Way and Path

The story of an Achilles injury generally starts the same…. “I heard a a popping noise” and “I was tackled, hit, pushed, kicked etc. from behind”. In reality it’s most likely a sharp turn, small bump or an awkward step.

HERE COMES THE SLOW MOTION PLAY BY PLAY. So if you’re one of those “I don’t want to see it!” people who refuse and hate to watch the slow motion injury replays, skip the next paragraph.

Initially comes surprise, even a bit of anger as to what has happened. “Who hit me!” might go through your head. No real pain in that moment, just confusion and frustration. But then comes the pain! Sharp and clear as it shoots up your leg and as as you fall to the floor. This is replaced quickly with the painful spasms of the calf muscle as you twist and worm about on the ground. You might even scream out and swear repeatedly. If you’re lucky, someone massages your calf and the pain quickly subsides. With the pain gone, you’ll realize that something is definitely wrong. Something is broken. It doesn’t hurt, though it’s a strange sensation to have absolutely no control of your foot. It’s like a big lump of useless flesh on end of your leg. An Achilles Tendon Rupture.

Is this the end of your sports career? I’ll discuss the prognosis for Kobe Bryant and offer up some ideas on recovery and prevention for this common condition.

The Achilles tendon is like a thick rubber band that connects the calf muscles to the heel bones. It’s the thickest and strongest tendon in the human body. Like many injuries it is subject to the class or grading system where a first-degree is less severe than a second-degree, and a third-degree sprain is actually a complete rupture or break. For example, “The Black Mamba” Kobe Bryant has most likely experienced a high second-degree sprain. This is indicated by his ability to walk and shoot the free throws after his injury. He has some control of his foot, so the tendon is still attached. It’s not uncommon for athletes over 30 to experience an first-degree sprain, and the acute pain in the area is the bodies early warning system for this affliction. Typically this injury escalates into a second-degree Achilles Tendon Sprain and then without proper care and attention, the rubber band is snapped in two and we have an Achilles Tendon Rupture.

Coincidentally a paper was recently published on Achilles injuries in NBA players by the American Academy of Orthopedic Surgeons in Chicago which examined just how devastating an Achilles Tendon Rupture has been on the performance of NBA players. Specifically, they examined the before and after statistics of 18 NBA players who’d sustained ruptured Achilles tendons between 1992 and 2012. Of those players, eight (Elton Brand, Dominique Wilkins, Gerald Wilkins, Laphonso Ellis, Christian Laettner, Stanley Roberts, Maurice Taylor, Dan Dickau) returned to the league for multiple seasons. Seven players never returned to play in the NBA (Isiah Thomas, Jamie Feick, Perry Davis, Don Reid, Emanual Davis, Jerome James and Laron Profit, and three players did come back, but for only one season (Voshon Lenard, Desagana Diop and Mehmet Okur). The paper concluded what we knew all along…“NBA players who returned to play after repair of complete Achilles tendon rupture showed a significant decrease in playing time and performance.” They go on to point out that “A total of 38.9% of players never returned to play”.

Using something called a Player Efficiency Rating or PER, (a formula developed by NBA journalist John Hollinger of ESPN) they compared the before and after statistics of each player. In John’s own words, “The PER sums up all a player’s positive accomplishments, subtracts the negative accomplishments, and returns a per-minute rating of a player’s performance.” Basically it’s a fancy formula that manages to put a rating on each player, and put all our favorite players in some sort of hierarchical order. LeBron, Durant, Paul and all the others are all conveniently ranked in this metric, but there are also some weird anomalies with players that only play a few games. For those eleven players that returned, the study showed an average Player Efficiency Rating drop off of 4.64 in the first year back and 4.28 in the second. In the Hollinger system a drop off of over 4 PER points is big. So big it’s been the difference between playing in the NBA and playing in Europe or not at all. It’s the difference between a guy who creates and scores and a guy who get’s scored on… and it’s always about buckets. For the record, Kobe Bryant has a top 10 ranking PER of 23.10 this year.

Dominique “The Human Highlight Film” Wilkins is the one big exception. Wilkins suffered his injury in the 1991-1992 season and then at the age of 32 came back to average 30 points once again in the following season. His remarkable comeback started tentatively. “I didn’t feel like I could jump the same way once I returned. I felt like if I jumped too hard or pushed too hard off my ankle, that it would pop again.” he said reflectively after the injury. His next quote, and it’s a long one, is pure recovery gold. “That was all mental. Once I got through that part, I told myself, You know what? If this thing is going to pop, it’s going to pop. But I’m going to play hard. I’m going to go off of it hard. I felt funny mentally. But physically, it was repaired better than ever. In fact, it was three times stronger than my other Achilles.” Wilkins would go on to make two more NBA All-Star teams, play on the gold metal winning “Dream Team 2″, and even win a Euroleague title along and accompanying MVP award with Panathinaikos in 1996. A fantastic career for a player who “Highlighted” the Jordan era of basketball.

The optimistic “prognosis”, and I have to think of “Prognosis Negative” from the Seinfeld series…

…is that an athlete can comes back, but is never the same. Hell, the second best recovery story for an Achilles tendon rupture is Elton Brand, and that’s nothing to cheer about. Chauncey Billups has returned from his injury with diminished skills and we’ve yet to see how backup center and dedicated baller, Zaza Pachulia will recover. Those that do return are forced to change their body mechanics and timing as a result of this injury. This often results in a big drop off in shooting percentage. This also opens the door for further injury as body balance adjustments put subtle new stresses all over the body. This affects speed, explosiveness and lift and results in a frustrating injury that forever changes an athletes game.

What I can offer, is some advise from someone who have battled this injury for 20 years. First, if you experience pain in this area, take it seriously. Do the RICE program. Recovery from an Achilles Tendon Rupture is very, very difficult (see above) and injury prevention can easily be inserted into your regular workouts. For those of you that are experiencing a 1st degree tendon sprain, further activity will cause micro-trauma within the tendon and eventually weakening the tissue further. You’re heading toward a 2nd degree, and eventually a rupture if you’re not careful! The tendon encounters extreme forces during jumping, sprinting and decelerating, so there are many opportunities for an injury to occur…. stay away from these activities! After a good rest and some massage therapy, get some professional advise and do the work in the gym.

If you’re an experienced or advanced Achilles injury survivor here are a few suggestions to help you through this affliction.

1. Heel Lifts Basically rubber heel cups that fit in your shoes. These allow you to continue to play with a minor work adjustment to the elevation of your heel.

2. Tendon taping Tape is applied to the injured area to limit motion in a way that promotes healing. This approach is certainly effective, but has drawbacks. First of all, you’ll need to start shaving the region before the tape is applied, and second it’s tedious and time-consuming. Not really an option for the weekend warrior.

3. The Achilles Tendon Strap This little known, but effective piece of kit is a lifesaver. You can find out more about it here on the Living Strong site. The basic idea behind this strap is to spread the muscular contraction forces away from the Achilles Tendon and to promote an early heel rise. I’ve been testing the strap from Pro-Tec Athletics with good results. The strap puts pressure on the area changing it’s dynamics and stress point while limiting the range of motion. I use the strap when I feel some pain and found it to protect against further aggravation. You can purchase one here as well.

So there you go, a long story about a crippling injury with a limited upside. Nice!

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