November 2011

Lockout lessons: NFL Achilles injuries spark debate

In the moment: Sports medicine #20890450

By Jordana Bieze Foster

Achilles injuries in the National Football League appear to be occurring earlier, more frequently, and in younger players than in previous seasons. Whether that apparent trend is related to the labor dispute and lockout that shortened the preseason is a matter of considerable debate.

In an editorial in the October issue of the Journal of Orthopaedic & Sports Physical Therapy, researchers from Cincinnati Children’s Hospital Medical Center suggest the shift in injury pattern may have resulted from the 18-week lockout denying players access to team trainers and other medical personnel, a shortened preseason training period—from 14 weeks to 17 days—or a combination of these factors.

“In training and conditioning, you need progressive loading to influence safe adaptations,” said Greg Myer, PhD, codirector of sports medicine research at CCHMC and the editorial’s lead author. “During this year’s preseason coaches and trainers were forced to do more in less time, so they were more likely to cut corners on progression into high-demand activities. And many players likely came into camp out of shape to begin with. Essentially, it was a perfect storm.”

The injury numbers in question are too small to be statistically significant, but are still provocative. Published historical data on NFL injuries suggest no more than three Achilles injuries should be anticipated during a six-week period, including training camp and preseason competition. This year, after just two weeks of preseason games, teams had reported 12 Achilles injuries—at least four times more than would have been expected.

The Cincinnati researchers’ arguments are supported by comments from Redskins tight end Chris Cooley, who told the Washington Post on October 27 that his failure to seek help for his rehabilitating left knee during the lockout likely contributed to his ending up on injured reserve after only five regular season games.

“I feel 100 percent that I’m a casualty for the season of the lockout,” Cooley said.

Robert Brophy, MD, assistant professor of orthopedic surgery at Washington University School of Medicine in St. Louis and assistant team physician for the NFL’s St. Louis Rams, was less convinced of a connection between the lockout and injury trends.

“It does make sense after the dust settles to go back and look at the injury data and see what we can learn, but my guess is there isn’t a lot,” Brophy said. “Clearly, in terms of the Achilles numbers there was a blip this year, but I think it’s difficult to make any definitive conclusions about cause and effect.”

Particularly curious is the finding that the average age of the players who sustained Achilles injuries this preseason was just 23.9 years, compared to 29 years in previous seasons. Achilles injuries are typically associated with degeneration and overuse, and would be  expected to strike older players more often.

Myer speculated that the Achilles may require a period of gradual adaptation to stress before being subjected to high loads, and that younger NFL players didn’t have the league experience or training time this season for adaptation. Brophy disagreed.

“It doesn’t make much sense to think younger players are getting injured because they lack conditioning,” he said. “It may just be a case of bad luck for those guys.”

It remains to be seen whether similar injury trends emerge in the National Basketball Association after its ongoing lockout ends. Myer noted that basketball players are more likely than football players to stay in game shape with offseason pick-up games, but Brophy also pointed out that the NBA will likely have a longer lockout than the NFL and a quicker transition to the regular season.

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