The hard road back after a painful blow

From the other side of the wall, the muffled sounds of halftime drifted through to Ilkay Gundogan. He could hear the murmuring voices of his Manchester City teammates exchanging notes, and then his manager, Pep Guardiola, starting to speak.

Gundogan had been with them only a few minutes earlier, joining in the celebrations as they took the lead against Watford, on the way to City’s first Premier League home win in three months. Not long after the goal, he had tried to snatch a loose ball from Watford’s Nordin Amrabat. The two collided. Gundogan fell to the ground and raised a plaintive arm to summon medical attention.

Initially, he was sure it was “not too serious.” There had been a strange sensation, coming from the outside of his right knee. “The same feeling as when you click your fingers, but without the noise,” he said. Aided by Max Sala, City’s team doctor, Gundogan got to his feet. He could stand. He could walk to the side of the field.

Sala thought it better if his game ended there, but Gundogan insisted he felt OK. Despite the doctor’s doubts, Gundogan persuaded Sala he should be allowed to continue and trotted back into the game. The first few touches, the first few passes, went fine, but as soon as Gundogan tried to turn, he felt the sensation again.

“I thought something was wrong,” he said. “I knew I had to come out.”

A few minutes later, in the treatment area that sits on the other side of the wall from the first-team changing room at City’s Etihad Stadium, Sala’s on-field suspicion — a ruptured anterior cruciate ligament — was confirmed with a few cursory tests.

Many athletes fear a torn ACL more than any other injury. It is not as visibly painful, or as gruesome, as a broken bone, but it is much more menacing. Not so long ago, it was more often than not the end of a career; even now, many who suffer it find they are never quite the same.

As Gundogan watched the second half of that December game against Watford on a laptop in silence, his knee packed in ice, he knew what was coming. He tried to be optimistic.

What he was facing, though, was intimidating. There would be the delicate hours of surgery, the endless days of rest, the long, slow weeks and months that would teach him first to walk, then to run, and finally to play again.

It would be painful, repetitive, exhausting. He would struggle to stave off the shadow of loneliness, to keep at bay the dread that in his absence from the team, he would be forgotten. Most of all, he would have to learn to handle it all not as one of the team, but on his own, trapped on the other side of the wall.

Dr Ramon Cugat knows how to put players, in deep distress and full of fear, at ease. For years, his clinic at Barcelona’s Quiron Hospital has been the first port of call for high-profile victims of knee injuries. Cugat’s expertise has restored a host of others to their former glories.

For such a major operation, the reconstruction of a cruciate ligament is surprisingly quick: just a couple of hours in theatre, no general anaesthetic. Gundogan’s whole lower body was numb, but, aside from the first few minutes, he was awake throughout. Cugat instructed his assistants to turn the video screen toward Gundogan, so that he could follow the process: two small incisions above and below the knee; the insertion of a tiny camera probe; the removal of part of his patella tendon, which was then fixed in place as a substitute for the ACL, completely torn and unrepairable.

It was 48 hours before he was allowed to stand up, but when he did, the pain was so intense he had to sit down immediately. The rehab work, though, began right away. His leg was packed in ice, as it had been in the hours after the injury, or blasted with cold air; he was put through a series of gentle movements to start to extend his range of motion. Gundogan referred to it as his “work.” This was his job now.

When he left the hospital, he went not to a hotel but to an apartment on Passeig de Gracia. Gundogan stayed for a month. He felt less isolated here, more a part of things.

Gundogan, 26, is not especially loud or notably garrulous. Born to Turkish parents in the industrial German town of Gelsenkirchen, he jokes occasionally about his “Southern” nature — a passion and emotion rooted in his ancestry. But he is, in many ways, typically Teutonic. He is soft-spoken, calm, happy to blend into the background. Often, he sinks into his own thoughts, contented in his introversion. He is most at ease, though, when he has company. He spends little time alone. His cousin Ilkan is often by his side, and his friends and family visit regularly.

He spent two hours of every day at the hospital, with only a member of Cugat’s staff for company, and two more in the apartment, under the watchful eye of Arthur Jankowski, his fitness coach, gently exercising his knee.

For months, the best part of the day was the first part. Every morning after he returned from Barcelona at the end of January, Gundogan had arrived at Manchester City’s training facility at the same time as the rest of the squad.

His schedule was physically exacting, his life mapped out for him by Cugat, Sala and City’s medical staff. Monday and Friday were for conditioning; Tuesday, Thursday and Saturday were for strength; Wednesday was cardio work. On Sunday, he rested.

The principal target, as explained by James Baldwin, the City physiotherapist overseeing his recovery, was “to restore the mechanics of the knee.”

Baldwin talked about “gait re-education,” and proprioception, making sure all the disparate parts of the body are working in unison.

In simpler terms, Gundogan was learning to walk again. Everything Gundogan did, every exercise in the gym with Baldwin, every session in the heat chamber or the pool, was designed to take him to the point of pain. The pain was not a punishment, but a reward. The pain was progress.

It was in the final weeks, as he inched closer and closer to the field, that he saw the true value of the day-by-day approach. By August, Gundogan believed he was ready.

On Saturday, September 16, 276 days after he had left the field and disappeared into the silence and the shadows, Gundogan emerged into the light again. With 66 minutes gone in a Premier League game against Watford, Guardiola turned to him and asked if he was ready. “Of course,” Gundogan replied.

He was aware of the curious poetry of coincidence, that he should make his return against Watford.

“Maybe it had to be that way,” he said.

Most of all, though, he was just glad to be back on the other side of the wall. His studs skittered on the floor. He walked out to the edge of the field, and the noise of the crowd hit him.