibly get," Kasten said. "At the end of the day, we all have the same goals -- to get 'em healthy and get 'em productive.

"But you can't declare someone healthy if they don't feel healthy."

Same goal, different process

The basics of recovery remain the same: Treat the injury and make sure the damage is healing. Then it's rehab, to ensure muscles are responding and a full range of motion has returned.

But today, doctors, trainers and physical therapists also are armed with more information than ever. Just as there is advanced analytics in sports statistics, there's advanced analytics in medicine.

The improved science has made obsolete the standard timetables on injuries. Phrases such as "out for four to six weeks" have given way to a more individualized approach.

"There's no question it's a case-by-case basis," said James Gladstone, the co-chief of sports medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York. "Ultimately, it's the athlete who feels whether the joint is responding properly or not. For some people, it can certainly take longer than others.

"You can tell someone structurally everything is good to go, but you have to rebuild the confidence in it. It's almost more subconscious than anything else. They've been told by everyone that it works. They see that it works. Yet they're not performing like it works totally."

Rose and Gronkowski have ushered in a different era of handling returns from injuries, choosing long-term benefits (lengthy career and significant financial rewards) over short-term gains (wins now).

It is an approach both criticized and applauded.

Some portray the player as selfish, scared and/or motivated by money.

Others say caution is the smartest way to protect a career.

In the case of Gronkowski, who the Patriots say is a game-time decision this weekend, he has been lauded and vilified, with his mother saying this week that her son was dying to play but not ready yet.

Helping or hurting?

It doesn't relieve the pressure to play when an athlete such as Los Angeles Lakers guard Kobe Bryant vows to recover quickly from surgery on his Achilles tendon.

Or take the case of Minnesota Vikings running back Adrian Peterson, whose unbelievably quick return from a torn anterior cruciate ligament -- and subsequent MVP season in 2012 -- made for a feel-good story but reinforced unrealistic expectations for other athletes.

Bryant, a 17-year veteran who has made his fortune, is at the point of his career where an expedited return makes sense. Peterson, 28, knows the market value of running backs diminishes once they hit 30, and NFL contracts are not fully guaranteed.

But in general, with pro careers short and the window to make a significant amount of money narrow, when is the right time for a player to return from or play through an injury? With so many variables in every case, it creates a complicated and delicate position for players, management, ownership and fans.

It did for Rose last season. Though management publicly supported him, it didn't stop fans and writers from calling for Rose to return.

Yet even while practicing after he was cleared to play, Rose felt the difference between being cleared and being ready -- he couldn't do all the things he could before the injury.

"I never felt like I could take on a double team," Rose said. "I knew I could get past one person, but in the playoffs you really have to think about the game. People are going to be throwing different strategies and defenses at you almost every other game, so I knew I wasn't ready to take on a double team in the playoffs."

There have been grumblings about Gronkowski's delayed return, but Patriots quarterback Tom Brady, receiver Julian Edelman and owner Robert Kraft have supported him.

"He's the only one who can decide when he's ready to play, and we're completely behind whatever his decision is," Kraft told ESPN Radio. "Obviously all of us would like him to come as soon as possible, but we're not going to let our short-term desire impede what's right for the long term."

Contributing: Jim Corbett, Jarrett Bell, Lindsay H. Jones, Tom Pelissero, Daniel Uthman, Sean Highkin, David Leon Moore, Jorge L. Ortiz