Analyzing the Rise in NBA Achilles Injuries This Season

Achilles tendon injuries have unfortunately become a recurring theme in professional sports, and the recent NBA season saw a particularly high number. During the NBA playoffs alone, several high-profile players suffered severe Achilles issues. Milwaukee Bucks guard Damian Lillard tore his left Achilles in the first round, Boston Celtics forward Jayson Tatum ruptured his right Achilles tendon in the second round, and Pacers guard Tyrese Haliburton sustained a torn right Achilles in Game 7 of the NBA Finals.

Beyond these playoff incidents, two centers, James Wiseman and Isaiah Jackson, experienced Achilles tears earlier in the season, as did New Orleans guard Dejounte Murray and Miami Heat guard Dru Smith.

This trend isn`t limited to the NBA. Other notable athletes have also faced Achilles tendon injuries, including USMNT forward Haji Wright, whose recent injury ruled him out of the Concacaf Gold Cup, and Cleveland Browns quarterback Deshaun Watson, who underwent surgery earlier this year for his second right Achilles tear.

Medical experts consulted on the issue point to overuse and sudden, accidental circumstances as primary culprits behind these injuries.

Karin Gravare Silbernagel, a physical therapist and professor at the University of Delaware, draws a comparison between current calf injuries and the hamstring strains prevalent five to ten years ago. She notes that as athletes have increasingly focused on upper-leg strength, the lower legs need comparable strength to withstand the demands of their sport.

“We need to start thinking about the calf and Achilles in the same way,” she stated. “Do we have enough strength … to be able to tolerate the sport that we`re doing? The lower leg is lagging behind some of the other things that we do.”

ESPN spoke with four experts to gain insight into the Achilles injuries seen this past NBA season and the general vulnerability of the Achilles tendon, as well as whether pain medication might obscure warning signs. Their responses have been summarized and rephrased for clarity.

How easy is it to injure a calf?

“It`s not hard at all,” said Dr. Michael Fredericson, director of physical medicine and rehabilitation for sports at Stanford.

“You use the calf in virtually every movement when you`re walking or running,” Fredericson explained, “so it is one of the most common injuries if you combine calf injuries and Achilles injuries.”

For NBA players specifically, overuse is the most frequent cause, according to Dr. Nirav Pandya, a professor of orthopedic surgery at the University of California San Francisco.

“As the season goes on,” he said, “you see a lot of these calf injuries crop up from the wear and tear of playing an explosive game.” He added that some injuries occur randomly, often during explosive actions like layups, when the body encounters excessive force.

What makes the Achilles tendon so vulnerable?

Unlike most other muscles and tendons, the Achilles operates under constant tension. While built for power and speed, this means it is perpetually “wound up and stressed,” noted Dr. Justin Greisberg, professor of orthopedic surgery and chief of foot and ankle surgery at NewYork-Presbyterian and Columbia University Medical Center.

“The stresses that go through the Achilles tendon are probably the highest in the body, many times body weight, [just from] walking,” he said. “… When you`re talking about a professional athlete who`s big and strong and doing serious running and jumping, you`re talking huge loads.”

When it ruptures, it`s not merely a simple tear.

“The explosion of the rupture really affects the … muscle, the part that does the work,” Greisberg explained. “… The whole muscle goes into a coma.”

For athletes, an injury can be triggered by a seemingly simple misstep, such as slipping on sweat, landing awkwardly, or stepping on another player`s foot, according to Greisberg.

Do calf strains lead to Achilles tears?

Not necessarily. Greisberg pointed out that many athletes who suffer Achilles ruptures have no prior injury history in that leg, suggesting a lack of warning signs in many cases.

Gravare Silbernagel stated that the available data doesn`t indicate a direct correlation, but she emphasized that any weakness in one part of the leg, like a calf muscle, makes the entire leg more susceptible to other injuries.

“We don`t necessarily see them going from having a calf strain and then rupturing the Achilles,” Gravere Silbernagel commented, “but they`re all attached.”

According to Fredericson, proper recovery after a calf strain is crucial for preventing subsequent injuries.

“If those muscles don`t fully recover,” he said, “then that muscle is going to be weaker and it can`t handle high-end stress as well.”

Could painkillers be masking warning signs?

The use of anti-inflammatory medications is common in professional sports, but Greisberg doesn`t believe painkillers are the primary cause of Achilles injuries. He suggests that the idea of athletes being numbed and playing through pain doesn`t apply in most rupture scenarios.

“The reality is that [in] the majority of Achilles rupture, athletes didn`t have any symptoms,” he stated. “… It was out of nowhere.”

Fredericson views the potential issue not as the medication itself, but whether it hinders an athlete`s ability to listen to their body`s signals. Gravare Silbernagel agreed that if an athlete doesn`t feel significant pain, they might not instinctively limit the load on the injured area.

“The concern is if you don`t have the pain,” she said. “If you take away the pain, then do you have these inhibitions or not?”

Why were there so many Achilles injuries this NBA season?

Fredericson attributes athletic Achilles injuries to overuse, highlighting the need to evaluate “the amount of load that the athletes are putting on their body and the amount of recovery.” He sees it as a combination of athletes playing through minor issues and inadequate rest.

“These athletes are some of the most supremely conditioned athletes we`ve ever had,” Fredericson remarked, “so I don`t think it`s a conditioning issue.”

Greisberg described it as a mix of chance and specific circumstances, suggesting athletes are pushing physical limits at increasingly high levels.

Pandya pointed to factors like intense playoff schedules (every-other-night games) and off-season commitments (like Olympic training) leading to higher training loads than usual this year. Star players often played 39 or 40 minutes per playoff game, a significant increase from regular season minutes with breaks.

“One of the things we know is whenever you increase the minutes you play over a period of five to 10 games, there`s an increase in injury risk,” Pandya explained.

Pandya also noted that today`s younger athletes accumulate more “mileage” on their bodies compared to previous generations due to starting high-level play at a younger age.

“If you`re looking at a calf muscle or the ligaments and tendons of the average 22-year-old player,” he said, “they`ve already had so much mileage on them, compared to players 30 or 40 years ago who weren`t doing that.”

How can athletes prevent these injuries?

Greisberg suggested stretching, particularly hamstrings and calves, and using supportive footwear can help prevent injuries. Traditional sneakers with a slight heel lift may reduce stress on the Achilles, while very flat shoes might increase it, potentially predisposing individuals to Achilles issues (though more often tendonitis than ruptures).

Gravare Silbernagel added that strengthening exercises for the calves can improve tendon strength. Pandya stressed the importance of players being attentive to discomfort and pain to avoid more serious injuries.

“Even though we`ve advanced surgery wise, it`s still a career-altering injury,” he cautioned.

What can teams learn from this season?

With multiple star players suffering Achilles injuries, experts believe teams should closely examine their training, monitoring, and rest protocols for athletes.

Prioritizing fundamental exercises to strengthen calves can aid injury prevention, according to Gravare Silbernagel. Additionally, Pandya emphasized the need to rest key players and avoid overusing them, particularly during the playoffs.

“I know it`s hard because you`re trying to win, but it`s making sure that you`re appropriately managing during the season and getting their bodies ready for that offseason,” Pandya stated.

He also stressed the importance of transparency from athletes regarding pain and potential injuries.

“It`ll take a big regrouping of looking at how they`re managing the players, making sure their bodies are ready, and also making sure they know that this is a risk and this isn`t something that happens once or twice a year,” Pandya concluded.

How long is recovery?

Even with optimal medical care and rehabilitation, returning to peak performance typically requires nine to twelve months. Greisberg stated there`s no safe way to accelerate this process without increasing the risk of re-injury. He suggested that future breakthroughs in sports medicine might focus on finding ways to prevent the calf muscle from becoming effectively non-functional (“going into a `coma`”) after a rupture.