It's a mystery: When we twist our ankle playing tennis, it can take weeks to heal, but when a pro athlete does it, he often misses barely a beat.
Take an NBA game last season between the L.A. Lakers and the Atlanta Hawks. Kobe Bryant was pushed in midair, and he landed with a thud on the court. He clutched his ankle and writhed in pain. A few hours later -- after X-rays found no broken bones -- his coaches announced he was out indefinitely with a bad sprain.
Bryant sent out a tweet about his recuperation and how he was going to spend his time watching movies and sleeping: "Compression. Ice. Django. Zero Dark Thirty. This is Forty and 1 hour of sleep."
Yet 36 hours later, Bryant was back on the court.
Did he have a miraculous recovery? Not necessarily. While professional athletes are in terrific shape, which helps when they get injured, they also have advantages rarely available to the weekend warrior: an instant medical response and a physical therapy regimen that kicks in quickly, that operates practically around the clock and that continues even after the athlete is back in the game.
"Most of the time, the pros get a prompt assessment and treatment by experienced trainers, and what may take a recreational athlete weeks to recover (from) may take a pro only a matter of days," said Benjamin Shaffer, an orthopedic surgeon in Bethesda, Md. who is head team physician for the Washington Capitals and assistant team physician for the Washington Wizards.
Granted, some professional athletes speed their return to competition by overusing painkillers, anti-inflammatories and other prescription drugs and by succumbing to pressure from teams to play through injuries, as The Washington Post reported in a series of stories last spring.
But for many pros, it is the hours of intensive daily attention from highly experienced physical therapists, along with specialized rehabilitation equipment and exercises, that make their rehab and yours quite different.
A cadre of professionals uses electric stimulation, compression sleeves, anti-gravity treadmills and individually tailored exercises to speed the repair of the body. These techniques and devices can mean the difference between an early return or weeks on the bench, Shaffer said.
While physicians and trainers involved with professional teams avoid talking about injuries to specific players, here's a look at what they do to get an athlete up and running again.
The advantage starts as soon as a player goes down. Trainers and physicians rush in with immediate care. "When our guys hurt themselves, moments after, we are treating them," said Greg Smith, the head trainer for the Capitals. "The body's natural reaction (to an injury) is to swell. We are able to control the swelling through compression and ice right away."
Smith often assesses an injury by manipulating deep into tissues with his thumb and pinpointing exactly where a player hurts. Once he figures out what's going on, he will suggest a remedy. "I am able to find problems," he said. "I can tell what is sore and what is not."
In addition to applying ice and compression, Smith said, trainers and physicians decide whether to bring the staff massage therapist into the locker room or to quickly conduct X-ray and MRI exams.
Time is of the essence when treating an injury, doctors and trainers say. In contrast to the pros' quick-response teams, you get stuck scrounging for an appointment with an orthopedist or waiting to schedule an MRI.
Amateur athletes go home, wrap some ice on the injury, elevate, take two ibuprofen and call the doctor in a few days if things haven't improved, said Jason Craig, an associate professor of physical therapy at Marymount University in Arlington, Va., who has worked with Irish Olympic athletes.
By the time an armchair athlete sees a doctor, not only may an ankle sprain still be very painful, but the delay -- and what people do during that time -- may also have made the injury worse.
"We use the acronym RICE -- rest, ice, compression and elevation -- no matter what or who is injured," said Kala Flagg, a physical therapist and certified athletic trainer who has worked with NFL players and other elite athletes. "If someone ignores the signs and symptoms, continues to stress it by walking or running, or he doesn't get a proper diagnosis, a Grade 1 sprain becomes a Grade 3 or a fracture."
Professionals also have all the time they need to devote to rehabilitation. "It's their job, unlike the rest of us," Shaffer said. "Their goal is to get back to playing at their previous level of activity" as quickly as possible. For regular people, "our recovery is an avocation. We do it between picking up kids and doing our day job."
An injured pro may go to physical therapy as much as three times a day, according to Flagg. "These athletes also may have a setup at home with hot tubs and cold tubs and icing machines. They have massage therapists and one-on-one yoga instructors. Their bodies are important. They aren't afraid to invest in them," she said.
Some teams even fine players if they miss a treatment session, she said.
"Pro athletes spend the majority of the day getting themselves in tiptop shape," Flagg said. "Their eating habits and training habits are different (from the average person's). They are lifting, running or practicing in addition to sitting in a hot tub or cold tub. They are training their bodies to prevent injury from the beginning."
Trainers continually monitor the health and biomechanics of their athletes. Smith, of the Capitals, studies his players in games, at practice and while they are training in the gym. What he sees influences the kinds of workouts he gives the players to keep them injury-free.
For example, hockey players engage their chest muscles over and over to shove opponents out of the way and to control the puck. As a result, their shoulders may rotate forward a lot, Smith says. This continual misalignment can make them vulnerable to injury. "It can happen to anybody, even someone working at a desk," Smith said. "When shoulders anatomically are not where they should be, that can cause an injury, or pinching on the vertebrae. We have to work hard to combat these kind of forces."
Smith helps players balance their back and chest muscles by having them do 30 strokes on a rowing machine for every 10 bench presses. This, he said, helps the shoulders to stay where they belong.
Those extra strokes are not a big time commitment, but they are the kind of exercise a weekend hockey player might not realize he or she should do to prevent an injury. Similarly, if a player comes to Smith with lower back pain, he checks to see if his hip flexors are to blame because they are too tight. If that is the case, he recommends specific exercise to increase flexibility.
"We are always checking guys out," Smith said. "We are looking at them. They are also attuned to their bodies. If (they say) their lower backs are tight, it could be their hip flexors."
During the NHL season, he said, the Capitals exercise in the gym daily for only 15 to 20 minutes and practice on the ice for about an hour, with one day off each week for complete rest. On game days, players don't go to the gym. They practice for about an hour, then nap for two to three hours before the game.
"You can't make them tired," Smith said. "They have to have proper rest. They sleep eight to 10 hours a day. The better rest (a pro athlete gets), the better they recover."
Moreover, fit and rested muscles don't get as fatigued during rehabilitation sessions. That's because oxygen and blood flow more efficiently through the body when muscles are fit and strong, said Howard Osterman, a Washington podiatrist and staff physician for the Wizards. Fatigue "is a real deterrent to rehab for the weekend athlete or average patient," he said.
Fitness and rehab equipment that trainers use with professional athletes aren't available from many physical therapists who treat ordinary people.
One example is a Game Ready device that is part ice pack and part compression sleeve. Trainers at professional games use Game Ready sleeves that slip right over an injured foot, shoulder or knee. The sleeve contracts while circulating icy water to reduce swelling.
Another example is the AlterG treadmill. Designed for astronauts, it lets athletes get back to running without allowing gravity to do further damage to injured limbs.
An air bag is strapped around a patient's waist. When inflated, the bag lifts the patient, allowing him to run without putting his full weight -- or even any weight -- on his legs. "This allows a patient to maintain some cardiovascular exercise without having to overstress fractures, strains and sprains," Osterman said.
Only a few physical therapy clinics offer the AlterG for recreational athletes. "It is still more the exception than the rule due to cost and reimbursement issues," Flagg said.
Still, there are times when pros and amateurs face the same issues.
Both kinds of athletes benefit from surgical advances: Where it once could take years to heal from an operation to fix a damaged anterior cruciate ligament, athletes now can often be back within six months to a year.
And being a pro doesn't protect you from post-surgical infection, as New England Patriots quarterback Tom Brady found in 2008.
"Tom Brady got the same infection Joe Public can get, even though he is a star quarterback" in great shape and with a great health and fitness team, Marymount's Craig said. "A lot of people think that if you are a pro athlete you will heal faster. It doesn't always happen."
And then there's the case of Kobe Bryant. Only a few weeks after he seemed to heal so quickly from that ankle sprain, Bryant tore his Achilles tendon, requiring surgery and six to nine months of rest, just like anyone else.