Rune\u2019s injury\u2014and how it will derail the career of one of the most promising in the sport\u2014led to a rallying of support for him\u2014and also a renewed outcry\u2014 from his peers in men\u2019s tennis.<\/p>\n
Rune\u2019s mother, Aneke, who travels the tour full time as his manager, also sounded off to Denmark\u2019s BT about the schedule.<\/p>\n \u201cThere have simply been too many mandatory tournaments,\u201d Aneke Rune said<\/a>. \u201cTournaments that players are obliged to participate in, and for which they are severely penalized financially by not playing them all. The players simply do not have time to recover properly throughout the season\u2026there is no rest, neither physically nor mentally.\u201d<\/p>\n Holger Rune, who reached a career-high ranking of No. 4 in 2023, had been on the bubble for qualifying next month\u2019s ATP Finals in Turin, and played a very full and globe-trotting schedule in recent weeks that admittedly included many optional tournaments: Davis Cup in Malaga, Laver Cup in San Francisco, ATP 500 Tokyo, and ATP 1000 Shanghai before going to ATP 250 Stockholm on a late entry.<\/p>\n Debates about the schedule are eternal and essential in tennis\u2014and I plan to do a deep dive on the tour calendars on Bounces soon. <\/p>\n But in all the noise around this topic in the days after Rune\u2019s injury, one thing I thought was missing was insight about this type of injury, its severity and growing frequency, and what the road could look like for a young tennis star with a ruptured Achilles.<\/p>\n So to gain insight for myself and for Bounces readers, I spoke today with Dr. Andrew S. Bi, an orthopedic surgeon at NYU Langone who specializes in sports medicine and has experience\u2014professional and personal\u2014with Achilles ruptures.<\/p>\n Our conversation began, unexpectedly, with Dr. Bi telling me of his own firsthand (firstfoot?) experience with this injury.<\/p>\n This interview has been lightly edited and condensed for length and clarity.<\/p>\n Dr. Andrew S. Bi, NYU Langone: Actually it\u2019s kind of a funny coincidence: a little bit of personal expertise is that I actually had an Achilles rupture myself in 2022, so it\u2019s a topic near and dear to my heart.<\/p>\n Ben Rothenberg, Bounces: Or near and dear to your heel, at least. I\u2019m curious now, how did yours happen?<\/p>\n Dr. Andrew S. Bi, NYU Langone: Yeah, I was playing basketball in our residency. In residency we have a men\u2019s basketball league, and I was playing basketball there and it ruptured. It was a similar kind of injury to how most of them happen: a non-contact landing from a jump, on an eccentrically loaded tendon.<\/p>\n The most common Achilles rupture is when you\u2019re landing from a jump: your foot is going from a position of plantar flexion\u2014where only your toes are on the ground\u2014to the heel on the ground, so the Achilles is lengthening.<\/p>\n Ben Rothenberg, Bounces: How random is this injury? After watching video of Rune\u2019s injury\u2014and then videos of many of the NBA Achilles injuries\u2014most of the movements in these moments of injury seem fairly routine. These don\u2019t look like some of the more obviously gruesome visuals where joints are clearly bending the wrong way, or whatever you may see with other sorts of severe acute injuries in sports.<\/p>\n Dr. Andrew S. Bi, NYU Langone: 100 percent. You see that in ACL tears or multi-ligamentous knee injuries in the NFL, and the knees and legs are bending totally out of position. Or with an ankle fracture like what happened to Chris Godwin<\/a>, a wide receiver on the Bucs last year, where the ankle just totally moves in the opposite direction. <\/p>\n Achilles ruptures most commonly happen in these eccentric contractions where the player is loading the calf or Achilles as it\u2019s lengthening, so either landing from a jump or kind of taking a step back to start sprinting. That was, with the specific example the Tyrese Haliburton injury last year in the NBA Finals: you can see him take that step back, load that calf. That intense load while the muscle-tightening unit is stretching and getting longer is when it\u2019s most at risk.<\/p>\n Ben Rothenberg, Bounces: How much is there in the way of prevention or risk assessment that could be done? I\u2019m curious, could a doctor or physiotherapist look at one of these athletes\u2019 legs, let\u2019s say 24 hours before they each had their these traumatic injuries: would they have been able to say, \u2018Oh wow, this Achilles is vulnerable, it\u2019s in bad shape\u2019? Or is it not as detectable or predictable as that?<\/p>\n Dr. Andrew S. Bi, NYU Langone: I mean, if we could do that, we would be hired by every professional sports team out there. (Laughs) <\/p>\n It really is kind of a freak accident, because players do these moves a million times across different sports and they don\u2019t tear their Achilles. It\u2019s just bad luck that sometimes the load is so much that the tendon gives way. <\/p>\n Now, you know, people can have tight gastrocsoleus, which is the calf muscle complex\u2014they can have tight calves. They can have Achilles tendonitis, wherein the Achilles tendon, where it inserts on the heel, is inflamed and causes pain. And when that happens, teams typically know to really scale back, trying to either rest them or rehab them before they let \u2018em go back to full-speed play, because those symptoms increase the risk for having an Achilles rupture.<\/p>\n If I remember correctly, I think Christian McCaffrey had bad Achilles tendonitis<\/a> that kept him out for a decent amount of weeks last season. And that\u2019s the reason why: because the Achilles tendon rupture is just so devastating.<\/p>\n Ben Rothenberg, Bounces: One of the patterns I saw in this admittedly pretty small sample set of videos I was watching\u2014Rune, Haliburton, and Jayson Tatum\u2014they all seemed to have some sort of preexisting strain or pain in that leg. Rune had his left thigh taped before he ruptured his left Achilles. Haliburton had a calf strain in Game 5<\/a> of the NBA Finals before rupturing his Achilles in Game 7. Tatum was wearing a sleeve on the leg he injured. <\/p>\n They all had something going on higher up on their leg, and they were playing through it. And so I wonder if that made them each more vulnerable? Like you said, could it lead to a dysfunctional tightening of muscles if there is something else amiss on that kinetic chain of their leg?<\/p>\n Dr. Andrew S. Bi, NYU Langone: Yeah, definitely. Any injury in a joint above\u2014or below, but for the Achilles it would typically be above\u2014any injury changes the biomechanics of how players run, jump, change direction. That predisposes you to another injury in that lower extremity. And that\u2019s why typically, teams are so careful returning players when they do have some kind of pain or symptom bothering them.<\/p>\n Ben Rothenberg, Bounces: There have been several of these high-profile cases we have mentioned, but maybe you know more objective metrics beyond what could be some recency bias. Are these injuries becoming more common? <\/p>\n From what I was reading in my research about Achilles ruptures, they\u2019re most common, population-wise, among men in their 30s and 40s. These recent high-profile cases were all athletes who are in their 20s. And so I just wonder if there is a trend towards this becoming more common, and if so, if you have any idea what might be causing this this increase?<\/p>\n Dr. Andrew S. Bi, NYU Langone: Yeah, that\u2019s a great question. Typically, just like you said, these injuries happen to, like, weekend warriors\u2014people who haven\u2019t worked out a lot and aren\u2019t physically in-shape and then go out and try and run sprints or play basketball and jump, and rupture their Achilles on the weekends. But, just like you said, we\u2019ve seen such a rash of these across all professional sports. <\/p>\n It\u2019s kind of funny, we actually published a paper on this in the journal <\/a>KSSTA<\/a> in 2023<\/a>. We published this paper with one of the senior foot-and-ankle specialists, Dr. John Kennedy\u2014he\u2019s pretty internationally renowned in foot-and-ankle sports medicine. Basically, we\u2019d initially thought [an increase in Achilles ruptures] was kind of related to that COVID layoff. Everyone was off from 1-2 years from organized sports, and we thought that significant layoff was what led to like a significant increase in the Achilles ruptures we were seeing in the general public\u2014as well as in the NFL, for those first two seasons after COVID. We haven\u2019t updated the study since, but it does seem like this trend is continuing. <\/p>\n So, you know, I don\u2019t have a good answer. It could be because players of all sports are just getting bigger, stronger, faster, and they\u2019re just putting loads on tendons that are not evolving as fast as sports performance is increasing. That could be why we\u2019re seeing such an increase in these injuries. <\/p>\n A good parallel is actually in the MLB with pitchers: the average speed of a pitch has just increased dramatically over the past couple decades\u2014insane amounts of change in pitching performance. And the UCL (ulnar collateral ligament), which is the ligament that is the main stabilizer to the pitching motion on the elbow, it\u2019s not evolving fast enough to withstand these loads, so we\u2019re seeing a significant increase in UCL tears in pitchers at all levels. It\u2019s almost inevitable that\u2019s a pitcher is going to have a UCL injury of some sort, just because of the speeds and demands that they\u2019re putting on that ligament.<\/p>\n Ben Rothenberg, Bounces: That makes sense. <\/p>\n On Rune\u2019s injury specifically, he described his injury as \u201cfull broken on the proximal part<\/a>.\u201d I guess there\u2019s different ways in which you can rupture your Achilles; what does his description indicate to you about the relative severity of his rupture, and what would the recovery look like for a \u201cfull broken\u201d proximal Achilles?<\/p>\n Dr. Andrew S. Bi, NYU Langone: So to best answer that question, a little background on the anatomy: the Achilles is this big tendon that inserts on the calcaneus (heel bone). It\u2019s approximately 7 to 10 centimeters in length, and then it becomes the muscle of the calf. <\/p>\n And so when he says it ruptured \u201cfully, proximally,\u201d that\u2019s what we typically call a myotendinous tear of the Achilles, so at the proximal\u2014or higher up\u2014 portion of the tendon, where the muscle becomes tendon. <\/p>\n You can also have mid-substance tendon tears, which is right in the middle of the tendon\u2014it just rips apart. And you can have distal, which is farther down the extremity, closer to the heel. You can have distal avulsions where the tendon pulls off the calcaneus. <\/p>\n The most common are these proximal ruptures, these proximal myotendinous tears. Actually, in the general public\u2014especially those who aren\u2019t athletically inclined and may be in their 40s, 50s, they just walk for exercise or lift weights and they don\u2019t do too much high demand activity\u2014 recent studies have actually shown very good results with non-surgical treatment of their ruptures. They get them into rehab really soon, they start loading the tendon early. And even though it seems crazy, these tendons\u2014especially these proximal myotendinous ruptures\u2014they heal well and patients do well without surgery. <\/p>\n Now, the caveat to that is with a professional athlete, you place totally different demands on the Achilles. And if you need high athletic performance from your Achilles, surgical repair is still superior to non-surgical repair, because you can generate more force after a year with the surgery.<\/p>\n Ben Rothenberg, Bounces: What would be the timeline, in your experience, for an athlete coming back to training and then to competition from an Achilles rupture like this?<\/p>\n Dr. Andrew S. Bi, NYU Langone: I\u2019m a little biased, again (because of personal experience with this injury), but the Achilles is probably one of the toughest musculoskeletal injuries to come back from to peak athletic performance. Your entire body loads through this one tendon at the bottom of your foot, and tendons, in general, heal slower than bones. <\/p>\n And so, at minimum, it\u2019s a one-year return to sports. But I can tell you, personally and from patients that I\u2019ve treated and that we\u2019ve seen over the years, even though they can return after a year, their strength is not at 100 percent after a year. They don\u2019t perform to their exact [previous] level until, typically, like 18 months, almost even two years. <\/p>\n Obviously Haliburton and Tatum are in their recovery phase right now, but prior players\u2014Kobe Bryant, Kevin Durant\u2014when they come back, you can always see in that first year back, which already a year after injury, their performances are just nowhere near their baseline. <\/p>\n But then in the second year of play, which is two years after injury, you can see people starting to get more confidence and getting back at their baseline level of play.<\/p>\n Ben Rothenberg, Bounces: So it can be a long road, and I especially have to imagine that in an individual sport like tennis it\u2019s got to be even tougher, since you can\u2019t adjust or modify your play as you work on a comeback as much as a team player might be able to ease back into competition.<\/p>\n Dr. Andrew S. Bi, NYU Langone: So, so tough. I mean, the demands that these professional tennis players are placing on their Achilles\u2014cutting, pivoting, accelerating\u2014and totally on an island, in front of everybody. Yeah, it\u2019s got to be super hard.<\/p>\n Ben Rothenberg, Bounces: After this injury, there\u2019s been a ton of talk from Rune\u2019s peers\u2014and his mom, who\u2019s his manager<\/a>\u2014about the tennis calendar, saying that the schedule is too packed and too tough.<\/p>\n So to their point: how much is overuse a factor in an injury like this? Maybe it\u2019s obvious to say that it would cause more wear and tear and strain on a leg to be playing more often, but yeah, how much is rest a clear preventative measure for injuries of this sort?<\/p>\n Dr. Andrew S. Bi, NYU Langone: Yeah, the appropriate amount of rest after loading any tendon or muscle is critical to prevent injury. And especially in sports like tennis where it\u2019s nearly year-round and there\u2019s not a long, dedicated off-season. Even what there is, players are still playing and training in the off-season. It definitely can place a big load on the tendon and increase the risk for injury.<\/p>\n Ben Rothenberg, Bounces: Yeah, I guess that\u2019s what we saw with Haliburton, too: it was Game 7 of the NBA Finals<\/a>, so he was at his maximum mileage point over the course of a season at that point.<\/p>\n Dr. Andrew S. Bi, NYU Langone: Yeah, and they were playing that NBA season after playing in Olympic basketball, so no off-season. <\/p>\n It\u2019s a lot on these guys. It\u2019s a lot to ask of your musculoskeletal system.<\/p>\n Thanks to Dr. Bi for his insights, thanks to you for reading Bounces, and please stay safe and healthy, folks! -Ben<\/p>\n Thanks for reading Bounces! This post is public so feel free to share it.<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/10\/https:\/\/substack-post-media.s3.amazonaws.com\/public\/images\/4b197647-e068-4293-9149-12313900eeb9_712x.png\")
<\/a>![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/10\/https:\/\/substack-post-media.s3.amazonaws.com\/public\/images\/b5202b8e-ee1e-441e-96b8-e6b6b8b9b550_706x.png\")
<\/a><\/p>\n![\"File:Lower](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/10\/https:\/\/substack-post-media.s3.amazonaws.com\/public\/images\/19008469-948f-4a1f-a2ee-55b4901dee0d_512x.png\" "\\"File:Lower")
<\/a><\/p>\n