NFL Week 5 Injury Notebook

After a rough start to the season, Week 4 seemingly gave the NFL a relative break on the injury front. Elsewhere, bye weeks are continuing to offer hurting players an extra week of rest and recovery.

Nevertheless, while the injury train slowed last Sunday, it did not stop.

Minnesota Vikings quarterback Teddy Bridgewater left his first professional start on a cart, while Detroit Lions wide receiver Calvin Johnson played decoy against the New York Jets—much to the horror of fantasy owners everywhere.

Will Megatron repeat last week, or will he return to form? What about Carson Palmer's nerve problem? Is Brandon Marshall ready to go?

Let's take a look in this week's injury notebook.

Sports Medicine Topic of the Week: High Versus Low-Ankle Sprains

Lefteris Pitarakis/Associated Press

Each week, we will look at a different Sports Medicine topic that may come into play during an NFL game. This week's topic: What's the difference between a high and low-ankle sprain?

High-ankle sprains continue to pop up every week. Oakland Raiders quarterback Derek Carr joined the growing list last week, as did Carolina Panthers running back DeAngelo Williams.

A high-ankle sprain differs from the more common low variety in several ways, starting with how they occur. Low-ankle sprains often arise as a result of a "rolled" ankle, while high-ankle sprains frequently involve forced outward turning of the toes with respect to the leg.

The underlying anatomy differs as well. Low-ankle injuries damage the ligaments that connect the lower leg to the outside of the foot, while high-ankles stretch or tear those that attach the bones of the lower leg—the tibia and fibula—to each other. A severe high-ankle sprain can even cause separation of the tibia and fibula and require surgery to fix the bones in place while the ligaments heal.

Finally, while high-ankle sprains generally require longer recovery times, every injury is unique. Though six-week high-ankle recoveries are somewhat common, others may require only week-to-week re-evaluation.

Prior weeks' topics

Week 2: The spine board

Week 3: The air splint

Week 4: The hamstring strain

Fantasy Football Injury Advice of the Week: Analyzing Practice Status Trends

Jim Mone/Associated Press

Did not participate. Limited. Full. How should you interpret these somewhat nebulous practice status designations in the context of a given player's injury?

Practice status designations—"did not participate," "limited" or "full"—are generally self-explanatory on a surface level. However, fantasy owners can read between the lines to gather more data.

For example, I routinely recommend against starting wide receivers who are battling hamstring injuries. However, last week, I suggested Atlanta Falcons wide receiver Roddy White—who had a recent hamstring injury—was a safer start than most.

Why?

Simple: His practice status trended up all week. The trend suggests his coaches and medical staff were comfortable increasing his workload despite his injury. He then rewarded faithful fantasy owners with a touchdown and 73 receiving yards.

On the other hand, a wide receiver participating in limited practice on Friday after missing both Wednesday and Thursday raises a very large red flag. A downtrending practice status should also make you shy away from a given player.

Somewhat similar logic applies to ankle injuries. A player who is recovering from an ankle sprain and takes full practice reps for multiple days in a row is usually doing quite well. Such a scenario implies the previous day's work did not reproduce symptoms significant enough to limit him the next day, thereby suggesting he can withstand an entire game's worth of snaps.

Prior weeks' advice

Week 4: Beware WRs with hamstring strains

Bye Week Recap

Richard Heathcote/Getty Images

Make sure players from the following teams are out of your fantasy football lineups:

1. Miami Dolphins: Unfortunately, the week off won't help running back Knowshon Moreno. He recently told The Palm Beach Post's Andrew Abramson that he still has "four more weeks" until he can take the field. Moreno dislocated his elbow during the NFL's injury-ravaged Week 2.
2. Oakland Raiders: Quarterback Derek Carr hopes to return after the bye, according to The San Francisco Chronicle's Vic Tafur. While not out of the question, such a timeframe probably represents the best-case scenario following his MCL and high-ankle sprains.

Teddy Bridgewater, QB, Minnesota Vikings (Yellow)

Jim Mone/Associated Press

Player: Teddy Bridgewater, QB, Minnesota Vikings

Injury: Ankle sprain

Latest News: ESPN's Ben Goessling noted Bridgewater missed Thursday night's game against the Green Bay Packers due to his left ankle sprain. He suffered his injury Week 4.

Alert Level: Yellow, if active, Week 6

Relevant Medicine and Anatomy: Those who watched the play during which Bridgewater's ankle sprain occurred saw another player's body force the rookie's left foot to turn sharply outward. As mentioned earlier in this slideshow, forced outward turning of the foot represents a classic high-ankle sprain injury mechanism. However, Will Carroll, Bleacher Report's Lead Writer for Sports Medicine, told me Bridgewater's injury is, in fact, not of the high-ankle variety.

Earlier this week, Bridgewater's reassuring MRI led to hope that he could go under center on Thursday. However, his "clean" MRI probably implied no significant damage instead of no damage at all.

Nevertheless, Goessling tweeted Thursday that head coach Mike Zimmer expects the rookie quarterback to be ready for Week 6. Carroll added that Thursday's rain played a role in the decision to sit the rookie for a week.

Possible On-Field Limitations and Considerations: When Bridgewater returns, watch closely when he runs. Fans can gauge his ankle's health by how strongly he can push off his planted left foot. Athletic trainers will likely add supportive taping to his footwear.

Fantasy Advice: The former Louisville Cardinal will likely be able to throw like his old self despite the injury. However, he may not be able to run outside of the pocket quite as effectively. Furthermore, next week, the Vikings face a Detroit Lions defensive unit that held the Packers to six points, a significant upgrade from the Atlanta Falcons' squad.

Follow-Up: Bridgewater's injury is one that will heal well with enough rest and treatment. The question: How long can the Vikings wait?

Carson Palmer, QB, Arizona Cardinals (Red)

Ross D. Franklin/Associated Press

Player: Carson Palmer, QB, Arizona Cardinals

Injury: Axillary nerve contusion

Latest News: According to Cardinals writer Darren Urban, Palmer's status remains about the same after yet another specialist visit:

"

...at some point, his nerve will 'wake up' but it’s impossible to know exactly when.

Palmer said he was told yet again there is no structural damage to his right shoulder, surgery is not needed and the problem is not career-ending or even season-ending.

[...] 

He has met with a nerve specialist, a neck specialist and a spine specialist since getting hurt. Palmer added the doctor he met with Wednesday told him it was a 'one in 100,000 chance' that he would hit the nerve where he did to cause his problem.

"

Earlier this week, Fox Sports' Mike Jurecki provided more detail about the former Heisman Trophy winner's diagnosis:

"

Cardinals QB Carson Palmer visited Los Angeles-based orthopedic surgeon Dr. Robert Watkins for additional information regarding the nerve issue in his shoulder. He's suffering from 'axillary nerve contusion' a numbness over part of the outer shoulder, shoulder weakness, especially when lifting the arm up and away from the body.

"

The Cardinals Twitter account already announced that quarterback Drew Stanton will take the reins of the offense once again this week.

Alert Level: Red (for now)

Relevant Medicine and Anatomy: Quite a bit of clarity surfaced this week regarding Palmer's status, including the location of the problem.

As Jurecki mentions, Palmer's injury involves his axillary nerve. The axillary nerve controls the deltoid muscle—the big, bulky muscle overlying the top-outer portion of the shoulder—as well as one of the muscles of the rotator cuff. It also provides sensation to a portion of the upper arm.

It seems the hit that originally caused Palmer's injury direct impacted the nerve, its surrounding tissue or both. The resulting swelling also possibly compressed—or is compressing—the nerve, limiting its function.

Nerve conduction studies can sometimes pinpoint exactly which nerve is malfunctioning, as can an expert neurologist's physical exam. The exact limitations that a player exhibits—in Palmer's case, likely a weakness or inability to raise his arm out to the side—can also point to the precise location of a neurological lesion.

Possible On-Field Limitations and Considerations: As mentioned in a previous injury notebook, muscle strength means nothing if a nerve signal cannot reach the muscle tissue. Additionally, the chance of atrophy—muscle weakening due to inactivity—rises the longer a nerve sits inactive, hence Palmer's need for intensive rehab.

Once the Cardinals signal-caller's nerve wakes up, he must continue to work on regaining any strength his deltoid and rotator cuff lost as a result of inactivity. Fans may want to pay attention to the accuracy and depth of his throws—especially deep passes.

Fantasy Advice: Palmer's recovery is very difficult to project. Fantasy owners still carrying the veteran might want to look elsewhere for more consistency.

Follow-Up: I cannot pretend to be a neurologist or spine specialist—though Palmer's spine doctor, Dr. Robert Watkins, is one of the best in the world—but all reports suggest the quarterback's team of physicians expect his nerve to recover.

Eventually.

Arian Foster, RB, Houston Texans (Yellow-Orange)

Scott Halleran/Getty Images

Player: Arian Foster, RB, Houston Texans

Injury: Hamstring strain

Latest News: After Week 4, Foster told the Houston Chronicle's Brian T. Smith that he "didn't feel 100 percent (himself)" during the game. According to Texans reporter Deepi Sidhu, the running back earned a "probable" tag this week, though he practiced only on a limited basis Thursday and Friday.

Alert Level: Last week: Orange. This week: Not quite orange but not yet yellow.

Relevant Medicine and Anatomy: The wave of hamstring injuries throughout the NFL continues—when does it not?—and Foster remains one of its victims. Hopefully, the Texans limited his practice work primarily to avoid re-injury.

To review Foster's struggle, take a look at last week's video and sports medicine topic of the week.

Possible On-Field Limitations and Considerations: Assuming he did not suffer a setback during the week, Foster will probably play better this Sunday. However, a sore hamstring can limit his top-end speed and agility, and a re-injury risk also remains.

Fantasy Advice: I warned you against starting Foster last week. My warning is not as loud this week, but it's still there.

Follow-Up: Barring re-injury, Foster's healing process for his hamstring will eventually catch up to the demands he places on his lower body. Nevertheless, until he practices in full for an entire week, this injury can still rear its ugly head in one way or another.

Ben Tate, RB, Cleveland Browns (Yellow)

Jeff Haynes/Associated Press

Player: Ben Tate, RB, Cleveland Browns

Injury: Knee sprain

Latest News: The Plain Dealer's Mary Kay Cabot tweeted Friday that Tate is probable to play this week. However, Tate called himself "questionable."

Alert Level: Yellow, if active

Relevant Medicine and Anatomy: Other than implying some degree of ligament damage, the diagnosis "knee sprain" does not provide much information. However, a review of the knee's four main ligaments can shed some light on Tate's injury.

For instance, the LCL runs along the outside of the knee, preventing it from buckling inward. The MCL—on the inside of the knee—keeps it from collapsing inward. The PCL deters the lower leg from moving backward, and the ACL stops over-rotation.

The timeline of Tate's recovery suggests a mild-to-moderate MCL sprain, but details remain scarce.

Possible On-Field Limitations and Considerations: Any type of knee sprain can limit a running back's agility and cutting ability. It can also lead to swelling and pain with continued use throughout a game, and re-injury risk also comes into play.

Fantasy Advice: If he plays, Tate will face a weak Tennessee Titans run defense this Sunday. However, in his first game back from injury—and with two other solid options occupying the Browns backfield in the form of Terrance West and Isaiah Crowell—a timeshare seems very possible. Look for other viable options before rolling with the former Houston Texan this week.

Follow-Up: Mild-to-moderate knee sprains usually heal well with time, rest and physical therapy. However, the final step of any rehab protocol is the successful return to competitive action, and Tate doesn't seem to be sure if he's ready just yet.

DeAngelo Williams, RB, Carolina Panthers (Red)

Patrick Semansky/Associated Press

Player: DeAngelo Williams, RB, Carolina Panthers

Injury: High-ankle sprain

Latest News: ESPN's David Newton reported Williams will not play this week due to his high-ankle sprain. CarolinaHuddle.com's Jeremy Igo tweeted the running back said he "is out a few weeks." Williams offered a picture of his cast on Wednesday.

Alert Level: Red

Relevant Medicine and Anatomy: It looks like Williams' high-ankle sprain will follow a fairly typical course: immobilization for a period of time followed by week-to-week re-evaluation. The cast prevents his tibia and fibula from moving against each other, allowing the ligaments that connect them to heal and scar down.

Possible On-Field Limitations and Considerations: Once Williams returns, fans should pay close attention to him planting and twisting on the affected side. If he can run to the right, plant his right foot and sharply twist to turn in the opposite direction, his ankle is likely nearing the end of its healing process.

Fantasy Advice: If you can afford a roster spot, hang onto Williams for now. After all, along with the San Diego Chargers, the Panthers backfield remains in a constant state of flux. Williams might one day find himself as the team's sole ball-carrier once more.

Follow-Up: The Panthers Twitter account reassured fans against a serious high-ankle sprain earlier this week. While such unstable sprains may lead to instability of the lower leg, mild and moderate injuries will heal with time.

Calvin Johnson, WR, Detroit Lions (Yellow)

Rick Osentoski/Associated Press

Player: Calvin Johnson, WR, Detroit Lions

Injury: Ankle sprain

Latest News: The Detroit Free Press' Dave Birkett expects Johnson to play this week. The wideout also played last week but finished with just two catches for 12 yards. The Lions injury report lists the superstar as "questionable." He did not practice on Wednesday or Thursday and received only limited work on Friday.

Alert Level: Yellow, if active

Relevant Medicine and Anatomy: Ankle sprains can limit a receiver's ability to cut away from defenders. They also weaken the involved ligament or ligaments until the healing process completes itself, potentially increasing the risk of further injury.

Possible On-Field Limitations and Considerations: While Johnson may not evade defenders as easily due to his ongoing ankle troubles, the sprain certainly does not affect his size. He remains a monstrous target in the end zone.

Fantasy Advice: Last week, the Lions hoodwinked many into thinking Johnson could play effectively through his injury—including me. Later, head coach Jim Caldwell—via ESPN.com's Michael Rothstein—all but stated the wide receiver played a decoy role on Sunday.

Will he do so again this week? Unfortunately, your guess is as good as mine, but if anything, it would seem his role should expand this week. For what it's worth, Birkett tweeted Wednesday that Johnson said he feels "definitely better than at this time last week."

If Johnson plays, owners should start him—this is Megatron we are talking about here—though some degree of uncertainty is understandable.

Follow-Up: It seems like Johnson is progressing. His recovery comes down to avoiding re-injury.

Brandon Marshall, WR, Chicago Bears (Green)

David Banks/Getty Images

Player: Brandon Marshall, WR, Chicago Bears

Injury: Two ankle sprains on the same foot

Latest News: According to the Bears injury report, Marshall practiced in full all week, earning a "probable" tag.

Alert Level: Green

Relevant Medicine and Anatomy: Marshall's full practice status for three days in a row suggests the increased workload did not lead to a significant recurrence of his symptoms. As mentioned in this week's fantasy injury advice of the week, a player participating in two consecutive full practices—or in this case three—is very reassuring.

Possible On-Field Limitations and Considerations: While Marshall might wear some supportive taping and still move slightly slower than normal this week, he will likely play at much closer to 100 percent than in weeks prior. Like Calvin Johnson, he remains a large red-zone target despite his injuries.

Fantasy Advice: There isn't enough out there in media reports to merit benching him in lineups. Start him and don't think twice.

Follow-Up: A higher re-injury risk remains a possibility, but it continues to fade with each passing day.

Jordan Cameron, TE, Cleveland Browns (Green)

Jeff Haynes/Associated Press

Player: Jordan Cameron, TE, Cleveland Browns

Injury: Acromioclavicular (AC) joint sprain

Latest News: According to the Browns injury report, Cameron practiced in full on Wednesday, Thursday and Friday. He is probable for Week 5.

Alert Level: Green

Relevant Medicine and Anatomy: The AC joint marks the point where the clavicle—the collarbone—meets a bony extension of the shoulder blade. Ligaments bridge the gap between the two bones, and just like any ligaments, they can stretch or tear. Mild injuries heal with relative rest and time.

Possible On-Field Limitations and Considerations: Expect a fully healthy Cameron this Sunday. The bye week likely did the trick and allowed him to finally turn the corner.

That said, the Akron Beacon Journal's Nate Ulrich tweeted that the tight end "expects to deal with (his) sprained AC joint throughout the season," which is probably a true statement. After all, he isn't a punter or a kicker. He's a tight end.

Fantasy Advice: You probably drafted Cameron as your No. 1 tight end, and it's time to start him without any doubts for the first time since Week 1.

Follow-Up: At any moment, a big hit or plant on Cameron's shoulder could take him out once more. Barring such a scenario, good pain control and therapy should allow the day-to-day limitations of his injury to remain in the past.

Vernon Davis, TE, San Francisco 49ers (Orange)

Tim Sharp/Associated Press

Player: Vernon Davis, TE, San Francisco 49ers

Injury: Back spasms, deep ankle bruise

Latest News: According to the 49ers Twitter account, Davis left Week 4's game after he suffered a blow to his back. He then experienced spasms that The Sacramento Bee's Matt Barrows reports subsided by Wednesday. However, the 49ers injury report lists him as "questionable" after he did not practice all week.

This injury comes in addition to a pre-existing deep ankle bruise. See last week's notebook for details.

Alert Level: Orange, if active

Relevant Medicine and Anatomy: Back spasms can occur after sprains, strains or direct trauma. Davis' appears to be due to the latter.

While the tight end's spasms reportedly stopped, his ongoing inactivity suggests a strain, a deep bruise or ongoing pain. Thankfully, no reports suggest an intervertebral disc issue or a vertebral fracture such as Brazilian soccer player Neymar's.

Possible On-Field Limitations and Considerations: If Davis plays, pain control reigns supreme. The tight end position places quite the demand on a player's lower back.

Fantasy Advice: Unfortunately, Davis remains a tough fantasy start this week—even if he plays. One has to wonder if he would see fewer snaps in order to limit the toll on his back and ankle. Significant pain could also drastically lower his effectiveness on the field.

Follow-Up: Like others in this week's notebook, rest, rehab and time are Davis' best friends.

Vontaze Burfict, LB, Cincinnati Bengals (Red)

Ross D. Franklin/Associated Press

Player: Vontaze Burfict, LB, Cincinnati Bengals

Injury: Concussion

Latest News: According to the Bengals injury report, Burfict did not practice all week. He is doubtful for Week 5. Bengals writer Geoff Hobson wrote that the team limited the linebacker to working out on the side of Friday's practice.

Alert Level: Red

Relevant Medicine and Anatomy: "On the side" work suggests Burfict remains in the third phase of the concussion protocol. The fourth and fifth stages involve non-contact and full practice, respectively.

In other words, the linebacker is a (very) long shot to play this week.

Possible On-Field Limitations and Considerations: Once Burfict clears the concussion protocol, he will likely play without limitations. Doctors and athletic trainers use the final phase of the protocol to ensure symptoms do not recur with maximal exertion.

Fantasy Advice: The Bengals defense continues to hold up its end of the bargain despite Burfict's absence. It remains a strong fantasy play against a struggling New England Patriots offense—yes, it felt weird to type that last part.

Follow-Up: Rarely, symptoms can return after a player clears the concussion protocol. More important, however, is Burfict avoiding another injury this year—and for as long as possible, for that matter. His most recent injury represents his second this season.

Fantasy Football Quick Hits

Don Wright/Associated Press

Quarterbacks

• Comcast Sports Net's Tarik El-Bashir wrote this week that in stark contrast to last year's recovery, details on Robert Griffin III's rehab remain scarce. RG3 suffered a subtalar dislocation earlier this season.
• Tennessee Titans quarterback Jake Locker looks to return to action this week. The team injury report lists him as "probable" after he practiced in full all week. He is recovering from a wrist strain.
• The Tampa Bay Buccaneers injury report lists quarterback Josh McCown as "questionable," but he did not practice all week. Do not expect to see him this Sunday.

Running Backs

• The Oakland Press' Paula Pasche tweeted Friday night that the Detroit Lions ruled out Joique Bell for Week 5. He is recovering from a concussion.
• CBS Sports' Jason La Canfora tweeted last Sunday that New Orleans Saints running back Mark Ingram is "on pace" to return following the team's Week 6 bye. He underwent hand surgery last month.
• According to the team injury report, San Diego Chargers running back Ryan Mathews remains out this week. He is rehabbing an MCL sprain.
• The Baltimore Sun's Aaron Wilson tweeted that head coach John Harbaugh expects running back Bernard Pierce to be ready this week. His role in a crowded Ravens backfield, though, remains less clear.
• The Carolina Panthers injury report lists oft-injured running back Jonathan Stewart as "doubtful." He is working his way back from a knee sprain.

Wide Receivers

• The Kansas City Star's Terez A. Paylor reported this week that wide receiver Donnie Avery needs sports hernia surgery. For now, fans should expect an absence of at least four to six weeks.
• Fox Sports' Mike Garafolo reported Tampa Bay Buccaneers wide receiver Mike Evans will miss two to three weeks with a groin strain. Groin injuries can linger and prove especially troublesome for wide receivers.
• The Houston Chronicle's John McClain expects Houston Texans wide receiver Andre Johnson to play this week. His role, however, might be another story. He is dealing with an ankle injury. Fantasy owners need to monitor his status all the way up until game time.
• Bengals.com writer Geoff Hobson reported wide receiver Marvin Jones hurt his ankle this week. The injury will likely delay his return from a foot fracture that he suffered earlier this year.
• According to the team injury report, Jacksonville Jaguars wide receiver Cecil Shorts will miss this week's game with an aggravation of his hamstring strain. The threat of a completely lost season due to this recurring injury is growing.

Tight Ends

• Seattle Seahawks tight end Zach Miller underwent arthroscopic ankle surgery during the team's bye week, according to ESPN's Chris Mortensen. The team hopes he will miss just two games.
• According to the team injury report, Washington Redskins tight end Niles Paul practiced in full on Friday. He is recovering well, and Bleacher Report's Will Carroll reported Friday night that the tight end cleared the concussion protocol. It looks like he will play on Monday.
• ESPN's John Keim thinks Redskins tight end Jordan Reed is a "50-50" chance to play this week. Regardless of his status, avoid him. Wait to see how his hamstring responds to a game.

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 (non-operative) 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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