Minnesota Vikings quarterback Kirk Cousins became the latest NFL player to suffer an Achilles injury this season, joining New York Jets quarterback Aaron Rodgers, Baltimore Ravens running back J.K. Dobbins and Buffalo Bills cornerback Tre’Davious White.
Cousins tore his Achilles tendon in his team’s win over the Green Bay Packers on Sunday, an MRI confirmed Monday. Like Rodgers, Dobbins and White, the injury is expected to cost Cousins the rest of the 2023 season.
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But what is the typical timeline to recover from this type of injury? And what could the process look like? The Athletic’s Inside Injuries expert Greg Scholz weighs in.
What is the Achilles? What happens when it’s ruptured?
The Achilles tendon connects the muscles in the calf to the heel bone. When you grab just above your ankle and squeeze the back of your leg, you can feel the Achilles. It’s very strong (fibrous), so tears/ruptures are more rare than something like tendonitis. The strength of the tendon is why experts look for the “ripple” effect in diagnosing these injuries on film. For a rupture to occur, there has to be a powerful, often sudden, overstretching force.
Steps in the recovery process
In the first few weeks post-rupture, it’s basically immobilization and then setting up a recovery plan. Ruptures can be treated with either surgery or by using a cast or splint. For athletes, surgery is generally preferred because it lowers the risk of re-injury. However, there are other complications that can arise post-surgery, such as infection or not giving the area enough time to heal after surgery, that non-surgical options don’t have.
After surgery, the recovering area is immobilized again for around two weeks until some range of motion (ROM) exercises are introduced that mainly involve moving the foot around. If there is pain in those exercises, it’s considered a setback and the exercises should be stopped immediately. Around the five-week mark, foot ROM exercises continue (which must be pain-free) with some stretching. For an athlete, this could be in a pool because of reduced impact and load. At this point, the ability to bear weight should be tested as well.
Around the two-month mark, the cast or boot should be used less and less frequently. Balance will be tested, ROM exercises continue to ramp up and walking mechanics should be tested as well. Around the three-month mark, Cousins — if he follows this path — should be able to complete some simple exercises like calf raises.
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He could return to some football activities at the four-month mark. First, though, his gait needs to look correct, his ROM should be close to where it was pre-injury (although it doesn’t have to be 100 percent) and there should be no pain throughout this process. He could start jumping (more of a hop) and jogging. This process continues to ramp up and workouts become more tailored to his position. If all goes well, this could be completed in around six months. Given Cousins’ age, however, this might not be the most likely scenario, but it’s worth acknowledging as a possibility.
Why Cousins’ recovery could vary from others who suffered same injury
According to the Cleveland Clinic, full healing of a torn Achilles tendon takes about four to six months, with longer timelines to be able to safely perform high-impact activities like running and jumping. That estimate is for average civilians and not professional athletes who need their bodies to perform at an extremely high level on a daily basis.
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Quarterbacks and Achilles injuries
Cousins doesn’t need the explosive lower half that a running back might need, but this is still a significant injury. Throws, escaping pressure, scrambling for first downs — all these require a strong and flexible lower half.
Past notable Achilles injuries
Cousins, Rodgers, Dobbins and White are far from the first players in the league to tear their Achilles in recent years. Others include Cam Akers, Tarik Cohen, James Robinson, Justice Hill and Marlon Mack.
Akers, who tore his Achilles in mid-July, 2021, is largely considered to have had a remarkable recovery from the injury. He returned to doing football-specific drills in November and to practice just before Christmas that year.
Then there’s Cohen’s case. The Carolina Panthers running back stacked major injuries in back-to-back years: First, he tore his ACL in Week 3 of the 2020 season and then he tore his Achilles in mid-May of 2021, nearly two months after having been released by the Chicago Bears. Cohen has not played an NFL snap since the 2020 season, but was signed to the Panthers practice squad in late September and is looking to make his return to the NFL after three years.
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In the NBA, the injury is also fairly common, with Klay Thompson, Kevin Durant, John Wall, DeMarcus Cousins, Rudy Gay, Wesley Matthews and Kobe Bryant among those to sustain it in the last decade or so.
What’s working against Cousins?
Cousins’ age, 35, is big here. Older athletes tend to have longer recovery times because as we age, our blood flow and elasticity decrease ever so slightly. This means that he might need an extra week or month. In other words, things might need to be more gradual.
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(Photo: Michael Reaves / Getty Images)
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