NFL Week 9 Injury Notebook
With the conclusion of Week 9's games, the 2014 NFL season will pass its halfway point. The ever-lengthening list of injured players throughout the league certainly reflects the toll of a long first two months.
Yet just as a team's injury list can grow longer with time, so can an individual athlete's.
Players like San Francisco 49ers tight end Vernon Davis already dealt with back and ankle injuries earlier this season. Elsewhere, Dallas Cowboys quarterback Tony Romo is now dealing with multiple ongoing back issues.
Some injuries, like multiple concussions, can even carry on from year to year—something former Buffalo Bills quarterback Kevin Kolb knows all too well.
Last week, Kolb penned a firsthand account of his ongoing struggles with post-concussive symptoms in retirement. The MMQB published the narrative Oct. 23:
"The ringing is like someone shooting a shotgun right next to my ear, every second of every day. It doesn’t go away.
The sensitivity to light also has a profound impact. I’ll be in a business meeting indoors and have to politely ask to put on my sunglasses before the headaches and double vision start.
But I can deal with those symptoms. The short-term memory loss is more difficult. Sometimes I don’t know if I’m just busy with a very full schedule and that’s why I can’t remember everything, or if it’s a concussion symptom.
"
Kolb's struggles serve as a sobering reminder of the potential effects of multiple concussions, and the entire NFL community certainly wishes him nothing but the best.
Elsewhere, Cleveland Browns tight end Jordan Cameron—who carries a history of multiple concussions—is currently recovering from his latest injury.
For more on Cameron and others, let's get started with this week's injury notebook.
Please note that the original form of this slideshow is current through midafternoon Friday and will receive periodic updates throughout the weekend.
Sports Medicine Topic of the Week: The Glenoid Labrum
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The shoulder labrum lies between the humerus—the upper arm bone—and the shoulder blade. Its cartilage forms a ring around the shoulder socket, and the head of the humerus sits within that ring.
By encircling the humerus, the labrum adds extra support to the shoulder. Without it, the joint could dislocate much more easily.
Like any tissue within the body, labral cartilage can tear. Pain, swelling and sometimes range-of-motion limitations can result. Even worse, the labrum generally does not heal well on its own. Often, significant tears will require surgical repair.
Labral tears come in many forms. If a shoulder remains stable after a tear, a player can attempt to rehab the injury for a few weeks and defer surgery. Doing so carries the benefit of delaying a long post-operative rehab course, one that usually extends beyond three months or more.
The significance of a labral tear varies widely by a player's position. For example, a quarterback dealing with a labrum issue may not return to his prior level—even after the best surgeons and physical therapists practice the best possible technique. On the other hand, players at positions less dependent on the shoulder may not notice much of a difference.
Prior week's topics
Week 2: The spine board
Week 3: The air splint
Week 4: The hamstring strain
Week 5: High- versus low-ankle sprains
Week 8: The meniscus and meniscus tears
Fantasy Football Injury Advice of the Week: Be Careful with RB Ankle Sprains
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Just as the shoulder anchors a quarterback's throwing motion, the ankle serves as a foundation for a running back's lateral agility.
Sprains loosen that foundation.
Not only does a sprained ankle cause pain and swelling, it makes the affected ligament less able to stabilize motion at the joint. Therefore, the plants and cuts on which a running back makes his living may suffer.
That's not to say fantasy owners should automatically sit a running back who will play through an ankle sprain, as athletic trainers can use supportive taping and other treatments to lessen its influence.
However, the presence of a sprain should make owners think a little bit harder.
For example, new or recurring sprains merit extra attention. They can lead to a setback at any time, not to mention split work with other running backs and less quickness on the field.
Prior week's advice
Week 5: Analyzing practice status trends
Week 6: Injuries and player attributes
Bye Week Recap
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Make sure players from the following teams are out of your fantasy football lineups:
- Atlanta Falcons: The Falcons are relatively healthy. Hopefully, the team can turn its attention to correcting the on-field mistakes that are continuing to plague Mike Smith's squad on a seemingly weekly basis.
- Buffalo Bills: The bye week will likely limit updates on Bills running back Fred Jackson's groin injury. His health status should become more clear next week.
- Chicago Bears: The Bears may need to recover mentally as much as physically following Week 8's dismantling at the hands of the New England Patriots.
- Detroit Lions: Lions wide receiver Calvin Johnson expects to return after the bye, according to NFL.com's Chris Wesseling.
- Green Bay Packers: There is never a good time for quarterback Aaron Rodgers to suffer an injury. However, the bye week gives him a great shot to miss no time due to the mild hamstring strain he suffered last week.
- Tennessee Titans: Wide receiver Nate Washington suffered an acromioclavicular (AC) joint sprain last week. The extra time off will do him good.
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Robert Griffin III, QB, Washington Redskins (Yellow)
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Player: Robert Griffin III, QB, Washington Redskins
Injury: Subtalar dislocation
Latest News: According to ESPN.com's John Keim, Redskins head coach Jay Gruden said RG3 will assume the starting role this week.
Alert Level: Yellow
Relevant Medicine and Anatomy: Will Carroll, Bleacher Report's lead writer for sports medicine, previously told me RG3 suffered a subtalar dislocation Week 2.
The subtalar joint lies just underneath the ankle joint and between two of the bones near the heel. It allows for eversion and inversion—or side-to-side motion of the sole of the foot.
Possible On-Field Limitations and Considerations: The subtalar joint and its ligaments play a crucial role in stabilizing the foot when a player plants and cuts. As such, RG3's injury could come into play when he scrambles. However, the injury should not affect his straight-line runs and in-pocket throws.
Fantasy Advice: Make no mistake: This was a serious injury. The former Heisman Trophy winner may need to shake off some rust, not to mention the low but real possibility of the above limitations.
Add in the fact that the Redskins take on a tough Minnesota Vikings secondary this week, and fantasy owners in one-quarterback leagues may want to look elsewhere. RG3's time as a weekly starter may come, but for now patience is the name of the game as the fantasy football season enters its dog days.
Follow-Up: Washington goes on bye Week 10. As long as RG3 does not suffer a setback this week, he will take on a weak Tampa Bay Buccaneers secondary Week 11.
Tony Romo, QB, Dallas Cowboys (Orange)
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Player: Tony Romo, QB, Dallas Cowboys
Injury: Back contusion
Latest News: Cowboys head coach Jason Garrett originally called Romo's injury a contusion. ESPN Dallas' Calvin Watkins tweeted Wednesday that a CT scan showed no structural or organ damage in the quarterback's back or abdomen. However, the team's injury report lists him as "questionable" after he did not practice all week.
UPDATE: Saturday, Nov. 1, 11:00 pm ET
According to ESPN's Todd Archer, doctors diagnosed Romo with two transverse process fractures in his back.
Transverse process fractures are stable but extremely painful fractures. Despite the fact that the diagnosis implies a broken spine, it is not impossible to play through such an injury if he can attain good pain control.
--End of update--
Alert Level: Orange
Relevant Medicine and Anatomy: Those watching Romo's injury saw the veteran take a hard hit to his back from a defender's knee. The defender then fell over him as the quarterback bent and twisted forward. Two possible issues can arise from such an injury mechanism:
- Back contusion with or without spasm and with or without a vertebral fracture: The direct impact causes bleeding within soft tissues—a bruise. The surrounding musculature then spasms to protect the area. If the impact is strong enough and in the right location, a vertebral process fracture can result.
- Disc herniation and nerve injury: Twisting and forward flexion can pinch an intervertebral disc, causing the center portion of the disc to leak out. The herniation causes inflammation that can compress a nerve root. This process led to Romo's back surgery last year.
The above two scenarios are related but separate processes. If Romo successfully avoided the latter type—it seems like he did—the first type should not impact his 2013 surgery.
Possible On-Field Limitations and Considerations: If all of the various media reports are true, Romo suffered only a direct-impact injury to his lower back—injury No. 1 above. Most of the time, such an injury comes down to pain tolerance and function, even in some types of vertebral fractures.
However, it's easier to utter the phrase "pain tolerance" than live it. The quarterback position demands seamless, coordinated motion of the lower body, core, shoulder and arm. If the throwing motion causes too much pain in and around his injury site, Romo's performance can suffer despite the fact that he can safely play through a contusion.
Fantasy Advice: If Romo plays, he becomes a very tough fantasy decision. He would face a less-than-stellar Arizona Cardinals secondary, but any significant contact to his lower back could take him out at a moment's notice.
If you have another viable option on your bench, starting him over Romo is probably the safer move, but the decision is not black and white by any means.
Follow-Up: Relative rest, massage, core exercises, anti-inflammatories and—you guessed it—time will take care of Romo's latest back issue, as will him avoiding direct hits to the area.
Hear that, Cowboys offensive line?
Montee Ball, RB, Denver Broncos (Red)
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Player: Montee Ball, RB, Denver Broncos
Injury: Groin strain
Latest News: According to ESPN.com's Jeff Legwold, Ball will not play this week.
Alert Level: Red
Relevant Medicine and Anatomy: Ball is recovering from a groin strain. Most likely, the injury involves a hip adductor, one of the muscles responsible for bringing the thigh back in toward the body's midline.
Mild groin strains may need as little as a couple days of rest, but more significant strains often necessitate a few weeks rehab or more.
Unfortunately, Ball's injury falls into the latter category.
Possible On-Field Limitations and Considerations: A groin injury is no picnic for a running back.
An adductor strain can linger and flare up at any time in the immediate post-injury period, even after a player meets all of his rehab goals. It can affect anything from his lateral agility to cutback strength and speed.
Fantasy Advice: Ball is out this week, but continue to avoid him even after he returns. Wait until he completes a game without an aggravation of the injury and at least moderate productivity. Even then, the Broncos backfield situation isn't exactly straightforward.
Follow-Up: Fortunately, Ball avoided the need for surgery. However, this injury isn't going completely away any time soon.
Thankfully, he should fully recover with enough setback-free time and rehab.
Giovani Bernard, RB, Cincinnati Bengals (Red)
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Player: Giovani Bernard, RB, Cincinnati Bengals
Injury: Hip "pointer"
Latest News: According to Bengals writer Geoff Hobson, Bernard will not play this week. NFL Network's Ian Rapoport tweeted earlier this week that the running back is dealing with a hip pointer.
Alert Level: Red
Relevant Medicine and Anatomy: The hip joint marks the location where the femur—the thigh bone—meets the lower pelvis. However, a hip "pointer" actually describes a contusion of and around the upper pelvis at the iliac crest—the bony part of the pelvis one can easily feel above the thigh.
Possible On-Field Limitations and Considerations: Like other contusions, Bernard's injury primarily comes down to pain control.
Nevertheless, running backs place tremendous demands on their lower bodies every play, and the pelvis represents the legs' communication with the core. If an injury limits that communication, speed, strength and function can falter.
Fantasy Advice: Once Bernard's swelling and pain resolve—they will—he will become a good fantasy play once more. However, the Bengals schedule is working against him.
Follow-Up: The Bengals play on Thursday night Week 10, and the additional four days will certainly help the young back. However, if he does play next Thursday, his chance of limited work is likely higher due to the short week.
Justin Forsett, RB, Baltimore Ravens (Green-Yellow)
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Player: Justin Forsett, RB, Baltimore Ravens
Injury: Ankle sprain
Latest News: The Ravens' injury report lists Forsett as "probable." After missing practice Wednesday and taking limited reps on Thursday, he practiced in full on Friday.
Alert Level: Green-Yellow
Relevant Medicine and Anatomy: As detailed earlier, the ankle anchors a running back's plants and cuts. When one or more of its ligaments overstretches or tears—a sprain—the joint not only becomes painful but also less able to do its job.
As a player works back from an ankle sprain, the injury itself will let him know where it lies on the road to recovery. The presence of recurring pain and swelling as a player ramps up his practice participation during his recovery suggests a sprain is still healing.
Possible On-Field Limitations and Considerations: Supportive taping will help Forsett this week. However, the injury is relatively new, so Ravens fans might not see the same level of quickness as in prior weeks.
Fantasy Advice: The crowded Ravens backfield always raises the concern of limited work for any given running back. However, if you are in a position where you need to start Forsett, his upward-trending practice status this week is reassuring.
Follow-Up: Make sure you follow Forsett's status closely until the team's inactive list becomes official. When it comes to running backs and ankle sprains, some level of doubt always exists.
A.J. Green, WR, Cincinnati Bengals (Orange)
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Player: A.J. Green, WR, Cincinnati Bengals
Injury: Turf toe "plus"
Latest News: According to the Bengals' injury report, Green practiced on a limited basis all week, earning a "questionable" tag. The Cincinnati Enquirer's Paul Dehner Jr. adds that head coach Marvin Lewis has the final say but "all signs are pointing toward the receiver taking the field against Jacksonville."
Alert Level: Orange
Relevant Medicine and Anatomy: This week's checkup on the elite wide receiver offers a positive swing on his status, but the injury remains the same: A nagging soft tissue injury that might pop up here and there through the end of the season.
As a reminder, the metatarsophalangeal (MTP) joint complex sits where the base of the great toe meets the foot. It is a complicated structure that includes bones, tendons, ligaments and cartilage. Some types of MTP injuries heal extremely slowly due to relatively low blood flow to the area.
Possible On-Field Limitations and Considerations: A fully functioning MTP complex allows a player to push his toe into the ground to quickly start forward, accelerate or plant and change directions. A painful MTP joint might limit the effectiveness of those movements.
As of Wednesday, however, Green "didn't seem to favor the right big toe injury that has bugged him since the season opener," according to ESPN.com's Coley Harvey.
Fantasy Advice: If the Bengals confirm Green is active, you can start him. His height makes him a prime target in the end zone, though a receiving yard total in the triple digits seems like too much to ask at this point.
Also be aware that Green's injury could send him to the sidelines at any time—a risk you'll likely have to take for the rest of the season if you carry the wideout on your roster.
Follow-Up: Continue to expect Green to remain week to week for the time being.
Reggie Wayne, WR, Indianapolis Colts (Green)
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Player: Reggie Wayne, WR, Indianapolis Colts
Injury: Elbow injury
Latest News: After sitting out last week's matchup against the Pittsburgh Steelers, Wayne returned to practice in full on Friday, according to the Colts' injury report.
Alert Level: Green
Relevant Medicine and Anatomy: Those who watched Wayne's injury saw him fall awkwardly on his extended arm. More than likely, the fall caused a "subluxation"—a partial dislocation.
Subluxations represent an injury mechanism, not a diagnosis. Recovery times depend on the extent of damage stemming from the abnormal joint separation. Wayne's one-week absence suggests his specific injury—a strain or sprain, perhaps—fell on the minor end of the severity spectrum.
Possible On-Field Limitations and Considerations: Wayne might wear an elbow brace, which could theoretically interfere with his pass-catching ability. However, if proper treatment controls the veteran's pain, he can perform at 100 percent.
Fantasy Advice: If you are in a position where you need to start Wayne against the New York Giants, his injury shouldn't dissuade you.
Follow-Up: Unless there is more to Wayne's injury than media reports suggest—and barring another awkward fall or hit to his elbow—his elbow should mostly fade into memory after this week.
Jordan Cameron, TE, Cleveland Browns (Red)
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Player: Jordan Cameron, TE, Cleveland Browns
Injury: Concussion
Latest News: According to Cleveland.com's Mary Kay Cabot, Cameron will miss this week's game due to his concussion.
Alert Level: Red
Relevant Medicine and Anatomy: Pro Football Talk's Michael David Smith notes Cameron's most recent injury represents his third concussion in two years.
Why does that matter?
In general, concussions tend to last longer and produce more significant symptoms with each successive injury. It also likely becomes easier and easier to suffer a more concussions, and the proximity of injuries also probably plays a role.
In other words, as a player's concussion tally rises, so does medical concern.
That said, there is no "magic number" of concussions past which a player needs to call it quits. Every player's injury history and recoveries are unique.
Possible On-Field Limitations and Considerations: Once Cameron returns to action, he should play at full speed. See last week's injury notebook for more information.
Fantasy Advice: Keep him on your rosters, and start him once he returns.
Follow-Up: As mentioned, Cameron's concussion history is lengthening, drawing up some concern. Hopefully, he avoids another head injury this season. Another injury this season could lead to an extended absence.
Travis Kelce, TE, Kansas City Chiefs (Green)
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Player: Travis Kelce, TE, Kansas City Chiefs
Injury: Rib injury
Latest News: The Chiefs' injury report tags Kelce as "probable" after the tight end practiced in full on both Thursday and Friday.
Alert Level: Green
Relevant Medicine and Anatomy: Rib injuries usually primarily come down to torso protection and pain control. Believe it or not, players also play through rib fractures on a semiregular basis—as long as the break doesn't threaten an internal organ, of course.
Possible On-Field Limitations and Considerations: Kelce may or may not wear extra rib protection this week, raising the theoretical possibility of decreased core range of motion. However, do not expect to see any tangible limitations.
Fantasy Advice: Start the rising star as you normally would. Do not think twice.
Follow-Up: With enough time and successful avoidance of repeat blows to the chest and back, Kelce's injury should eventually fully heal.
Jason Verrett, CB, San Diego Chargers (Red)
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Player: Jason Verrett, CB, San Diego Chargers
Injury: Labrum tear
Latest News: According to U-T San Diego's Michael Gelhken, Verrett will miss multiple weeks and eventually need surgery on his labrum tear. He is out this week.
Alert Level: Red
Relevant Medicine and Anatomy: As described earlier, the cartilaginous labrum helps stabilize the shoulder joint. When it tears, it usually does not heal well on its own.
Tears come in many shapes and forms, and surgery aims to undo the damage.
While a player can attempt to rehab a labral tear in the short term in an attempt to delay surgery, he may not always succeed. Quarterback Mark Sanchez and running back Doug Martin are two recent examples of unsuccessful trials of rehab.
Possible On-Field Limitations and Considerations: If Verrett attempts to return this season, he will be vulnerable to pain from direct blows to the shoulder. However, if he cannot regain full range of motion, he might go under the knife sooner rather than later.
Fantasy Advice: The Chargers defense has struggled recently, and Verrett's absence certainly won't help. There are better fantasy options this week.
Follow-Up: Within a few weeks, we'll likely know whether Verrett will undergo surgery during or after the season. That surgery will probably come with a recovery time approaching or exceeding three to four months.
Fantasy Football Quick Hits
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Quarterbacks
- New England Patriots quarterback Tom Brady remains on the team's injury report with an ankle issue. However, it didn't limit him in recent weeks. There is no reason to suspect it will this week, either.
- The quarterback position magnifies even the mildest of shoulder sprains. However, Kansas City Chiefs signal-caller Alex Smith practiced in full all week despite a sprain, according to the team's injury report. Expect him to play at close to 100 percent.
Running backs
- Arizona Cardinals running back Andre Ellington took his weekly spot on the team's injury report this week, though he earned a "probable" tag.
- New York Giants running back Rashad Jennings isn't coming back this week. NJ.com's Jordan Raanan writes Jennings still is "not close to being ready for game action because of a sprained MCL."
- San Diego Chargers running back Ryan Mathews remains out this week, according to the team's injury report. He is dealing with an MCL sprain.
- According to The Philadelphia Inquirer's Zach Berman, it looks like Philadelphia Eagles running back Darren Sproles will return this week. He is recovering from an MCL sprain.
- Carolina Panthers running back DeAngelo Williams returned to the field Thursday night. He suffered a high-ankle sprain earlier this season.
Wide receivers
- Baltimore Ravens wide receiver Michael Campanaro is dealing with a hamstring strain, according to The Baltimore Sun's Aaron Wilson.
Tight ends
- According to Wilson, Ravens tight end Owen Daniels is a game-time decision this week. Daniels underwent arthroscopic knee surgery last week. Recovery times following knee scopes depend on the amount of work a surgeon does within the knee, and an absence of less than two weeks would certainly represent one of the speedier returns in recent memory.
Dr. Dave Siebert is a second-year resident physician at the University of Washington and a member of the Professional Football Writers of America. He plans to pursue fellowship training in Primary Care (nonoperative) Sports Medicine.
Stats were obtained from NFL.com official statistics.
Questions about players on this list? Not on this list? Send 'em to Dave on Twitter.
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