B&B 9/2/20

Injuries Down and The Damage Done

With a week to go, more or less, before the NFL season gets under way, more or less, the new-look training camps haven’t changed much in the last week. We’ll see something of a shift as teams make cuts, lock up a practice squad, and start moving into game mode, but by how much? The lack of preseason games mean no one has any idea what things will look like. We’ve all seen enough empty stadiums at this stage that it shouldn’t be a shock and the way football is shot for TV, it will be more or less irrelevant.

The injuries are, for the most part, down. There’s simply less contact, which means fewer major injuries and concussions, but to be fair …

… there’s also less non-contact injuries. The simplest way to look at this is with ACLs. There are currently 9 and we normally see around 35 in a season, with the majority of those coming before Week 2. Either we’re going to see a change in the timing, or we’re going to see a reduction in injuries so significant that teams will have to consider doing this every year.

That’s not to say there aren’t injuries or that there’s any real reduction in risk. Reduce risky behaviors and you should see less adverse incidents, which is what we see here. If you believe in luck and luck balancing, or load and load balancing, Weeks 1 and 2 of the season are going to be ugly.

However, there is one other less apparent pattern I’ve noticed and I think you will too. Read through today’s injuries and bumps, and I’ll meet you at the bottom.

Before that, you’ll notice this is another free Black & Blue Report. I decided to do one more, so please forward this to friends who might be interested. You know, the ones not in your fantasy league. Another couple hundred subscriptions and I’ll quit nagging you to help me gain subscribers.

So let’s get to the injuries:

Derwin James DB LAC (torn meniscus - repair)

Derwin James will miss the season with a meniscus tear. The reason is the surgery and yes, this is an injury that can have a two week return. Why is James’ being quoted as six to eight months? Rather than having the torn meniscus trimmed or removed, he’s having his repaired. This has a much better long term outcome, if it works, but takes longer to heal.

Think of this like shock absorbers on your car. The meniscus acts as shock absorber inside your knee, as well as contributing to a weight-bearing stability as well. Yes, you can just take a broken shock absorber off the car, but the ride gets bumpy. Inside the knee, less stability and more grinding of bone on bone. By repairing it, James is hoping to avoid all that and have a longer career (and a healthier knee.)

Meniscus repair is relatively new. It’s been tried a long time and it still doesn’t have a great success rate, with studies going from just under 50 percent to up around 70 percent. When it works, it’s great, and when it doesn’t, it’s a simple procedure to just remove it, which was the original option. Lots of upside, no real downside aside from the lost time.

James is clearly putting his long term future ahead of any team concerns and in 2020, it’s hard to argue this isn’t the year to miss. I do worry if James ends up not having the repair hold willl come off looking worse or if front offices will look a bit askance at what they’ll call a “me-first attitude” rather than an informed medical option.

Tyrell Williams WR LAC (damaged shoulder labrum)

A week ago, Tyrell Williams was going to try and play through his labrum tear. Now, he’s headed for surgery. For those of you asking why, I’d read that first sentence again. Williams realized that either he's not functional enough to play WR or that the pain was too much for him to deal with. I was dubious about the chances of him playing through this, but I am a bit surprised it turned so quickly.

That’s not to say Williams isn’t right. With pain, it’s impossible for any of us to judge what a player can or even should take on. With function, that’s easier to see. The Chargers have Mike Williams out as well with a shoulder (see below), leaving them with Keenan Allen and a bunch of other guys. This could end up being good in the long term - someone might step up and some of the guys working with Justin Herbert might have more familiarity once he takes over.

Again, the calendar makes this injury look worse than it is. Four to six months doesn’t give time for Williams to have any realistic chance at coming back, but he could be back as soon as January. There’s just no games until next season, which means that Williams should have plenty of time to heal up even if there’s setbacks and there’s no reason to rush any steps. It’s a relatively easy rehab and players tend to come back well from this in function.

Alvin Kamara RB NO (inflamed lower back)

Skipping past the contract stuff, the news that caught some off guard when Alvin Kamara skipped practice was that he had an “epidural.” My response to this was “yep, common.” The term epidural conjures up the shot women often get before childbirth, to stop all the pain. It’s not the same and with Kamara, it was actually an injection into his SI joint, which is in the pelvis/spinal junction. That’s not good, but neither is it unusual or childbirth-level pain.

Kamara’s already back and moving, so we have to think the shot is providing him some relief. As a smaller runner on a hard surface, this kind of lower back/leg pain is common and yes, this is a sadly common treatment for it. Even outside of sports, doctors will often suggest a similar type of injection for lower back pain. The worry here is that this offers relief, but nothing in the way of cure. It can help the body get time to heal itself, but that usually involved anti-inflammatories and extensive therapy, with surgery a possibility at the end.

That increases Kamara’s risk. He now has a known lower back issue, one that they won’t have time to work on much in season. Latavius Murray didn’t do a convincing imitation of Mark Ingram and Kamara is not as hard to hit as Christian McCaffrey. Kamara’s in a tough situation and either about to get a big new contract or be on the road to the open market, where he either needs to sit and heal or put up big numbers. I hate uncertainty and this situation is just full of it.

Lamar Miller RB NE (post-ACL reconstruction)

The musical chairs for running backs this off-season put the oft-injured Lamar Miller in New England, where he’s competing with Sony Michel for the “big back” role, alongside James White and Rex Burkhead’s returning runners. That’s been the most fungible of them in the Patriot offense, but changes at quarterback might force changes elsewhere. The question then is would increased load help or hurt Miller, who couldn’t stay healthy in Houston.

New England has taken backs that have a singular skill set and made use of them, either by isolating them into a role or keeping them healthier somehow. That’s been one of the lesser noticed pluses of the Pats “system”, which is more a consistently solid medical staff than anything else, operating outside of the Bradysphere.

Miller has looked good coming off his ACL reconstruction, though he has yet to demonstrate them in a game for obvious reasons. What we have been able to see from him are all the physical skills that you want at this stage. He’s showing burst from stop, the ability to cut and accelerate off those cuts, and the ability to change direction at speed. The downside is that Sony Michel, coming off foot surgery, is doing the same. The Pats will have options at running back, which makes it a very uncertain set in Week 1 aside from the injury concerns.

Kenyan Drake RB ARZ (sprained foot)

As far as I know, there’s no fashion markets for walking boots. If a player is in one, it’s for a reason, not because it’s the latest from Jordan or Adidas. Kenyan Drake and the Cardinals tried to play off that Drake was seen in a walking boot for nearly a week, only coming back to the field in full this week. There’s still no word other than “routine wear and tear” but that’s not enough for me.

Drake was seen late last week at practice without the boot, with reports saying he was “jogging” and another saying he was doing high knee drills. Everything seems to be straight line but not necessarily low impact, which rules out stress fractures and reactions. Instead, I think this was a mid-foot sprain that they decided to take some stress off with the boot. It meets all the criteria, though my best team source couldn’t confirm this. This is also what Drake dealt with twice before - once last year in an unexplained sighting with another boot, and also in college.

With just a week before their first game, we’ll have to watch to make sure that the boot stays off and that Drake is able to cut, which is the major worry. Chase Edmonds is the available backup and really only had that one big game against the Giants last season on his resume, but this is going to be a pass-first team. That could mean that we’ll see a lot more Kyler Murray focus in Week 1.

Carson Wentz QB PHI (strained groin)

“Soft tissue” and “lower body injury” … yeah, it sounds different in Philly and not just because the team is wracked with injuries, which is unusual. The team is using very non-descriptive and vague terms, for no apparent reason. Soft tissue is a phrase that has infected the entire NFL and if a team is using that term - which encompasses pretty much everything that’s not bone - then they might as well just say nothing and not insult their fans.

With Wentz, it’s a simple groin strain, just enough for him to miss a little time to heal it up ahead of the start of the season, but not a major concern for him or for the team. Why they felt a need to couch this in language like that is beyond me. Wentz’s bigger worry is that he’s lost half of his line, his top two receivers, and outside of a dinged up Miles Sanders, has no depth again at running back to take some of the load off him.

There’s no reason to expect that Wentz won’t be at or near 100 percent in Week 1, but the simple run of injuries that the Eagles are on right now is worrisome. Wentz needs weapons and he needs to not get hit as much, unless the team wants to see him take these kind of small injuries that build up and often create bigger problems later in the season.

Bumps and Bruises:

Yes, the Eagles have gone full NHL, calling Jalen Reagor’s injury an “upper body injury.” It’s a sprained shoulder, which is on the upper body and he’s very questionable for Week 1 … AJ Green did practice one day - Wednesday - but won’t take part in the Sunday scrimmage as he comes back from ankle surgery and a strained hamstring from a couple weeks back … Mike Williams will miss up to a month with a Grade II AC sprain. It could be as little as two weeks, but most of this will come down to the stability of the shoulder and its ability to hold up to the inevitable hits and falls of a WR … Breshad Perriman is dealing with severe swelling in his knee. Imaging didn’t show anything structural and this would be rapid onset of something degenerative. The Jets feel like they have a handle on this, but expect Perriman to miss practices and potentially games if this situation gets worse. Think Todd Gurley (who I’m told is the healthiest he’s been in years right now) … Patrick Onwuasor has a sprained knee and will avoid surgery, but will still miss six weeks. The Jets expected him to take over for CJ Mosley, who opted out … Deebo Samuel is expected back at practice next week for the Niners. Whether he can be fully back from his foot injury by Week 1 is very uncertain … Nick Bosa missed practice with a hip flexor strain that caused a lot of discoloration on his leg. The team doesn’t think it’s serious and expects him reading for the first game.

Did you notice the pattern? Yeah, there seems to be a team bias. The Jets, Eagles, and Chargers are well represented here and in a normal distribution, it should be pretty broad. My column isn’t all-inclusive, so there’s some amount of selection bias in may, I’m sure. It’s not a huge concentration, but enough that there may be some bias in either the players they have or some other factor. Neither team is horrible in terms of long term results, while the teams that do have horrible longer term records aren’t showing big changes. Could be random here, but worth noting. Also, team movement - for instance, Lamar Miller, who had the injury with the Texans, but is now with the Pats - makes it tougher to notice these kinds of patterns.