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Steve Smith Sr. Achilles Tear: Injury Overview and Career Outlook

Evan Habeeb-USA TODAY Sports

There's been a lot of speculation recently that Steve Smith Sr. was reconsidering his decision to retire at the end of season. However, just seven weeks after losing Terrell Suggs to a torn Achilles tendon, it appears the Ravens have lost Smith Sr. to the same injury. This article will provide an overview of his injury and whether this may be the end of his Hall of Fame career.

WHAT IS THE ACHILLES TENDON?

Tendons are tough bands of fibrous tissue that help connect muscles to bone. The Achilles tendon happens to be the strongest and largest tendon in the human body. It is crucial to athletic performance and has been shown to support loads up to ten times one's body weight during running, jumping, and other athletic activity.

It is formed through the conjoined tendons of the gastrocnemius and soleus muscles of the calf, and extends down and inserts onto the calcaneus (heel bone). Its main purpose is to allow for the transfer of power from the calf muscles to the foot. When the calf muscles contract they create plantar flexion at the ankle (see below); a movement that is essential for someone to be able to "push-off" and perform actions such as sprinting or cutting. Thus, without a functioning Achilles tendon, these movements become impossible to execute.

WHAT CAUSES THE ACHILLES TENDON TO TEAR?

Quite simply, the Achilles tendon tears when an athlete places a load upon it that exceeds what it can handle. This often occurs when the Achilles lengthens too much too quickly, thereby stretching the tendon to the point of tearing or breaking.

In athletics, this is commonly seen when a player attempts to suddenly propel themselves forward or change directions by "pushing-off" (standing on toes, driving heel to ground). This exact mechanism is evident on the play that Smith Sr. got injured.

Research has shown that individuals who experience Achilles tears often have an underlying condition termed Achilles tendinosis. This pathology is a result of overuse/wear-and-tear and causes the tendon fibers to lose their organized structure and results in microscopic tearing. There are often few warning signs and many athletes can experience this without any symptoms of pain. Over time, chronic degeneration can ultimately result in rupture of the tendon.

HOW IS AN ACHILLES TENDON TEAR DIAGNOSIS MADE?

Magnetic resonance imaging (MRI) is utilized to make a definitive diagnosis, however, medical personnel typically knows whether it's torn or not based on the result of on-the-field testing. To assess the integrity of the Achilles tendon team doctors and trainers will utilize the Thompson Test. This test involves squeezing the calf muscles to cause them to contract. If there is no disruption to the Achilles, then plantar-flexion at the ankle will occur. However, if a plantar-flexion moment cannot be elicited, then the Achilles tendon is compromised.

WHAT IS THE TREATMENT AND RECOVERY TIME FOR A TORN ACHILLES?

Nearly all Achilles tears are treated surgically due to the fact that tendons lack adequate blood supply to heal on their own. In fact, tears treated non-surgically have been shown to have a higher risk of getting re-injured. A 2014 research study found that Achilles tears treated surgically re-ruptured 3.6% of the time while those treated conservatively had a re-rupture rate of 8.8%.

In terms of recovery time, a minimum of 6 months is usually required before an individual can resume normal functional activity. For professional athletes, it can take up to a year of grueling rehab before they are fully recovered and able to handle the rigorous demands of their sport.

WHAT DOES THE RESEARCH TELL US ABOUT THE OUTLOOK OF SMITH SR.'S CAREER?

A 2010 research article studied 31 Achilles tendon ruptures in NFL athletes between 1997 and 2002. Of these athletes, 64% returned to play in the NFL at an average of 11 months after injury. The remaining 36% never returned to play at the NFL level.

The study also examined the durability and athletic performance of the athletes who were able to come back and play. To measure performance, the authors developed a "power rating"  which measured each player's productivity by using statistics gathered during game play.

In the three seasons following their return, the players experienced a significant decrease in games played compared to the three seasons preceding the injury (11.67 games per year pre-injury vs. 6.17 games per year post-injury). They also found an average decrease of nearly 50% in power ratings for these players; suggesting that their quality of play declines substantially even if they are able to return to the league.

With that said, by no means are Achilles tears impossible for NFL athletes to overcome. Michael Crabtree and Demaryius Thomas are two examples of wide receivers who have rehabbed from this injury and gone on to enjoy further success in the league. Still, neither of them were 36 years old at the time of their injury.

If Smith Sr. decides to return for another season, there's no doubt that his age will complicate his recovery. But it's certainly hard (and perhaps unwise) to bet against him.

- Dr. Bobby Esbrandt, PT, DPT, PES