Cardinals' Kyler Murray clears mental hurdles in ACL recovery

Leslie Plaza Johnson/Icon Sportswire

TEMPE, Ariz. -- On film, it looked like a typical scramble.

After a low snap, Arizona Cardinals quarterback Kyler Murray dropped back, but before he could get his feet set, he saw Atlanta Falcons linebacker Bud Dupree closing in and made the split-second decision to escape the pocket. Like he had done hundreds of times before, Murray took off and evaded a defender with his quickness before throwing the ball away to avoid a sack.

The play seemed, like Murray's pass, to be a throwaway. It was 5.5 seconds in a three-hour game, a meaningless third down on the third play of the game.

But for Murray the play was monumental.

It was the first time Murray had run in a game on his surgically repaired right knee since Dec. 12, 2022, when he tore the ACL. It was the moment Murray was curious about in the days leading up to his first game in 11 months. He knew when he took off and ran for the first time it would define his return.

"To do it for the first time when I took off that third down, I felt kind of slow, but it was kind of an eye-opener, like, 'OK, we're good,'" Murray said. "Then it was just feeling aches and soreness after the game but other than that, I prepared myself hard for that moment."

For that play to happen, Murray needed to completely trust his knee.

Getting to that point wasn't just a physical journey. It was mental, as well.

"You have to be mentally locked in with it, regardless of if you're off the field or you're on," Murray said. "It doesn't just turn on."

Cardinals coach Jonathan Gannon wanted the two to be aligned on his comeback. From the time he was hired in February, Gannon was consistent with his messaging: He wanted Murray's mental health to mirror his physical health.

"They get in car crashes for their job, for their livelihood," Gannon said of NFL players. "So, I always think that even if your body is healthy to play, I think your brain has to be healthy to play and there's a certain aspect of players that you have to be confident in what your body is allowing you to do.

"I've seen guys that have come back and they don't look like they're normal selves. It's typically not because of the physical, it's the mental."

Clearing the mental hurdles during a rehabilitation can be done multiple ways, said Dr. John Murray (no relation to Kyler Murray), a clinical and sports psychologist who has worked with NFL players. Visualization and mental imagery, along with muscle relaxation, are therapy options that can help athletes get through the most difficult scenarios -- sometimes more difficult than what they'll actually encounter on the field, Dr. Murray said. Rebuilding a player's confidence through positive self-talk and showing them how others have come back from similar injuries helps with the process, too. A lot of times, players will lose their vigor and energy after suffering an injury or be hit with bouts of depression or withdrawal, Dr. Murray added.

For about a quarter of injured players, Dr. Murray said the idea of reinjuring themselves is a "real significant factor."

For professional athletes coming back from ACL surgery, there's about a 20% higher chance of having another ACL injury, according to Dr. James Tibone, co-director of sports medicine and orthopedic specialist at Cedars-Sinai Medical Center in Los Angeles.

Kyler Murray didn't know what everyone meant when they talked about the mental hurdles, until he went through them.

"Once you're in that moment, or you feel down or whatever it is, then you're in that zone and it's not a good feeling," Murray said. "Everybody in here has probably felt some type of way about themselves or about the situation that they're in, or you never know why you're feeling the way you're feeling.

"You've just got to pray about it and try to be happy and choose to be happy. For me, I definitely was persistent and just tried to stay strong throughout the whole thing. Tried to stay positive and optimistic about getting better faster than they said [I would]."

What Murray went through after that first scramble is what other quarterbacks who came back from ACL injuries experienced.

When Los Angeles Rams quarterback Carson Wentz returned from his ACL injury, which he suffered in December 2017 with the Philadelphia Eagles, three games into the 2018 season, it took him a couple of rollouts and a dive to think to himself, "Good? Good."

From there, he slowly built himself back to how he felt pre-injury, a process that took a few games, he said.

Rebuilding trust in a surgically repaired knee doesn't happen quickly, Cincinnati Bengals quarterback Joe Burrow said.

"It takes a while," he said. "It takes a long time, really. You're gonna be out there playing before you feel quite 100 percent and that's just how it goes in that kind of rehab as long as you want to get back out there with your guys.

"It takes years to get back to where you were in all your exercises. It just takes a lot of work."

It took Burrow, who tore an ACL in November 2020, until this past offseason for his repaired left knee to feel as strong as his right knee during exercises. Detroit Lions quarterback Teddy Bridgewater, who missed two seasons after tearing an ACL and dislocating a knee in August 2016, said he needed to do things outside of football to help him rebuild trust in his knee, such as basketball and cliff jumping. The unpredictability of where he'd land on a rebound helped strengthen Bridgewater's confidence in the knee.

During Murray's rehab, he relied on Cardinals senior reconditioning coordinator Buddy Morris and his doctors to reassure him that his knee was making progress.

"I go out there and run for the first time, I'm limping, and I look scared, and then I see a video of myself or whatever it may be, and I'm like, 'OK, that doesn't look right,'" Murray said. "Immediately, the scariness goes away and then cutting, same thing. In order for me to get better, I have to trust it. If the doctor tells me I'm good, if Buddy says I'm good, then we're good.

"As far as being scared, you get one day of those reps to be kind of hesitant, but after that, we've got to go so that was kind of the mindset."

Part of Murray's process to return was to play without a brace. That decision, former NFL quarterback Robert Griffin III said, will help Murray feel like himself.

"Wearing the brace is a constant reminder that you did get hurt," said Griffin, a former NFL quarterback who tore the ACL, LCL and meniscus in one of his knees and is now an ESPN analyst. "I'm happy that Kyler's doing that. ... That means that not only the doctors are comfortable, but the player is comfortable with where they're at physically, that they can go do that.

"Kyler, he needs every one of his weapons, and one of his weapons is his ability to move. It's always been that way for him. He can be a quarterback that sits in the pocket, but he's the dynamic $200 million quarterback that they paid him to be if he has everything."

Around the nine-month mark of his recovery is when Murray began to feel like he could start playing again. At the start of the season, Murray asked not to be put on the physically unable to perform list because he didn't want to miss the first four games of the season. But he wasn't rushed back.

It's not easy to keep an NFL player who is pushing to return from a major injury at bay, Griffin said.

"I'm telling you right now, just as players, the way that we're wired, we're all Type A personalities where we think if we're 70 percent, we're a 100 percent," Griffin said.

There's no such thing, Griffin said, as a quarterback taking too much time to return from an ACL injury.

In the lead-up to Murray's return on Nov. 12 against the Falcons, he wanted to get that first run out of the way. Morris tried to replicate situations during Murray's rehab to prepare him to take off and move. But, like his quarterback counterparts who went through the same rehab, he didn't know how his knee would hold up or how he'd handle it mentally until it happened.

Whenever it did, at whichever point of the game, Murray knew it would mean he was back.

"He kind of looked like who I thought he was going to look like," Gannon said. "Probably a little better."

ESPN NFL Nation reporters Sarah Barshop, Ben Baby and Eric Woodyard contributed to this report.