With the NFL pre-season training camps over and the season in full swing, the risk of catastrophic injuries looms large. While soft-tissue injuries like hamstring pulls and calf strains are common, it's the season-ending injuries involving joints and connective tissues that raise alarms. One such devastating injury is the Achilles tendon rupture, a condition that has been on the rise not just among professional athletes but also among weekend warriors.
With the quick rise of sports like pickleball, we are seeing record numbers of achilles injuries come through our clinic
The Sound of the Dreaded 'Pop'
The Achilles tendon is the thickest tendon in the human body, and when it ruptures, the sound of the 'pop' is haunting. Those who have experienced this injury describe it as feeling like being kicked or hit with a baseball bat on the heel. The injury is not just physically debilitating but also psychologically traumatic. Having to wear a boot for 4-12 weeks, being on crutches and being non weight bearing and a 6-12 month full recovery timeline is mentally straining for athletes that just want to go.
The Alarming Statistics
A study from Finland revealed a significant increase in the incidence of Achilles Tendon Ruptures (ATRs), from a rate of 2.1 per 100 person-years 30 years ago to 21.5 per 100 person-years more recently. In the NFL, the rate of ATRs has doubled from 0.341 injuries per 10,000 athlete-exposures in 2009 to 0.731 in 2016. The COVID-19 pandemic has also contributed to this rise, with a marked increase in ATR cases during 2020 and 2021.
Anatomy and Causes
The Achilles tendon is capable of handling up to 10 times the body weight during explosive movements. Most ruptures occur 2-6 cm from the insertion in the calcaneus, the narrowest segment of the tendon. The rupture often happens due to acute loading during acceleration or deceleration, or landing from a jump. However, degenerative changes in the tendon can also contribute to the rupture.
The Aaron Rodgers Case
On September 11, 2023, NFL star Aaron Rodgers suffered a complete tear of his Achilles tendon, ruling him out for the season. This incident serves as a grim reminder of the vulnerability even elite athletes face concerning Achilles injuries. Rodgers' injury has reignited discussions about player safety, training regimens, and the need for preventive measures.
There are some debates in sports that the field surface is the cause of these injuries. If you look at this particular case The injury occurred on a first-and-10 play with 11:40 remaining in the first quarter after Rodgers was sacked by veteran pass rusher Leonard Floyd. The way in which the tackle was made forced Rodgers ankle into dorsiflexion (foot toward the shin). This forced dorsiflexion cause over lengthening of the achilles, which caused the rupture.
Based on this specific injury I would say it is unlikely that being on natural grass would have saved his achilles.
Risk Factors and Prevention
In the complex landscape of sports injuries, particularly Achilles Tendon Rupture (ATR), there's no one-size-fits-all explanation or solution. The causes are multi-factorial, ranging from previous injuries and early specialization in a single sport to over-specialization and poor exercise selection. Studies have shown that athletes with a history of lower extremity injuries are more susceptible to ATR. Early specialization, especially in sports like gymnastics, puts athletes at risk due to the high-impact nature of the sport. Over-specialization, on the other hand, leads to repetitive stress on specific body parts, increasing the risk of injury.
Exercise selection and progression rates are also critical. The trend towards heavier resistance in sprinting and acceleration drills, for example, has been linked to a rise in ATR injuries. The type of surface athletes practice on and the footwear they use can also contribute to the risk. Artificial turf fields have often been blamed, but studies show that the type of surface may not be as significant a factor as previously thought. Footwear that offers too much traction or is too lightweight can also be problematic.
Pharmaceuticals like Fluoroquinolone antibiotics and corticosteroids have been associated with an increased risk of ATR. Even diet and nutrition can play a role, although the evidence is not yet conclusive. Collagen supplementation combined with vitamin C has been suggested as a preventive measure. The key takeaway is that a holistic approach is essential for both understanding the causes of ATR and devising effective prevention strategies. Coaches, athletes, and healthcare providers need to consider multiple variables, from training regimens and equipment to pharmaceuticals and nutrition, to mitigate the risk of these devastating injuries.
The rising trend of Achilles tendon ruptures is a multifaceted issue that requires a comprehensive approach for prevention. The case of Aaron Rodgers serves as a cautionary tale, emphasizing the need for more research and preventive strategies to protect athletes at all levels.