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Only days before the Los Angeles Rams opened training camp this past July, the team’s prized running back dialed the head athletic trainer with ominous news.
Cam Akers described crumpling to the ground while doing box jumps during a private workout. When he went to plant his right foot, Akers heard a sickening pop and felt a sudden jolt of sharp pain in the back of his leg.
“Instantly it was a gut punch,” Reggie Scott told Yahoo Sports. “Right away I knew it wasn’t good.”
Scott clung to hope that Akers hadn’t blown out his Achilles tendon until the second-year pro pulled up to the Rams’ practice facility and emerged from his car. Akers walked with an obvious limp and couldn’t push off his right foot like normal.
When further testing confirmed the Rams’ fears, Akers was distraught. Achilles tears for years have hastened the retirement of veteran athletes and diminished the trajectories of rising stars. Rather than taking over as the Rams’ lead back in 2021, Akers suddenly faced months of rehab and an uncertain future.
“Is my season over?” he asked Scott. “What about my career? Will I ever be the same?”
What Akers has shown over the course of an astonishingly swift 5 ½ months of rehab is that Achilles ruptures don’t have to be career killers anymore. Athletes can come back the same — and young players in their prime can do it faster than was once considered realistic.
Last Sunday, only 173 days removed from tearing his Achilles, Akers returned to the Rams, carrying the ball five times and catching three passes in an overtime loss to San Francisco. His stats weren’t eye-popping, yet it was a big first step toward joining the growing list of prominent athletes who are making successful comebacks from Achilles tears.
There’s nothing about Kevin Durant that suggests he’s limited in any way by his 2019 torn Achilles. He’s still Kevin Durant, maybe the planet’s best basketball player and most unique talent. Klay Thompson’s emphatic one-handed poster slam in his return on Jan. 9 was also an encouraging sign that he hasn’t lost a step. Teammate Kevon Looney told reporters afterward, “When Klay had perfect knees and Achilles, I don’t remember him dunking like that.”
— Yahoo Sports (@YahooSports) January 10, 2022
Maybe most remarkable of all is the Russian gymnast who summoned the strength to compete at last summer’s Tokyo Olympics three months removed from undergoing Achilles surgery. Artur Dalaloyan pounded his legs on all six apparatus, helping his team win gold and finishing sixth in the individual all-around final.
Those comeback stories raise these obvious questions: What has changed? Why are more athletes now able to overcome what for decades has been one of the most feared injuries in sports?
The answer is that in recent years orthopedic medicine has hurtled forward. Thanks to improved surgical techniques, more aggressive rehab strategies and new technological advancements, athletes are redefining what’s possible after Achilles surgery.
Once a career ender
To understand how devastating an Achilles tear once was for an elite athlete, you only have to go back about 15 years. On a Monday night in 2006, the injury waylaid a three-time Pro Bowl linebacker and prematurely forced him into retirement.
LaVar Arrington was chasing down a Dallas Cowboys running back when he heard a loud pop in his lower left leg. He assumed that a Dallas player had kicked him from behind until he turned around and discovered that nobody was there. Only then did Arrington realize that he wasn’t the victim of a cheap shot. He had ruptured his Achilles.
“I can remember saying in my head, ‘Wow, Var, this is it,’ " Arrington wrote four years later in a first-person Washington Post column. “I knew that would be the last time I would set foot on an NFL field as an active player.”
Arrington’s sudden retirement at 28 was uncommon but not unthinkable. In 1994, an Achilles tear cemented 12-time NBA all-star Isiah Thomas’ decision to hang up his hightops at 32. Eleven years later, Eagles starting receiver Todd Pinkston also never played another NFL snap after rupturing his Achilles at 28.
While numerous other athletes of that era fought back from Achilles tears, many never came close to recapturing their previous form. Elton Brand has admitted his 2007 Achilles tear sapped him of the power and explosiveness that made him a two-time NBA All-Star. LaPhonso Ellis, Christian Laettner, Gerald Wilkins, Maurice Taylor and Mehmet Okur are among the other NBA players who blew out their Achilles in their prime and didn’t come back the same.
“It used to be a career-altering injury,” said Ned Amendola, a Duke University orthopedic surgeon who specializes in sports medicine. “There was a point where when you had a torn Achilles, returning to an elite level was very difficult.”
The discrepancy between then and now can be explained by the contrast in how Achilles tears are treated.
Whereas the procedure once required an 8- to 12-centimeter incision in the back of the calf, fewer orthopedic surgeons still insist upon a fully unobstructed view of the tendon to stitch it back together. Many now pass the stitches through much smaller incisions to reduce wound healing time and limit the threat of infection and other complications.
Superior suturing devices and techniques have also strengthened tendon repairs. Athletes have been able to begin rehabbing earlier without fear of stretching out or retearing the surgically repaired tendon.
Two decades ago, athletes who underwent surgery to repair a torn Achilles could expect to spend the next 6 to 8 weeks in a cast while their tendon healed. The prolonged immobilization produced unwanted side effects — muscle atrophy, stiffness and scar tissue, all of which hindered an athlete’s recovery rate and ability to regain his or her prior form.
“If it’s immobilized 6 to 8 weeks, maybe there's scarring around the tendon and the athlete’s explosiveness never comes back,” said Jason Bariteau, an Atlanta-based foot and ankle specialist. “It's the difference between being an all-star and making the team. Those little small percentages are everything.”
Get moving early
Akers’ path to demolishing the typical 9- to 12-month timeline for Achilles tear recovery began on the operating table. He put his NFL future in the skilled hands of Dr. Neal ElAttrache, the Los Angeles orthopedic surgeon who once repaired Tom Brady’s knee and Kobe Bryant’s Achilles.
What ElAttrache first did during surgery was to suture the ends of Akers’ tendon together in such a way that the tension matched the running back’s other Achilles. ElAttrache then installed what he called an “internal brace,” a second high-strength suture anchored into Akers’ heel bone. The purpose was to reduce the strain on the tear site while the tendon healed, preventing it from rupturing again or stretching out.
Though at the time he couldn’t have predicted that Akers would return in time for the Rams’ playoff game against Arizona on Monday night, ElAttrache emerged from surgery cautiously optimistic about the running back’s prognosis. The surgeon felt confident that his repair was strong enough to allow Akers to be aggressive early in his rehab.
“There’s no reason anymore to accept a tenuous repair that is going to delay you from getting the muscle moving and the ankle moving for several weeks,” ElAttrache said. “With the newer techniques and equipment, you should be able to accomplish a repair that’s strong enough to get you moving early.”
With ElAttrache’s blessing, the Rams’ training staff wasted no time working to prevent muscle atrophy and joint stiffness. It started with 10 days of toe curls, range of motion exercises and blood flow restriction therapy while Akers waited for his incision to heal. Then, once wound infection was no longer a threat, the real work began.
The Rams essentially installed a training room at Akers’ house so he could work out around the clock. Especially vital was an anti-gravity treadmill that allowed Akers to rapidly regain his typical walking pattern without putting too much weight on his right leg and overstressing his surgically repaired tendon.
The impact of Akers’ early mobility and strength work became apparent within four weeks of his surgery. The running back shed his walking boot with the heel lifts inside and began walking in everyday shoes, a milestone that athletes usually don’t reach until later in their recoveries.
“When we saw him walking normally so fast, we all started looking at each other,” Scott said. “That’s when we got this sense that he had a chance to get back before this season was over.”
While that became the goal for Akers and the Rams, it was always unspoken. Scott and his staff would always just tell Akers, “If you keep hitting your marks, you might have a chance to do something special.” That became their code words, their way of establishing a target without actually saying it.
Over the next few months, Akers hit every milestone. Twelve weeks after surgery, the tension in his surgically repaired Achilles remained similar to his other one. After 16 weeks, the tendon’s elasticity had returned. By November, he was doing football-specific drills again. Just before Christmas, Akers returned to practice.
Whereas it was once a guessing game for when a player was ready to return from an Achilles tear, the Rams didn’t have to rely on gut instinct. They used force plates to collect data on the power that Akers generated when he planted to make a cut. Sometimes, Akers performed better on the surgically repaired leg than he did on his normal side.
Even with all that data, it was something else that cemented to ElAttrache that Akers was ready to return against San Francisco last Sunday. The week before in Baltimore, Scott told ElAttrache that Akers was seething that the Rams didn’t clear him to play in that game.
“That may sound like a little thing and it might be unscientific,” ElAttrache said, “but psychological readiness is a big thing to a physician. He wouldn’t have reacted that way if there was something that didn’t feel right or wasn’t functioning up to snuff.”
Preventing an Achilles tear
What will be the next major Achilles tear advancement? Some believe that it will be figuring out how to prevent Achilles tears from happening instead of merely coming up with the best method of treating them.
Over the past six months, the NFL has endured an unprecedented spike in Achilles tears, from Akers, to James Robinson, to Sterling Shepard, to Jeff Okudah, to Takk McKinley. As a result, the league has asked orthopedic surgeon Dr. Robert Anderson to lead a study examining how and why these Achilles injuries are occurring.
“When you look over five years, it could turn out to be a blip on the screen,” said Anderson, a foot and ankle specialist who has treated the likes of Patrick Mahomes, Derek Jeter and Steph Curry. “But there have been more Achilles tendon injuries than usual this [season], so there is more emphasis on studying it.”
Among the questions Anderson hopes to answer: What football position groups are vulnerable to Achilles tears? Do most of them happen when a player is worn down or coming off a period of rest? How big a factor is dehydration? Anderson even hopes to review video of every Achilles tear to analyze if there’s any consistency or correlation in how they occur.
“We still don’t know why these things happen,” Anderson said. “That’s why we need to study it.”
Athletes across sports would surely welcome new theories for how to prevent Achilles tears. To this day, even with the advancements in treatment, a ruptured Achilles often evokes more dread among elite athletes than even an ACL tear or a broken bone.
Dr. Richard Ferkel has repaired the Achilles tendons of more than a half dozen NBA players, from Thompson, to DeMarcus Cousins, to Wesley Matthews, to Rodney Hood. Before their surgeries, they all limped into Ferkel’s office in Van Nuys, California, wondering the same thing that Akers did six months ago.
Will I ever be the same as I was before?
“That’s the first thing they’re concerned about,” Ferkel said. “Every athlete asks that because they’ve seen what can happen. Some athletes haven’t been the same.”
What Ferkel tells his patients is to study the encouraging results of recent Achilles repairs and to reach out to peers who have successfully recovered from the injury. The tale of Akers’ return to the Rams in 5 ½ months promises to be especially reassuring.
Akers wore a microphone last Sunday during the Rams’ overtime loss to San Francisco. The mic’d up segment captured a few 49ers players approaching him after the game to congratulate him on his speedy return.
“Much respect for coming back the way you did,” 49ers linebacker Fred Warner told Akers.
“Appreciate it!” Akers responded.
It’s ElAttrache’s position that Akers won’t be the last athlete to return from an Achilles tear this quickly.
“When you get guys that show this is possible,” the surgeon said, “the next step is that this should be expected.”