Achilles Tendon and Ruptures
The Gastrocnemius and Soleus (calf muscles) combine to form the Achilles tendon on the posterior (back) aspect of the lower leg which attaches to the calcaneus (heel.) The Achilles tendon is the largest and strongest tendon in the body.
The function of the Achilles tendon and calf muscles is to perform plantarflexion. We use these muscles to walk, run, jump, and cut everyday. Examples of plantarflexion include standing on your tip toes or pressing the gas pedal.
A rupture of the Achilles tendon is a brutal injury due to the functionality of the tendon (everyday use) and the prolonged healing process. Achilles tendons are poorly vascularized (area that does not receive a lot of blood flow.)
Patients that suffer an Achilles tendon rupture describe the injury as feeling as if they are being kicked hard in the back of the leg and some have even heard an audible pop of the tendon during rupture.
Timetable for Return to Sport
Rehab is a grueling process to regain the ROM (range of motion) and dynamic movement post-injury. Typical Return to Sport (RTS) for athletes following Achilles tendon ruptures is around the 9-12 month mark, with rehab sometimes extending into the 18 month mark in some patients.
A primary concern following Achilles tendon rupture and repair is a return to prior level of strength and explosiveness. A study showed that peak torque in the injured leg was markedly less than the non-injured leg.
A positive note is that patients that suffer an Achilles tendon rupture only have about a 5% chance of re-rupture per “Examination of Orthopedic and Athletic Injuries 4th edition.”
But just how positive is the reinjury rate?
Although the reinjury rate may be low, this chart shows that running backs have an extremely difficult time returning to elite status. Due to the nature of the running back position requiring explosive movements, an Achilles tendon injury is devastating.
A study on NBA players following an Achilles tendon rupture showed that players had reduced games per season, minutes per game, and performance ratings at the 1 year and 3 year marks.
Looking Ahead
So are Achilles tendon ruptures still the death sentence of NFL players, specifically running backs? The simple answer is that we just don’t know. Marlon Mack will be a closely examined comeback case. If Mack can prove he’s fully recovered then we know modern science has made tremendous progress.
