Conversations Tiger Woods Needs to Have | Opinion

Tiger Woods has cheated death twice.

Recently, his life was saved by a seatbelt. Doctors at Harbor-UCLA Medical Center worked on saving his legs.

When we saw images of the car crash and Woods' name flash across screens, many of our minds went to a dark place. First, we were scared his life was in danger. Then we remembered four years ago how his struggles with pain medication took center stage.

On May 29th, 2017, at 2:03 a.m., Florida police found Tiger Woods asleep, slumped over the wheel of his black Mercedes-Benz. A breathalyzer test read a 0.00 level of alcohol content. Woods hadn't been drinking. His blood, however, told a different story.

Tests came back positive for THC (the active ingredient in marijuana), Ambien (a sleep drug), Xanax (a benzodiazepine for anxiety and depression) and two prescription opioid painkillers—Vicodin and the even stronger Dilaudid. Woods later explained he was using these powerful medications to treat his back pain and insomnia

The combination of medications Woods took was potentially lethal, and not just because he was driving. As we know, opioid addiction is a real problem. The combination of opioids and benzodiazepines that Woods was using is an even more dangerous scenario. Mixing these two medications have led to the deaths of many less fortunate people.

A 2017 Stanford study found that the percentage of opioid users finding themselves in the ER who had been co-prescribed benzodiazepines nearly doubled from 9 percent in 2001 to 17 percent in 2013. This combination of drugs can suppress the signal for you to breathe, and overpower your brain's inherent signal to keep breathing. Sometimes these prescriptions come from different doctors who aren't aware of what's already in the patient's medicine cabinet.

As Woods recovers from his surgeries, it will be important for someone to reconcile his medications and decide what he should and should not take. Likely any old prescriptions need to be discontinued and careful thought taken to what medications should be added.

Pain comes from what the brain tells the body and different medications act at different areas along the pathway. Opioids or narcotics act at receptors in the brain. This is often what people think of when they ask for "pain medication." But we can also treat pain at the site of injury with anti-inflammatories or along the nerves that connect the injured area to the brain with nerve-specific medicine. Sometimes cognitive brain therapy can help. All of these can treat pain, not just opioids.

"It is clear that addiction is a chronic medical condition, not a character flaw," said Wilson Compton, a doctor and deputy director of the National Institute on Drug Abuse. He has spent time as a treating clinician in the NFL's substance abuse program. While he can't speak for Tiger Woods, he does have experience with athletes and medication addiction.

"Substance use disorders affect people from all walks of life," Compton said.

When people are in recovery from opioid addiction, exposure to opioid medications after a new injury can precipitate a relapse.

After considering what pain medicine Woods will need, we also need to think about his long road to recovery, both physically and mentally.

Tiger Woods' road to a comeback will be a long one. He will likely get back to his daily activities but playing sports, especially professionally, is something completely different. His bones can heal anywhere from 8-12 weeks, but what makes his swing is his total body control.

Tiger Woods
Tiger Woods reacts after finishing on the 18th green during the final round of the Masters at Augusta National Golf Club on November 15, 2020, in Augusta, Georgia. Patrick Smith/Getty Images

It is an orchestral symphony working from the ground up. The golf swing will require ankle and leg rotation so he will have to work out any stiffness to achieve full motion. He likely lost motion in his back from spinal fusions. It's like a catapult or rubber band—the farther you pull it back, the more energy is created to launch. The same is true with a golf swing. Every degree counts.

To restore motion, strength and coordination could easily take at least a year. If you look at ACL surgery, it's an arthroscopic knee surgery with two small bone tunnels, but it often takes a year to get a high level athlete back to full performance.

Rehabilitation generally follows four phases. The first is the immediate recovery: reducing swelling and pain and improving range of motion while things heal up. Second is strengthening, once the injured areas have healed in more stable positions. Third is beginning to perform more complex movements. Fourth is sports-specific training. Each stage can take weeks or months depending on the type of surgery and the person.

"Having treated [Woods] countless times over the course of my 15 years on the Tour, he is a very determined athlete with a great capacity for healing. And I hope he bounces back this time as he's done each time before," said Jeff Hendra, a physical therapist and PGA Tour consultant.

Hendra is most concerned about the muscular damage that Woods may have suffered, especially in his lower legs and ankle. The muscles of the lower leg are imperative for weight transfer during the backswing and push off on the downswing when hitting a ball.

Hendra knows that high-level athletes can often compensate for a loss of mobility somewhere in the chain of motion, but at some point, he says, "compensation will only get them so far until those compensatory mechanisms cause dysfunction and ultimately break down in other areas." Hendra has great hope for Woods.

Thanks to his surgeons, his athletic ability and his drive, Woods will likely recover physically. But mentally, we can't lose sight of the fact that his identity is tied to golf, and a return may be a year or more away, if at all.

Like many professional athletes, it's hard to say goodbye to the game, and the spotlight, if and when that time comes. Being a part of the sport, even if it's not at the center of the action, can help athletes still feel like they are part of a community.

It can be a daily struggle for an injured athlete to watch from the sidelines, especially if they can't just work harder or push through pain.

Often athletes diagnosed with an injury just want to know if they can still play. When they can't, it's important to work around the injury, focusing on aspects of the game they may have neglected in the past.

Others need to find hobbies outside of their sport to keep their mind occupied in a healthy way, even as they train for their return. Talking to a sports psychologist can help treat the fear and anxiety that bubble up. Setting priorities in life, especially for an aging athlete, can help redefine what success means to them.

"[Woods] is able to incorporate skills of mindfulness, visualization and being present better than average," said Deborah Graham, a golf psychologist. Her client list includes over 400 players on the PGA Tour, LPGA Tour and Champions Tour.

From her perspective, one of Wood' greatest strengths is his mental toughness in competition. This mindset can help him off the course as well.

According to Graham, his greatest initial mental challenge will be in recovery. He will have to address the "deflating feelings of losing macro control over his life as a whole and losing micro control of his daily routines." Having had career-threatening injuries and surgeries before will provide him a framework from which to work.

"If he embraces positively what he has learned from his past recoveries," Graham said, he may "see this as but one more challenge to conquer as he has done so many times before."

Time will tell if Woods can return to professional golf. In the meantime, if Woods doesn't surround himself with the right team, or focus on the right goals, he may not recover on an emotional level. That combined with a history of pain medication abuse is an unspoken battle he will have to fight long after the headlines vanish.

Maybe this time, if we don't ignore the conversation of addiction, or mental well-being, his battles won't be fought in the dark.

Jonathan D. Gelber, MD, MS is an orthopedic surgeon and sports medicine specialist. He is the author of Tiger Woods's Back and Tommy John's Elbow: Injuries and Tragedies That Transformed Careers, Sports, and Society. You can follow him on Twitter @JonathanGelber.

The views expressed in this article are the writer's own.