Written by Tom Christ, PT, DPT, OCS, FAAOMPT
@FantasyInjuryT
The last week of the regular season is here! The final chance for fantasy players to get their teams into the playoffs. This week, more than ever, the week 14 fantasy football injury update is critical. A number of key players went down with injuries last week, and several aim to return to playing in week 14. What are the impacts of these injuries? And who can you trust this week? Let’s find out! As always, the Fantasy Injury Team Podcast is available on Apple and Spotify, and now Youtube with detailed analysis of all the major injuries!
Quarterbacks
Lamar Jackson
Lamar Jackson is dealing with a posterior crucial ligament (PCL) injury that reportedly will sideline him for 1-3 weeks. This timeline puts Jackson’s week 14 status in doubt. I have concerns for Jackson’s rest-of-season outlook due to this injury.
The PCL is a ligament that helps stabilize the knee and provides sensory information about the position of the knee called proprioception. Specifically, the PCL prevents the shin from moving backward on the thigh bone and provides some lateral stability. With a sprain, there is some loss of this stability, some loss of proprioception, pain, and swelling. Depending on how significant the injury is, the injured fibers of the ligament may never actually form back together, making healing difficult. It is true that the PCL is not as significant for football players as the ACL, but we have seen PCL injuries impact fantasy performance and tend to linger.
Jackson has developed as a thrower since entering the league, but he is an elite fantasy player because of his legs. The impact of this injury on his knee stability and proprioception can go a long way toward impacting his rushing ability. When the knee is less stable, and an athlete’s awareness of their leg’s position is impaired, speed, quickness, and power are impacted. These three factors are vital for Jacksons’ ability to run. If his speed or agility is declined by just milliseconds, he loses much of his advantage as a runner.
The tricky situation for fantasy players is Jackson likely will play during the fantasy playoffs. It will be very tempting to start him, and even an injured Lamar Jackson is probably just as good as anyone on waivers. The problem is it will be very challenging for him to have his same rushing production with this injury. This season, we saw Dalton Shultz and Julio Jones struggle in the first several games after this injury, and both players have suffered setbacks throughout the season. Last year, the same applied to Ezekiel Elliot. If Jackson was a volume pocket passer, such as Mahomes, Brady, Burrow, or Herbert, I would not be as bearish on his rest-of-season outlook. But his running upside takes a major hit with this injury.
Tua Tagovailoa
Tua suffered an ankle injury that does not appear to be serious. It is unclear what part of his ankle was injured, but for quarterbacks, this does not appear to matter. Quarterbacks show almost no decline in fantasy stats when returning from either lateral ankle sprain or high ankle sprains. It is certainly possible his mobility could be impacted, but Tua’s fantasy value is not dependent on his rushing ability.
Depending on which ankle is injured, we could see some impact on his throwing mechanics. As a left-handed thrower, he generates force on his throw by pushing off his left leg. A left ankle injury could impact throw power. His right foot and ankle accepts his body weight during the follow-through. Therefore a right ankle injury could impact his stability, therefore, accuracy.
Jimmy Garoppolo
Some encouraging news came out this week on Jimmy G’s left foot, stating that he will not need surgery. He has multiple fractures, all of which will heal naturally. No surgery indicates that the fractures were non-displaced, meaning the fractured parts of the bones are positioned where the cells can reach each side of the fracture to heal properly. This also suggests that the bones injured have an adequate blood supply.
While this bodes well for Garoppolo, he still has an uphill battle to be ready for the playoffs. Playoffs start in five weeks, and typical bone healing calls for 4-6 weeks, but when it’s the foot and multiple fractures, this can be longer.
Garoppolo will be immobilized in a boot or cast for at least four weeks and possibly longer. Immobilization leads to stiffness and weakness of the associated joints. Stiffness and weakness will take some time to resolve after discontinuing the immobilization phase. It will take Garoppolo a few more weeks of rehab to run and cut, let alone play football.
For fantasy, Garoppolo’s season is over. In reality, the Niners would have to make a deep playoff run for him to have a chance to play. For next season, there is no reason to expect any residual issues from this injury. Typically, foot and ankle fractures put a player at risk for future injury due to residual stiffness. As a thrower, however, Jimmy does not run nearly as much; therefore, the consequences of any altered mechanics, such as impaired shock absorption, are less pronounced.
Trevor Lawrence
The former 1st overall pick is dealing with a left big toe injury suffered in week 13. Lawrence claims that he is feeling well and will be ready to play on Sunday against the Titans. What is the importance of the big toe in athletics?
The big toe must extend up to 90° with running. Most injuries of the big toe occur to the ligaments or tendons on the underside of the toe. This means that whenever the toe is extended, these structures are stretched, which can be painful. This type of injury often impacts speed and quickness, leading to impaired performance from skill-position players. As a pocket passer, however, Lawrence won’t see much impact from this injury. Another key factor in Lawrence’s favor is that this is his left foot. As a right-handed thrower, Trevor creates power by pushing off his right foot. When a thrower’s back leg big toe is injured, we almost always see a change in their mechanics to avoid putting pressure through the toe. Any quarterback will tell you that footwork is of upmost importance to throwing mechanics. Luckily for Lawrence, this won’t be an issue since it’s his left toe. I don’t expect much impact from this injury.
Matthew Stafford
Updates on Stafford’s injury came out this week, and we learned the super bowl champion is dealing with a spinal cord contusion. This sounds terrifying, but depending on the severity, it may not be. We knew Stafford was dealing with leg numbness following his injury, this diagnosis explains it.
A spinal cord contusion is swelling within the spinal cord that pushes against part of the cord. The swelling compresses the area of the cord it pushes on, creating symptoms. Symptoms will be dependent on the part of the spinal cord affected. Within the spinal cord, three main sensory tracts go from the periphery (away from the spinal cord, usually limbs) to the brain. They are called ascending tracts since they send the sensory stimulus from the periphery up to the brain.
A spinal cord contusion is different than a spinal cord injury. A spinal cord injury is often permanent. As the swelling from the contusion subsides, symptoms resolve, and people return to normal. We can expect Stafford to make a full recovery. He has, however, been placed on the IR, and the Rams have nothing to play for this season, so there is no reason for him to play again this year.
Running Backs
Kenneth Walker
De-coding Pete Carrol’s press conferences might as well be a full-time job. Carrol is notorious for providing the media with bogus and useless information. In regards to Walker’s ankle injury, Carrol has described it as “jammed” and “strained,” stating it’s an injury to the top part of the ankle. Medically, the term “strain” indicates an injury to a muscle or tendon, whereas a “sprain” is an injury to a ligament.
I cannot say if Pete knows this, but if we trust his wording, this tells us an injury to a muscle or tendon has occurred. When he says “jammed,” this makes me think Walker is dealing with an anterior impingement of the ankle that has caused a strain of the extensor digitorum longus or extensor hallucis longus muscles or their associated tendons. The tendons of these muscles run along the front of the ankle into the top of the foot; therefore, excessive jamming of the foot and ankle could cause these tendons to be pinched between the foot and shin bones. It is possible a bone bruise also occurred.
If correct, this is not a major injury. Walker could miss this week, but rest-of-season he should be fine. Rehab will be dependent on pain and swelling control. Unlike a sprain, where ligament injury leads to some instability and loss of proprioception (described above with Lamar Jackson), this type of injury to these muscles does not create a major mechanical impairment. Continue to monitor practice reports, but as long as Walker can get pain and swelling under control, I expect him to play without any issues.
D’Andre Swift
Swift enjoyed a few weeks off of the injury report. This week, he’s back. Another ankle sprain, his third of the season. At this time, it is unclear if this is an aggravation of the same ankle sprain he has battled all season or a totally new injury. Either way, an ankle sprain impacts a runner’s agility. Agility is Swift’s game.
As mentioned above, the ligaments of the ankle have a strong proprioceptive role, helping runners know where their limb is without looking. Proprioception is vital for cutting on a dime to change direction. With recurring ankle sprains, proprioception is impacted, leading to faulty mechanics and misplacing one’s foot when running and cutting. Missteps due to loss of proprioception put an athlete at risk for future injury.
Taping and bracing can help with ankle stability, but nothing replaces one’s natural ligament support. Swift’s natural ligament support is compromised by now.
Running backs see an average decline of 2 fantasy points in their first game after an ankle sprain. While Swift is an elite talent, the type that can outperform league averages, Detroit has been very conservative with returning injured players. Prior to last week, Swift had not seen more than 34% of snaps from weeks 9-12. With teammate Jamall Williams on a tear this season, I would not be surprised to see Swift’s snap percentage decline once again due to this injury.
Joe Mixon
Mixon has returned to full practice after missing two games with a concussion. He is in line to play this week. We do not typically see a decline in fantasy production after concussions.
Michael Carter
Carter has returned to full practice after missing last week with an ankle sprain. Like Swift above, Carter is an agile back. Ankle sprains impact lateral agility and proprioception, and running backs see a decline of 2 fantasy points in their first game after a sprain. I would not be surprised if Carter’s fantasy output takes a hit this week. In addition to his injury, the emergence of Bam Knight will likely take snaps away from Carter. Not to mention the Jets play the stingy Buffalo defense this week.
D’Onta Foreman
Foreman is dealing with a foot injury and a rib injury. Carolina is coming off their bye, and there were no reports of his injuries before this week, meaning they are likely minor.
A foot injury could impact his lateral agility and running power. Foreman is a tough downhill runner, so agility is not such an issue, but if he can generate power, that would be a problem.
I have talked in depth about rib injuries this season in regard to Justin Herbert, Aaron Rodgers, Alvin Kamara, and James Conner. For a running back, the ribs are particularly impactful. The lats and pecs attach to the ribs, which are very important for protecting the ball. When these muscles contract (to hold onto the ball), they pull on the ribs. When injured, this hurts a lot! The obliques are abdominal muscles that attach to the ribs. They contract and pull on the ribs when bracing for impact and help rotate the body when running. Again, when contracting and pulling on an injured rib, this hurts!
Runners also take hits to the ribs all the time. This also hurts! Ultimately rib injuries come down to pain tolerance. We will continue to monitor Foreman’s status through practice this week.
Mark Ingram
Ingram will miss 4-6 weeks with an MCL tear. With the expected timeline of 4-6 weeks, this is likely a grade II injury. This means swelling, partial tearing of the ligament, and joint laxity (excessive mobility). The swelling and laxity impact ability to play. If swelling persists, the knee becomes stiff and weak. With laxity, the knee becomes unstable and is prone to buckling and caving inward.
Running backs average missing 3.1 games and perform poorly when they return from an MCL injury. This isn’t relevant as he will not be back for the rest of the fantasy season.
Wide Receivers
Courtland Sutton
Sutton is likely to miss week 14 as he rehabs from a hamstring injury. Sutton has been frustrating this season for fantasy, and this frustration will carry over into the fantasy playoffs.
Hamstring injuries are the most common injury in football. The load on the hamstring increases dramatically as a runner increases speed from 80-100%. This is why receivers are the most common position group to suffer these injuries, they have enough distance to get up to 100% of their sprint. Because of the load on the hamstring increasing at top speed, deep-threat receivers like Sutton are most impacted. To make matters worse, a previous hamstring injury increases the risk of another by 2.7x.
Sutton is likely to miss this week, and receivers average missing 1.9 games due to a hamstring. When they return, receivers see a decline of 2.8 fantasy points in the first game back, and only 25% meet or exceed their pre-injury averages. In half-point scoring, this season, Sutton has only averaged 8.4 ppg. A decline of 2.8 points would be significant, making it hard to trust Sutton in the fantasy playoffs.
Rondale Moore
Rondale Moore did not practice Wednesday as he deals with a groin injury suffered in week 11. Receivers average missing 1.5 games with a groin injury, but multiple have missed up to five games.
The groin helps stabilize a runner while on one leg and helps cut when pushing off the inside leg (right leg to cut right). Despite its size and strength, an injury to the groin is easy to compensate for, which is why players’ fantasy production is hardly impacted when they return from this injury.
If Moore suits up this week, don’t expect his injury to limit him. The challenge with starting Moore is that both DeAndre Hopkins and Marquise Brown will also be suiting up. The three have yet to all play together this season.
Kadarius Toney
Toney returned to practice after missing two games with his third hamstring injury of the season. Details on the hamstring can be found above in the write-up on Courtland Sutton.
Whenever we see recurring hamstring injuries, we must consider the health of the sciatic nerve. The sciatic nerve runs from the low back all the way down to its branches in the toe. This nerve should be able to move within the back and leg during normal leg motions such as walking and running. When the nerve is irritated or stuck, the body intrinsically knows to protect it. How does the body protect a nerve? By causing muscles to violently contract to prevent motion that would aggravate the nerve. In this situation, the leg going forward motion would aggravate the sciatic nerve, and the hamstring muscle is literally sacrificed to protect the nerve. Further detail can be found in a previous article.
I do not know if a sciatic nerve irritation is the root cause of Kadrius Toney’s recurring hamstring injuries, but I do know that the Kansas City training staff better be testing for it!
Tight Ends
Hayden Hurst
Hurst is unlikely to play in week 14 as he recovers from a calf injury. The calf is highly involved in running, cutting, and jumping, therefore, will impact athleticism.
When we sprint, our ankle stays in a plantarflexed position (ankle pointing downward). The calves are responsible for this motion. The calves function similarly to a spring with running, where they bend and recoil to create power. An injury to the muscle will impact the springiness, therefore slowing a runner down. Luckily for Hurst, his size as a tight end helps his ability to get open and catch the ball more so than his athleticism. Because of this, tight ends are not as impacted as receivers by calf injuries, but still do see a decline of 1.4 fantasy points in the first game back. For a middle-low tier tight end, 1.4 points is a big difference. Hurst can be dropped to make room to pick up a tight end that can help you this week.
More information
As always, you can subscribe and listen to the Fantasy Injury Team Podcast for weekly insight into all the major injuries!