Achilles Rupture : what does it mean for you, your patients, & Boogie Cousins??
Achilles tendons are the most frequently ruptured tendon and they generally occur without prior warning signs.
On Friday January 16th, Pelican’s All-Star DeMarcus Cousins suffered a ruptured Achilles tendon upon landing while grabbing a rebound at the end of the game. After being assessed after the game by the team’s medical staff the diagnosis was confirmed and he was ruled out for the rest of the NBA season.
what is an Achilles Rupture?
The Achilles tendon or calcaneal tendon is a strong fibrous band which originates from the gastrocnemius, soleus, and plantaris muscles and inserts into the calcaneus bone (the heel). A rupture generally will occur 2-inches above the insertion into your heel. Ruptures will occur during activities which require your body to accelerate, decelerate, or pivot quickly.
Patients will commonly will hear a “pop” and have difficulty walking immediately after sustaining an injury.
How is it diagnosed?
The Thompson test and Matles test are the two most clinically relevant tests to perform on your patients/have performed on you (1).
The Thompson test involves the therapist squeezing the muscle belly of the gastrocnemius and observing ankle plantar flexion.
The Matles test involves laying the patient on their front with the involved knee bent and observing the angle of resting dorsiflexion of the ankle (looking for > neutral)
To confirm the diagnosis the diagnosis, physicians may request an X-ray, ultrasound, or MRI.
Surgical vs. Non-Surgical?
Non-surgical management of an acute Achilles rupture involves being casted with the Achilles in a shortened position followed by a functional orthosis for 6-weeks.
Surgical management involves an end-to-end repair at the site of the tear followed by the exact same protocol (2).
At 18-month follow ups, both surgical and non-surgical patients have similar functional outcomes. However, patients who opt for surgical management achieve calf strength better and quicker both 6 and 18-months post repair (2). This is a reason why pro-athletes will generally opt for surgical management.
What does Rehab look like?
A typical rehab protocol will start 2 weeks post surgery with some light range of motion (ROM) exercises and help controlling pain and swelling.
Around the 6 week mark, rehab goes into full swing with the goals of achieving full weight bearing during gait, improved ROM, strength, and proprioception by the 12 week mark.
From week 12 and beyond the focus switches to functional, dynamic, and sport retraining.
What about Return to Sport (And Boogie’s Hall of Fame Career)??
It has been reported that 70%-100% of athletes return to their sport within 1-year of the injury. However, weakness and function remain an issue at time of return to sport. This may be because the involved leg typically has a longer Achilles tendon, decreased strength, and ROM even after proper rehab protocols (3-4).
This includes asymmetrical knee and ankle kinematics post repair, asymmetrical loading during jumping and altered running mechanics (DF, eversion, rear foot abd) (4)
Amazingly this has been studied in the NBA!! From 1988-2011 23 NBA players suffered an acute Achilles rupture (5). Only 18 of these pros returned to play and 17 out of those 18 saw reduced minutes and decreased efficiency in scoring and defence!!! (5)
NBA Hall of Famer, Dominique Wilkins is the one exception, playing another 7 years and earning 2 more All-NBA team honours. More recently, we’ve seen a better percentage of pros recover from Achilles ruptures, like Elton Brand and Wes Matthews, to play in the NBA. Unfortunately, stats don’t lie… and neither of these players have returned to their former selves.
Boogie Cousins is an elite talent but the deck is stacked against him. We will following his rehab closely and crossing our fingers he makes a full recovery to become a dominant big man in the league once more!
(1) Schwieterman,B. et al. (2013). Diagnostic Accuracy of physical examination tests of the ankle/foot complex: A systematic review. Int J Sports Phys Ther. 8(4): 416–426.
(2) Lantto, I. et al. (2016). A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. The American Journal of Sports Medicine. 44 (9): 2406 – 2414
(3) Powell, H. et al. (2017). Individuals Post Achilles Tendon Rupture Exhibit Asymmetrical Knee and Ankle Kinetics and Loading Rates During a Drop Countermovement Jump. J Orthop Sports Phys Ther;48(1):34-43.
(4) Silbernagel, K., Willy, R., & Davis, I. (2012). Preinjury and Postinjury Running Analysis Along With Measurements of Strength and Tendon Length in a Patient With a Surgically Repaired Achilles Tendon Rupture. J Orthop Sports Phys Ther. 42(6):521-529
(5) Amin. N, et al. (2013). Performance Outcomes after repair of complete Achilles tendon ruptures in National Basketball Association Players. The American Journal of Sports Medicine (online)