Long road to recovery: What awaits Tiger Woods

In the days immediately following Tiger Woods’ Feb. 23 single-car rollover accident near Los Angeles, we learned a lot about the injuries to his right leg and ankle and subsequent trauma surgery.

He suffered “comminuted open fractures” (meaning bone has punctured the skin — aka “compound fractures”) of the upper parts of the tibia and fibula and underwent a 10-hour surgery that, among other things, inserted rods, pins and screws into his leg, ankle and foot, as well as released the muscle sheathing around in his calf.

The former was done to stabilize the bones and meant to be permanent; the latter to prevent, or perhaps treat, onset of “compartment syndrome” — a dangerous condition in which the muscle’s sheathing (aka fascia) swells to the point that blood supply to a muscle is cut off, resulting in the muscle and surrounding tissue dying.

But since he was transferred from Harbor-UCLA Medical Center to Cedars-Sinai Medical Center three days after the crash, other than a couple of Woods tweets thanking fans and fellow golfers for their support, we haven’t gotten many specifics — and likely won’t again — about his treatment and recovery.

So we asked Cleveland Clinic Florida-Weston foot and ankle surgeon Dr. Niall Smyth, who has seen countless similar cases in South Florida, to surmise what kind of post-operative treatments Woods likely has undergone and what awaits him in the future. 

Wound care 

With compound leg fractures, not to mention all the damage done to his skin from the accident and surgery, infection is of paramount concern. 

“The wounds are being cleaned daily and he’ll be given IV antibiotics for as long as his doctors think necessary,” says Smyth. “The importance of preventing infection can’t be overstated.” 

Starting the recovery process 

While it’s virtually certain that Woods can’t yet bear any weight on his right leg, Smyth believes doctors would have had Woods out of bed, and vertical, as soon as possible. 

“Whether it be with crutches, a walker, a wheelchair or some other kind of assistance, you always want the patient out of bed, even if for only for short periods. Otherwise, you start getting circulation issues, digestive issues and a host of other complications,” he explains. 

Another early aspect of Woods post-op treatment, says Smyth, likely would have been having a physical therapist put him through as much range of motion therapy as he could tolerate. 

In the early post-op stages, he wouldn’t have been in a cast, but “he may or may not have been in a splint.” 

The reasons he wouldn’t have been in a cast, says Smyth, are both because of the need for constant wound care and because with the kind of post-accident and post-op swelling he’s likely dealing with, doctors wouldn’t want to constrict his leg in any way.  

During the time when Woods was in bed, his leg would have been elevated. 

More damage, more surgeries — and more pain 

With high-speed impact injuries, the damage — and resulting pain — to bones and soft tissues is almost always far more severe than with similar-sounding injuries suffered during athletic competition. 

“Think about it: There’s only so much speed and force a human being can generate,” explains Smyth. “The most severe kinds of fractures we see are in automobile accidents and high-distance falls.” 

Most experts agree that Woods likely will need more surgical procedures as his recovery progresses. 

Two of the most recent high-profile compound-fracture leg injuries happened to NFL quarterbacks: the Washington Football Team’s Alex Smith in 2018 and the Dallas Cowboys’ Dak Prescott in 2020. 

Smith famously required 17 additional surgeries before returning to play last season. Prescott reportedly recently underwent his second surgery but is on-target for a full recovery and return to the field in 2021. 

At this early stage, Woods shouldn’t be concerned with returning to athletic competition — but rather with regaining everyday function in his leg, foot and ankle.  

Last week, Dr. Matt Provencher, former team physician for the New England Patriots, explained to FOX Sports his most pressing concerns for Woods. 

“A high-speed injury such as this can cause significant debilitation, loss of strength, pain, early arthritis and loss of joint motion — especially in the foot and ankle,” says Provencher. “The talus [the ankle bone that attaches the leg to the foot], if injured, is a serious concern, as this bone is very important for ankle function, mobility and push-off. Healing of this bone will be paramount.” 

Provencher, who is now FOX Sports' injury and performance analyst, also notes that the “releases for compartment syndrome, which were important to save the muscles of Woods' leg, can lead to chronic and mild-to-moderate weakness, pain and loss of strength, though those do not occur in all cases. For the tibia and fibula fractures to heal, there has to be enough skin and muscle coverage over the injury, but if the damage to the tissue was too severe, Woods will need additional surgery to provide a rotational muscle and/or skin flap to cover the wound.”   

Woods has famously had prescription medication struggles in the past, so in terms of managing the worst of the pain, his doctors may have opted for other forms of “multi-modality” pain relief, says Cleveland Clinic Florida’s Smyth — including local anesthetic and anti-inflammatory injections. 

First major milestone 

Smyth notes that recovery in accidents like Woods’ often happens in fits and starts. 

Being released from the hospital “only happens when all of the logistics are in place for the patient” he says. 

That means modifications to the home if necessary and round-the-clock assistance — which wouldn’t be an obstacle for a person in Woods’ position but often is for patients who live alone.  

But the first major milestone Woods doctors will want him to reach, says Smyth, is “being able to bear weight without assistance.” 

Smyth says he’s seen the amount of time it takes for patients to reach the weight-bearing stage range from “two to four weeks to as long as three months. It all depends on the severity of the injuries.” 

Part of the reason that it is so important for Woods to begin bearing weight as soon as possible is “because of how quickly the leg atrophies” Smyth says. 

Equally as important is that once he’s able to bear weight on his right leg, he’ll be able to jump-start the arduous work of physical and functional rehab. 

Among the ways that Smyth believes Woods will eventually be able to start his rehab work is with an AlterG (i.e., anti-gravity) treadmill, as well as with exercises in a pool, tension-band exercises, electrical stimulation and massage.

When Woods is eventually able to stand and walk, however gingerly, on his own, Smyth notes that his physical therapist will at first focus on him “regaining his sense of balance correction, how his body moves in space and feeling secure walking on uneven ground. In other words, the kinds of things we all take for granted.” 

As the days and weeks since Woods’ crash turn into months, Smyth says Woods’ doctors will also be on the lookout for the kinds of damage that don’t necessarily show up on X-rays and MRIs. 

“It’s easy to see how bones are healing,” he says. “But with blood vessels and nerves, it’s much trickier. Nerve damage and circulatory damage are very common with these types of injuries and they’re especially fickle. Sometimes they come all the way back, other times they don’t. Only time will tell.” 

But Smyth believes one of the things most working in Woods’ favor is that “the higher the fitness level of the patient before the accident, the better the chances for as full a recovery as possible.”