SANTA CLARA, Calif. -- At some point every day, San Francisco 49ers running back Tim Hightower reaches into his pocket and pulls out a list. It is nearly six years old at this point but has found a permanent home in Hightower's wallet.
Written on the list is a series of goals for the future that Hightower first jotted down while laying on a hospital bed after tearing the anterior cruciate ligament in his left knee on Oct. 23, 2011.
"I carry it with me everywhere," Hightower said. "I look at it every day. You’ve got to know where you’re trying to go every single day."
Not that Hightower would ever forget. Standing outside the locker room in the bowels of Levi's Stadium after his second organized team activity with the franchise he grew up loving and signed with as a free agent in April, Hightower says he almost gets goosebumps just thinking about how he got back to this point.
He remembers the times in his nearly four-year absence from the game in which he almost walked away. He knows the exact moment he began feeling like himself again. He recalls how the repeated setbacks in his recovery shook his confidence in ways he never imagined. And most of all, he's grateful just to be back playing football.
"It was a long process," Hightower said. "It was scary. One thing, when you are playing this game, there’s a level of confidence that comes along with it. You get used to competing and playing at a high level and being very confident in what you do. For the first time in my life, I really felt like like my confidence was challenged. Everything that you’ve known, everything that you’ve been accustomed to and worked for, you can’t do it. You have to kind of re-identify -- who am I? What if this is really over? Where do I go from here?"
Hightower's NFL journey began in Arizona, where he was a fifth-round pick in 2008. He spent three seasons with the Cardinals, playing an integral role in a run to the Super Bowl before he was traded to the Washington Redskins in 2011. Early in the third quarter of a Week 7 game against the Carolina Panthers, Hightower rushed for 4 yards behind left guard. When he didn't get right back up, he knew instantly that something was seriously wrong.
The diagnosis was a torn ACL, a common injury in the NFL and one from which plenty of players have recovered. What Hightower wasn't counting on was the infection in the knee that went unnoticed by doctors. He attempted to come back in 2012, but something felt off and Washington released him.
From there, Hightower spent his time working out in Houston, hoping for a call from a team. Finally, the New York Giants asked him to work out. Just before that opportunity, Hightower's knee, as he describes it, "blew up." Hightower had no idea the knee was infected and was ready to walk away from football forever at 27.
If it weren't for his wife, Rikki, and that list, he probably would have.
"I told my wife, 'I’m done,'" Hightower said. "I had a child on the way and I can’t keep doing this. I have got to do what’s responsible and best for this family. She said, 'Hey, look, take a minute, go pray about it, think about it, but that’s not what you said you were gonna do. When you sat in the hospital after you tore your ACL, you sat there and wrote down every single goal and you wrote down what you want to accomplish and you told me to hold you to it. So I’m going to hold you to it. This isn’t it.'"
A new set of doctors examined Hightower and discovered the infection in the fall of 2013. Hightower was frustrated that it hadn't been discovered sooner but considered himself lucky that it hadn't spread. That doesn't mean there weren't more bumps on the road back to the NFL.
Hightower recalls questioning himself for the first time in his athletic career. He could no longer do the things he'd always done on the field and that shaken confidence carried over into his day-to-day life.
"You get so used to being the best and one of the best at something," Hightower said. "Confidence comes from proven, demonstrated ability. You build a certain confidence from doing and when you are not able to do something for the first time, it’s like, 'Uh, what do I do now?' Then if you are no longer able to physically do it, mentally it starts to now question other things in my life. Am I capable of being a good husband? Am I capable of being a good citizen? That confidence carried over into everything else and then for me, for the first time you are questioning all these other things about yourself and I think that was a first for me."
After getting treated for the infection, Hightower began to start feeling like himself again. Hightower got a tryout with New Orleans late in 2014 and showed enough to land a futures contract in January 2015. He was released, re-signed and released again in September, but stayed in shape and the Saints brought him back in early November after a season-ending injury to running back Khiry Robinson.
Soon enough, Hightower was not only back to suiting up but playing an important role. He played in eight games with three starts, checking off two of the goals on his list -- getting back in the league and starting a game -- that season. In a Week 14 win against Tampa Bay, Hightower made his first start and finished with 28 carries, a workload that would leave most backs feeling the pain for days.
It was in those moments during and after the game that Hightower realized he was all the way back.
"I think as that game went on, the way my body felt, I started feeling stronger, I started feeling things were slowing down," Hightower said. "I think at that point, you kind of click into that zone and you are no longer worried. Your body is fine and now you can worry about the X’s and O’s and strategies, you’re not necessarily worried. From there, I don’t think I looked back."
Indeed, Hightower re-signed with New Orleans in April of last year and served as the primary backup to Mark Ingram, rushing for 548 yards and four touchdowns. He won the team's Ed Block Courage Award and drew unanimous praise from his teammates for his leadership and perseverance.
"Everything he's been through, the injuries, just to be able to bounce back when people told him time after time that he wasn't going to be able to play again, and just have that drive, that inner will just to succeed and not to be denied, I admire that," Ingram said in December. "He deserves that award and everything else that's coming to him."
Hightower hit free agency again this offseason and did so with a specific idea of what he was looking for. His approach to free agency was less about cashing in and more about finding the right fit.
As a kid growing up on the east coast, Hightower latched on to the 49ers of Ronnie Lott, Jerry Rice and Joe Montana. He dreamed of one day wearing the red and gold. He also had great respect for coach Kyle Shanahan from their brief time together in Washington and running backs coach Bobby Turner. When the 49ers came calling, Hightower called it a "dream come true."
Now, Hightower is looking to make the most of his newest opportunity. He has embraced a leadership role that he knew was a big part of the deal when the 49ers signed him and he made a strong first impression by turning down the chance to take franchise legend Frank Gore's jersey number (21). Having recently turned 31, Hightower believes his absence from football has left more in his tank than other backs might have at his age.
"I’m sure nothing is ever how it’s predicted," Hightower said. "But I would definitely say for me, personally, it’s given me a greater appreciation of just the here and now. In one second, my career flashed in front of me and it was gone. So for me, just come in here every single day preparing, maximizing and then when I leave this building asking if I gave everything I had today. Did I focus on the details? How can I be better? And then carry that to the next day. Not that I didn’t appreciate the game of football before, I like to think that I did, but just the attention to detail, just the consistency and accountability, I think there’s definitely a heightened awareness there.
"I’ve got very, very lofty and, to most, probably crazy and unattainable goals. But that’s what keeps me going, it's what keeps me driven. I definitely feel like there’s still a lot I can do and a lot I need to do."
And if Hightower ever loses sight of what those goals are, the answers can be found in his wallet.