Midway through the first quarter of Sunday’s Game 4, Milwaukee Bucks guard Damian Lillard exhibited the classic result of an Achilles tear when he fell to the floor before immediately grabbing his left lower leg and ankle. He was clearly in pain and appeared to look around as if surprised by whatever just took him out.
Many athletes will report feeling as if someone kicked them in the back of the leg when they feel the sudden pop of the Achilles tendon, which serves as the connection between the calf muscles and the foot. (When the calf muscles contract, the energy is transferred through the tendon to push the foot off the ground. It can be as low energy as propelling the body forward while walking or as intense as exploding skyward for a dunk.)
At age 34, Lillard falls into the prototypical age group for an Achilles injury among elite athletes. The sport he plays — with its repetitive jumping, running and push-off/pivot maneuvers — put him in a higher risk category. Those movements place load on the tendon through repeated and alternating tension/elongation with explosive contraction.
Most recently, Lillard had been sidelined due to a deep vein thrombosis (DVT) diagnosis he received in March. DVTs, or clots that reside in a vein, often present in the calf and early treatment often focuses on blood thinners and rest. The idea is to not disrupt the clot and cause it to potentially travel to the heart and lungs. While the treatment is essential for resolving a clot, it typically results in deconditioning given the athlete’s inability to train. Contact is not allowed while the athlete is on blood thinners due to the increased risk of bleeding. Once the medication is discontinued, an athlete can return to play.
That said, whenever an athlete returns from an injury that has resulted in weeks or months away from competition, there is always a reconditioning process. The ramp-up period can vary depending on a multitude of factors, including the nature of the injury, the time away, the level of activity during that time, the specific demands of the sport and the athlete’s mental readiness to return.
Seasonal calendars can influence the ramp-up time when there is an urgency to return (i.e. the playoffs) but there are extensive conversations between the athlete, the medical staff and any other relevant parties throughout the process to discuss potential risks. There is no way to know for certain whether the several-week absence increased Lillard’s risk for an Achilles injury, but it was likely an unfortunate combination of risk factors that created the environment for his tendon failure.
What matters now is Lillard’s recovery and what he can expect going forward and into the 2025-26 season. Surgery will come soon, followed by a very controlled return of mobility. Some athletes have casts put on for a short period; others are placed in a removable boot. Either way, motion is very controlled in the early weeks as the tendon heals. While some movement is key for ankle joint mobility, it is essential to protect the repair and not overstretch it. The Achilles’ elasticity is key to its function. Over-lengthening the repair is like stretching a rubber band until it becomes non-functional. Once healed, a more aggressive range of motion and strengthening begins followed ultimately by a return to running, jumping and other explosive movements.
Return to play for athletes typically hovers anywhere from six months to a year, with NBA athletes averaging a 10-month recovery, influenced by the athlete’s overall healing, return to fitness and the seasonal calendar. As repair techniques have improved, athletes have been able to look more like their pre-injury selves, but the experience is unique to the individual. Most athletes will report that they don’t fully regain their explosiveness until their second season of competition after surgery.
The bulk of the scientific literature addressing return to play/performance issues for NBA players indicates that, of those who return to competition (ranging from 70-80%), the majority do not return to pre-injury performance levels in terms of games, minutes played and efficiency. The conversation is complicated by the fact that many NBA athletes sustaining these injuries are in the latter phase of their career, during which these metrics may have already been in decline.
Still, it’s worth looking at some specific player comps within the sport, and what their return to play timelines can tell us about Lillard’s road back to the court.
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Kobe Bryant: Perhaps the most memorable NBA player to return from an Achilles injury, Bryant coincidentally was also 34 years old at the time of his injury during the 2013 playoffs. He underwent surgery in April and returned to action in December that year. Bryant returned fairly rapidly but lacked explosiveness. The following year his season ended prematurely due to a shoulder injury that required surgery. The subsequent season was his last.
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Klay Thompson: Thompson’s situation is somewhat unique, in that he tore his Achilles while recovering from a torn ACL suffered during the 2019 NBA Finals that forced him to miss the entire subsequent season. As he was nearing a return to action to start the 2020-21 season, he suffered his torn Achilles. He ultimately returned midway through the 2021-22 season at the age of 31 and, as expected, averaged fewer minutes and his shooting efficiency was down. But, Thompson bounced back the following year, averaging four more minutes per game and posting career highs in 3-pointers and rebounds.
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Kevin Durant: Durant tore his Achilles during the 2019 Finals while with the Golden State Warriors. Notably, he signed a four-year deal with the Brooklyn Nets during his recovery, reflecting their confidence in his ability to return at an elite level. Durant was out for the entire 2019-20 season but returned to action the following year and looked strong. He only played in 35 games that season, mostly due to other injuries, but he performed like vintage Durant when he was on the court. Perhaps the 18-month window between injury and return to play helped boost his performance metrics upon return. Durant’s numbers make the case that NBA players in their 30s can indeed return to pre-injury levels post-Achilles tear.
