NFL Week 7 Injury Notebook

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistOctober 18, 2014

NFL Week 7 Injury Notebook

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    The NFL world stood still for roughly 30 seconds last week during Sunday Night Football when New York Giants wide receiver Victor Cruz sobbed as he left the field on a cart. News of his patellar tendon tear followed on the broadcast shortly thereafter.

    The season-ending injury clearly overwhelmed the 27-year-old as he left the field, providing a heartbreaking look at a passionate athlete facing the end of his 2014 campaign. Both teammates and opponents alike offered their support in an emotional moment of football brotherhood, one falling short of only the scene following a severe neck injury.

    Regrettably, Cruz's injury represented just one of numerous season-ending blows that took place last Sunday. Elsewhere, New England Patriots running back Stevan Ridley and linebacker Jerod Mayo, Miami Dolphins running back Knowshon Moreno and New York Jets cornerback Dee Milliner will all watch the rest of this season from the sidelines.

    That said, rarely do NFL fans see the kind of raw, painful and sobering emotions Cruz displayed Sunday night, and everyone who watched surely hopes for nothing but a complete recovery. According to NFL Network's Albert Breer, the wideout underwent surgery to repair the tendon later in the week.

    Fortunately, Cruz and his fellow injured stars will work with medical and rehabilitation staffs that sit among the best of the best. As such, there is not yet reason to doubt any of their returns for at least part or all of the 2015 season. These athletes are some of the most motivated and genetically gifted humans on the planet, after all.

    Yet while some players' seasons ended last week—and while others' hit a roadblock—some veered back on course. Let's take a closer look in this week's injury notebook.

    Please note that the original form of this slideshow is current through the midafternoon on Friday and will receive periodic updates throughout the weekend.

Sports Medicine Topic and Fantasy Injury Advice of the Week

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    The sports medicine topic and fantasy football injury advice of the week slides are taking a brief break and will return for Week 8. See below for topics from previous weeks.

    Sports Medicine Topics of the Week

    Week 2: The spine board

    Week 3: The air splint

    Week 4: The hamstring strain

    Week 5: High- versus low-ankle sprains

    Week 6: What's meant by a "mechanism of injury"?

    Fantasy Football Injury Advice of the Week

    Week 4: Beware WRs with hamstring strains

    Week 5: Analyzing practice status trends

    Week 6: Injuries and player attributes

Bye Week Recap

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    Michael Perez/Associated Press

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

    1. Philadelphia Eagles: The Philadelphia Enquirer's Jeff McLane reported running back Darren Sproles suffered a "slight tear of the MCL in his left knee" Sunday and may miss a few weeks. However, the bye week will help limit the injury's effect on his team's offense.
    2. Tampa Bay Buccaneers: Earlier this week, Tampa Bay Times' Greg Auman tweeted quarterback Josh McCown remains out with a thumb injury. Expect limited updates until next week.

Derek Carr, QB, Oakland Raiders (Green)

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    Ben Margot/Associated Press

    Player: Derek Carr, QB, Oakland Raiders

    Injury: High-ankle sprain, MCL sprain

    Latest News: Carr dropped 282 passing yards and four touchdown passes on the San Diego Chargers last week. He missed zero games after suffering high-ankle and MCL sprains Week 4. According to the Raiders' injury report, the quarterback returned to full practice by Thursday.

    Alert Level: Green

    Relevant Medicine and Anatomy: Carr went down via the somewhat common injury mechanism of falling over his planted foot, thereby twisting his knee inward and toes outward. Such a mechanism can cause significant leg and ankle injuries—San Diego Chargers running back Danny Woodhead, for example—but may also lead to much less serious sprains.

    Fortunately, it seems Carr's fell into the latter category.

    Possible On-Field Limitations and Considerations: Carr is not much of a threat to run—his carries total is at eight for the entire regular season—so outside of the possibility of him displaying slightly less mobility in the pocket, Raiders fans can expect a healthy quarterback this week.

    Fantasy Advice: If you are in a position where you need to start Carr, his injury shouldn't factor into your decision. Week 6 provided enough reassurance against any significant lingering issues.

    Follow-Up: Barring re-injury, Carr recovered from—and closed the book on—his first significant injury as a professional quarterback quite well.

Carson Palmer, QB, Arizona Cardinals (Yellow)

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    Rick Scuteri/Associated Press

    Player: Carson Palmer, QB, Arizona Cardinals

    Injury: Axillary nerve contusion

    Latest News: After attempting 44 passes last week, Palmer told's Josh Weinfuss that he felt "great," adding, "It felt great all day. I treated it today [Monday], and it definitely was tired after the game but felt really good."

    According to Cardinals reporter Darren Urban, head coach Bruce Arians said the quarterback is "full go."

    Alert Level: Yellow

    Relevant Medicine and Anatomy: It looks like Palmer's nerve really did finally "wake up," so to speak. However, as previously mentioned in this column, nerve injuries can also lead to muscle weakness—weakness that a player must build back up.

    Earlier this week, Football Guys' Dr. Jene Bramel pointed out that Palmer might remain at risk until he completely reconditions his shoulder. The veteran is likely well on his way to doing so—and is possibly even there—but until he does not show up on the Cardinals' injury report whatsoever, his condition merits at least some attention.

    Possible On-Field Limitations and Considerations: As before, pay attention to the zip of Palmer's short throws as well as the depth and accuracy of his long ones, especially toward the end of the game.

    Fantasy Advice: Despite the above warnings, Palmer turned a big corner this week by reportedly feeling well after extensive work last week. If you want to start him, you can do so fairly comfortably against a less-than-stellar Oakland Raiders defense.

    Follow-Up: The Arizona offensive line's job is now more important than ever. Another significant blow to Palmer's throwing shoulder could easily lead to a significant setback.

Tony Romo, QB, Dallas Cowboys (Green)

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    Elaine Thompson/Associated Press

    Player: Tony Romo, QB, Dallas Cowboys

    Injury: Rib injury, ongoing back rest, ankle injury

    Latest News: The Dallas Cowboys' injury report listed "back/ankle" as the reason Romo missed practice Wednesday. The Dallas Morning News' David Moore reports the Cowboys signal-caller needed to work on rib and ankle issues, and he missed his fifth Wednesday practice in a row. However, the quarterback then returned in full Thursday.

    Moore also highlighted how one injury can affect another, saying, "Romo injured his rib in the first quarter of Sunday’s game when he was hit by Seattle linebacker Bobby Wagner. With the sore ribs, he’s had to alter some of the core exercises he does for his back."

    Alert Level: Green

    Relevant Medicine and Anatomy: In sports medicine, the "kinetic chain" concept describes the idea that one cannot look at individual injuries in isolation. Rather, each body part represents a portion of a larger machine, and one failing can affect all others.

    For example, an ankle injury can affect a player's gait, in turn altering his posture and, therefore, core muscle movement.

    Hopefully, the pain from Romo's rib and ankle issues—as mild as the injuries seem to be—will not linger long enough to significantly affect the muscular strength and support around his spine.

    Possible On-Field Limitations and Considerations: Romo can still play well as long as the Cowboys' medical and athletic training staffs can help him with any or all of the following, as needed:

    • Rib protection
    • Ankle support
    • Pain control

    Fantasy Advice: As long as no surprises pop up over the weekend, keep Romo in fantasy lineups as you normally would.

    Follow-Up: Avoiding further injury is paramount for Romo. Coming off back surgery, he needs to keep as many pieces of his kinetic chain in good shape as possible. For the time being, fantasy owners should not take his status for granted.

Reggie Bush, RB, Detroit Lions (Green-Yellow)

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    Rick Osentoski/Associated Press

    Player: Reggie Bush, RB, Detroit Lions

    Injury: Ankle sprain

    Latest News: Bush originally suffered his injury Week 5. He sat out Week 6, but the team's injury report shows him practicing multiple days in a row this week.

    Alert Level: Green-yellow, if/when active

    Relevant Medicine and Anatomy: Ankle ligaments stabilize motion at the joint, keeping the bones of the heel and lower leg in their proper anatomical alignment.

    Like wide receivers and hamstring strains, running backs and ankle sprains generally do not go together well. The position requires a player to repetitively stress the joint's ligaments with each plant and cut.

    Possible On-Field Limitations and Considerations: Fans should watch Bush plant and push off his injured ankle. Sharp, quick cuts would suggest his injury is healing well.

    Fantasy Advice: Before assuming Bush will play, setting your lineup and moving on, make sure the running back does not surprisingly land on the Lions' inactive list prior to the game. Ankle setbacks are possible at any time, as a previous day's work can lead to significant pain and swelling later on.

    If Bush does play, temper your expectations slightly as he gets going again, especially with the ever-looming possibility of split work with fellow running back Joique Bell. However, there is not enough concern out there for owners to bench him based purely on the injury itself.

    Follow-Up: Minor ankle sprains usually heal well. As Bush's teammate wide receiver Calvin Johnson knows all too well, the running back's long-term prognosis comes down to avoiding setbacks.

Jonathan Stewart, RB, Carolina Panthers (Green-Yellow)

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    Player: Jonathan Stewart, RB, Carolina Panthers

    Injury: Knee sprain

    Latest News: The Charlotte Observer's Jonathan Jones shared some good news this week: Stewart said he will play this Sunday. He went down with a knee sprain Sept. 21.

    According to the team's injury report, he is practicing in full this week. On Friday, the Panthers' Twitter account tweeted he will, indeed, start Week 7.

    Alert Level: Green-yellow

    Relevant Medicine and Anatomy: A precise diagnosis did not surface following Stewart's injury, but the timeline of his recovery suggests a low- or mid-grade MCL sprain.

    The MCL, or medial collateral ligament, runs along the inside of the knee. It connects the femur—the thigh bone—to the tibia, or shin bone, and prevents the knee from collapsing inward.

    Isolated MCL injuries—even complete tears—generally do not require surgery and heal with bracing and rest.

    Possible On-Field Limitations and Considerations: The fact that Stewart practiced in full this week is quite reassuring. Expect him to play at or very near 100 percent, barring a surprise.

    Fantasy Advice: Stewart is going to take the reins of an injury-depleted Panthers backfield and is worth a start if you need him. However, his injury history speaks for itself.

    Follow-Up: Nothing seems to ever be a guarantee for Stewart. Hopefully, he bucks the trend this time.

Kelvin Benjamin, WR, Carolina Panthers (Green to Red)

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    Player: Kelvin Benjamin, WR, Carolina Panthers

    Injury: Concussion

    Latest News: The Panthers' injury report lists the rookie as "questionable" for Sunday. He missed practice Wednesday and Thursday but returned in full Friday.

    Alert Level: Green, if active; otherwise red

    Relevant Medicine and Anatomy: The NFL's and other concussion protocols lead athletes through progressively intensive workout regimens and monitor for the return of concussion symptoms.

    If an athlete can move through an entire protocol—including the final step of maximum-intensity exercise in the form of full-contact practice—without symptoms recurring, he can likely safely return to the field.

    However, if concussion symptoms do return—headache, nausea and confusion, to name a few—whatever level of exercise brought them back was too much for the player's healing brain. The protocol then slows down.

    Possible On-Field Limitations and Considerations: As much as possible, concussion protocols are designed to let a player return to live-game action only when he can perform at 100 percent symptom-free.

    Fantasy Advice: If Benjamin clears the protocol, you can start him without hesitation. Rarely, a player will first re-experience symptoms during a game and leave, but this usually represents the exception, not the norm.

    Follow-Up: Once his current concussion completely clears, Benjamin must try to avoid repeat injuries as best he can. Two concussions close to one another can lead to more severe and longer-lasting symptoms.

A.J. Green, WR, Cincinnati Bengals (Red)

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    Player: A.J. Green, WR, Cincinnati Bengals

    Injury: Turf toe

    Latest News: Earlier this week, Green told ESPN's Bob Holtzman that he will not need surgery but expects to miss Week 7. The Bengals' injury report notes that the wideout did not practice this week, earning a "doubtful" tag.

    Alert Level: Red

    Relevant Medicine and Anatomy: As mentioned in previous injury notebooks, turf toe injuries involve the metatarsophalangeal (MTP) joint complex, a complicated structure of bones, ligaments, cartilage and muscle tendons where the base of the big toe meets the foot.

    Not only do certain types of MTP injuries heal quite slowly, but the joint plays a crucial role in pushing off, planting and cutting on the football field. As such, players can easily aggravate and re-aggravate MTP injuries during football practices or games, as is the case with Green.

    Green's looming multiweek absence likely represents either a more significant injury than at other points in the year or his team's attempt at letting it heal more definitively before putting it through another football game.

    Possible On-Field Limitations and Considerations: Quick starts at the line of scrimmage as well as plants and cuts are the name of the game. Once Green returns, his quickness and agility will serve as a barometer to measure his toe's health.

    Fantasy Advice: Even if Green somehow plays this week—it looks like he won't—keep him on the bench. Wait until he completes multiple practices in a row leading up to a game.

    Follow-Up: The lack of the need for surgery is encouraging. Consider him week-to-week.

Calvin Johnson, WR, Detroit Lions (Red)

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    Player: Calvin Johnson, WR, Detroit Lions

    Injury: High-ankle sprain

    Latest News: On Wednesday, Lions writer Tim Twentyman suggested Johnson is still dealing with significant limitations due to his injury. His practice status—via the Lions' injury report—is less than reassuring, to say the least.

    Alert Level: Red

    Relevant Medicine and Anatomy: The ligaments a high-ankle sprain involves keep the tibia and fibula—the bones of the lower leg—in place while a player plants and turns on his lower leg. Stressing injured high-ankle ligaments with such a motion can lead to pain or a sense of instability.

    Possible On-Field Limitations and Considerations: It almost goes without saying, but a skill-position player who cannot comfortably plant and turn on his foot poses much less of a threat to opposing defenses.

    Fantasy Advice: Continue to avoid Johnson, even if he takes the field this week. Once he completes a game with at least a handful of targets and a few dozen receiving yards, you can safely put him back into your lineup.

    Follow-Up: Earlier this week, head coach Jim Caldwell—via the Detroit Free Press' Carlos Monarrez—"did not close the door" on sitting the Lions superstar through the team's Week 9 bye.

Jimmy Graham, TE, New Orleans Saints (Orange)

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    Player: Jimmy Graham, TE, New Orleans Saints

    Injury: Shoulder sprain

    Latest News: Reports continue to circle about Graham. NFL Network's Ian Rapoport tweeted last Sunday that the star is "expected to miss 2-3 weeks after the bye."

    On the other hand, ESPN's Mike Triplett tweeted Thursday that head coach Sean Payton is "still optimistic" about the tight end's availability this week. On Friday, Triplett added that Graham said it might "come down" to a pregame evaluation.

    Alert Level: Orange

    Relevant Medicine and Anatomy: Specifics are lacking, but Graham's injury more than likely constitutes a mild-to-moderate acromioclavicular (AC) joint sprain. Cleveland Browns tight end Jordan Cameron dealt—or continues to deal with—a similar injury earlier this season.

    AC sprains involve the ligament complex that connects the clavicle—the collarbone—to a bony extension of the shoulder blade.

    Possible On-Field Limitations and Considerations: The AC joint is one of multiple joints in the shoulder. All of the shoulder joints must function well and in concert to allow a player to utilize his full range of motion and strength.

    Limited range of motion might affect Graham's ability to reach out and catch a pass.

    Fantasy Advice: If Graham does play this week, he will likely become one of Week 7's toughest fantasy decisions. On one hand, he represents a constant touchdown threat in the red zone. On the other, one big hit could knock him out of the game at any moment, and he might be playing through limitations.

    Pay close attention to any and all reports that surface this weekend.

    Follow-Up: AC injuries can require surgery in severe cases. Milder cases will generally heal well with relative rest and conservative treatment.

Jadeveon Clowney, LB, Houston Texans (Yellow)

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    Rick Scuteri/Associated Press

    Player: Jadeveon Clowney, LB, Houston Texans

    Injury: Lateral meniscus tear and meniscectomy

    Latest News: On Thursday, Texans writer Drew Dougherty, citing an update from head coach Bill O'Brien, called Clowney a "gametime decision." However, Dougherty also noted that O'Brien suggested Clowney could play on a bit of a snap count.

    Alert Level: Yellow, if active

    Relevant Medicine and Anatomy: The lateral meniscus functions as a shock-absorbing cushion on the outside of the knee. The medial meniscus sits on the inner portion of the joint.

    When a meniscus tears—often a result of sudden, sharp twisting of the knee—a surgeon can either remove or repair the torn portion. While removals lead to shorter recovery times, repairs offer a greater chance of avoiding an increased risk of long-term knee problems.

    A surgeon cannot successfully repair all meniscus tears. The shape, size and location of a given injury looms large when making the decision.

    Possible On-Field Limitations and Considerations: The last phase of any postoperative rehab is completing a successful return to the playing field. A need for ongoing rehab might show up as a less agile Clowney at the end of the game—if he plays at all.

    Fantasy Advice: The Texans defense falls somewhere in the middle of the pack this week in terms of fantasy value. Even if Clowney plays, that probably won't change that much.

    Follow-Up: Clowney's practice status during the week that follows his first game back will speak to his knee's true status.

Fantasy Football Quick Hits

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    • According to the team's injury report, Washington Redskins quarterback Robert Griffin III returned to practice this week. He's getting closer.
    • If Tennessee Titans quarterback Jake Locker can return from his thumb injury this Sunday, he will take on a weak Washington secondary.

    Running Backs

    • Though he has not missed a game this year, Arizona Cardinals running back Andre Ellington is no stranger to the team's injury report. He remained on it this week due to his foot injury.
    • According to ESPN's Adam Caplan, Tennessee Titans running back Shonn Greene will miss this week's game due to a hamstring injury.
    • NFL Network's Kimberly Jones reported that head coach Tom Coughlin ruled out running back Rashad Jennings for this week's game.
    • Adam Beasley of the Miami Herald notes Miami Dolphins running back Lamar Miller is dealing with a knee injury. However, with Knowshon Moreno out for the season, Miller's value goes up significantly.
    • According to head coach Ron Rivera—via the Carolina Panthers Twitter account—running back DeAngelo Williams is still a "couple of weeks" away from returning from his high-ankle sprain.

    Wide Receivers

    • According to The Kansas City Star's Terez A. Paylor, Kansas City Chiefs wide receiver Donnie Avery is out this week. He continues to recover from sports hernia surgery.
    • Arizona Cardinals wide receiver Michael Floyd popped up on the team's injury report Wednesday with a groin injury. He returned in full Thursday, but if he is one of your weekly fantasy starters, you should monitor his status all the way up until game time.

    Tight Ends

    • Barring a setback, it looks like San Francisco 49ers tight end Vernon Davis continues to recover well from his back injury. According to the team's injury report, he practiced in full this week.
    • ESPN 710's Liz Mathews reported this week that Seattle Seahawks head coach Pete Carroll ruled out tight end Zach Miller for Week 7. He is recovering from arthroscopic ankle surgery.

    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 official statistics.

    Questions about players on this list? Not on this list? Send 'em to Dave on Twitter.