Listen in today as we sit down with Nixon Dorvilien and Bendu Yeaney to discuss achilles injuries, specifically in the sport of basketball.
Transcript
Odera: Hey guys, it’s Odera checking back in on the “can you explain why this happens” podcast. Today we’ll be talking all things achilles. If you guys haven’t seen it yet, in the past year, year and a half, two of the NBA’s top players, those being Kevin Durant and Klay Thompson suffered season ending achilles injuries. You know this is not the first time we have seen this happen in the NBA and I’m sure it will not be the last. But it’s definitely work asking why this injury occurs so often in the sport of basketball. To answer this, it’s only right that we talk to someone who works directly with basketball athletes and has a much better understand of the mechanics of basketball. So we’ll be talking with a men’s athletic trainer here at Notre Dame and we’ll even get to sit down with an NCAA basketball athlete who will share her story about when she tore her achilles. So without further ado, lets gets started
Odera: All right. So today guys we have with us, um, Nixon Dorvilien from the Notre Dame sports medicine staff. Um, Nixon, if you could just briefly introduce yourself, um, kind of tell us about the work you do and the work that you’ve done in the past.
Nixon: Oh, yes. Um, this is my second year at Notre Dame. My 16th year working, I just completed my 16th year work working, um, collegiate and professional basketball. Um, worked in the NBA, the NBA G league. And, um, here at Notre Dame, I work really closely with the strength and conditioning department, you know, to, um, just provide, you know, healthcare, um, and injury rehabilitation for, you know, these student athletes too.
Odera: So, um, we can go ahead and just jump right in. Today we’ll be talking about, um, kind of the Achilles tendon, um, and then that the relation to basketball. So if you could, just, from a general standpoint for those who either don’t watch the sport of basketball or don’t really know too much about, um, the anatomy of the body, could you just tell us what exactly is the Achilles tendon? Um, what does it do and what’s its function?
Nixon: So Achilles tendon is, um, in layman’s term, it’s, you know, it’s in the back of your heel pretty much, um, it it’s the gastroc and soleus muscles, you know, they kind of blend and become formed this really thick sheet tendon, um, type tissue that attaches in the posterior posterior of your ankle in the back of your ankle. And, um, it’s, um, it’s a really big shock absorber, you know, for jumping and landing, um, specifically landing. Um, and it’s very, very, very important. So for, in my line of work, you know, that’s one thing we measure here with the basketball team. We look at, um, the amount of motion that they actually have, um, in the ankle joint comparative, you know, from, um, right to left. And if there is, um, you know, a huge asymmetry or, you know, one side is, you know, has much more motion, we investigate, try to improve. I mean, find out why you know, there is a lacking in the motion and then we try to improve it because we know for a fact, you know, you know, lack of motion through the ankle joint is, um, kind of a recipe for disaster, especially in our business.
Odera: Definitely. And so just bouncing kind of off what the Achilles is. Can you explain to us what it means for someone to tear or rupture their Achilles?
Nixon: Okay. So for Achilles rupture, you know, um, or tear, you know, it’s, uh, you know, uh, it’s a pathology, um, you know, it’s pretty much, yeah, it, I don’t know how to explain it. It’s, uh, you know, it’s a rip, it’s a severe strain, you know, and, um, and then it’s a positive sign. You know, if you do this, we do it’s test and call it the Thompson, you know, where you squeeze the calf when you squeeze the calf, you know, if there’s no, um, if their ankle doesn’t move, when you squeeze the, um, calf, then, you know, that’s usually indicative of a tear and you confirm it, confirm it with an MRI, you know, um, you know, further imaging. And then, um, usually, you know, for the most part, those require surgical repair.
Odera: Now, now with the sport of basketball, um, you know, basketball players go through several different motions within practice, games, um, conditioning, I mean, anything like that. So why is it that this, this injury, the Achilles terror rupture, what is it specifically with the sport of basketball that makes this injury so, so prevalent in the sport?
Nixon: So there’s a few factors, right? Um, I can just shoot out, you know, a few off the top of my head. Um, one, I would definitely say overtraining, you know, you’re not allowing the body time to repair and recover after, you know, training sessions, the example that, you know, younger and younger, you have, uh, what you call AAU basketball and kids are specialized so much. And I, you know, seeing young men coming through the combine, you know, getting ready to start their professional careers, but the problem is their body’s already, you know, 30 year old bodies based on their lot of games and work, they already, put in, you know, um, that’s one thing. So I would definitely say over-training and Early specialization, um, and pretty much, you know, you wearing out the joint. Two, Um, I would say, um, you know, again, you know, lack of motion, you know, it could be, um, and lack of motion could be also from, you know, training and losing, you know, range of motion through the ankle, you know, because let’s say you had a ankle injury and you’re coming back from the ankle injury, but you never completely, you know, regain motion, um, or you’re not pain free for, you’re going to alter the biomechanics.
Nixon: So by altering biomechanics, you’re, again, going to place a different type of stress through the, um, Achilles on the Achilles tendon, which again, costs would be susceptible to injury. Um, also another thing as we get older, you know, um, we’re not as, um, the tendon is not as elastic as it used to be, you know, that adding with increased, you know, mass body weight, you know, for example, um, then that’s a way you can put yourself at increased risk to rupture the achilles tendon.
Odera: Got you. So, so if I think about maybe, you know, comparing the sport of basketball with say soccer, so in soccer, you have a player just mostly just doing, running up and down, out, down a field, um, with basketball, you know, you see we’re running up and down a court changing direction at different speeds at different times. Um, you have jumping for rebounds jumping for shooting, um, pivoting. So what, what if any effect do those types of motions, shooting, playing defense, um, shuffling, what effect do those have on the tendon
Nixon: That’s a really good point you brought up because so it, um, and that kind of goes into training and specificity. So it appears, um, here’s what I’ll say. So for example, on the surface of, um, soccer, you’re running on the soft, the surface, you know, and in basketball, the surface is of, um, so if you’re, for example, if you’re just practicing your jumps on, like, let’s say on a gymnastic school or, or, you know, you’re training as a basketball player, you know, just on grass and you try to, you know, come to a basketball court, then you’re kind of in a way, setting yourself up for failure, because your body’s going to say, “Hey, wait a minute, wait a minute. I’m used to the floor giving much more” and that tendon’s not prepared for that stress that’s being placed on it. So, um, so that’s definitely, um, a huge difference. Um, and then obviously, yeah, training, um, the training has to be, um, adequate, if that makes sense, you have to train the body to prepare for the demands that, you know, that, that did set. And there’s a principle called “said principle” specific adaptation and goes to van. I don’t know if you heard that term before, but that term, um, it, it just, it’s a good term to follow and people who tend to follow that, um, that, um, that philosophy tend always do well in the world of training or rehabilitation.
Odera: Gotcha. Gotcha. So now with, with the Achilles, um, with the injury, so how, when you see people with this injury, how long is the recovery period, and then also what is occurring during this period to… After post-surgery what’s happening to restrengthen the Achilles?
Nixon: Okay. So post-surgery, um, one of the biggest things is you actually have to leave it mobilized, and that it’s, it’s kind of just specific to that one area, because the problem is, especially with achilles tendons, you don’t want to stretch out the repair too fast, you know, post-surgery. So post-surgery, the docs actually used to give them specific guidelines based on the technique that they use, um, um, in a surgery. So the one big thing is you want to, you know, allow the proper scarring to happen. And then after that, you want to gradually, you want to gradually begin to restoring one, your range of motion, you know, You want to specifically, um, you know, begin strengthening, you know, within guidelines, by the way, because again, you can’t, um, you can’t go through them, you know, one day, okay. We have all of our motion to jumping. No it’s specific. It’s like very specific, um, guidelines want to follow, you know, when, um, rehabbing Achilles tendon.
Odera: Got it. And so are there any precautions or recommendations that, that you can make to, to a basketball athlete, um, to, to prevent an Achilles injury for, from happening? Is it, is it almost always going to happen or are there things that athletes can do to…
Nixon: There’s definitely, there’s definitely things you can do, you know, to try to mitigate, um, you know, this injury and one, I would definitely say, you know, you want to, as you get into any sport, you want to just gradually build into it. You don’t want to, like, for example, I’m 42. I can’t just go tomorrow and just start playing in a rec league. You know, it’s probably not the smartest thing. You know, you are, you probably want to, you know, build, you know, a few months of training before you go, you just want to build into it. That’s the biggest thing. And you have to listen to your body because usually, you know, people would have, you know, starting having police pain, they would have pain before the rupture. A lot of times, you know, they’ll all nights, the back of my ankle just feels really tired or I’m having, you know, pain back there and they keep trying to push through it, push through it, and then it fails, you know, eventually fails, you know,
Odera: Next up we’ll hear from our special guest who actually plays college basketball and has suffered her own season ending achilles injury
Odera: All right. So today we have Bendu it’s Yeaney right?
Bendu: Yep.
Odera: All right. Bendu Yeaney, um, who is a college basketball player at the university of Arizona? Um, Bendu, I’ll let you introduce just briefly introduce yourself, um, a little bit.
Bendu: Okay. So I play for Arizona women’s basketball this year. Um, in my previous years I was at Indiana university. Um, I started, you know, most of my career there. Um, you know, we went to the w nit, um, NCAA tournament. Um, I’m from Portland, Oregon. Uh, and so I wanted to get closer to home. So that’s why I transferred to Arizona. And, uh, you know, um, I did tear my Achilles in 2000, I think, 18, 19 the 2018-19 season. Um, and it was during the NCAA, the NC , a NCAA tournament. Uh, and, um, so, and also I was at home. That was my first time I was ever at home. Um, being able to play in front of my friends and family and, you know, an injury like that ended my season.
Odera: Gotcha. So, um, so as you mentioned, you did, uh, tear / rupture your Achilles during that season. Um, so for me as like someone who watches basketball, I know like when people do go through that injury, some describe it as they feel like a pop in that area or like someone kicked them, um, like in the back of their ankle. So I guess for you, can you just take us a little bit through the injury? Like, um, what happened, what specific movement were you doing, um, or completing when the, when the injury occurred? Just talk a little bit about that.
Bendu: What was crazy about it is I did the same exact move the play before and nothing happened. So basically, um, my teammate had passed me the ball, so I caught it, like I had to jump to catch it. So I caught it in the air, came down and I tried to take off right away, as soon as I took off, like my leg gave out and it felt like somebody kicked me and obviously in basketball, like if somebody kicks you, it’s a, it’s a foul, but nobody was behind me. And like, even in front of me, nobody was able, like to trip me, but just kind of, uh, legs gave out. And I was like, you know, I look back as soon as it happened, when I fell down to the ground. And I like, obviously I noticed nobody was behind me and I, I, as soon as I did it, I grabbed my Achilles.
Bendu: Cause I was like, you know what? Like this, uh, um, this doesn’t feel right. Like, this doesn’t feel like I rolled my ankle. This doesn’t feel like any other, other injury that I had. So I grabbed it. And then, um, you know, I, I tried to get up to walk and as soon as I walked on it, um, I, I couldn’t walk on it. So I don’t know, like Kobe was a different type of breed the way he walked on it. Like, I thought I could be like a thug and walk on it, but nah, that was not, it was not, it, as soon as I walked my foot literally felt like there was no ending to it. Like I literally, like when I took a step, it, like, I was like, I literally felt like I was going like down in earth. Like it, it felt so weird.
Bendu: And then that’s how I really knew that, like, you know, I had ruptured it. Um, and then they kind of tried to calm me down as soon as I felt that I was like, Oh yeah, no, I’m, you know, I’m done for the season. And, you know, I was, I was freaking out. I was like, Oh my God. Like what if I don’t walk again and things like that, because I’ve never had an injury like that. Like, I didn’t even know, like, when you tear your Achilles, like you don’t feel your foot anymore type thing. Like, I did not know that
Odera: Now, like before, before that instance, before the injury happened and every and everything, like, I guess days prior or weeks prior months prior, was there any type of feeling in, in the, the foot that it happened in? Like, was there any pain, any soreness or anything that like, could have triggered the thought that, you know, maybe something is, is wrong in that area or that I could have an injury in the next couple of weeks, uh, months, et cetera?
Bendu: Um, yeah, so, it was basically like a whole year before. Um, I had, I started having like, you know, kind of like stabbing pain in my Achilles. Well, it wasn’t even my Achilles. It was more like at my heel. And so when I started having that, you know, we thought it was just tendinitis. So like that, that summer before I tore my Achilles, you know, we just rested me. We were like, okay, you know, you just need a lot of rest. And then throughout the whole season, like after the games, like my foot would be killing me and we just kept thinking it was tendinitis. Like, and so I saw a doctor about it, you know, there was no tears, no nothing on my foot. So we thought it was good. Um, and they were like, like nine times out of 10 people who have like issues with their Achilles, don’t actually tear it.
Bendu: That’s what they told me. And so, you know, they’re like, you’re going to be fine. Like, you’ll be able to go through the whole season after season, if you still feel the same exact pain, you know, we’re going to go, we’ll take a look. And so, you know, me thinking, I was like, you know what, I’m going to be able to get through the season and everything, like, you know, I can, I could play through pain and it wasn’t like always painful. It was like, sometimes it was just like, uh, you know, it was like, kind of like, sometimes it would be like numb or like, sometimes it would be really painful. Like some games I, after games, I couldn’t walk. Um, so like leading up to the tournament, I kind of, I kind of felt like something was going to happen, but like, I didn’t want to like, just speak into existence.
Bendu: Cause it just, it wasn’t feeling how it normally felt. It just kept feeling more tighter than it was. And then, um, the game before actually I thought I tore it the game before, um, because I had did a move and I think I stretched it out like really, really far. And it was just hurting. Like it was hurting worse than I ever had felt it before. And it was just hurting. I was like, you know what, like, I don’t know if I tore this. I think I tore a lowkey, but I was like, this is, I was like, I don’t know if I tore it because I feel like if I tore it, like I wouldn’t be able to walk. But then I was like, then I thought about Kobe and how he tore his and he was able to walk. So I was like, ah, I don’t know. I don’t, I don’t know. But then I really tore. I was like, Oh yeah, no, I can walk on this one. Gotcha. Okay.
Odera: Um, so like after you tear it, you know, you they’re carrying you back to the bench or locker room. So I guess after that game, was it straight to like surgery or was it, how does the process work? You go straight to surgery then rehab or is it just uh rehab?
Odera: No. So with me, um, they knew exactly I had to have surgery. There was no way to repair it because I tore my Achilles, um, differently than usual people tear theirs. So mine broke off the bone of my heel. And so like, my tendon was perfect. Um, but it was just, it just broke off the bone in my heel. So there was no way of me being able to just rehab and, you know, coming back, I had to have surgery. So, um, I think when I got back to Indiana, um, I think the next day I had a doctor’s appointment and then that Friday I had surgery, just so I could get the process, like moved up because I didn’t want, like I was in pain. I was in a lot of pain. So I was like, you know what, I need to get, you know, in and out as fast as possible.
Odera: So are you in pain even… So you, you tear it during the game you’re in pain, like from that point up until surgery time?
Bendu: Basically because like my foot, as soon as you, like, as soon as I tore it my foot, like was like three times bigger than… cause I swole up really fast. It was three times bigger than what it was. And like, obviously, like you have that one thing, like you’re scared of like a blood clot because it’s so swollen and things like that. So, you know, it was just like, it was swollen and it was throbbing and I like, it was a different type of pain. Like if you roll your ankle that, that pain hurts, but this was like, like probably 20 times worse. And so, um, so I had to have surgery right away. And then, I mean, obviously surgery hurt like the first like month and a half, two months hurt because it was like, my scar was so big. Um, it just felt like I needed to itch, like scratch it, but I couldn’t because it was like a bunch of, um, stitches. Um, and it was just like, it was so uncomfortable cause I couldn’t shower cause you can’t get stitches wet and things like that. So it was just so uncomfortable
Odera: Now, now, like after the surgery, how, how soon after surgery are you able to, to go into rehab? To, to restrengthen and then also while in rehab, like what type of exercises or workouts are you doing to, to restrengthen the tendon?
Bendu: So what’s crazy about it is that since I tore mine a different way, my process of coming back was a little bit shorter. So usually when you tear your Achilles it’s, you know, it’s, it’s like, uh, over a year to come back. Mine was nine to 12 months. Um, so I was able to, as soon as it was like, as soon as I was able to put pressure on my foot, I was able to start rehab. So I probably started rehab maybe a month and a half, maybe two months, like right at two months, um, doing like slowly, like riding the bike just with my foot in the boot and things like that. So like I never had a cast, I had an air cast or not air cast, like one of those boots. Um, so I was able to like, you know, start walking faster, um, with like one crutch and like the boot on.
Bendu: Um, so when I first started so first it was like, we just did the bike. I still had crutches. I was just more getting the motion down and getting, trying to get the blood flowing in my foot and then, um, and moved to, uh, it’s like trying to slowly take out the stitches. Um, probably like at three months we started taking, we took out half the stitches. So then I started to get more like, kind of like movement in the foot. Um, and then, you know, we did, like, we started doing some band work, um, just like small little band work, like just to get, you know, my, my nerves back kicking, because that’s the biggest thing that was the biggest thing with me is that my nerves kind of basically shut down. Um, so we were really trying to get my nerves back, like firing and things like that, especially cause I’m an explosive player. So I need like all, all my, everybody needs their nerves, but like I needed it to come back faster. Um, and so that’s then we started doing like, things started getting rapid, um, with, you know, bikes every day. And then we started walking and trying to get my heel or heel raises, toe touches, like and stuff like that. So, um, it was pretty quick, but, um, it was also repetitive a lot.
Odera: Okay. And so like obviously now, obviously you’ve been able to return to the court, um, being at Arizona. Um, so is there anything now that you do differently, um, whether it’s in terms of like full court workouts or even like stretching before practices before games, um, is there anything you’re doing now that you weren’t doing before you had the injury?
Bendu: Um, I think right now I tape my, I tape my ankle’s a little different. Um, because now I have this, my scar is probably like, from my tip of my heel to like the middle of my back of my foot. It’s like probably this small, so I can’t wear certain basketball shoes anymore because it rubs against my, my tendon too much. And it just like, it just aggravates it, aggravates the scar. So I started having to double, um, double, like there’s like we have these like, uh, what’s it called pads. So we like double the pads. It’s long enough to like, not have like rub against my scar. So I take my foot differently. Um, you know, I wear different shoes now. I’m more of a low top person than the high top because it’s just my scar. It hurts my scar too much.
Bendu: Um, and you know, I stretch a little bit more, there’s certain workouts that excuse me, there’s certain workouts that I still can’t do. Um, like trying to jump off of one foot really fast, like, like a fast motion. I still can’t do that. And you know, it’s almost been two years since I tore it, but like that stuff comes back very slow. Um, but sometimes my take-off is a little different, so I have to change my take-off. I start with my left and then actually like push off with my right sometimes. Um, because like sometimes that, that movement, you know, bothers it. But, you know, I probably stretch a little bit more than I used to. Um, just because like, you know, stretching kind of carries a lot of things. Um, so I think I stretch more and like now I’m trying to make sure that, you know, everything around it, like my ankle is really stable and things like that. So I’m trying to build more like muscle memory and stuff around my ankle just because you know, it is more sensitive now.
Odera: Gotcha. And so as a player in the NCAA, can you just speak a little bit to, what is, I guess basketball season, I think starts in maybe mid-October, late October extends all the way to early April. Uh, can you just speak a little to what I guess the loads, um, on your body, like during, I know you guys are practicing, working out, like what, what is, what effect do you think that, that, if anything had on, on your injury?
Bendu: Uh, what’s crazy about it is, uh, in Indiana. I think that I had more off days and more like it was, the load was heavy, it was heavy, but I think that we also had, um, when we had heavy loads, we also have days that we were like, we have more days off, um, at Arizona where we play it’s different, the way we play here. Um, so we have Mondays usually off and then we practice through the week and we have to play Friday and then we have to play Sunday. So it’s like, we don’t have those days to really have off so like the loads here are a lot more. So I would think that being here, you know, I would have more, um, pushback with my foot then I would have Indiana just because we, you know, we have different, it was different. Um, but I think it was just with, you know, athletes in general, we put on a lot of loads from, you know, having to do weights, basketball for almost three hours sometimes, you know, and like, that’s not, we have, we do it like six times a week and not only have one off day, which, you know, if you work a regular job, you have at least two or three in a week, you know, to rest your body.
Bendu: Um, and so I think that, especially now in this tournament, we’re not going to have that much time. So, you know, rest, our bodies will recover. And I think that does hurt, a lot of athletes, um, when they have pre-existing injuries or, you know, just injuries that come out of nowhere, because you know, we’re not getting the proper rest that we need. Um, we’re working, we kind of overworking our body sometimes.
Odera: Special thanks to both of our guests Nixon and Bendu for their insight on all things achilles. Hope you guys were able to take away something from their experiences and better understand why this terrible injury happens so much in basketball. And with that, we will see you all next time on the “can you explain why this happens” podcast.
References
– Ground Reaction Forces in Distance Running by Peter R. Cavanagh
– A Profile of Ground Reaction Forces in Professional Basketball by Irene S. McClay
– Achilles Tendon Rupture: A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention by Gregory William Hess