Written by Tom Christ, PT, DPT, OCS, FAAOMPT
The season is halfway over! It’s now time to start pushing toward the fantasy football playoffs. This week we did not see as many devastating injuries; however, as always, there are several injuries to discuss on the week 9 fantasy football injury update. A number of key players attempt to make their return from injury this week, and a few players unfortunately re-aggravated existing injuries. As always, more discussion can be heard on the Fantasy Injury Team weekly podcast on Apple and Spotify! Let’s dive in.
Prescott went 21 for 27 for 250 yards and two touchdowns. His 78% completion percentage indicates his accuracy is back. Accuracy was his main concern with returning from the thumb injury suffered in week one. Recovering from a thumb fracture involves re-gaining grip strength. Without proper grip strength, there is a risk of accuracy loss rather than a decline in throwing power. Prescott is now 100% and can be started with confidence.
Jones, who continues to recover from a left high ankle sprain, went 24 for 35 for 194 yards, one touchdown, and one interception in a win over the Jets last week. Jones’s stat line was not impressive, but he appears to be over the hump from his high ankle sprain.
The concern with his sprain being on his left leg was the stability when following through on his throws. His weight shifts to the left leg when he follows through, requiring his ankle to be strong and stable to accept his weight properly. A high ankle sprain can compromise this stability, leading to accuracy issues. Jones appears to be over this by now, and as long as he does not re-injure his ankle, he should continue to improve this season.
Taylor, who missed weeks 5-6 due to a high ankle sprain, has unfortunately re-injured his ankle.
A high ankle sprain is very painful and impacts a player’s ability to plant and change direction. In addition to pain-limiting function, the sprain leads to a gap between the tibia and fibula bones. In a normal situation, these two bones fit snugly against the talus bone of the foot, creating the talocrural joint. When the tibia and fibula are gapped, the foot and ankle are less stable, making it harder to plant and cut.
It is not out of the question for Taylor to miss more time due to this injury. NFL running backs average missing 2.2 games due to a high ankle sprain. Earlier this season, Taylor missed two games. I would not be surprised to see him miss more time. Fantasy players must be glued to Indianapolis practice reports this week.
Edwards injured his hamstring on Thursday night in just his second game back after his ACL tear last season. Unfortunately, when returning to play after an ACL tear, hamstring injuries are very common. I discussed this at length with ESPN’s Stephania Bell on the Fantasy Injury Team Podcast this week.
There are numerous reasons that hamstring injuries occur after an ACL tear. For starters, the hamstring is often neglected in ACL rehab. This neglect is because in ACL rehab, the quad muscles become very weak after surgery, and so much attention is spent on re-gaining quad strength, whereas hamstrings are not as prone to post-surgical weakness. While the hamstrings aren’t necessarily weak, they still become deconditioned to the stresses associated with high-level athletics.
Additionally, following surgery, it is common to see the glute muscles become inhibited (difficulty activating). When we see glute inhibition, the hamstring often compensates and works too hard. While this sounds contradictory to the paragraph above, this overuse of the hamstrings can lead to injury.
Another reason for hamstring injury post-ACL tear is the athlete’s single leg balance is not always 100% when they return to play. Many clearance tests to return to sport incorporate single-leg stability. Still, the criteria to be cleared to play is for the surgical leg to perform at 90% of the unaffected leg. This 10% makes a difference! Not only is the hamstring a common compensator for glute inhibition, but it will also compensate and attempt to stabilize on one leg (cutting), which can lead to an overload of the muscle.
Luckily Edwards’s injury appears minor, and he has a chance to play this week. Running backs only see a decline of 0.7 fantasy points in their first game after a hamstring injury. Edwards plays middle-of-the-pack New Orleans defense this week and could be a worthwhile start.
Conner has missed three games due to a rib injury. Conner did not practice Wednesday, and we will have to monitor his outlook for this week against the Seahawk’s 4th worst rush defense.
Rib injuries are tricky. Few injuries are as painful as rib injuries. The ribs are involved in every athletic movement, and even with breathing, making it difficult to offload the injury. The big pec and lat muscles attach right onto the ribs and generate a strong pull on the ribs when pumping the arms to run and when firmly grasping the football to prevent fumbling. This muscular attachment makes it challenging for a ball carrier to play through a rib injury.
The good news is that Conner is now four weeks out from his injury. Bone healing time is 4-6 weeks; typically, after 2-3 weeks, pain is significantly better. With rib injuries in the NFL, the ability to play is typically dependent on pain control. Conner is likely nearing a return, but it is unclear how much of a role he will now have in this offense. Eno Benjamin and Darrel Williams are both serviceable backs and likely will compete for snaps.
Patterson, who injured his knee in week four, is back practicing this week.
We were not given much detail on his injury, but we do know that he had his knee scoped. This is typically a clean-out procedure for either a meniscus or cartilage issue. With any knee scope, returning to play depends on pain and swelling control. 4-5 weeks is typically more than enough time to control the pain and swelling, and in a small sample size, we see no decline in RB fantasy output in the first game back.We will continue to monitor Patterson’s activity in practice this week. If he plays, he is worth flex consideration, as he was the RB7 prior to the injury.
The 32-year-old ball carrier suffered a grade II MCL sprain in week eight and is expected to be sidelined 3-4 weeks.
The MCL provides stability to the inside of the knee, helping prevent the knee from caving inward. When injured, this creates pain and swelling, leading to stiffness and instability in the knee. Stiffness and instability make it difficult to plant and cut. A running back needs to be stable on one leg to quickly plant and change direction.
Rehab consists of pain and swelling control via massage, gentle range of motion, exercises to activate the leg musculature, and progressing to single leg stability and agility drills when tolerable. Rehab outcomes are typically very good, and we almost never see any surgical techniques performed for MCL injuries.
Ingram is well past his prime and has not scored double-digit fantasy points all season. Running backs score 2.9 fantasy points below their pre-injury average in their first game after an MCL sprain. He does not need to be kept on rosters.
The Rams rookie suffered a severe high ankle sprain on the opening kickoff of the 2022 season. Over the summer, Williams suffered a foot fracture that forced him to miss OTA’s and part of camp. Williams has suffered not one but two major lower body injuries in the past six months. Each contributes to foot and ankle stiffness that does not always improve after the injury has healed. Stiffness in the foot and ankle can negatively impact gait and running mechanics, rendering an athlete prone to injury.
That said, he is young, which makes recovering from injury much easier. LA has the worst rushing offense, averaging an abysmal 3.3 yards per carry. While durability is a concern, his opportunity is ideal. He must be rostered in all leagues, and if he suits up this week, he has flex potential pending reports on the expected workload.
Hubbard missed week eight due to an ankle sprain. Meanwhile, his counterpart D’onta Forman ran for 118 yards and three touchdowns. Foreman now should have a stranglehold on the Carolina backfield and is a potential fantasy league winner.
Hubbard practiced in a limited fashion on Wednesday and appears to have a shot at playing against Cincinnati’s 11th-ranked rush defense this week. Hubbard is a shifty back, and ankle sprains will impact lateral agility more than downhill running. This does not bode well for Hubbard. With Hubbard’s injury and the emergence of D’onta Foreman, there is no reason to start Chuba this week.
How hard is coaching? Really? Sean McVay is an outstanding coach and has a nice big ring from last season, but come on, what the hell was Kupp doing in the game down 17 with one minute left? Take your best player out when the game is clearly out of reach!
Kupp suffered an ankle sprain in the last minute of last week’s blowout. Luckily, the reports are minor; however, he did not practice Wednesday. It is not unusual for a veteran to miss Wednesday practice when dinged up, so we will continue to monitor Kupp’s status for this week.
As mentioned above with Hubbard, an ankle sprain impacts lateral agility. For a receiver, this is route running and run after the catch. Both of which are Kupp’s games. This injury certainly could slow him down a little, as receivers see a decline of 1.7 fantasy points when they play after an ankle sprain, but he is so good that it does not matter. If Kupp is out there, he will find a way to produce.
Bateman aggravated his midfoot injury in week eight and will miss some time. I wrote about the mechanics of a midfoot injury last week (in quotes below), and unfortunately, the high demands on this region of the foot render it prone to re-injury.
“The mid-foot is highly involved in all athletic motions. This is the region of the foot that must undergo deformation during the different phases of gait, and the ability of the foot to supinate is pivotal for athletic ability. To clarify, when the foot is accepting weight, the mid-foot actually collapses slightly into pronation; this is normal and allows for shock absorption. When the foot is ready to push off, the midfoot raises up and helps supinate the foot to create a rigid foot to push off the ground with. When the mid-foot is injured, the mechanisms of pronation and supination can be affected. This can throw off the normal shock absorption (during pronation) and rigid foot push-off (supination).”
This re-injury is exactly what happened with Bateman.
With the amount of force the midfoot takes on with running and cutting, I find it hard to imagine Bateman being relevant again during this fantasy season. Now, if Baltimore makes a playoff run, he may be able to make an impact for the team later in the season. For now, if you need to win in the near future to make the fantasy playoffs, you simply must trade Bateman.
The Packers WR1 returned to practice Wednesday as he deals with a shoulder injury. As a receiver, he must have full shoulder range of motion to run and catch. Green Bay won’t put him on the field this week if he can’t move his shoulder properly.
His shoulder injury won’t impact per-play production; however, I would not be surprised to see a snap count restriction affecting his overall fantasy output. Fantasy players must monitor Green Bay beat reporters this week to gain any information on a projected snap count.
Allen aggravated his hamstring while training during the bye week and is unlikely to play this week. Chargers coach Brandon Staley stated that Allen’s injury is not responding as they hoped, and it is unlikely we will see him play soon.
Hamstrings are very frustrating. A previous hamstring injury increases the risk for a future hamstring injury by 2.7x! There are a few reasons for this.
The hamstring is highly involved in sprinting. The load on the hamstring increases dramatically when increasing speed from 80-100%!
The hamstring is a common compensator. What I mean by this is that when the glute muscles are not functioning efficiently, which often occurs when a player has a history of injuries (especially ankle or low back injuries), the glutes will often shut down, and the hamstring works overtime. This extra work on the hamstring leads to injury.
A major underlying factor for hamstring injuries that is seldom talked about is the existence of sciatic nerve irritation or tension. Now let’s be clear, this is different than a nerve injury. The sciatic nerve runs from the low back down to branches in the toes. There are several ways the nerve can become “stuck” or irritated, often related to previous injuries. When the sciatic nerve is irritated or stuck, the body will protect it at all costs. A common protection method is forcing the hamstring to tighten up, often contributing to injury.
Whatever the cause of his recurring hamstring injuries, he won’t be playing soon, and it is more likely that we cannot trust him this season. Allen is another one that fantasy players should trade if they can.
New Orleans continues to give us the bare minimum updates for Michael Thomas’s turf toe injury. He has missed five games, and last week coach Dennis Allen gave us no timetable for his return.
Turf toe can linger. Turf toe is an injury to the tendons or ligaments on the underside of the big toe. It is very challenging to offload the injured tissues because of the role of the big toe in walking. The big toe must extend upwards 60° with walking and up to 90° when running. This puts immense stress on the injured tissue.
Let’s hope that Thomas can get back on the field soon, but in the meantime, we continue to wait. I think he can be productive again this season and is worth holding on the IR.
Like his teammate above, fantasy players will continue to wait to see when Landry will return from his ankle sprain. Receivers average missing 1.3 games due to an ankle sprain, and Landry is well past that now, indicating it was more severe. The risk following severe ankle sprains is for re-injury and the development of chronic ankle instability, as well as chronic ankle stiffness.
Chronic ankle instability is when an athlete repeatedly sprains their ankle, and the ligaments become so lax that they can no longer appropriately stabilize the ankle joint. This causes issues as the ankle ligaments stabilize the ankle and provide sensory information to the brain and spinal cord to help make reflex decisions while playing. The loss of this reflexive reactivity can impact a player’s ability to change their footing quickly, allowing them to remain stable while running, cutting, or landing from a jump, which can lead to further injury.
Chronic ankle stiffness reduces shock absorption from the ankle joint and subsequently increases loading through the rest of the leg and back. The increased loading elsewhere in the lower body can contribute to injury.
Ultimately, when Landry does return, it would be wise to sit him until he proves he can be a fantasy asset again.
Andrews is reportedly dealing with two minor injuries to the ankle and shoulder. Coach Harbaugh states that Andrew’s injuries are not major, and he should not miss much time if any.
Shoulder injuries typically won’t impact per-play efficiency but often will lead to a team limiting players’ snap count. With the emergence of rookie tight end Isaiah Likely (from my alma mater Coastal Carolina), it is not out of the question for Baltimore to allow Andrews to ease back into his role.
His ankle injury may slow him down a bit. Tight ends average a decline of 2.2 fantasy points in the first game after an ankle sprain. Overall, no single injury here is too threatening; however, the collection of injuries does provide some concern. Andrew’s, however, is a superstar, and in fantasy football, we start our superstars.
Irv Smith Jr.
Smith Jr. suffered a high ankle sprain in week eight that will keep him out for 8-10 weeks. This is much longer than typical, as tight ends average missing 4.6 games. The lengthy anticipated time out clearly indicates a grade III sprain, and Vikings coach Kevin O’Connell has stated that surgery is on the table for Smith.
With this severe injury, the tibia and fibula bones are gapped away from each other, causing injury to the ligaments that typically keep them congruent. The main ligaments injured are the Anterior Inferior Talofibular Ligament, the Posterior Inferior Talofibular Ligament, the Interosseous Membrane, and sometimes the Deltoid ligament. With an expected 8-10 week absence and possible surgery, any or all of these ligaments could
be compromised. The surgery these days is usually the “tight rope” procedure made famous by Tua when in Alabama.
Smith can be dropped in all redraft formats, as he will not return before the end of the fantasy playoffs. Minnesota knew this, and they moved to acquire tight end TJ Hockenson to help make a playoff run.
Smith should be able to return to 100% next season, but he now runs the risk of chronic ankle stiffness that was mentioned above with Jarvis Landry.
Thomas practiced in a limited fashion Wednesday as he manages a calf injury that he returned from last week. His return was unremarkable, playing 56% of snaps and failing to make a catch.
It is common for tight ends to dip in their fantasy output in the first game after a calf injury, though typically, they see only a mild dip in performance. By games 2-3, after a calf injury, tight-end fantasy output is back to their baseline.