This weekend the Tennessee Titans suffered a major blow to their offensive line. Their starting center, Lloyd Cushenberry III, suffered a torn achilles in their 20-17 overtime win over the New England Patriots. During the first possession of the 2nd half, Cushenbery was pass blocking when he went down. He was evaluated on the field and eventually walked off the field with help. He was taken back to the locker room for further evaluation. Upon further testing and confirmed with an MRI, he was diagnosed with a torn achilles. The Titans have not reported yet whether he will require surgery at this time, however it is a season ending injury.
The achilles tendon attaches the calf muscles to the back of the heel and is a common injury in sports. Typically, this injury is seen in high intensity sports and will generally occur due to a sudden strong force. Achilles injuries occur due to high repetitive stress, tight musculature, or trauma. An achilles rupture is easy to diagnose on the field by performing a special test called the Thompson test. The test is performed by squeezing the calf muscles and watching to see if the foot points down like stepping on a gas pedal. If the foot does not move, then there is a high likelihood of an achilles tear or rupture. An MRI will be done to confirm the extent of the injury and where along the tendon the rupture has occurred.
Conservative treatment would be to immobilize the ankle, either with a walking boot or cast, and place the patient on crutches to avoid weight bearing while the tendon heals. Most of the time with achilles tears or ruptures, surgery is the best option with a better outcome long term. The surgery that is performed will depend on the extent of the injury. If there is only a tear, the surgeon will remove the damaged area of the tendon and repair it with stitches. Depending on the extent of damage during an achilles rupture the surgeon may be able to bring the two ends back together with sutures for proper healing to occur. If there is severe damage, the surgeon may have to replace the tendon using another tendon from the patient’s foot to ensure proper healing and a successful outcome.
After surgery, the patient will be placed in a walking boot and is typically non-weightbearing using crutches or a kneeling scooter for several weeks. They will begin physical therapy right away to address pain and work on hip and knee strengthening and mobility. Massage and gentle range of motion techniques will be done to decrease muscle spasms and joint restrictions through the ankle to promote proper healing. As the patient begins to improve range of motion exercises will begin so the patient can start moving their ankle around without putting weight through it. Once they are cleared to begin weight bearing in the boot, exercises will progress to standing. There are many ways to continue to strengthen the lower body and core while in a walking boot. It is vital to maintain the overall lower body strength so that the patient is ready to progress once out of the walking boot with good support of surrounding joints and musculature.
As the patient progresses through physical therapy the exercises gradually become more challenging while maintaining tendon integrity to avoid possible re-injury. Continued strengthening with a focus on single leg activities like step ups and lunges will be great to improve the patient’s tolerance to activities like stair climbing. Balance activities will be pivotal in enhancing the patient’s ankle stability and proprioception. These exercises ensure that the patient’s achilles and ankle will be ready to perform single leg balance activities and tolerate walking on uneven surfaces without issue. Once the patient has achieved good strength, mobility, and balance gains, they will begin sport specific training to ensure they are ready to return to the field. These exercises will include plyometric exercises like box jumps and agility exercises like ladder drills. It will be important for athletes to regain their power and speed prior to returning to the field. Achilles recovery can take 6 months or more for a full recovery and return to activity.
The Titans may have lost Cushenberry for the rest of the season, however they can expect him to be back next season. Whether he has surgery or not, he will need to complete extensive physical therapy to regain his power, speed, and quickness for a full recovery to dominate on the field next year.
Don’t forget to give Portsmouth PT a call if you run into any injuries so we can help you get Back to Sports, Back to Work, and Back to Life!
Published November 9, 2024 | Posted in NFL Injury Spotlight.