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Week 4 Injury Report

Three weeks down! The start of the 2022 NFL season has already given us all we can handle with injuries, but the season is just beginning! In week three, we saw several key players suffer injuries of varying severity, and many others look to make their return to the field this week. Let’s dive in!

Quarterbacks

Tua Tagovailoa

What a bizarre injury this was! Video of Tua attempting to walk after taking a hit in the first half of Miami’s classic battle against division rival Buffalo surely looked like Tua had a concussion.  However, Tua was quickly cleared of a concussion and diagnosed with a back injury.  Football fans were quick to display their skepticism, and the NFL conducted a formal review.  Ultimately, it appears it was just a back injury.  How might this impact Tua in tonight’s game against Cincinnati? 

A back injury has the potential to impact a thrower significantly.  Look at Jameis Winston, whose completion percentage dropped from 67.6% in week one to 62.5% and 61% in weeks two and three, respectively, after suffering a back injury.  Sure, a small sample size for a quarterback who has never been the most accurate, but watching him play, you can see something has been off.  Throwing mechanics must be considered here.  The power behind a throw starts from the ground up, starting with the back leg.  This power is then transferred through the back via rotational movements to transfer into the throwing arm and hand finally.  When a player has a back injury, it is possible they will not rotate through the full motion due to pain and stiffness.  This can impact power generation and accuracy. 

In addition to his back injury, Tua is also dealing with an ankle injury.  This can impact a thrower’s ability to push off (if it’s the back leg ankle) or their stability during the follow-through (if it’s the front leg ankle).  Either of which has the potential to impact his performance. 

With Tua playing on Thursday night, he has less than ideal time to recover.  It looks like he will play, but it is unlikely he is at full strength.

Mac Jones

Jones suffered a severe high ankle sprain on Sunday. This was obvious by watching the video of the play. His foot and ankle turned outwards while he was rolled up from behind, a classic mechanism of injury for the high ankle sprain. We could tell it was pretty severe by his complete unwillingness to weight bear as he hopped off the field.

The current discussion is whether or not Jones needs surgery. With a grade II or III high ankle sprain, the indication for surgery can be controversial, whereas a grade I never needs surgery. This type of injury causes the tibia and fibula (two shin bones) to gap away from one another. This becomes an issue for athletics as now the foot and ankle has more give, rather than being rigid when attempting to push off.

The large bone on the right is the tibia, and the thinner bone on the left is the fibula.  With a high ankle sprain, the ligaments that hold these bones together (not seen) are injured, causing these bones to slightly separate from one another. If Jones does undergo surgery, it would likely the the “tight rope” procedure made famous by his former college teammate Tua.  This procedure has shown to yield good outcomes and a quick return to play. 

The good news for Jones is that no decline in statistics are seen when Quarterbacks return from a high ankle sprain.  He will likely miss 4-6 weeks but should play like himself when he returns.


Justin Herbert

The Chargers superstar quarterback did not look himself last week, playing through rib cartilage fractures.  He was reluctant to take deep shots, and his accuracy was poor compared to what we have grown to expect from Herbert. Ribs are tough, especially for a thrower.  Several key muscles involved in throwing, such as the pecs, the lats, the serratus anterior, and the obliques, all attach to the ribs.  Therefore, whenever he throws, these muscles pull hard on his injury, which hurts!

Additionally, the ribs attach to the thoracic spine (upper and mid back).  The thoracic spine is where we generate a lot of our rotation when throwing.  This also stresses the injury sites. The good news for Herbert is that he had no setbacks last week.  As the pain continues to subside, his function should improve.  I expect him to continue to look better each week, and by weeks 5-6, as long as he has not had any setbacks, he should be close to 100%.

Zach Wilson

Wilson will now be over six weeks removed from surgery to debride (clean out) his meniscus injury. This is ample time to recover; with this type of procedure, there is no true tissue healing outside of the skin where the incisions are. A meniscus debridement is simply cleaning out of the torn portions of the meniscus, which is essentially a cushion. Recovery from this procedure is all about pain and swelling management. Both of these can take several weeks.

It was his right knee, which is the leg he pushes off to generate power during his throw. However, Wilson has been throwing for a few weeks now, and there is no reason to expect he is not 100% ready to go. We saw Ben Rothlisberger return in two weeks from a similar procedure back in 2016, and he played just fine.

Jameis Winston

Well reported now, Winston is dealing with multiple fractures in his lumbar spine. We have seen Jameis struggle since suffering this injury, with a decline in completion percentage from 67.6% in week one to 62.5% and 61% in weeks two and three.  Jameis is known for his accuracy, and by that, I, of course, mean his ability to throw the ball to the wrong team accurately. He has thrown a Winston-Esque five interceptions in the two games he played dealing with this injury.

The good news is it does not appear that Jameis has suffered any setbacks thus far. The inflammatory phase of healing from a fracture typically takes 7-10 days. This is the phase of healing that is most painful and most likely to hurt performance. As he moves past this phase of healing, his performance should improve.

Running Backs

D’Andre Swift

Swift re-aggravated his week one ankle sprain and now also has what is being reported simply as a “shoulder sprain.” Coach Dan Campbell is less than optimistic about his star running back playing this week.

The re-injury to the ankle sprain is not unexpected, as this type of injury carries a high re-injury risk. When Swift does return, this injury is what would impact his performance more so than the shoulder as an ankle sprain will impact a players ability to quickly cut and create power off of that ankle.  Speed and agility is Swifts bread and butter, so this type of injury could impact him more than it would a power back.  Whenever he returns, I expect Detroit to be cautious with his workload, especially since Jamaal Williams has been playing so well.

The shoulder injury is a bit vague right now, and we will have to continue to monitor the Detroit beat reporters for more details. As of now, it is being reported simply as a shoulder sprain. Within this, it could be a true sprain to the glenohumeral ligaments or an AC joint sprain. RBs average missing 3.2 games due to an AC joint sprain, but much less from a glenohumeral ligament sprain. Neither injury shows a notable decline in performance when they return.

Dalvin Cook

Cook suffered yet another shoulder dislocation, to the same shoulder that he dealt with recurring dislocations last season. The good news is that Cook should not miss much time due to this injury, and his performance when on the field should not be impacted. The bad news is that this type of injury has a very high recurrence rate. It will not be surprising if his shoulder continues to dislocate during games this season.

He will wear a protective harness designed to hold the shoulder into the socket; however, this alone will not be enough to prevent another dislocation if he is hit the wrong way.

Typically with a shoulder dislocation, the labrum tears. The labrums job is to help hold the humerus bone in the shoulder socket. The labrum will not heal without surgery; however, in many cases rehabbing the shoulder can allow the rotator cuff muscles to become strong enough to compensate for the loss of the labrum’s integrity.  

Cook could have had surgery on his shoulder in the offseason but elected to rehab instead. For many people, rehab is enough to manage a dislocation and prevent future issues. However, NFL running back is exposed to more stress on the shoulder than the average person. Because of this, I expect Cook will rehab his shoulder during the season, allowing him to continue playing, and undergo surgery in the offseason.

David Montgomery

Montgomery is dealing with what is believed to be a minor high ankle sprain.  Fans should recognize that there is a spectrum of all injuries.  Yes, the high ankle sprain typically carries a 4-6 week recovery like we are expecting with Mac Jones, but this is not always the case.  In fact, running backs average missing only 2.2 games, with many missing zero or one game.  

Performance, however, may be impacted. A high ankle sprain will affect the ability to plant and cut off the ankle, which is vital for running backs. We often see players look slower when cutting off the injured ankle. There are two reasons for this. 1) Pain inhibits function. 2) With a high ankle sprain, there is a separation of the tibia and fibula bones, impacting the ankle’s ability to create power. This leads to a slower push-off.

The other factor for Montgomery is the emergence of his counterpart Khalil Herbert.  Coach Matt Eberflus has referred to Montgomery as “day-to-day” indicating he is not concerned for his week 4 status.

J.K. Dobbins

Dobbins finally made his 2022 debut last week to the tune of 7 carries for 23 yards and a 43% snap rate. This was not unexpected, as we historically see running backs struggle in their first several games after an ACL injury. This is part due to teams easing them back into their workload, and part due to the continual recovery.

Running backs can struggle for several weeks, even the entire first season when returning from an ACL injury. Dobbins did have more time than usual to recover, as his injury was before last season started but his injury was more involved than typical. I would not be surprised if Dobbins struggles for a few more weeks before getting it together by mid-season.

Christian McCaffrey

CMC did not practice Wednesday or Thursday due to a thigh injury. At this time, it is not believed to be overly serious but fantasy players should monitor this throughout the week.

Joe Mixon

Mixon suffered a minor ankle sprain on Sunday, but has already been cleared for Thursday nights game against Miami.

Wide Receivers

Amon-Ra St. Brown

St. Brown suffered what appears to be an ankle sprain in Sunday’s loss to the Vikings. Testing suggests that St. Brown’s injury is not severe but it is possible he could miss some time. He is a massive part of the Detroit offense, accounting for 33% of their passing yards through three games. The good news for fantasy players with St. Brown is that when he does return from his ankle injury, WRs are hardly impacted from a statistical standpoint from this injury.

Chris Godwin

Godwin missed weeks two and three due to a hamstring injury suffered in week one. He participated in practice for the first time since injuring his hamstring this week and will hope to take the field against Kansas City in what could be a classic shootout.

Coming off of a hamstring injury, wide receivers numbers are typically not as prominent as their pre-injury averages in the first game.  This is due to the hamstring limiting explosiveness.  In fact, when a runner increases speed from 80-100% of a sprint, the load on the hamstring increases by 1.3x.  If the hamstring is still injured, this will limit top end speed, and has a high risk of reinjury. 

We must also consider that Godwin is only about 9-months removed from ACL surgery. The combination of these injuries make for high re-injury rates and potential for limited snaps. Godwin a risky start if he plays.

Keenan Allen

Allen also is returning from a hamstring injury and returned to practice on Wednesday.  As mentioned with Godwin, hamstring injuries will impact top end speed.  Top end speed is not Keenan’s game though, so even if he is not 100% he should still be productive. The concern of course, is that hamstring injuries have a high recurrance rate.  LA may be cautious with their star receiver and hold him out another week.  We will have to continue to monitor.

Sterling Shepard

Shepard suffered an unfortunate season-ending ACL injury at the end of the Monday night loss to Dallas. The injury video shows a non-contact mechanism of injury that appears more consistent with a patellar tendon tear, but testing revealed an ACL tear. 

This is the same leg that Shepard tore his Achilles last season. Shepard returned from that injury in roughly nine months, much faster than typical. It is certainly possible that mechanical compensations from the Achilles injury may have played a role in this injury. Specifically, following an Achilles repair, there is often residual stiffness in the ankle and subsequent weakness of the glute and calf muscles. These factors increase loading through the front of the knee, and decrease stability of the leg, particularly when fatigued.

Shepard’s season is over, but fortunately, he will have almost an entire year to rehab to get ready for next season. Let’s hope for the best for him!

Michael Thomas

My personal pre-season pick to be the fantasy football league winner.  Michael Thomas suffered a toe injury in week three’s loss to Carolina. Early reports are that his injury is not severe and is not expected to cause Thomas to miss the trip to London for Sunday morning’s game against Minnesota.

Thomas has been no stranger to the injury report the past three seasons. This type of injury could impact his speed and ability to cut. These factors could affect his fantasy performance; however, Thomas does not rely as much on his speed as other wide receivers. Thomas is a savvy route runner who uses his body and exceptional hands to make plays. If he plays, I would not expect any issues due to the toe injury.

Jarvis Landry

Landry is reportedly “battling foot soreness” after last week’s loss to Carolina. The good news is it does not appear to be serious. If this is truly just soreness and no injury to any ligaments, he will actually feel better with light exercise throughout the week. It appears that Landry will play Sunday morning in London.

Julio Jones

Finally, reports from Tampa Bay provided some clarity on Julio Jones knee injury. We learned that the future Hall-Of-Famer is dealing with a PCL injury. This is the same injury that Dallas tight end Dalton Schultz is dealing with. Julio has been questionable the past two weeks, ultimately missing each game.

The PCL’s primary job is to prevent the tibia (shin bone) from translating backward on the femur. It also assists the ACL in preventing unwanted rotation and inward collapsing of the knee. The difference is the PCL prevents these motions when the knee is already bent significantly. Because football is not played with our knees bent to 90° or more, the PCL injury is less impactful on athletic performance than its counterpart, the ACL.

To play, pain and swelling must be under control. Additionally, the pain and swelling from a PCL injury can impact quad strength and stability on one leg. A player, especially a wide receiver, is prone to additional non-contact injuries without adequate quad strength and single leg stability. Therefore Tampa is likely cautious and making sure Julio is ready to go.

When Julio does return, it would not be surprising to see him moving slightly slower than usual. However, with Tampa’s receiving corps depleted, Brady may still hammer Jones with targets making him a worthwhile play in fantasy if he can go.

Rondale Moore

Another explosive receiver battling a hamstring injury.  Moore has not yet hit the field in 2022, but has been practicing this week.  If Moore is able to go this week, his game is built on his speed and explosiveness, therefore his hamstring injury could slow him down a bit.

Kadarius Toney

Toney, also dealing with a hamstring injury, did not practice on Wednesday. This is not a good sign for the second-year receiver who missed last week’s game against Dallas. I discussed on the Fantasy Injury Team podcast how I felt New York was rushing Toney back too fast when they put him on the field week one.  This was secondary to a video of him a week before the season started struggling to cut and clearly showing that he was in pain. Hamstrings are notorious for re-aggravating when poorly managed. Even if Toney does find a way onto the field this week, he will likely see a reduced snap count and is at a higher risk for re-injury.

Tight Ends

Dalton Schultz

Just like Julio, Schultz is dealing with a minor PCL injury.  Schultz was close to playing on Monday, but likely was still managing pain and swelling.  If these components are under control he should be able to play this week. His injury may slow him down a bit, but as a tight end, his game is not built on as much explosiveness as a wide receivers would be.  Therefore I would not expect his performance to be impacted much.

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