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Don’t look

By Timothy Cocks Physio world, Science and the world 22 Aug 2014

A recent, horrific injury on the basketball court to Indiana Pacer, Paul George, brought to mind a similar incident from 2013 involving college basketballer Kevin Ware.

While the injuries are somewhat similar, the initial experiences that the men report couldn’t be more different:

Paul George talks recovery, pain for first time since injury

When I looked down and saw my bone sticking out, I knew it was bad. I’ve felt pain before. This was a pain I’ve never felt before.

“It felt like gasoline was on my leg and someone lit a match. Felt like my leg was in flames. It was a quick five minutes then my body went into shock.”

‘I honestly didn’t feel pain’: Ware ‘blessed’ despite horror basketball injury

“I honestly didn’t feel pain,” Ware said about the compound fracture to his right leg. “It was more shock. I’ve never felt anything like that.”

I thought it was just my ankle,” Ware said. “Coach kind of gave it away. His eyes got huge.”

Ware said he was concerned about his own long-term basketball future as he lay on the court, but also his team’s short-term success.

“‘Just win coach, just win,'” he said he told Pitino. “I am going to be fine.” That impressed Pitino, who, speaking earlier on Wednesday with ESPN, praised Ware’s attitude and recounted the words he said to him in the hospital.

“‘I don’t know too many people with their bone sticking out of their leg would have thought about the team like that,”‘ Pitino said. “So that speaks just so highly of you as a person.”

In one interview Ware reports that he never looked down at his leg and only realised how bad his injury was by looking at the reactions of his coach and teammates.

Ware has since said that he has never watched the gruesome video footage of the incident and has no plans to, ever, fearing it could hamper his full recovery and ability to play with confidence.

There might be a neuroscience nugget in this, for someone with a strongish stomach? Perhaps to help explain that injury, nociception and pain are not all the same thing, and how pain is a construct that relies on multiple sources of information.

-Tim Cocks

Learn about dozens of other neuroscience nuggets as you get your think on and get up to date at a noigroup course. You can also immerse yourself in some brainy books with Explain Pain 2nd Ed and The Graded Motor Imagery Handbook


  1. There was a long blog post on Soma Simple about Kevin Ware’s injury in May of ’13. Of special interest to me is the video of Ware’s teammates and the commentary about that. Put “Kevin Ware” in the search engine and then scroll down to “The is all you need.”


    1. Hi Barrett, I believe that I recall the post, and in particular the discussion of Ware’s teammate’s reaction of horror and withdrawal when they saw his protruding tibia. From memory the video showed that Ware’s teammates nearly climbed over each other to get away.

  2. davidbutler0noi

    Images of sports people doing ghastly things to their bodies are more and more common and its almost de riguer to show such images and clips at meetings and conferences. The viewers watch, gasp, groan and then generally forget about it once the thrill has past. We rarely learn anything from it and there is no “deep” learning – ie useful knowledge that we can retrieve later on in a different context.
    What I see here in this blog post is precious educative material – two ghastly injuries but two very different responses. Nociception, even massive blasts of nociception do not necessarily mean pain. This is a neuroscience nugget and the story uses one of the most valuable educative elements – that of contrast.

    These examples could well go into a clinician’s “storybook” while the athletes are still quite famous. No doubt it will happen again and then the story can be refreshed. I wish we had such examples here in Australia to use, though not wishing to put the “mozz” on any of our athletes.


    1. Thanks Dave
      It’s probably another post in itself, but Ware’s recovery was good educative material as well, it was very evident from the interviews he gave that he-
      -Had strong belief systems
      -Immediately re-engaged with his social/support network (team)
      -Believed that if he was to recover, that it was up to him, and felt that he was in control over the direction he was heading, despite the horrific injury.
      -Was not passive in his recovery and very quickly returned to activity/active treatment
      -Had solid support systems around him (his coach spoke glowingly of him and his mum appeared with him during an interview not long after his injury), and he spoke very highly of the doctors and therapists who were helping him get back on his feet
      -Was able to fully express a range of emotions – he cried in one interview, but was able to maintain a sense of humor- laughing and expressing a sense of gratification to his fans, friends and family.
      -Had a definite plan to get back to playing basketball

      Not so evident, but some speculation on my behalf was that he-
      -Did not necessarily equate experiencing pain with doing harm/more damage (he was very quickly back into training and posted a picture of himself on an exercises bike less than three weeks after his injury)
      – Did not go searching for passive and/or ‘miracle’ cures (no searching for a physical therapist who could get him back on the court faster by putting his sacrum back in – looking at you Tiger).

      Some pretty powerful healthy-immune behaviours there (Pg 88-89 of Explain Pain 2nd Ed!) and the antithesis of the four major yellow flags for chronic pain (Pg 104-105 Explain Pain 2nd Ed!).



  3. This is great story material for a topic that comes up often in my own discussions with clients and colleagues: the supposed distinction between acute and chronic presentations. I’ve often been told “that’s all very interesting, but I don’t see many chronic cases in my clinic”.

    As if nociception =/= pain is an oddity that emerges over time and mostly in cases of ‘psychosomatic abnormality’…

    Thanks for the tidbit

    1. Thanks Toby,
      I think you raise such a vital point. In a previous role, contracted to an insurance company, I was involved in reviewing the treatment provided by physiotherapists to people with work injuries.

      I’d often have a chat with physiotherapists about their treatment goals, progress, thoughts, concerns etc.

      It was quite amazing the number of times that in response to my question as to whether the physiotherapist had provided any pain education to the patient, I received a response along the lines of “Well, it’s acute back pain at the moment so I haven’t, if they don’t recover then I’ll consider it”…..


  4. This topic pairs well with your previous blog titled “Nothing either good or bad but thinking makes it so”.

    The acute tissue trauma explanation carries risk of modulating a pain experience for the worse, even in circumstances where a trauma-focused dialogue is logical. On the flip side, straying from tissue trauma may alienate the patient.

    Rephrasing (deboning..?) a previous diagnosis without diminishing the information it contained is a tricky thing.

    There are certainly worlds within the words. Czeslaw Milosz captured a lot about language when he said:
    “Language is the only homeland.”


  5. stevewhereareyou

    Awesome post Tim. I recall watching that game and probably reacted just like his team down at the bench. A mixture of shock and disgust and horror. Although I didn’t experience any pain, I know that some might (eg Osborn & Derbyshire 2009) from watching such an event. I thought that it was really interesting that Ware has the insight or instinct (or perhaps advice) to not watch the video of his own injury. Powerful metaphor sitting there for our patients who replay/re-experience their own injury moment “video” over and over. That has got to be a neural driver for persistent pain. And now through the gift of media some individuals have the opportunity to re-live their moment again and again in hi-def, super-slow-motion.
    Cheers – Steve

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