In Monday night's Game 5 of the NBA Championship between the Golden State Warriors and the Toronto Raptors, star player Kevin Durant sustained what appeared to be a season-ending injury to his Achilles tendon. This is a major blow to Mr. Durant as he was hoping to help contribute to the Warrior’s 4th title in the past 5 years.
In this blog, we will explore how costly this injury is to Mr. Durant after being out for nearly a month with what was reported as a calf strain. Money aside, with health as our focus, this could be an eventual career-shortener, if not, a career-ender (as there may be a domino effect of other injuries to ensue. ie. Kobe Bryant).
The Achilles Tendon and how ruptures happen:
The Achilles tendon is the junction where all your calf muscles tether into bundles of fibers that attach to your heel; think of the steel suspension cables on the SF-Oakland Bridge. We can seem to understand if one of these fibers or a few fibers rip, the ankle/foot will lack the full capacity to handle twisting, bending, and shortening and lengthening of the Achilles tendon. Even with 10-25% fibers torn in the tendon you are still capable of moving. A common complaint is that it feels sore and has an ache with movement. Often time it lingers for 30-60 min after use but it goes away until maybe the morning when you place your foot down on the floor for the first time. This could be called a “tendonitis” or a “tendonosis” or maybe even a “strain” (see the cable-like fibers below which are analogous to the steel cables above that suspend and stabilize a bridge). Tensile strength is the key point to understand here and there is no other tendon in the body which does it better.
How can a simple soreness/strain lead to a breakdown and an eventual tear of the Achilles tendon?
The cables or fibers begin to fail if trying to balance the tension and pulling surpasses the capacity, all of it comes crashing down, and the tendon ruptures.
While at Boston University I was taught by our anatomy professor that healthy tissues don't tear, it's the degenerated ones that do. Fifteen years later and I still firmly believe this.
The Achilles’ and the calves’ job is to produce power and push off. When you add a heel bone that is misaligned, this can add side-to-side instability, tensioning things further. This forces the Achilles tendon to perform 2 full-time jobs. If we had to do that, we’d breakdown too.
So unfortunately for Kevin Durant, trying to go one way and quickly changing direction was the wrong combination of movements which created this perfect storm.
So why was this missed by so many, if it was, in fact, missed?
They say Durant initially felt discomfort in his calf about a month ago. Most of the time, our brain (where pain is ultimately felt) can perceive an area not related to the actual site. This is because the signals are poorer to certain parts of the body that are generally not our face/head, hands and feet. The Body map or Homunculus as we call it, can further misinterpret the signals and then we are left treating the symptom and not the cause.
Couldn’t some of the initial testing have caught this tear early? In my opinion MRIs should have caught this in the first place, but who knows what was actually said and what was reported through media outlets. This may have to be a question we could ask the Golden State personnel. Is there suspicion that medical advice was just ignored or not fully disclosed by/to player or organization? We will never know!
How could this have been prevented?
I believe open, clear communication between the healthcare provider and patient is necessary. Also asking the right questions leads to a good examination. If evidence showed the possibility of a tear Mr. Durant should have been shut down from activities for 8-10 weeks for adequate healing and rehabilitation.
What’s the road to recovery look like for Kevin Durant?
He will have surgery to repair this, see picture above. This will be arguably the longest and most painful and frustrating recovery for Mr. Durant. He will need plenty of rehabilitation and patience. For the average person, in my professional opinion, it’s at least a good 6 months to perform at an athletic level and it could be closer to a year or maybe even two for full recovery. I wouldn’t rush Mr. Durant back and would safely say to get to a FULL recovery and be able to perform highly it should take 10-12 months to do it right.
What we may see is he is rushed back too early in about 7-8 months, and that will just break our hearts here at Rehab and Revive.
What would rehab have looked like before the tear or after repair?
The healing course for the tear vs a repair is often similar except the duration and how aggressive a therapist could progress the patient. As mentioned above, a tear would require a good 8-10 weeks.
Tear Rehab: Help decrease the swelling and help encourage scar tissue formation around the tear. In cases there have been chronic micro injuries (which I suspect there were many for Durant) we would need to create scar tissue with techniques like friction massage.
Then we would work on getting the tendon to slide and glide and shorten and lengthen using manual techniques. Then we would encourage weight bearing and stability of the ankles, knees, and hips. After, one would work on strengthening and endurance, before power and jumping. I’d say for the average patient rehab would be 2-3x a week until proper power is restored and then reduced to 1-2x a week to encourage efficient running and sprint techniques.
Surgery Rehab: There will be a lot of non-weight bearing time to see it through and make sure it begins to heal with the fiber coil, which is most often the case with these surgeries. I’d like to say 16-20 weeks and then begins a much slower process of above basically twice as long as a tear.
You could say it would have been a much better bet to have Kevin Durant waiting on the sidelines to preserve both his health and career.
Heal smarter, Not Harder,
Dr. Justin C. Lin, PT, DPT, MS, CSCS, CFMT