How An Achilles Tear Affects NBA Players (Or, Why Kobe Is Screwed)

How An Achilles Tear Affects NBA Players (Or, Why Kobe Is Screwed)S

The Lakers season begins tonight with their home opener against the Clippers, but Kobe Bryant won't be playing. Bryant tore his Achilles tendon on April 12, and while he's still "ahead of schedule" in his six-to-nine-month recovery, he still hasn't begun running. He will miss at least the first several weeks of the season, but some missed time in November is the least of his problems. An achilles tear is a devastating injury for an NBA player; here's our look at exactly how bad the outlook has been for other NBA players from back in April.

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How An Achilles Tear Affects NBA Players (Or, Why Kobe Is Screwed)

How An Achilles Tear Affects NBA Players (Or, Why Kobe Is Screwed)S

Kobe Bryant, your favorite high-functioning sociopath and mine, tore his Achilles tendon Friday night during a win against the Warriors. We've been hearing about "torn Achilles" for years now, but for most fans, the operational definition of the injury remains ambiguous. You hear a player has torn an Achilles, and you assume he'll be out for a year or so, and that he probably won't be as fast or explosive when he comes back. That interpretation isn't necessarily wrong, but it elides a lot of the real complications and effects of the injury.

The Achilles connects your calf muscles to your heel bones. It is the thickest and strongest tendon in the human body. Kobe's injury is a third-degree tear, which means that his tendon has completely ruptured. Think a rubber band; an Achilles with a minimal to moderate tear is like a rubber band with a nick in it that's still mostly holding together; an Achilles with a third-degree tear is a rubber band that snapped in two and is flopping uselessly around. Surgical treatments and rehab processes can vary widely from doctor to doctor, but Kobe's six- to nine-month range seems realistic, though perhaps verging on optimistic.

That's because, even after surgery to repair the tear, there's a lot that can go wrong. Patients are typically rushed into surgery relatively quickly to keep the ends of the tendon from shortening, which would reduce range of motion and the ability to store energy. Surgery poses the risk of over-elongating the tendon, though, which could also severely impair functionality. Since the Achilles tendon is so closely related to running speed and power generation, any of that is bad news for an athlete—and especially for an athlete as driven as Bryant.

What Does It Mean For NBA Players?

Coincidentally, Bryant's injury comes just a few weeks after a group of doctors presented a paper on Achilles injuries in NBA players at the American Academy of Orthopaedic Surgeons Annual Meeting in Chicago.

The paper, "Performance Outcomes after Repair of Complete Achilles Tendon Ruptures in National Basketball Association Players," isn't available online yet (it will be published in an upcoming issue of the American Journal of Sports Medicine), but the baselines it lays out aren't encouraging for Bryant's prospects, especially if he still plans on retiring after next season.

Dr. Douglas Cerynik and Dr. Nirav H. Amin, both of Drexel University, were co-authors of the paper and kind enough to speak with me this past weekend. Along with their other collaborators, they examined 18 players who'd sustained ruptured Achilles tendons between the years of 1992 and 2012. Of those players, seven never returned to play in the NBA, and 11 came back for at least one season. Eight of those 11 returned to the league for multiple seasons.

The average age for injured players was 29.7, with seven years of playing experience (Kobe's in his 17th year); in the first year back from injury, players played 5.21 fewer minutes per game. That number dropped to 4.42 in the second year back. More tellingly, player efficiency rating (PER) dropped by 4.64 the first year back and 4.28 the second. To understand how severe that drop is, consider: This year, a difference of 4.64 PER is the difference between Kobe Bryant and Ersan Ilyasova.

On a per 40-minute basis, "athletic" stats like blocks, rebounds, and steals actually held steady post-injury. The same is true for field goal and free throw shooting percentages. Given players' dropoffs in overall efficiency, that was surprising, so I dug a little deeper and looked at rebound rates, free throw attempts, and other areas that might affect a player's PER. There is a general decline in FTA in post-injury years (which would pose a problem for Kobe, given how many shots he takes), with rebound rates actually holding more or less steady. The dropoffs showed up in any number of categories. Some players shot abysmally once they came back; for others, usage rates plummeted, suggesting they were no longer capable of creating their own offense. But taken as a whole, there was an obvious and expected drop in efficiency for nearly everyone.

Position didn't affect recovery time, Amin says. "We had a well-rounded group of players," he says. "There wasn't a conclusion that said all the forwards came back and none of the centers. It was spread evenly throughout."

Indeed, players as diverse as Elton Brand, whose game by the time of his injury existed almost purely from 15-18 feet, and Maurice Taylor, who brought power, finesse, and, later, extreme apathy to the low post, were both able to recover within a year or two and remain productive. (Though neither ever matched pre-injury rates.) However, both were relatively young at the time of their injuries (28 and 25, respectively). Dominique Wilkins was the only player to return completely to form after the injury.

Players also missed an average of 55.9 games, but that number is obviously noisy; you'll miss more games if your injury comes at the beginning of a season, rather than just before the off season.

Also, an obvious caveat: This isn't a humongous sample size. Because the NBA doesn't have a centralized injury database like the NFL's, compiling data can be difficult. The Drexel team spent months searching Google and old media clips for instances of Achilles injuries. (So if you spot any missing names on the list below, excluding very recent names like Chauncey Billups, shoot me an email.)

So, What About Kobe?

Even seemingly favorable comparisons don't paint a very encouraging picture for Kobe, who's 34 years old. The experience of Dominique Wilkins—who ruptured his Achilles in the 1991-1992 season, at age 32, and came back to average 30 points the following year—has been invoked several times over the past few days. Wilkins was also an aging, athletic slasher, and he came back to play at an All-Star level for four more years, and at a high level for two more after that. It's an encouraging comp for Kobe fans. Except: It's not, really.

At the time of his injury, Dominique had played 27,482 minutes over 10 seasons (playoffs included). Kobe, now in his 17th year, has logged 54,041 minutes. He's just two years older than Wilkins was at the time of his injury, but he has twice as much pro basketball mileage on his legs. And that doesn't even take into account Kobe's slogs through international competition (another 37 games started).

How An Achilles Tear Affects NBA Players (Or, Why Kobe Is Screwed)S

The better, if still remote, comparison is Isiah Thomas, who at the age of 32 tore his Achilles (it was the same year as Wilkins's injury). Thomas had played more seasons (13) and far more minutes (39,732 combined regular season and playoffs) than Wilkins, however. Rather than face the grueling comeback that Bryant is facing, he never played in the NBA again.

Age Is A Factor

Kobe, who turns 35 in August, is already on the wrong end of the aging curve. That alone doesn't bode well for his recovery.

"There have been 18 [Achilles tendon ruptures] over a 23-year period, and Kobe's on the extreme end of the age range," Amin told us. "Players of a similar age have generally not been able to return to play."

Kobe's age likely contributed to the injury in the first place. According to Cerynik, the average age of players who suffered Achilles ruptures was 29, while the average age of players in the league over the same period was 27. What's more, the injured players had 7.6 years of experience; the league average was six.

It's simple physiology, really. As the body ages, tendons and ligaments lose water content, making them more fragile and less elastic. This is where old-man knee ache comes from. It happens at different rates for different people, but it's nonetheless inescapable.

Mike D'Antoni Is A Factor, Too

Kobe's been playing 38.6 minutes per game. He certainly hates the sideline, but there's some precedent here with Lakers coach Mike D'Antoni: He tends to play his stars for long minutes, and those stars tend to go down with injuries—think Amar'e Stoudemire and Jeremy Lin in New York. Is it possible that Kobe's injury could have been prevented, had the L.A. coaching staff been more diligent about his minutes?

The short answer is: Yes, of course. Overuse of tendons is one of the main and obvious causes of injuries to them. And Kobe had been playing a prodigious amount of minutes all season long, and especially leading up to the injury. (Bryant is second in the league at 38.6 minutes per game, and fourth in total minutes behind three players who have played more games. He'd averaged 45.2 minutes in six games in April, and dating back to last month, he'd had a stretch of 48, 47, 43, 47, 48, 41, and 45, which would have been 48 had he not been injured.) Still, it's difficult to be certain, according to Cerynik.

"Definitively, you'd need serial MRIs every month over the season. But there are two ways that the Achilles tears: a chronic, prolonged condition or an extreme sudden one," Cerynik says. "Only one player [in the study] had a prior history of Achilles strain, which caused us to assume that a lot of them were sudden forceful injuries. We don't have the records from each case, though, so it could be that there were other factors."

The one thing that's certain, though, is that the injury needs time to heal properly. "If there's no infection—that's one of the early risks—then it's the immobilization period, and progressing in a gentle fashion and not overtaxing and causing secondary damage to something that's healing," Cerynik says. "You'd see that with some of the microfracture guys who tried to come back early and had to sit out again."

"Gentle fashion," "not overtaxing," "immobilization." Does that sound like the Kobe ethos to you?

The Case For Kobe

To argue in favor of Kobe Bryant returning whole next year and resuming his role as a force in the league, you can't rely on science or precedent or basically anything anyone has ever seen related to Achilles tendon injuries. You just have to throw your hands up and say: Kobe is a freak, and therefore will be just fine. It actually isn't as absurd an argument as it sounds.

By definition, an NBA athlete is a freak-show anomaly, a star player like Kobe even more so. Bryant is an exceptional player and athlete, and he always has been. Unlike the undersized Brand, Kobe is the prototype for his position. He's big for a shooting guard, and he's strong and skilled enough to work from the post effectively. And while an unsure left ankle could slow his celebrated footwork, he should still have enough length and spring in his legs to rise for his jumper. He hasn't been playing any defense this year anyway, so it's not like that will get any worse.

And as much as he still relies on his seemingly ageless athleticism, he's just as much of a mutant when it comes to diagnosing plays and identifying soft spots in defenses. He's shown this year that he also has the capacity to exploit those skills as a high-level point guard when needed. It's a cruel piece of fortune that Kobe went down the same year he finally showed us how complete his game can be, by peeling back new layers and deconstructing the role of primary distributor.

The proposition, then, is that Bryant's mind and body are too far removed from those of a typical NBA player to consider the possibility that he'll be a typical NBA Achilles casualty. It's not a wholly unconvincing argument. Just know that there's no such thing as a genetically "good healer" or a "fast healer." Good overall health and fitness, which Kobe certainly possesses, can go a long way toward limiting complications like infection, but no more. Kobe is a human being. And for human beings of all athletic abilities, this is a devastating injury.

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The list of NBA players in Drexel paper:

Elton Brand
Dominique Wilkins
Gerald Wilkins
Laphonso Ellis
Christian Laettner
Stanley Roberts
Maurice Taylor
Dan Dickau
Voshon Lenard (begins one-season players)
Desagana Diop
Mehmet Okur
Isiah Thomas (begins career-ending players)
Jamie Feick
Perry Davis
Don Reid
Emanual Davis
Jerome James
Laron Profit

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