Ideally, the setting would have simply featured a high-stakes playoff game with the NBA’s best players showcasing their greatness.
Instead, pain, heartbreak and uncertainty awaited.
In Game 7 of the NBA Finals against the Oklahoma City Thunder, Indiana Pacers guard Tyrese Haliburton ruptured his right Achilles tendon. Ironically, Milwaukee Bucks guard Damian Lillard ruptured his left Achilles tendon in Game 4 of a first-round closeout loss to Indiana. Shortly after that, Boston Celtics forward Jayson Tatum ruptured his right Achilles tendon in Game 4 of a second-round loss to the New York Knicks.
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All three NBA stars injured one of their respective Achilles amid different circumstances. Haliburton showed limitations in Game 5 of the NBA Finals with a strained right calf only to heal well enough to thrive in Game 6. Lillard had missed the final 14 games of the regular season after nursing a blood clot in his right leg. Tatum only missed Game 2 of the Celtics’ first-round series against Orlando to heal a bone bruise in his right wrist. Nonethless, former NBA player Gilbert Arenas said recently that both Lillard and Tatum told him they nursed calf issues before injuring their one of their respective Achilles.
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Sportskeeda spoke to four medical experts about this trend, their outlook on each player’s return and what can be done to mitigate the risk of players suffering Achilles injuries.
The panel included:
Dr. Nirav Amin, premier orthopedic and trauma specialist
Dr. Alan Beyer, executive director of Hoag Orthopedic Institute
Dr. Douglas Cerynik, CEO of Stabiliz Orthopaedics.
Dr. Jonathan Kaplan, associate professor of orthopedic surgery at Duke University.
Editor’s note: The following one-on-one interviews have been edited and condensed. Their interviews with Sportskeeda were also conducted separately.
What do you make of Tyrese Haliburton, Jayson Tatum and Damian Lillard all having Achilles injuries during the playoffs?
Amin: “Damian Lillard is a little bit older (34). But Tatum (27) and Haliburton (25) are still early in their careers and entering the prime of their careers. It is concerning when Achilles injuries are happening earlier in players’ careers. Historically if you look at the literature of our papers, the injuries were happening to players in the prime of their career or in the latter part of their career. But the concerning part is now Tatum and Haliburton are the latest two to injure their Achilles earlier in their career.”
Beyer: “It’s very reminiscent of the Kevin Durant calf injury followed by an Achilles injury [in the 2019 NBA Finals]. Let’s talk about these Achilles injuries after supposedly there was a calf strain that was rested a little bit, imaged and everything looked okay. And then next thing you know, there is an Achilles rupture after they returned to play. That’s exactly what happened to Kevin Durant. In these cases, I’m not saying the doctors were wrong or the trainers were wrong and they let them go back too early. But when you have a calf strain, the damage isn’t just limited. It extends down the length of the calf injury. After the time of initial injury, there probably is a small degree of injury to the Achilles as well. That is not recognized because most of the problem is up at the calf. Then you rehab the player and then let him rest a little. Then he goes back out, and that micro injury to the Achilles is still there. It’s not completely healed. Then he goes out and does these super-human elements with their jumping, starting and stopping. And then boom, pop goes your Achilles tendon.
These guys have become too strong for their own bodies. They work out so much and get so strong. They’re able to jump so high. They are exceeding, in some cases, the amount of force that the Achilles is able to take with some of their jumps and sudden decelerations. We’re starting to see people reach the limits of what the human body can take.”
Cerynik: “Compared to the historical number, those injuries have happened to younger players even with less minutes played overall compared to Kobe Bryant, Dominique Wilkins or Kevin Durant. Historically, you would start seeing this happen to people older in age and/or tons of minutes played. It’s somewhat of a concerning trend.”
Kaplan: “With a lot of soft-tissue injuries, we see them happen in different scenarios. We’ll see a run of soft-tissue injuries during preseason or training camp because they went from being sedentary to ramping up. Then we see another uptick in injuries at the end of the year after people have been playing throughout the year. A lot of these athletes are also playing through other injuries. Tyrese had the calf injury earlier in the week and tried to play through it. That’s going to change your mechanics and how you use your lower extremities. That probably disposed him to rupturing his Achilles. Dame had been in and out with other injuries, including the blood clot. That affects the calf, too. And then Tatum had been in and out in the season with rest management.
The hard part now with these rest periods is they have to cite a reason, so it’s hard to know if the athletes are dealing with other injuries or if they are just aches and pains. Tatum may have dealt with calf and knee soreness before he ruptured. So I’m not totally surprised by these injuries. I’m not surprised at all with Tyrese rupturing his Achilles tendon. It’s very similar to what happened to Kevin Durant [in the 2019 NBA Finals] when he had his calf injury and then he came back his ruptured his Achilles.”
Haliburton, Tatum and Lillard all previously had calf injuries. From an outside perspective, to what extent do those calf injuries directly lead to an Achilles injury?
Amin: “Good question. The challenge is that when you, me and the media hear about calf injuries, it’s a little bit unclear on what that means. The injury reports say ‘calf strains,’ but the actual definition of where that is seems a little bit debatable. In Game 5, Haliburton was not as mobile and some criticized him for his performance. The calf strain may have hindered him. But in Game 6, he clearly improved his performance. In Game 7, it seemed like he returned to normal and was on pace to have an excellent game. So it’s hard to determine whether the calf strain is a precursor to the Achilles tendon rupturing. Or if it’s just causing more levels of wear on the Achilles tendon.”
Beyer: “There has to be some relation. I just think there is no way to put a number on it. That’s just conjecture. I don’t know what the answer is. You can’t sit every guy who strains his calf for six to eight weeks. Then you won’t have enough players to play the game. We just have to be more cognizant with recognizing and imaging the Achilles tendon and measuring somehow the integrity of the Achilles tendon. We just need to get better at this. These athletes are becoming too strong and too powerful for us to keep up with them in terms of our ability to diagnose, shut them down when needed and rehab them. We’re starting to hit a tipping point here.”
Cerynik: “There is some associated risk. When you look at clinical literature, a lot of that is on the average human being and the ‘weekend warrior.’ That’s very different than a high-performance athlete. It’s not really a direct comparison. But if you want to say we don’t want to change the way we’re playing, then they’re going to miss even more time because everybody is going to be concerned that every calf strain will be an Achilles rupture. That just might not be really addressing the root problems. You don’t see Achilles ruptures much in endurance athletes, whether it’s a marathon runner or a professional cyclist. It’s these super explosive activities. You don’t even see it honestly all that much in the NFL. It happens, but not the same frequency. Why is this more frequent than it used to be? That’s really the question that people should be addressing. It shouldn’t be, ‘Oh, I get a calf strain, how do I not end up with an Achilles rupture?’ That’s good, but that might not be addressing the underlying issue.”
Kaplan: “I’m not treating these athletes, but I treat other athletes with similar problems. There is not an exact percentage. But about 10% of people that rupture their Achilles tendon are dealing with some muscle skeletal issue, whether they had underlying issue with their Achilles or are dealing with a knee injury or a calf injury. These joints are connected. So we see a high rate of adjacent joint problems. The hard part is the real world we don’t see a lot of calf strains and then they rupture their Achilles tendon shortly after. But that’s because our recreational athletes and ‘weekend warriors’ take a lot more time off if they strain their calf. High-level athletes can push through a lot of injuries. Tyrese can work with the trainers, get the inflammation down and tape it. Then he can push through and get back. That’s why we see a higher rate of it in professional athletes.”
To what extent does the NBA’s style of play contribute to Achilles injuries?
Amin: “Historically, there were a lot more postups in the NBA where you dropped the ball to seven-footers. Now there are a lot of pick-and-rolls and two-man games at the perimeter. Seven-footers are also more agile. So there are a lot more steps and lateral movement. Tatum, Haliburton and Lillard are all perimeter players to use acceleration and deceleration to get their shots up. All three have a similar makeup with attacking the rim and taking stepback 3s. Not all three model their game the exact same. But they all play a perimeter-based game with some level of driving to the rim. Even during the Shaq-Kobe era in the early 2000s, the guards didn’t have to move in and out laterally as much.
If you look at how the game has evolved over the last 20 years, it’s evolved to analytics and 3-point shooting. The acceleration and deceleration with guarding 3-point plays has made it really hard to make lateral movements. For the length of the season, you look historically at the number of games played, but the actual steps taking place now is higher than the historical norms.”
Beyer: “Is there really a way to change that, though? Let’s take away the jump shot and go back to set shots. You have to have both feet on the floor when you shoot the ball. That’s not going to happen. It’s the natural evolution of the game. I think that it’s the price when people play at such a high level. I don’t know if there ways to mitigate this with rule changes to the game. Unless you get to the point where someone is diagnosed with something, there is a prescribed period of time that they have to sit out and not play. But how can you do that? Sprains and strains come in all forms. Some are not as bad as the other. You can’t treat a guy with a Grade 1 sprain the same way with a guy that has a Grade 3 sprain. So I don’t know what the right answer is. I’m really stumped on that one.”
Cerynik: “If you compare today’s style of play to the 90s or early to mid-2000s, the style of play has changed significantly. It’s a much more explosive game with speed. Personally, I’m starting to wonder are we starting to push the bounds of human athletic capabilities? It lends to a style of play and physical traits of the players that might just be potentially setting folks up for these types of injuries. It’s all hypothetical, but I think something warrants further exploration.
It’s tricky. It’s not the flavor people are looking for right now. But they have to find ways to slow the game back down a little bit. I don’t want to say it should come back to a power game. But a lot of it relates to around changes in defensive rules that promoted explosive offenses. With an explosive offense, they need 3-and-D guys, a 6’9” guy that is very lightweight and explosive. Now this person has to function at their max ability that maybe more than the human body can handle. I could be wrong, but the hand-checking is a major way to slow the game back down a little bit and hopefully reduce that type of injury. You just did not see that as frequently in the older style of play.”
Kaplan: “It’s a great question. Specifically with the way the game is being played, The game is spread out over a much greater distance. There is so much asked from a 3-and-D player with the drive and kick. You’re constantly moving. Players are playing over a greater distance. Your centers are coming out to the 3-point line and spreading out the court. They are playing more fullcourt and half-court press.
The game has changed so much. They’re covering more distance. They’re doing a lot more explosive maneuvers. You used to dribble down, set up and call your play. Everyone sets up their position. Then they moved around. Whether it’s the triangle offense or key set plays, each player is moving in a very clear pattern. Now players are moving in a clear pattern at a bigger pace and are doing it with more frequency. They’re flowing between each other more. So there is much more explosive agility maneuvers that predispose you to Achilles ruptures.
Tyrese is above the 3-point line and catching the ball. You can see he is catching it to drive in. He wasn’t going to spot up and shoot a 3. He caught the ball, extended his foot and was going to push off so he can blow past his defender. Then he’s either going to take the ball to the rim or he’s going to kick it out. That type of play puts more strain on soft tissues.
Athletes are so in tune with their bodies year round. They are giving their bodies time to rest. But a lot of these athletes have personal trainers they work out with in the offseason and are working on a lot of high impact training with footwork and agility movements. Maybe they need to reconsider their offseason training programs to let their body recover and decrease some of that year-round force they’re putting on their soft tissues.”
What do you think of any proposal about shortening the season?
Amin: “I think the back-to-back games are really challenging. But Kawhi Leonard is a very good example regarding player load. The NBA is firm that they don’t want players doing load management. But I think there should be some level of breaks. I also think the playoffs should be shortened. It used to be five games in the first round [until 2003]. I think the travel schedule is tough on these players. They’re also playing games at different time intervals to maximize different TV time. There’s not enough rest between each series. That puts a lot of load on the players. They are also used to playing 25-30 minutes a game. In the playoffs, they’re now playing 30 to 40 minutes a game. They’re playing an extra five to eight minutes a game with not enough rest between games.
But that’s in conjunction with the game itself. The game has evolved. About 20 years ago, we didn’t have seven-footers standing around on the perimeter. You played man-on-man defense and you were in the post. The two-point shot has fallen out of favor because a 3-point shot can make the difference. Because of that, the closeouts on a drive-and-kick require you to accelerate toward that player and decelerate once you close out and then you’re jumping up and down. That puts an incredible load on the Achilles. There is a lot of moving parts in a short amount of time.”
Beyer: “You’ve got a convert on that. I think the 82-game season in a period of time in which they play it is a grind. I think that’s true in baseball as well. If the NFL goes to 18 games, we’re going to see more injuries. You’re treating these athletes as pieces of meat and gladiators in the Coliseum and not really taking into account that maybe you’re exceeding what the human limit should be. Maybe we should go back to a 54 or 62-game schedule. But if the Lakers are worth $10 billion, they’re going to want to play more games, not fewer games (laughs).”
Cerynik: “The knee-jerk reaction is going to be there are not enough rest days or they played in the Olympics. You can’t really say that about Tyrese, by the way. But with reduced practice days. Go back to the 90s and early 2000s, you had guys playing in all 82 games and plus extended postseasons. But you didn’t see that in the young players. My personal opinion is that shortening the season is looking at the wrong thing. That focuses on the wrong problem. Instead of addressing how this problem came to be, that would be an attempt at fixing the problem without really changing anything.”
Kaplan: “Maybe fewer games can help with that. Maybe more time in between games can help with that. But it’s not just one size, fits all. A lot of athletes talk about that they need more time off in between games. I don’t think that’s a wrong idea. But I don’t think it’s the time off or the number of games that’s the issue. They aren’t playing significantly more games than in the past. Sure, there are the Play-in games, but most of these guys weren’t even in the Play-in games. I think it’s more about the way the game is played. I also think it’s the way athletes are training throughout the year.”
Which Achilles injury concerns you the most?
Amin: The Dame injury is hard just for the age and the mileage that he’s had. But Kevin Durant is a great example of almost being the same player before his Achilles injury. You can argue that because there are better surgical techniques than there were historically.
The one I worry about the most would be Tatum because he uses his ability to drive to the basket to finish and set up his perimeter game. I think that’s worrisome. Haliburton seems to play along the perimeter and sets up the offense from that level. Dame has traditionally been a jump shooter overall. So I think if you mirror that with Kevin Durant, you hope that Dame can come back and be a similar shooter. You assume Haliburton can come back and reestablish his ability to set the tempo and flow. With Tatum’s explosiveness to the basket, that’s where I get a little bit concerned. Will he still have the same explosiveness? Kobe Bryant didn’t have the same explosiveness after his Achilles, but he was older and had a myriad of injuries afterwards.”
Beyer: “Youth is better. Toward the tail end of Kobe’s career, we saw that cascade of injuries happen one after another. A lot of that was a function of his miles on the odometer.”
Cerynik: “I view Tatum and Haliburton along the same lines as far as age and playing time. They are both very concerning. Dame has played longer in his career than the others. So there may be a slight bit more predisposition to the injury. But for a 25-year-old, that’s concerning. As rehabilitation protocols have changed and improved, people can come back and perform at a high level. So the younger guys have that potential to come back and perform at a high level. But it’s still a tough injury to come back from. If you’re older, yes it’s harder to recover. But if he has any decline in athleticism, Dame’s style of play still lends to a successful game. With Dame, he will find ways to adapt with his level of determination and his skill. As you get to the twilight of your career, you already find those ways to adapt. But if you are on the early or middle side of your career, there is a lot more to figure out.”
Kaplan: “I would say Damian Lillard because of the age factor. As you’re an older player, it is harder to come back to the same level of statistical value than if you were younger. It’s not exact science. Age doesn’t always dictate how good someone is. But we just know that age progresses, you become less explosive and less statistically productive than you were. So that matters. But to Damian Lillard’s benefit, he drives and shoots 3s. He can rely just on 3-point range. That can work in his favor. Tatum can do everything before his injury. So now you have to wonder if he can do everything the same way as he could before the injury.
My concern for him is if he can come back and be this super well-rounded elite player in every facet of the game? Or is something going to slip? Is his explosiveness to drive to the lane going to be a little bit slower and not as prolific versus his ability to shoot. Each player is a little bit different. With Tyrese Haliburton, he obviously does everything. He scores. He does assists. He drives. He is such a good playmaker. So I’m optimistic he can do that because he’s not relying as much on his explosiveness with dunking or attacking the rim. Each player has their own unique path on how well they will be able to come back.”
From an outside point of view, do you see any scenario for any of them to return next season?
Amin: “I’d be shocked. There’s just too much movement with acceleration and deceleration in the same space. Here’s another hard part: to get into game shape, players describe a six to eight-week timeframe to get into game shape. If they would say, ‘You’re going to return during the playoffs,’ I think you’re doing a disservice to the player. Players are really competitive and want to play. But I think you have to be respectful to the human body and understand there is no way they can come back and play on any level that actually helps the team.”
Beyer: “I would be very surprised given the price of talent today. You don’t rush them back a couple of months early at the risk of shortening their careers.”
Cerynik: “That’s a tough question. Aaron Rodgers could be a good example. He was significantly older and was able to make a quick recovery. But the demands of the game are different. That might be pushing the bounds of human capabilities. Would that be a wise decision? I don’t know. Especially with the younger guys where there is so much money invested in their career, both by the team and them personally, you have to weigh that very carefully. I would be surprised and would have a level of concern for their long-term future and potential.”
Kaplan: “It’s possible that all three of them come back toward the end of the regular season or for the playoffs. Players usually miss nine months to a year. But those are averages. Some players can come back between six to nine months. But usually what we see when players come back between six to nine months is that they’re not very good statistically. They don’t have as much strength, endurance and explosive power. So is the team in a position where they really need that type of a player? That’s why a lot of times in basketball you don’t see guys come back the next season. That’s what the Nets did with Kevin Durant. That was smart. You didn’t see as much as a productive dip as you did with other players because they didn’t rush him back. It would be a matter of if the team is in a good enough position where they’re in the playoffs or making a good playoff run and they have a need for that player and they’re willing to take a production dip and risk a reinjury.
But the hard part about basketball is when a player ruptures their Achilles, the organization has a hard situation. They’re now faced with whether they face the next two years with their current situation or do they ‘blow it up,’ start moving players and planning for the future? It’s hard to know what your organization is going to be like in two years because the NBA landscape changes so quickly.”
Assuming all parties don’t take shortcuts with the rehab process, what are your expectations for how Tyrese, Tatum and Dame will be after their return?
Amin: “Haliburton, Dame and Tatum will come back the following year. But I think it would be hard to judge them. It’s very unfair to expect a player to be the same player in year one. It takes a couple of years.”
Beyer: “The one thing I always think about Achilles injuries with basketball players is they always lose a quarter or an inch of their vertical leap. That’s going to change their shooting. They will have to recalibrate their shooting eye. If they shoot the same way, every single shot they take is going to hit the front of the rim. They really have to work on their shooting when they’re back because they won’t have the same vertical leap.”
Cerynik: “It’s an interesting question. I think Durant reset the bar a bit. Durant might be a one-of-one with his size and skill. But I think if you’re older and more advanced in your career, you will have to adapt your game similar to Klay Thompson. If you are younger, I would hope there is potential to get back to the level that you are at. Would you come back at that level? I don’t know. Would it take a couple of seasons? I’m not sure. Since we’re looking from the outside, there are things that we don’t know. There are different ways with repairing the Achilles. A lot has changed since Dominique’s day, for the better.
You don’t always know how it was repaired and the rehabilitation protocol that they’ll follow. So there’s a potential for great variability. If we assume they are all getting the highest level of care, it’ll be interesting to see how the younger guys come back, perform initially and then perform long term. That’s a little bit more of an unknown compared to the historical data we have.”
Kaplan: “Most players will get back as early six months and as late as nine months to a year. That first year back, they’ll be able to play, but they don’t play as well as they did statistically before they got injured. Then we usually see in the second year back, their statistics reach the maximum they’re going to get. Then the season after the second season tends to emulate what their best is going to be.”
Mark Medina is an NBA insider for Athlon Sports. Follow him on X, Blue Sky, Instagram, Facebook and Threads.
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