After the Seattle Seahawks’ win on Nov. 9, it was determined that cornerback Richard Sherman had ruptured his Achilles tendon during the game and will miss the rest of the season. Sherman was on Seattle’s injury report the week of Oct. 30 because of his Achilles. It was painful for most of the season.

What causes Achilles tendon rupture?
A normal Achilles tendon is unlikely to rupture. Usually, there is a pre-existing tendinopathy (tendon disease). This tendinopathy is often not painful prior to the rupture. And not all painful tendinopathies rupture. As with other muscle, tendon or ligament insertion site problems (enthesopathies), Achilles tendinopathy is most common in middle-aged people (those ages 35 to 60). Athletes sometimes develop tendinopathy or rupture in their late 20s or early 30s. Patellar tendon, quadriceps and Achilles tendon ruptures are generally problems of an athlete near the end of their professional career (e.g. Kobe Bryant, Tony Parker, etc.).

The media has portrayed Richard Sherman often as a critic of Thursday Night Football because it requires players to play after minimal time off. Did the short interval between the Seahawks’ last game and the Thursday night game cause Sherman’s Achilles injury?
The relationship between activity (painful or not) to tendinopathy is unclear. Patients with painful tendinopathy often don’t rupture. Many ruptures are not preceded by symptoms. Tendinopathy most often occurs in middle-aged patients of varied activity levels and is not clearly related to activity. Rupture is often the result of a stretch to the muscle when it is contracting, called an eccentric load.

Is surgery necessary for an Achilles tendon rupture?
Rupture of the Achilles tendon can be treated operatively or nonoperatively. The tendon heals when immobilized with the foot pointed toward the ground (plantarflexion). This can be done in with a removable splint, with weight-bearing and with graduated motion exercises. Surgery adds risks of infection and wound problems, but is felt by some to speed recovery and limit re-rupture. Studies have shown similar outcomes between patients treated with and without surgery, including similar rates of re-rupture, which is uncommon in general.