Sports Rehab Write-Up: WR Tim Patrick

Agh! Another nasty, non-contact injury in training camp! This time it’s Denver Broncos WR Tim Patrick.

The Broncos have been in the news a lot lately, and not necessarily for the best reasons! With the season looming, drama’s being stirred & expectations are being raised; and, to make things tougher, the injury bug is creeping in at the worst time possible!

During the Broncos July 31st practice this past week, Patrick went down during a 7-on-7 drill, running what seemed to be a fairly mundane route out of the backfield. We see a hop, we see a step, we hear a pop, we see a fall; for those of us with a sports medicine background, this was a pretty clear case of an Achilles rupture.

“So look, yes, he’s got an Achilles tear. I spoke to him last night. Of course, he’s disappointed… He’s tough-minded. He’s a real good leader. And the good news is, it’s a clean injury, and that is a better than likely 100% recovery. It’s pretty clean, relatively, the type of surgery he’s gonna have. I don’t have a date yet when that’s gonna take place, but that’s where we’re at there.” -Denver Broncos HC Sean Payton

So, the team’s officially ruled their stud receiver out for the 2023 season with a torn left Achilles. This is almost exactly a year from the day Patrick suffered a right-sided ACL tear that kept him out of last year’s season. If we look back from today, this past year of Patrick’s career is a pretty interesting case that underscores some very noteworthy concepts. Let’s take this opportunity to review the literature regarding Achilles tendon ruptures & we’ll apply our findings to Patrick’s situation for some further insights!

The Achilles tendon is the most commonly ruptured tendon in the human body. It’s also our largest & strongest tendon; thus, it’s generally the most well-known. Considering our anatomy & the location of our Achilles tendon within the kinetic chain, its great size & strength are a definite necessity. Whether we’re walking, running, or jumping, the Achilles is responsible for transmitting the accumulation of our produced forces into the ground through the rigid lever that is the foot.

Diagram of the Achilles Tendon & Calf Musculature // Source: rehabmypatieint.com

No one really knows what exactly causes an Achilles tendon rupture; there aren’t any definitive predictors & generally, when we do see a rupture, it’s during an activity that our athletes have done a million times over without an issue. The one major constant is the sudden, high-intensity loading of the Achilles & calf muscles in a push-off type motion, but there has to be more to it than that.

There are two main theories surrounding Achilles tears: the degenerative theory & the mechanical theory (Thevendran et. al, 2013).

Degenerative theory suggests that Achilles tears are due to structural changes that occur within the tendon. Notable contributors to Achilles tears under the degenerative theory are aging, reduced blood supply, repetitive trauma, & poor recovery. Degenerative theory is a very fitting explanation when applied to a veteran, single-sport athlete who plays at an extremely high intensity for half of the year & rests for the other half.  Proponents of the degenerative theory suggest that extended periods of relative inactivity in athletes – like during the offseason – result in an accumulation of non-healing micro-trauma, which may lead to rupture in the long-term. A death by a thousand cuts.

Mechanical theory also singles out athletes returning to play after prolonged inactivity. According to the mechanical theory, the ultimate cause of rupture may be one specific instance of poor biomechanics due to a variety of factors such as fatigue, overtraining, or even detraining. Form breakdown or a lack of muscle coordination can apply excess force to the Achilles at just the right (or wrong) moment leading to a rupture – a perfect storm.

Keep in mind that Patrick’s injury timeline is extremely similar to that of a well-known NBA sharp-shooter: 4-time champion, Golden State SG Klay Thompson. If you recall, coming off of his rehab for a torn left ACL in 2019, Thompson ruptured his right Achilles & had to jump right back into yet another rehabilitation process. It’s actually not very uncommon that we see athletes suffer from an Achilles rupture after recovering from an ACL tear in the opposite leg. Asymmetries post-ACL tear can linger multiple years after repair (Sharafoddin-Shirazi et. al, 2020) & those imbalances often lead to additional injuries down the line if not adequately addressed (Fulton et. al, 2014).

 Having your season derailed by an ACL tear is tough enough; but to go through a full year of rehab only to be set back by an even tougher, more debilitating injury is heart-breaking.

“It sucked, it was like the darkest days of my life really… That was a big test of my mental health, I learned a lot about how to stay mentally healthy through my rehabs. If there was a silver lining, that was it.” -Klay Thompson, on his 2020 Achilles Injury

            Hopefully, Tim’s staying strong through this latest challenge. Denver HC Sean Payton seemed to suggest that the receiver is planning to take the surgical route, which the literature generally favors for lower re-rupture rates & faster return to sport (Deng et. al, 2017); though, Tim’s likely still looking at a 12-month road to recovery (if not longer). When it comes to returning from an Achilles rupture, the major key to success is regaining strength & power through an aggressive, well-structured rehab program.

Football is an extremely demanding sport; requiring absurd levels of power & explosiveness at the professional level. Unfortunately, calf strength never quite reaches pre-rupture levels after a torn Achilles; but, skill, perseverance, & attention to detail can always help an athlete succeed in ways that strength & power can’t! We saw Klay come back from the exact same set of circumstances & perform at an All-Star caliber level, so the blueprint is there! Tim Patrick has a year full of hard work ahead of him, but the life of a professional athlete is one of hard work & perseverance!

If you’re dealing with a similar injury & seeking professional guidance, consult your trusted physical therapist to equip you with the appropriate strength & ROM exercises to get you back in the lineup!

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Works Cited & Further Reading

Thevendran, G., Sarraf, K. M., Patel, N. K., Sadri, A., & Rosenfeld, P. (2013). The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal surgery, 97(1), 9–20. https://doi.org/10.1007/s12306-013-0251-6

Sharafoddin-Shirazi, F., Letafatkar, A., Hogg, J., & Saatchian, V. (2020). Biomechanical asymmetries persist after ACL reconstruction: results of a 2-year study. Journal of experimental orthopaedics, 7(1), 86. https://doi.org/10.1186/s40634-020-00301-2

Fulton, J., Wright, K., Kelly, M., Zebrosky, B., Zanis, M., Drvol, C., & Butler, R. (2014). Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. International journal of sports physical therapy, 9(5), 583–595.

Deng, S., Sun, Z., Zhang, C., Chen, G., & Li, J. (2017). Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 56(6), 1236–1243. https://doi.org/10.1053/j.jfas.2017.05.036

Park, S. H., Lee, H. S., Young, K. W., & Seo, S. G. (2020). Treatment of Acute Achilles Tendon Rupture. Clinics in orthopedic surgery, 12(1), 1–8. https://doi.org/10.4055/cios.2020.12.1.1

Lantto, I., Heikkinen, J., Flinkkila, T., Ohtonen, P., Kangas, J., Siira, P., & Leppilahti, J. (2015). Early functional treatment versus cast immobilization in tension after achilles rupture repair: results of a prospective randomized trial with 10 or more years of follow-up. The American journal of sports medicine, 43(9), 2302–2309. https://doi.org/10.1177/0363546515591267

But savage Achilles, more cruel than war itself, is still alive, ravager of our creation. Let him be given up to me. I would let him feel what I can do with my three-pronged spear: but since I am not allowed to meet face to face with the enemy, destroy him unexpectedly with a hidden arrow!