Alex Smith Gets Real About His Injury, Fear and Pain Management

In the world of sports, certain days loom large. Fans remember they day they celebrated a championship; players never forget when they walked across the draft-day stage and officially became a pro.

But some memories are much worse. And for former NFL quarterback Alex Smith, November 18, 2018, changed everything.

"I didn't know, when I woke up that morning, obviously [it] would be kind of a defining day in my life," he told Newsweek. "But, no, it was game day in the NFL. And game days are special, right? You only play once a week. And so, as a starting quarterback in the NFL, incredibly special.

"But it was a beautiful day in D.C. I was, you know, 14 years into my NFL career at that point. And, incredibly blessed. Like, I was on top of the world. I mean, as a starting quarterback in the NFL, we were in first place in the division. I was playing great. I just signed a new contract, in D.C. I mean, I had three beautiful kids, like, again, felt like I was at peak health at that point."

Within a matter of hours, though, everything had turned upside down. During the third quarter of the game against the Houston Texans, Smith was sacked and didn't get up. In a situation that was eerily similar to that of former Washington quarterback Joe Theismann, who was in the stands that afternoon, the signal-caller suffered an ugly leg injury. He was taken to a hospital with a tibia and fibula fracture and quickly rushed into surgery.

While no one would wish that situation on another, things seemed fairly standard for a pro athlete who had suffered a serious injury. But the tale soon took an ugly turn.

"I had emergency surgery that night and woke up to great news in the hospital that, you know, the bone was really well aligned. They put in three plates and, like, 30 screws. And, I needed to stay a few days for observation and luckily, never made it out of the hospital," Smith recalled.

"And a severe infection kind of set in, necrotizing fasciitis, which is a fancy word for flesh-eating bacteria in my leg. And I was rushed into a bunch of other emergency surgeries over the next couple of weeks to try and cut out the infection and save my leg, and my life."

Things even reached the point where amputation became reality.

"And, yeah, it was there. I mean, I was there shortly thereafter that I woke up to the reality, you know, confronted with a choice, you know, to cut off my leg or to opt for a lot of other surgeries with no guarantee of saving my leg," he said. "And thankfully, I had an amazing care team that were able to do that, to successfully save my leg.

"It was a two-year process of multiple surgeries, moving body parts down there, over a lot of the last tissue that I had, again, lost from the infection, and wore a steel cage for nearly a year. I mean, I was in a wheelchair for a long time and, obviously crutches after that for a long, long time."

But even after leaving the hospital, the challenges weren't over. Beyond the physical obstacles of everyday life—Smith wore an external stabilizer, making ordinary tasks like getting comfortable or climbing out of bed tough—he was also facing a less visible issue: pain. And that wasn't really discussed.

"As we went home and [were] handed bags of medicines and a pamphlet this thick on how to, you know, directions, and one of them was a rescue medication," he said. "Because of some of the side effects of these drugs, that were the only options out then. And again, my wife and I were terrified. Right. Like not knowing how to manage that. Were we going to screw this up?"

The experience set the stage for Smith's new endeavor, speaking about the realities of pain and encouraging people to have a game plan for when life calls an unexpected audible.

"These weren't conversations that we had, and no one had with their medical team at that point," he said. "So, [I'm] proud to partner with Vertex Pharmaceuticals to start trying to change that narrative. That again, one, pain is universal to all of us. But so personal as well. ...

"We all deal with injuries and pain in life and, again, encouraging everybody out there to start having these conversations. When it does come up, have these conversations—there are more options out there than you think—with your doctor, with your care team, kind of break the stigma. And so much of how taboo pain management has been in this country for a long, long time because there were such limited options. But, again, things have changed. And [I'm] proud to partner with Vertex to kind of change the narrative about it."

Feeling Pain and Fear

As a professional athlete, Smith knows all about putting on a brave face and forging ahead. Football players, especially quarterbacks, are supposed to push through the pain and lead their team to victory. Fans remember heroes who gritted their teeth and made things happen, not the guy who landed on injured reserve.

But the former first overall pick in the 2005 draft can now be candid about pain and where he could have done things a bit differently. Taboos, after all, are broken down only by speaking about the subject.

Fear is also a piece of Smith's story that would usually be off-limits to a professional athlete. Beyond his journey with pain—he remembered, for example, feeling afraid to ask his doctor questions that could appear dumb—there was fear, which surfaced when he made his return to the field. Despite all of the recovery and rehab, fear still lingered in the background.

"I remember how scared I was," he said of receiving clearance to return to football. "Like what if they're wrong? What if I go out there and my leg, it breaks again. What if it's not strong enough? Like, what if I go out there and make a fool out of myself because I had lost so much tissue and muscle and tendons that like, again, I was going to have to try to adapt and modify to play and wear a brace and like, what if I just make a complete fool out of myself?"

In that moment, though, a support system made all the difference.

"These were all fears that I had, that I dealt with," Smith continued. "And I'll never forget leaving there. You know, my wife and I just talking about everything. And I remember her telling me, like, 'Listen, like two years ago when you were laying in the hospital bed and you were receiving all this bad news, you would have given anything to hear to have this option available, right? Like, here you are. You got this. They were talking about cutting off your leg. And two years later, now you just got this great news to go do this and you would have jumped at it. Right?'"

Smith did eventually get his opportunity and returned to the field during the 2020 campaign, stepping in for an injured Kyle Allen on October 11, 2020. He'd appear in eight games that season, earning Comeback Player of the Year honors before calling it a career.

And while most of us don't have a potential award waiting at the end of their journey, pain doesn't look at your resume before flaring up. If anything, the average person has less support around them than a pro athlete does.

That's where the things that Smith spoke about—being open about fear, breaking down the stigma around pain management and having a game plan in case of your own injury—come into play.

"I wish I could go back and have these conversations beforehand and be more proactive about it," he said. "And again, really open about my story and hopefully helping others to not now make some of those mistakes.

"If anybody out there is wondering about what is available and having help find, you know, dealing with these conversations...[go to] paingameplan.com. There's a bunch of resources out there because I think one of the things, too, as I look back, if you let it spiral and get out of control, it can really get to a bad place."