Even in world-class athletes, Achilles tendon injuries can be avoided
As I’m sure the whole world has heard, one of the greatest basketball players in world suffered a horrible injury in Game 5 of the NBA finals. Kevin Durant ruptured his Achilles tendon in the second quarter of the game and shortly after underwent surgery.
This can be an extremely devastating injury with a long recovery, and can often be career altering, if not career ending. There has been a lot of controversy as to whether or not Durant should have even been playing as he was still recovering from a calf strain, which occurred a month prior to the Achilles rupture.
Golden State Warriors coach Steve Kerr stated, “This last month was a cumulative collaborative effort in his rehabilitation. And that collaboration included his business partner, our medical staff, his own second opinion doctor outside the organization. Kevin checked all the boxes, and he was cleared to play by everybody involved.”
Knowing what he knows now, Kerr said that holding Durant out would have been the only decision. In a press conference after the game, the president of the Warriors, Bob Myers commented, “The initial injury was a calf injury. This is not a calf injury. I’m not a doctor, I don’t know how those are related or not, but it’s a different injury.”
One problem leads to another
He’s definitely not a doctor. The fascia or connective tissue of the calf muscles, namely the gastrocnemius, plantaris, and soleus muscles form the Achilles tendon, attach the muscle to the calcaneus or heel bone. Often if there’s a problem with the calf muscles or the tendon, there will be a problem with the other as well.
Following an injury, muscles spasm as a protective mechanism which is known as muscle splinting. Muscle splinting causes shortening of the muscle length. Muscles should normally be able to stretch to 120% of resting length. Chronic muscle splinting can cause fatigue in the muscles, which can lead to contracture. If the muscles are in a state of contracture they can put more tension on the tendon where it attaches to the bone. You can think of it like a violin string that gets too tight. The more you turn the pegs, the tighter the string gets and the easier it gets to snap under pressure.
The media has also been making statements that Kevin Durant “may have” had what’s known as microtears in the Achilles tendon before it ruptured. The problem with something like microtears is that they can’t be visualized or seen in imaging like x-rays or MRIs. But the muscle contracture of the calf pulling the tendon tighter and tighter can sure cause microtears to exist. A study of 7,232 patients showed that 4% of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (1). Although an Achilles tendon rupture is considered an acute process, histological analyses have demonstrated that, even in the setting of acute rupture, degenerative changes are regularly found within the tendon (2).
Check the biomechanics
Whether it’s a professional, collegiate, high school, or even the weekend athlete that suffers an injury or even experiences pain and inflammation of the calf or Achilles tendon, it’s important to look at the biomechanics of the injury and to have a full biomechanical analysis performed by a professional. This can not only aid in recovery but can also prevent further and much worse injury such as rupture.
One factor known to contribute to overuse degeneration and inflammation is excessive pronation. Excessive pronation, which can be caused by flattening of the arches of the foot, can have a tendency to develop tendonitis in the Achilles tendon due to greater stress biomechanically placed on the tendon while running or even walking. Reducing any tendency to excessively pronate the foot is one of the best ways to recover or treat Achilles tendonitis and calf injuries.
Anytime there is an injury to the calf or tendon, long term prevention must be considered in conjunction with recovery methods. This is especially true for someone like Kevin Durant, as acute rupture of the Achilles tendon occurs most frequently between the ages of 30-40 and more commonly in males.
Low-level laser healing
Some great options that should be considered for anyone at any age that has symptoms of a calf or Achilles tendon injury are low-level laser therapy, deep friction massage of the calf muscles, custom orthotics to prevent excessive pronation and biomechanical faults, and of course restricted activity. Low-level laser therapy increases micro vascularization or blood supply to the area decreasing pain and inflammation and decreasing the time it takes for soft tissues to heal. Low-level laser has been shown to be an extremely effective treatment for sports injuries such as jumper’s knee, tennis elbow, and Achilles tendonitis (3).
Although the application of heat and massage can be contraindicated in the initial phase of an acute calf or tendon injury to avoid risk of hemorrhage, friction massage can be extremely helpful in decreasing adhesion formation in the subacute phase (4). Essentially massage along with passive and active stretching keeps the muscle loose, which can prevent the tightening and contracture discussed earlier. The contracture and adhesion in a sense tightens the violin string, which is the tendon, and massage prevents it from getting so tight that snapping or rupturing could occur.
Orthotics to prevent overuse injuries
One of the most important options any athlete — from recreational to professional — in the prevention of overuse injuries to the lower extremity is the use of custom-made corrective orthotics. Through slow-motion cinematography it has been shown that pronation of the foot can cause a whipping action of the Achilles tendon, which may lead to micro tears of the tendon (5). Not only can orthotics prevent this pronation while walking and running, they have even been shown to help conditions such as back pain and dysfunction (6). Shoes that provide adequate heel stability should also be worn in conjunction with orthotics.
Even world-class athletes like Kevin Durant, who have some of the best medical teams in the country, can go down with significant non-contact injuries. When we see this happen it’s a great time to remember how important it is for even the recreational athlete to have professional evaluation of the biomechanics, alignment, and function of their feet and lower extremities in order to increase performance and prevent injury.
The treatment of biomechanical faults is discussed in-depth during Practice Xcelerator sessions, which are held throughout the country. Click here to request more information.
- Yasui, Y et Al. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. Biomed Res Int. 2017:7021862
- Tallon C. et Al. Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons. Medicine and Science in Sports and Exercise. 2001;33(12)
- Morimoto, Y MD et Al. Low level laser therapy for sports injuries. Laser Ther. 2013; 22(1): 17-20
- Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med. 2009;2:74-77
- Clement, DB et Al. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984; 12:179-84
- Cambron, J, DC et Al. Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial