A Deep Dive into Cam Akers’ Miraculous Recovery from Achilles Tendon Surgery (Fantasy Football)

Los Angeles Rams running back, Cam Akers, tore the Achilles tendon in his right leg in July while performing box jumps. He was getting ready for training camp, which was set to start in just a couple of weeks, and he was set to take a huge step forward in his career as the bell cow back for a potent Rams offense…and then in the blink of an eye…it’s over. In season-long fantasy leagues, we all knew his 2021 season was over, and in dynasty, the discussion turned to “Should you get out from Cam Akers now on the cheap?” These Achilles injuries are career enders for the running back position.” “Cam probably won’t ever be the same again.”

Now, just over six months removed from surgery, Akers is set to play in Super Bowl LVI against the Cincinnati Bengals. What’s even more incredible than that is the fact that Akers was designated to return off injured reserve right around Christmas then officially activated to the Rams roster, playing in Week 18 and then three subsequent playoff games. Is this just a flash in the pan? An outlier? Or can we learn from this situation and make adjustments to how we view this injury in the future? Let’s dive into Akers’ recovery, the details of the surgery, and the recovery and examine what criteria we should look for when trying to identify other players who might have success after an Achilles injury in the future.

The Research is Dated

In the late 2000s and early 2010s, the data across the board was conclusive, and several research studies agreed:

• Running backs and linebackers demonstrated reduced performance compared to other positions upon returning to play
• Players who suffered an Achilles injury were more likely to play fewer games in the future and play fewer seasons in the NFL compared to those who did not suffer an Achilles injury
• 30-40% of players who tore their Achilles never returned to play again in the NFL
• Return to play usually takes at least 9 months but often takes up to 12 months

Sources:

1. Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League
2. Performance and Return to Sport After Achilles Tendon Repair in National Football League Players

While that data was helpful in the last 8-10 years, there’s a major issue with these findings, and that primary issue is that this data is now largely outdated thanks to a newer procedure for the Achilles tendon (more on that soon). Simply put, the research conducted during the 2000s is dated at this point, and while it does help us to understand at a basic level that this is a serious injury and one that shouldn’t be taken for granted, the data isn’t as relevant as it once was. The findings above were taken from a sample of players who tore their Achilles in the late 90s and early 2000s. Again, the baseline data is helpful. We know the injury is serious, takes a diligent and lengthy rehab plan, and can affect a player for the rest of their career. But the medical field changes. Technology is advanced and our understanding of how to treat injuries is always evolving.

It’s time to adjust and examine what’s changed in the medical field over the last 5-10 years.

A New Surgical Approach to Achilles Tendon Repair

Years ago, there was only one surgical approach to repairing the Achilles after it was torn, and this procedure was called an “Open Repair.” As the name implies, the doctor makes a single large incision on the back of the leg and sews the two parts of the Achilles tendon back together. In this approach, recovery is slow and the tendon can’t be loaded too quickly in rehab or the surgery will fail. Most surgeons use a protocol that then places the patient in a walking boot for up to 12 weeks.

Think about that. For three months, the tendon is protected by a boot. Your calf muscle, foot and ankle muscles, quads, hamstrings, etc. start to get weak and atrophy (shrink in size). You can’t strength train appropriately, can’t work on cardiovascular fitness, and obviously, the thought of any sport-specific training is months and months away. No doubt, this procedure leads to a much slower return to prior activity levels, even in day-to-day patients. Anecdotally speaking in patients I’ve worked with following this procedure, some are still experiencing weakness and discomfort 9+ months after this type of procedure. Of course, when you consider the level of tissue damage that happens with this procedure, it makes perfect sense.

While this procedure did prove to be effective in the long term for allowing patients to return to their day-to-day activities without issues, it clearly has its limitations in helping the best athletes in the world return to the field as the data suggests above. So, what’s new? What’s next in the Achilles tendon repair procedure?

Recently, the go-to procedure for a ruptured Achilles has now become a technique called “internal bracing” which means adding a sutured bridge brace over the top of the repaired portion of the tendon. The extra support helps protect and stabilize the repair site so the patient can begin physical activity much earlier in the rehab process while the underlying repair heals securely. In this post-operative protocol, athletes do not have to spend three months in a walking boot. Weight-bearing can begin sooner, strengthening can begin sooner, and higher-level activity can begin sooner, leading to better outcomes and a quicker return to play.

With this internal bracing procedure, athletes are able to start strengthening sooner, so they don’t lose muscle as quickly as patients did even 10 years ago. I really can’t put into words how crucial this aspect is in physical therapy. We lose muscle faster than we put it on, and in the rehab world, that can lead to a delayed return to the field and performance when returning to the field.

There are many more details about this procedure, and I’m happy to answer those if you reach out to me via social media or drop a comment on this article, but I’ll spare you the nerdy details for now.

To put into context how advantageous this new procedure really is, let’s compare some of what Cam Akers was doing just a few months out from surgery to what the “traditional” rehab plan looks like after an open procedure.

5 Weeks Out From Surgery

• In the open procedure recovery, the patient is still in their walking boot. They can fully weight bear on the ankle but must be in the boot to do so. Strengthening is primarily done in a non-weight-bearing position.
• Cam Akers posted a video of himself walking on a treadmill at 70% of his body weight without a boot.

3 Months Out From Surgery

• In the open procedure recovery, the patient is just now getting out of the boot and learning to walk normally without a limp. The strength phase has begun.
• Cam Akers posted a video of himself performing ladder drills.

4 Months Out From Surgery

• In the open procedure recovery, the patient is out of their walking boot and they’re just starting to get into a weight-bearing strengthening routine out of the boot.
• Cam Akers posted a video of himself performing single leg hopping drills.

5 Months Out From Surgery

• In the open procedure recovery, the patient is getting stronger and starting to do some higher-level strengthening but still nowhere close to 100%.
• Cam Akers returns to practice in a limited fashion. He returns to play in Week 18 for his first game since the surgery, exactly 5 months and 28 days after surgery.

These comparisons are simple and certainly don’t tell the whole story, but from a 1,000-foot view, we can certainly tell that this new procedure allows the patient to progress at a much, much quicker rate than previously. That’s a huge advantage when we discuss return to play and return to performance timelines.

Analyzing Cam Akers‘ Performance Thus Far

Of course, we have to be careful when trying to make assumptions based on small sample sizes, but let’s be real. The fact that Akers is on an NFL football field getting serious run is incredible in and of itself, but the box score leaves a lot to be desired.

Yes, Cam Akers is back on the field, but it seems extremely unlikely that he’s actually back to 100% just six months removed from surgery, even with this accelerated protocol. In one month back on the field, Akers’ efficiency has been difficult to find. On 59 attempts, Akers is running for just 2.61 yards per attempt and has yet to find the end zone (he did fumble at the one-yard line against the Bucs). On tape, he certainly looks more powerful when running toward the left where he can push off the left foot (his non-injured side) and use his healthy Achilles to its full effectiveness.

Yards per carry isn’t the best metric to measure an RB’s efficiency, so let’s look at a few more. Per Next Gen Stats, Akers has ranked 7th in rush yards over expectation among 11 qualified backs in the Wild Card round. In the Divisional Round, he ranked 8th among eight backs, and in the Championship Round, he ranked tied for 4th among five backs. PFF’s Ian Hartitz also showed Akers has been one of the most inefficient backs of the 2021-2022 season when you combine the regular and post-seasons.

Cam Akers is dead last in yards per carry (2.6) and PFF rushing grade (39.7) among 79 running backs with at least 50 carries this season (including playoffs)

— Ian Hartitz (@Ihartitz) January 31, 2022

Akers’ recovery to this point has been nothing short of remarkable, but clearly, the underlying data shows he’s a player who’s not performing up to his usual standards. For reference, in 2020, Akers carried the ball 191 times for an average of 4.43 yards per attempt.

Optimism for 2022

We’ll still get one more game from Akers in the 2021-22 season when he takes the field one final time in the Super Bowl in just under two weeks, so we’ll have another data point in the sample, but the underlying metrics suggest Akers isn’t himself quite yet. I do, however, fully expect Akers to hit the ground running this summer as he enters training camp. Part of the issue with some of the research studies is that the outcomes used often take into account the time it takes to return to play, but that does not necessarily equal return to performance at 100%. As discussed in the prior section of this article, Akers is likely not back to 100% yet, but with seven months of training between the end of the Super Bowl and the start of the Rams’ training camp in 2022, Akers will be one year removed from his procedure. At that point, he’ll be light years ahead of where’s at now. He’ll be stronger, more explosive, and have a full offseason of focusing on football, not just rehab.

Factors that Lead to Akers’ Success

Age: At the time of injury, Akers was just 22 years old. In the older studies referenced above, the athletes in those samples were on average 4 years older than Akers with names like Arian Foster in that sample. Younger athletes recover faster. Tissues can heal more quickly thanks to the higher quality tissue. When we’re talking about a repair of one of the body’s strongest tendons, that matters a ton.

Draft Capital: We know draft capital matters in the NFL, and the same is true for injuries. Research across the board shows that players selected in the first two rounds of the NFL Draft are more likely to return to the field following an Achilles injury than those who are drafted later or are undrafted. Intuitively, this makes sense. When an NFL franchise has a financial incentive for a player to perform (i.e. higher draft capital), they’re going to get more opportunities to regain their role in the offense.

Early Surgery After Injury: Per The Athletic’s Jourdan Rodrigue, Akers had surgery very quickly after his injury. This factor is crucial and one that leads to better success following the procedure than a delayed surgery. It helps to maintain the proper length of the tendon, thereby helping the tendon heal at an appropriate length, leading to better strength and power output.

Conclusion

Cam Akers set the new standard for the recovery process following Achilles tendon repair surgery, and while his return in 5.5 months is an incredible feat, it’s probably still unrealistic to expect players who suffer the same injury to have the exact same recovery process moving forward. Akers is only going to get better as the 2022 calendar year progresses as his strength will further improve and his power/quickness will develop even more. There’s a reason to be excited about Akers for fantasy football in 2022, but assuming every player who has an Achilles injury is now “good to go” moving forward is probably fool’s gold.

This is still a serious injury and one that requires a lengthy rehab process. In Akers’ case, everything went right. As with any major surgery, there can be obstacles to cross and side effects that can lead to reduced performance upon returning to the field. The research in NFL athletes hasn’t quite caught up to today’s modern procedures. We need more data over the next couple of seasons as most of the research studies out there right now are weak and reference injuries from a different decade.

However, one thing we can do is use Akers’ story and incredible recovery as a way to possibly identify NFL players who may have success after this injury. For Akers, the quick turnaround time after the injury is crucial. Draft capital is important – we know NFL players taken earlier in the NFL Draft or those who have a multi-year contract are more likely to have the support from their organization to make this recovery more possible. They’ll have more chances to get back on the field and regain their role. And finally, age is a major factor in performance after the injury and surgery. Younger athletes tend to have much better outcomes.

Congratulations to Akers on his remarkable recovery. My hope is that we can use his case to identify which players we can project to return from this once career-ending injury, but the reality is that we should not start taking this injury lightly. It’s still an uphill battle for athletes to regain their full capacity, and this is obviously a smaller sample size.