Dr. Flynn's Mailbag: On Tom Brady's Achilles, effectiveness of padding, and helmet technology

Hi everyone! Hope everyone had a relaxing Thanksgiving with family and friends. I am especially thankful this year that I’ve gotten a chance to meet so many of you through the excellent questions you submit every week. Thanks so much for your insight and comments. If you’ve never submitted a question, I would love to hear from you! Make sure you check out the contact information at the bottom of the page.

Let’s jump right into the biggest news of the week: Tom Brady’s Achilles injury. Brady missed practice on Tuesday with an Achilles injury, which has been reported to be “not serious.” But when did it happen? It’s hard to know. The Patriots are very tight-lipped about injuries. The two most likely scenarios are that it is either tendonitis that could have been bothering him at a lower level for a while or a more acute strain of the tendon that could have occurred during Sunday’s game.

Looked like Brady's ankle got tied in knots on the K Mack RTP play in the 4th Q. Might that have contributed to an Achilles strain? (Andy Johnson 100, @100Zeus)


This was a great point, Andy. Mack was flagged for roughing the passer after he hit Brady low in the fourth quarter. As Brady spun to get down, his ankles did take a little bit of a beating. However, after reviewing multiple angles on that play, I did not see anything that would clearly have caused an Achilles strain. He looked fine afterward, no limp or special attention paid to his ankle. Brady came out of the game after that series, but I suspect it was due to the time and score of the game more than anything.

Richard Sherman had an Achilles injury going into the year and said it was just a matter of time before it burst.  Could this be the same type of deal or just a tendinitis issue like u said? (SportsFan, @loveandsportz)

Some quick background - the Achilles tendon is the rope-like structure that attaches the calf muscles to the back of the heel. The Achilles tendon is stressed during push-off and stretched when the foot is forcefully dorsiflexed (toes and foot flexed up towards your nose). Achilles injuries are incredibly common — I see at least a few cases every day that I see patients.

If Brady’s injury is Achilles tendonitis that he has been managing for a while, then there is a slightly increased risk of rupture. In reality, that risk is incredibly low, however. The stresses onAchillesilles of a quarterback are very different than the stresses on a cornerback. Sherman’s job required him to jump, quickly stop and start and change direction. While Brady is known for his quick, excellent footwork, his movements are much less likely to result in an acute injury than those of a cornerback like Sherman.

I read thru the TB12 Method and didn't see anything regarding how to prevent Achilles injuries. So, outside of rest, does taping the ankle provide any additional value in preventing a worsening of injury? (Edward Ingraham, @Whofan70)

Edward, I’m glad that you asked! If you’re looking for a source on injury prevention or treatment, I’d recommend checking out the American Academy of Orthopedic Surgeons website. The best prevention for Achilles tendonitis is wearing appropriate shoes, maintaining calf flexibility, and strengthening your lower core and gluts. Taping has not been shown to be effective in preventing worsening of an Achilles injury. Sometimes a sleeve or compression sock is worn to keep the area warm during exercise — this can be especially helpful in cold conditions.

Off the subject of Tom Brady, here are two really great questions that Brian Keegan, a BSJ subscriber, sent me over a month ago about protective gear in the NFL. Thanks for being so patient with me, Brian!

Over the last decade, most receivers have adopted the practice of "cheating up" their knee pads, presumably to keep their knees freer. This seems both a little dumb (ineffective) and a little unwise (dangerous). But it does not seem that most knee injuries are impact related. Thoughts?

I agree with you, Brian, it seems that most knee injuries are not impact-related. To be honest, I hadn’t noticed that receivers have “cheated up” their knee pads, but the biggest risk of doing so would be more significant distal thigh/upper knee bruising from a direct hit (similar to the hit Brady took from Kam Chancellor last year). Many athletes were not happy when the league mandated thigh and knee pads because of the added weight and potential loss of mobility. Wearing protective equipment like pads appropriately is the most effective way to prevent or lessen contact injury, so “cheating up” the pads is less effective and does open the athletes up to greater risk.

I have seen stories on design changes to helmets in response to CTE and can see some in practice. But to date they appear to be minor nibbles. Do you know if there are better protective changes in the pipeline? Has any thought been given to making the outer layer less ballistic and more impact-absorbing?

This is a major hot-button issue in football right now. I could write pages about it, but will keep this short because we all have some post-Thanksgiving bargains to find! There is very poor data showing that change in helmet design can significantly decrease occurrence and severity of head injuries in football. More padding, less padding, padding on the inside, padding on the outside - they’ve all been tried. The problem is that much of the injury to the brain during a hit comes from the shearing forces on the neurons caused by the head moving violently in one direction and rebounding back in the other. The best way to prevent or lessen severity of head injuries would be either to avoid the trauma or prevent the head from moving so violently. I wish that solution to this major NFL problem could be found in a fancy new helmet design, but I don’t believe that to be the case. It’s time to search for a new preventative method.

Dr. Jessica Flynn is a sports medicine physician at Lahey Hospital and Medical Center in Burlington, MA. She writes about injuries in professional sports on her blog, DocFlynn.com. You can follow her on Twitter @jessdeede.

Have a question for a future Dr. Flynn Mailbag? You can send those to her at any time via email (docflynn@bostonsportsjournal.com), or you can Tweet them to her here.