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By Shamard Charles, M.D.
On Sunday, Tiger Woods won the Masters for the fifth time — his first since 2008.
What makes his return to prominence, at 43 years old, nothing short of miraculous is that it came after a series of well-documented back and knee problems, leading many to question if his dominance was coming to an end.
Here we chronicle Woods’ historic comeback and how he successfully returned from four knee surgeries and four back surgeries:
December 1994: Undergoes first knee surgery on left knee to remove two benign tumors and scar tissue.
Dec. 13, 2002: Undergoes second knee surgery on left knee to remove fluid inside and outside the anterior cruciate ligament, or ACL, and remove benign cysts.
August 2007: Ruptures the ACL in his left knee while running on a golf course after the British Open, but is able to keep playing. Wins five of the last six tournaments he plays, including the PGA Championship for his 13th major.
April 15, 2008: Has third knee surgery — arthroscopic surgery on his left knee to repair cartilage damage.
May 2008: Advised weeks before the U.S. Open that he has two stress fractures of the left tibia and should rest for six weeks, the first three weeks on crutches.
June 24, 2008: Eight days after winning the U.S. Open, has surgery to repair the ACL in his left knee, his fourth knee surgery, by using a tendon from his right thigh. Additional cartilage damage is repaired.
December 2008: Injures the Achilles tendon in his right leg while running as he prepares to return to golf.
May 9, 2010: Withdraws from the final round of The Players Championship, citing a bulging disk. He later said it was a neck issue that caused tingling in his right side, and that it first became a problem as he began practicing harder for his return to the Masters a month earlier.
Aug. 21, 2013: Famously drops to his knees after one shot because of back spasms.
March 31, 2014: Has first back surgery for a pinched nerve.
Sept. 16, 2015: Undergoes second back surgery — a micro-discectomy — to remove a disc fragment that was pinching his nerve.
October 2015: Hasa third back procedure to relieve discomfort in his back and sets no timetable for his return to the PGA Tour.
April 20, 2017: Undergoes a fourth back surgery. The spinal fusion, labeled a ‘success’ by his surgeon, Dr. Richard Guyer, to alleviate pain he had been experiencing in his back and leg.
How his knee affected his back
“Knee injuries are often one of the first injuries we see in golfers,” Dr. Alpesh Patel, chief of orthopedic spine surgery at the Northwestern Memorial Hospital, in Chicago said. “Once their mechanics are off, then we’ll see back injuries secondarily. So, it’s not uncommon that in Tiger’s story we saw a chain link between one and the other.”
Patel notes that this sequelae of injuries doesn’t just happen in competitive golfers but also occurs in recreational golfers — except later in life.
“We may first see these arthritic issues starting in late 30s and early 40s — as opposed to the late 20s and 30s as in Tiger’s case — and then back injuries in mid to late 40s,” Patel said.
Dr. Todd J. Albert, orthopedic spine surgeon and surgeon-in-chief at the Hospital for Special Surgery, in New York, also notes the role that genetics plays in degenerative conditions that plague the knee and back.
“More than likely, Tiger’s knee and back conditions were related. His genetics might be such that he had some early degeneration of his cartilage in his knee that caused him to change his swing mechanics and exacerbated the degenerative cartilage in his back. In other words, his knee degeneration and his disk degeneration may be related,” Albert said.
The back fusion surgery that was key
According to TigerWoods.com, Woods’ bottom lower-back disc severely narrowed, causing sciatica and severe back and leg pain. He tried conservative therapy, which included rehabilitation, medications, limiting activities and injections, but it failed to resolve his pain, so Woods opted to have surgery. The procedure was a minimally invasive surgery called an Anterior Lumbar Interbody Fusion which entails removing the damaged disc and re-elevating the collapsed disc space to normal levels. This allows the diseased vertebrae to heal to the other. The surgery gave Woods the ability to stand pain free.
Dr. Richard Guyer of the Center for Disc Replacement at the Texas Back Institute performed Woods’ surgery.
“The idea is to reduce motion at the level that is causing him most pain. In essence by repairing that vertebrae you are taking that sick motion out of the matrix where he was repeatedly injuring himself. It was the right procedure for him. He is also an amazing athlete with great determination,” Albert said.
Publicly Woods tempered his expectations. “When healed, I look forward to getting back to a normal life, playing with my kids, competing in professional golf and living without the pain I have been battling so long,” he said in a 2017 statement.
Woods’ surgery is unique because it was performed on the front side of his body where less muscle is affected.
The typical recovery is fairly quick and most people are able to walk immediately after surgery, Patel says. “Patients are out [of the hospital] within a day or two. If someone is doing desk work, they might be back to work in 3 to 4 weeks. For someone who is doing low or moderate forms of exercise, they are back in 3 to 4 months. For higher intensity sports, or return to competitive golf … 9 to 12 months, but recreationally maybe a little sooner,” he added.
The best recovery yet
Both Albert and Patel point out that there are many popular misconceptions and beliefs about spine surgery, citing that some of these opinions stem from the fact that spinal injury is only rocommended in extreme cases.
Albert notes that too many fusions have been done when more conventional methods such as physical therapy, yoga and Pilates could be used to increase core strength, thereby decreasing the strain put on the neck and lower back. “The only indications for a surgery like this are for cases of proven instability, multiple failed disk operations that have resulted in collapse, or repeated failures of conventional therapies,” Albert told NBC News.
People experiencing progressive neurological symptoms, such as weakness, numbness and/or tingling in the legs should seek medical attention as early intervention decreases the likelihood of having surgery, he added.
Patel cautions against people with mild or moderate back pain from seeking surgery as a first option, but highlights that Woods’ redemption story is an example of great care and perseverance intersecting with dedicated rehab.
“There is quite a bit of debate as to whether back surgery works and there is variability in the outcome of treatment, but I think successful outcomes increase with a clear diagnosis, a highly motivated patient, and shared decision making,” Patel said.
“In a well-chosen patient, these surgeries can have good results. Tiger’s recovery is probably the best yet. But I fear that people can go overboard, and say, ‘hey, this works for Tiger and this will work for me’.”