Dr.Dan’s NFL Injury Updates Week 2

Well, I didn’t expect that when I volunteered to write this article that we’d be starting one of the most injury-plagued NFL seasons in recent history. Seriously, between indictments and injuries there’s almost no one left.

While all these injuries are devastating fantasy teams, at least it makes the waiver wire and trading blocks a bit more interesting (maybe? I’m trying to look on the bright side here). Seriously, an injury or two isn’t the worst that could happen, you could be one of these guys:

Might as we give up now

Might as we give up now

If you learned anything from week 2, it’s to keep an eye on the injury reports right up until game time (Thanks for that one Brandon Marshall), and that when everyone told you not to draft a NY Giant, they were right.

Okay, before we get started, this many injuries is going to need some organization. First, we’ll cover the injury of the week. I’m only covering one this week because med school needs some of my attention too (I guess). Whatever injury I discuss is going to apply to a dozen players anyway, so take it or leave it. Following that we’ll recap all the injuries that have occurred, split up by position. Within each position, I’ll mostly mention only new ones, but if there is an injury from a previous week that’s worth an update, it’ll be there.

Ankle Injuries

The ankle seemed to be a favorite injury this week, benching players including RGIII, Allen Hurns, Jamaal Charles, Lamar Miller, Vernon Davis, and Mercedes Lewis. The fact that each of these players injured their ankle in a slightly different way speaks to the complexity of the ankle joint, so let’s just dive right in.

The ankle joint consists of three bones, the tibia and fibula of your leg, and the talus (ankle bone) of your foot. It’s a synovial joint, meaning it is filled with a lubricating fluid, allowing for smooth joint movement, and is surrounded by a fibrous capsule to keep the fluid in place. The joint acts as a hinge, mostly allowing for up (flexion) and down (extension) motion of the joint. Notice the limited range of motion if you try to invert your foot towards your other foot or evert it away from your body. The limited range of motion in eversion/inversion is important – it stabilizes the joint and our upper body in activities like walking, running, or, well, playing football. This stability is achieved by various groups of ligaments surrounding your ankle, which will be the focus of our discussion today.

Screen Shot 2014-09-16 at 12.14.16 PMAll of the player’s injuries mentioned above are ankle sprains, minus RGIII’s freak ankle dislocation (that’s not normal). A sprain is defined as damage to a ligament, usually caused by direct trauma or stretching of the ligament beyond its normal range of motion. There are two main groups of ligaments in the lower ankle, the lateral ligament and the medial ligament. Each of these is actually made up of many smaller ligaments going in slightly different directions, but we could be here a while if we go through all those. Damage to the lateral ligament is an inversion sprain, which accounts for 85% of ankle sprains, and damage to the medial ligament is an eversion sprain. See the picture below to help you figure out which is which. There is a third type of sprain, a high ankle sprain, which damages the ligaments of the lower ankle in addition to the interosseus (between bone) ligament between your tibia and fibula. This is common in football players due to quick side-to-side movements and sudden twisting, both of which result in excess rotation of the joint.

Screen-Shot-2014-09-14-at-1.44.50-PMSo, if an ankle is inverted too much, you end up stretching your lateral ligament beyond its functional capability. This will tear one or many of the smaller ligaments that make up the entire lateral ligament, resulting in a sprain. Same goes with too much eversion of your ankle with a medial ligament sprain. The severity of the sprain depends on how bad the tear is and how many of the smaller ligaments you’ve torn. Tack on a twisting motion and a tearing of the interosseus ligament and you’ve got a high ankle sprain.Screen Shot 2014-09-16 at 12.14.22 PMSo what causes all the swelling and pain (not to mention the nasty bruise you sometimes get with a sprain)? When the ligaments tear, blood vessels also tear, leaking blood and fluid into the surrounding area. Your immune system senses the injury as well, and sends its white blood cells to the area, resulting in inflammation and increased blood flow. All this excess fluid causes swelling, which stretches out the nerves in the area and causes the throbbing pain you feel with a sprained ankle. Anytime you use the injured ankle, you stretch these nerves even more, which is why it hurts when you walk on the ankle.

Treatment is mostly rest and rehab. Initially, the RICE method is recommended (Rest, apply ice, compress, elevate). The purpose of this is to decrease pain and accumulation of fluid in the ankle. Treatment for the first week is mostly protective, as you don’t want to injure the ankle further (contrast this to what most players want, which is to play on the injured ankle). In the weeks after, it is important to avoid aggravating the injury and to begin strengthening the ankle. Ankle exercises (such as ankle circles) lead to a faster recovery and a decreased chance of reinjury, as do balance exercises (wobble board). See the link for further explanation.

https://www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST%20Ankle%20Sprains%2008.pdf

Recovery lasts from a week or two for mild sprains, but can extend to up to 8 weeks or more for severe sprains or high ankle sprains. It varies from individual to individual, so be sure to keep an eye on any players you have with a sprained ankle. If they miss a week or two, it may be better than having them play through it and causing more damage, so don’t be too disappointed.

 

Notable Injuries

Quarterbacks

  • RGIII – Washington Redskins
  • Dislocated ankle: no bone fractures, but the ankle is dislocated. He’ll be out indefinitely until we see how the ankle heals, but the team is optimistically hoping for a 4-5 week recovery.
  • Backup: Kirk Cousins
  • Carson Palmer – Arizona Cardinals
  • Right shoulder: Palmer landed on one of the nerves in his shoulder, and apparently it’s decided to stop firing for a bit. Nerves are unpredictable and it is likely he’ll be a game-time decision this week.
  • Backup: Drew Stanton

 

  • Old
  • Shaun Hill – St.Louis Rams
  • Thigh Injury: Sounds like Shaun Hill will be back this week. But it’s the Rams, who cares?

Wide Receivers

  • AJ Green – Cincinatti Bengals
  • Toe/foot ligament strain: Green had a negative MRI and may be able to play this week, but it’s much more likely the team will let him rest and we’ll see him after the Bengals week 4 bye.
  • Backup: Mohamed Sanu / Brandon Tate
  • Eric Decker – NY Jets
  • Hamstring: Decker’s hamstring bothered him during preseason, and it appears he’s reinjured it. Not good news for the Jets No.1 receiver.
  • Backup: no one worth writing about
  • Roddy White – Atlanta Falcons
  • Hamstring: The Falcons have a short week with a Thursday night game, so keep a close eye on White’s status. He didn’t practice on Monday or Tuesday.
  • Backup: Harry Douglas / Devon Hester
  • Allen Hurns – Jacksonville Jaguars
  • Sprained left ankle: Hurns is day-to-day. It doesn’t look like it’s too bad of a sprain but it could slow him down in week 3.
  • Backup: Hurns was Cecil Shorts’ backup, if you’re picking up the backup of a backup you’re in trouble.
  • Desean Jackson – Washington Redskins
  • Shoulder (AC joint, the ‘connection’ between your shoulder blade and your clavicle): Jackson is day-to-day, but has stated he wants to line up against his former team, the Eagles, in week 3. Keep an eye out for news, but I would expect him to play week 3.
  • Tavon Austin – St.Louis Rams
  • Knee sprain (MCL): After an MRI Monday, it looks like Austin has a mild injury to his MCL. Reports have him possible playing this week or missing a week or two. Certainly not a fantasy start (that didn’t have much to do with the injury though…)
  • Backup: Brian Quick (may actually be worth a look)
  • Mike Evans – Tampa Bay Buccaneers
  • Chest/rib injury: not much info out on this one yet. Looks like everyone cares more about the fact that the timing of the injury lead to a Tampa loss as the game clock ran down, rather than the fact that he may have actually gotten hurt.

Running Backs

  • Jamaal Charles – Kansas City Chiefs
  • High ankle sprain – Probably out 4-6 weeks. This was a big blow to fantasy owners.
  • Backup: Knile Davis
  • Mark Ingram – New Orleans Saints
  • Broken hand: What’s being reported as a hand injury by most sources appears to be a broken hand. Looks like he’ll be out at least 4 weeks.
  • Backup: Not so much a backup, but Pierre Thomas will likely get more looks.
  • Ryan Mathews – San Diego Chargers
  • Sprained MCL: Mathews got an MRI Monday and it looks like he’ll be missing 4-5 weeks, but hopes to be back sooner (don’t they all?)
  • Backup: Donald Brown / Danny Woodhead
  • Knowshon Moreno – Miami Dolphins
  • Dislocated Elbow: I’m pretty sure I called this injury “uncommon” last week, but here it is again. Moreno’s doesn’t appear to be as bad as Eifart’s was, but he will still likely miss 4-8 weeks depending on the results of Monday’s MRI.
  • Backup: see below / Damien Williams
  • Lamar Miller – Miami Dolphins
  • Right ankle: Miller apparently left in a boot, but it looks like he’ll be just fine. He’ll be getting a lot more looks with Moreno out.
  • Doug Martin – Tampa Bay Buccaneers
  • Knee injury: Martin should be good to go in week 3. His backup Bobby Rainey put up impressive stats in week 2, so Martin has to prove that he’s healthy and productive this week against the Falcons.
  • Maurice Jones-Drew – Oakland Raiders
  • Hand Injury: MJD had minor surgery on a hand injury last week, and did not play in week 2. His status is questionable for week 3, but I wouldn’t be starting an Oakland Raider unless I really had to.
  • Backup: Darren McFadden
  • Deangelo Williams – Carolina Panthers
  • Thigh Injury: Sounds like Williams will be back for week 3 against the Steelers after sitting out on Sunday.

 

  • Old
  • Ben Tate – Cleveland Browns
  • Knee: Still injured. Always injured.
  • Andre Ellington – Arizona Cardinals
  • Foot: While still sore, Ellington put up 100 yards against the Giants in week 2. Take that as you will, but it is slightly concerning that the Cardinals are running him so hard while he’s nursing an injury this early in the season. Looks like he’ll be starting.
  • Toby Gearhart – Jacksonville Jaguars
  • Sprained ankle: Gerhart is making progress with his ankle, but not so much on the ground. With 8 yards in 7 attempts in week 2, he may as well be on the bench.

Tight Ends

  • Jordan Reed – Washington Redskins
  • Hamstring: Coach Gruden said that Reed would have to play in at least one practice this week to be considered to start Sunday. That’s looking unlikely, so expect Reed to be on your bench at least one more week.
  • Backup: Nile Paul
  • Mercedes Lewis – Jacksonville Jaguars
  • High left ankle sprain: The Jaguars are used to playing without Lewis, who missed a large chunk of last season. It looks like this sprain will keep him out 6-8 weeks.
  • Backup: Clay Harbor / Mickey Schuler
  • Vernon Davis – San Francisco 49ers
  • High ankle sprain (maybe): Davis was spotted on crutches afterwards, and will likely get an MRI today. If reports of the ankle sprain are true he good be out for a while.
  • Backup: Vance McDonald / Derek Carrier
  • Jordan Cameron – Cleveland Browns
  • Shoulder (AC joint): Cameron’s shoulder injury kept him out of Sunday’s game, but his status for week 3 is currently unknown. Don’t drop your Cameron replacement just yet.

 

Let’s hope for a healthier week 3, for all our sakes.

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