NFL's 1st Week of Training Camp Is the Most Dangerous

Will Carroll@injuryexpertSports Injuries Lead WriterJuly 29, 2013

GLENDALE, AZ - DECEMBER 23:  Cornerback Patrick Peterson #21 of the Arizona Cardinals is looked at by teammates and coaches after an injury during the NFL game against the Chicago Bears at the University of Phoenix Stadium on December 23, 2012 in Glendale, Arizona.  The Bears defeated the Cardinals 28-13.  (Photo by Christian Petersen/Getty Images)
Christian Petersen/Getty Images

If it seems like the first week of training camp brings more than its share of injuries, that's because it does.

We've already seen players like Dennis Pitta, Jeremy Maclin, Dan Koppen and Percy Harvin hit with major injuries, while others find themselves recovering from what could have been worse.

What is the cause of this front-loaded bad luck? No one is really sure, but I asked several experts around the world of sports medicine for their take on this and it's clear that there's no agreement. 

Bill Barnwell, who compiled the best research on games lost while at Football Outsiders and now writes for Grantland, thinks that the linear nature of injuries during the regular season points to one simple cause.

"Camp rosters are bigger," he said via email.

This issue is true and definitely a contributing factor. While we notice the big names more, that's a simple perception issue. The statistical increase is not only one of larger numbers, but of better players.

One NFL team physician, who could not be identified due to NFL rules on speaking with the media, agreed with this point. "There's a minimum level of NFL talent to make even a camp roster, but we cannot tell who will be able to hold up until they do. Add in some level of traumatic or 'bad luck' injuries and it gets very noisy in the data."

Some of the top names in physical therapy agree.

Kevin Wilk of Champions Sports Medicine worked with Adrian Peterson last year and is the therapist of choice for many athletes, especially those that had surgery with Dr. James Andrews in their shared Birmingham location.

Wilk believes that the issue is not only increased roster size, but the way football practices.

"Guys show up in good shape, but is it football shape? There's a difference between being well conditioned and being ready for the functional demands of the sport. I'm also concerned with how quickly football starts. They go for long periods of time and high intensity very quickly," Wilk explained.

Mike Reinold, another top physical therapist and former athletic trainer for the Boston Red Sox, concurred.

"There could also be a natural selection process," he said. "The game is so fast, so powerful, etc, that you have to be in perfect shape to play. 'Shape' doesn't just mean conditioning, but other extrinsic and intrinsic factors.

"Maybe they are just worn down from their career, maybe their cartilage is slowly deteriorating. Maybe their strength, endurance, and neuromuscular control are decreasing with age. These players have less threshold of getting hurt and since fragility of NFL is so extreme, these players are weeded out early."

Before you think that the consensus is that this is bad luck or part of the game, note that none have said that there isn't more that could be done to prevent these injuries. Dr. David Geier is even more explicit about this.

"I think some of the injuries, especially the noncontact knee injuries, are potentially preventable. While ACL injury prevention exercise programs might not prevent every ACL tear, those landing and cutting exercises might decrease a few of them," Geier said. 

Some of Barnwell's research, including his groundbreaking work on adjusted games lost (AGL), is more complex than we can go into here. However, there are important points that bear further looks if you want to dig deeper into the issue. 

Before we get out of the preseason and into the real games, we are likely to see a majority of the injuries that we'll have all year. Clear statistics are not publicly available, though some of the research that the NFL did to justify pursuing an 18-game season did give us an idea of how front-loaded these are.

Even with reduced contact and new rules for rest, the injury rates held relatively steady last season. 

Part of the issue is what is called the "roach motel" effect of the injured reserve list. Aside from the designated to return rule that started last season and is limited to one player per team, the IR works the same way as a roach motel—players go in, but they don't come out.

When it comes to sheer numbers, it's almost always linear, but to some extent, players that go on the DL vanish. Out of sight really is out of mind. 

It's clear that there is no simple answer for this issue, but equally clear that the NFL is doing very little in the way of trying different things in order to reduce injuries.

With the innovations in football like read-option offenses, it's clear that change can happen, but a football practice and training camp are run much the same way that George Halas and Paul Brown did it.

While moving off-site from world-class facilities that include top-notch modern medical amenities has been questioned and even abandoned by a few teams, it's clear that there is plenty of room for more innovation. 

Peter King summed up the general attitude well in his MMQB column on SI.com.

Why are teams so willing to risk injuries to vital players by practicing full-speed so often during the summer? I say: It’s the game. Would you want Miguel Cabrera opening the regular season in baseball having faced nothing but soft-toss in spring training?

In fact, the NFL has done very little to prevent or even quantify these injuries. There is no required injury reporting in the offseason and even simple tracking takes on a top-secret air.

While the Philadelphia Eagles are getting noted for their sports science focus under Chip Kelly's new administration and there are two other teams—the Buffalo Bills and New York Giants—who have similar programs, it is hardly league-wide. 

Until the NFL makes a concerted effort to change its culture, focusing on prevention, research and reducing the opportunities for injury, there's little chance that injury prevention and management will take great strides forward.

In that case, fans should get used to losing a few more players before they even get close to Week 1. 

Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Football Outsiders. All quotes obtained firsthand unless otherwise noted.

Before we get out of the preseason and into the real games, we will likely see better than half of the injuries that we'll see all year. Clear statistics are not publicly available, though some of the research that the NFL did to justify pursuing an 18-game season did give us an idea of how front-loaded these are, beyond the anecdotal. Even with reduced contact and new rules for rest, the injury rates held relatively steady last season.