NFL Week 11 Injury Notebook
Sometimes, appearances can be deceiving when it comes to NFL injuries, and the days leading up to Week 11's matchups proved to be no exception.
Shortly after his team lost to the San Francisco 49ers in overtime last week, a picture of New Orleans Saints cornerback Keenan Lewis' left knee surfaced via NFL on CBS' Twitter account.
Simply put, that looks horrendous.
But is it?
More than likely, the swelling in Lewis' knee represents nothing more than a bursitis, or inflammation of a space within the knee leading to a buildup of fluid. If doctors can drain the fluid and control swelling with anti-inflammatories, the defensive back could miss as little as no time despite his knee's appearance. His status will likely depend on his pain control and range of motion.
On the other hand, last week Arizona Cardinals quarterback Carson Palmer went down with a knee injury on a seemingly innocent play. However, doctors eventually diagnosed a torn ACL.
As I described here, while the play looked quite benign, a perfect storm of Palmer's weight distribution and positioning led to what was, in reality, a very serious injury. The entire league hopes for nothing but a full and speedy recovery for the veteran quarterback.
With those lessons in mind, let's get going with this week's injury notebook, starting, as always, with the sports medicine topic of the week.
Please note that the original form of this slideshow is current through Friday evening and will receive periodic updates throughout the weekend.
Sports Medicine Topic of the Week: The Ever-Confusing Sports Hernia
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Disclaimer: The following is an oversimplified description of a complex and evolving topic within sports medicine.
A sports hernia is, oddly enough, not a hernia.
A true hernia describes a protrusion of tissue through the abdominal wall. On the other hand, a sports hernia does not involve such a protrusion. Recently, terms such as "athletic pubalgia" and "inguinal disruption" surfaced as an attempt to better describe the misnomer.
Instead, the condition implies chronic pain in the groin that worsens with sudden bursts or acceleration. Many times, it's thought to arise from a core muscle injury or an imbalance between a hip adductor and the rectus abdominis—the "six pack" muscle.
If one muscle pulls on the pelvis harder than the other—usually the hip adductor wins out over the rectus abdominis—the other can fray and tear. The core can also tear following a sudden and sharp twist of the upper body.
Core muscle repairs often yield resolution of the pain. Recovery times usually fall into the four-to-six-week range, though particularly troublesome injuries can linger longer or even indefinitely.
All of that said, the definition, study and treatment of inguinal disruption remain active areas of research.
Prior weeks' 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
Week 9: The glenoid labrum
Week 10: X-rays, CT scans and MRIs, oh my
Fantasy Football Injury Advice of the Week: A Season's Cumulative Injury Toll
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The media capture most major injuries that take place within the NFL, but much goes on behind the scenes, as well.
Every year, players accumulate small injury after small injury, and their cumulative effect usually starts to surface in the later portions of the season. While a given bump or bruise may not force a player to sit out, many coexisting maladies may start to take a toll.
Just ask Carolina Panthers quarterback Cam Newton.
After a Monday Night Football outing that saw the Philadelphia Eagles sack Newton nine times, questions arose about the signal-caller's health. According to ESPN.com's David Newton, the QB admitted to being
"hurt":
"If you are asking me am I hurt right now? Yeah, I'm hurt. I haven't felt 100 percent for a long time," said Newton, whose Panthers will take a four-game losing streak into Sunday's game against Atlanta. "But is that going to be my excuse as to why we're on a losing streak? No. Absolutely not.
But if you ask me a question, 'Is Cam Newton hurt?' Yes, I'm hurt. That is all honesty. But can I play? Yes, I can play and I will be playing.
"
Newton is not the only player whose 2014 injury history continues to lengthen as the season wears on. When deciding between two roughly equivalent options in fantasy football, it's sometimes worth considering the number of times a given player has been on the injury report so far that year.
Prior weeks' advice
Week 5: Analyzing practice status trends
Week 6: Injuries and player attributes
Week 9: Be careful with RB ankle sprains
Week 10: Identifying WR decoys
Bye Week Recap
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Make sure players from the following teams are out of your fantasy football lineups:
- Baltimore Ravens: The Ravens will have to move on without cornerback Jimmy Smith after the bye. He underwent season-ending foot surgery earlier this month.
- Dallas Cowboys: You'd be hard-pressed to find a player who will appreciate a bye week more than quarterback Tony Romo. He suffered two transverse process fractures in October.
- Jacksonville Jaguars: Wide receiver Allen Hurns will use the bye week to recover from a concussion.
- New York Jets: The Jets recently turned to Michael Vick to lead the offense. He carries quite an injury history.
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Robert Griffin III, QB, Washington Redskins (Green)
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Player: Robert Griffin III
Injury: Subtalar dislocation
Latest News: According to the team's injury report, RG3 practiced in full all week.
Alert Level: Green
Relevant Medicine and Anatomy: The subtalar joint sits directly underneath the ankle joint. It stabilizes foot inversion and eversion, or side-to-side motion of the heel.
Possible On-Field Limitations and Considerations: RG3 put up respectable numbers against a tough Minnesota Vikings defense last week. He also didn't suffer any obvious setbacks, and those watching saw him plant and cut on his foot without much difficulty.
There is no reason to expect anything different this week. If anything, he may play even sharper.
Fantasy Advice: If you are in a position where you need to start the former Baylor University standout, you can and should. He proved his health last week.
Follow-Up: Barring another injury, RG3's ankle should soon become a thing of the past.
Montee Ball, RB, Denver Broncos (Orange)
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Player: Montee Ball, RB, Denver Broncos
Injury: Groin strain
Latest News: It's been more than a month since Ball went down with a serious groin strain. According to the team's injury report, the Broncos gave him a "probable" tag after he practiced in full all week.
Alert Level: Orange
Relevant Medicine and Anatomy: Groin strains, or hip adductor injuries, involve tearing of one or more of the muscles that connect the femur—the thigh bone—to the pelvis. Ball's injury likely constituted far more than a minor pulled muscle.
Possible On-Field Limitations and Considerations: A running back uses his hip adductors to pull his leg back toward his body's midline. As such, a sore or weak hip adductor can limit his lateral agility and direction-changing ability.
Fantasy Advice: Groin injuries tend to linger, and the running back position might be the toughest role to play after a significant strain. Let Ball prove his health before putting him back into your lineup.
Follow-Up: For Ball, it all comes down to avoiding setbacks. Unfortunately, that isn't necessarily an easy task after this type of injury.
Reggie Bush, RB, Detroit Lions (Orange-Red)
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Player: Reggie Bush, RB, Detroit Lions
Injury: Ankle sprain
Latest News: On Friday, DetroitLions.com writer Tim Twentyman provided an ominous update on Bush:
"The Detroit Lions are hoping running back Reggie Bush can improve enough over the next couple days to play in Arizona on Sunday, but that seems unlikely at this point after Bush missed the entire week of practice with an ankle injury.
[...]
Bush left last week’s game against Miami after aggravating the ankle injury that’s already kept him out of two games this season.
"
Alert Level: Orange-red
Relevant Medicine and Anatomy: As I discussed in Week 9's injury notebook, the ankle anchors the ship that is a running back. Not only does a sprain limit a back's effectiveness and agility, but it can linger on and on due to the demands of the position. Regrettably, it seems Bush is learning this unfortunate reality firsthand.
Possible On-Field Limitations and Considerations: If Bush does play—it doesn't look like he will—he will probably see limited work. Even so, whatever work he does see will be on an ailing ankle.
Fantasy Advice: Not only is Bush unlikely to play, but his team faces a staunch Arizona Cardinals run defense. Look elsewhere.
Follow-Up: Rest might be just what the doctor ordered in order to let Bush's ankle heal once and for all.
Arian Foster, RB, Houston Texans (Orange)
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Player: Arian Foster, RB, Houston Texans
Injury: Groin strain
Latest News: According to ESPN's Tania Ganguli, head coach Bill O'Brien called Foster a "game-time decision." However, multiple members of the media, such as NFL.com's Michael Fabiano, called him "likely out."
Alert Level: Orange
Relevant Medicine and Anatomy: Like Ball, Foster's injury likely represents a hip adductor tear. However, the mere chance of him playing this week suggests he is dealing with a much milder injury than his Denver counterpart.
Possible On-Field Limitations and Considerations: Again, with a groin strain, Foster's lateral agility becomes an unknown, as his ability to cut away from defenders at the last second may suffer.
Fantasy Advice: Foster surprised us earlier this year when he played extremely well through a hamstring strain, so it's possible he tries to accomplish a similar feat this week. If he somehow does take the field, he becomes a tough fantasy decision. Luckily, we'll know his status early on Sunday.
Follow-Up: If Foster's strain is of the low-grade variety, he should have an excellent chance to play Week 12.
Ryan Mathews, RB, San Diego Chargers (Yellow)
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Player: Ryan Mathews, RB, San Diego Chargers
Injury: MCL sprain
Latest News: It looks like Mathews will make his long-awaited return this week. The Chargers' injury report lists him as "probable" after he practiced in full all week. He is working his way back from a severe MCL sprain.
Alert Level: Yellow
Relevant Medicine and Anatomy: The MCL, or medial collateral ligament, connects the femur to the tibia along the inner portion of the knee joint. It prevents the knee from buckling inward during complex motions such as planting and cutting. Isolated MCL injuries usually do not require surgery, even in the case of complete tears.
Possible On-Field Limitations and Considerations: Do not expect to see Mathews run at 100 percent this week, but it's possible he approaches it. However, the Chargers might understandably work him back into action slowly after his prolonged absence.
Fantasy Advice: If you are looking for help at the running back position, Mathews offers a nice potential boost this week. The Chargers take on a weak Oakland Raiders run defense on Sunday, leaving the door open for double-digit fantasy points.
Follow-Up: Mathews needs to avoid contact that causes him to fall over his planted foot and force his knee inward. Otherwise, he will only get better each week.
Andrew Hawkins, WR, Cleveland Browns (Green-Yellow)
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Player: Andrew Hawkins, WR, Cleveland Browns
Injury: Thigh/knee
Latest News: The Houston Texans' injury report lists the Browns wide receiver as "probable" to play through his injury. He practiced in full on Friday.
Alert Level: Green-yellow
Relevant Medicine and Anatomy: Details are scarce, but it seems likely that Hawkins is dealing with a quadriceps strain. The quadriceps muscle group pulls upward on the front of the lower leg, thereby straightening the knee.
Possible On-Field Limitations and Considerations: The quads allow an athlete to drive forward with his legs and leap into the air. A sore or weak quad—if that is, in fact, what Hawkins is nursing—could limit his ability to do so. It could also lessen his top-end speed.
Fantasy Advice: Hawkins almost went last week. With another week of rest, start him if you need to.
Follow-Up: Muscle strains always carry a risk of re-injury, especially at skill positions, as sprinting requires a player to rapidly cycle his legs through extension and contraction.
Brandon Marshall, WR, Chicago Bears (Yellow)
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Player: Brandon Marshall, WR, Chicago Bears
Injury: Ankle sprain
Latest News: According to ESPN Chicago's Michael C. Wright, Marshall is optimistic about playing this week:
"Marshall said his most recent ankle injury isn’t as severe as the high ankle sprain suffered against the Bills.
"
"It’s a different ankle. It’s not as bad as the right one," Marshall said. "The right one was like a high ankle sprain. I don’t believe this one was a high ankle sprain. It hurts really bad, but I’m going to do what I always do; just go at it really hard and treat it really good.
Alert Level: Yellow
Relevant Medicine and Anatomy: Another week, another ankle sprain for Marshall. Thankfully, he implied his injury is a low-ankle sprain. Low-ankle injuries involve the ligaments that connect the lower leg to the foot and generally heal faster than high-ankle injuries.
Possible On-Field Limitations and Considerations: Ankle injuries can prevent a wide receiver from cutting away from defenders as effectively. However, athletic trainers can add support to a player's ankle in the form of tape.
Fantasy Advice: Marshall's week-to-week, boom-or-bust fantasy season continues. That said, one of his most productive games came after he nearly sat out with a prior ankle injury. Furthermore, the Bears' injury report lists him as "probable," and there isn't enough out there to merit benching the potential WR1.
Follow-Up: 2014 continues to be unkind to Marshall's ankles. They certainly aren't at 100 percent, and they might not be for some time.
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, things are not looking good for Cameron this week—and potentially longer:
"You don't know," said (head coach Mike Pettine). "It's a tricky thing. You can have a guy be without symptoms for a day or two, then it comes back."
[...]
Cameron has been ruled out for Sunday's game against the Texans, his third straight absence with the concussion.
"
Alert Level: Red
Relevant Medicine and Anatomy: Concussions come in many shapes and sizes. However, generally speaking, symptoms worsen and last longer with each successive injury.
Possible On-Field Limitations and Considerations: If Cameron returns this season, he needs to keep his head up. Another concussion in 2014 could cause serious problems.
Fantasy Advice: If and when the tight end returns to action, you can safely put him in your lineup. However, there's no guarantee as to when that will be.
Follow-Up: Concern continues to mount for the Browns tight end. As Cabot writes, his most recent injury represents his third in less than two years. His longer-than-average recovery, unfortunately, comes as no surprise.
Kyle Rudolph, TE, Minnesota Vikings (Green-Yellow)
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Player: Kyle Rudolph, TE, Minnesota Vikings
Injury: Sports hernia surgery
Latest News: According to ESPN.com's Ben Goessling, Rudolph earned a "probable" tag from the Vikings this week. He looks to return from his late-September sports hernia repair surgery.
Alert Level: Green-yellow
Relevant Medicine and Anatomy: As a reminder, sports hernias do not actually involve the protrusion of tissue through the abdominal wall. Rather, the phrase describes a muscle injury that leads to jolts of groin pain brought on by sudden starts and sprints.
Possible On-Field Limitations and Considerations: Though ongoing pain remains a possibility, sports hernia surgery usually goes quite well. Watch Rudolph start off the line of scrimmage this week. If his accelerations are sharp and quick, his recovery went well.
Fantasy Advice: The Vikings face a dismal Chicago Bears defensive group this week. As such, Rudolph may quickly insert himself back into the realm of fantasy relevance.
Follow-Up: As long as Rudolph avoids situations where he gets tangled up with defenders and twists awkwardly to the ground, he should only get stronger by the week.
Star Lotulelei, DT, Carolina Panthers (Red)
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Player: Star Lotulelei, DT, Carolina Panthers
Injury: Low-ankle sprain
Latest News: Earlier this week, the Charlotte Observer's Jonathan Jones provided some good news after Lotulelei went down with what originally appeared to be a serious ankle injury:
"Lotulelei has a sprained right ankle, Panthers coach Ron Rivera said Tuesday. X rays and an MRI were both negative, and Lotulelei’s sprain is not a high ankle sprain.
[...]
Lotulelei will not play this week against Atlanta, and Rivera expects the second-year defensive tackle to return after the Week 12 bye.
"
Alert Level: Red
Relevant Medicine and Anatomy: Despite the news, make no mistake: This was a significant injury. Those watching it unfold saw the star tackle step on another player's foot in such a way that his foot and ankle formed a near 90-degree angle. The misstep severely overstretched one or more of the ligaments that connect the outer portion of his lower leg to the outside of his foot. Fortunately, Lotulelei avoided a fracture. Not infrequently, this injury mechanism comes with a broken fibula.
Possible On-Field Limitations and Considerations: Once Lotulelei returns, he can likely play well with the help of supportive taping. His position does not require the same level of plants and cutbacks as, say, a running back.
Fantasy Advice: The Panthers gave up 45 points to the Philadelphia Eagles last week. With or without Lotulelei, there are better fantasy options for Week 11.
Follow-Up: Without a fracture, Lotulelei's injury should heal well with time. That said, in rare instances, the injured ligament or ligaments will not scar down well, thus leaving some instability in the joint.
Fantasy Football Quick Hits
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Quarterbacks
- Just like last week, New England Patriots quarterback Tom Brady wound up on his team's injury report due to an ankle issue. Also like last week, he earned a "probable" tag. Start him.
Running backs
- ESPN.com's Coley Harvey reported Friday that Cincinnati Bengals running back Giovani Bernard will not play this week. He is dealing with a hip injury.
- According to the Kansas City Chiefs' injury report, running back Jamaal Charles is dealing with shoulder and elbow injuries. However, he practiced in full all week, which offers enough reassurance to start him without hesitation.
- It looks like New York Giants running back Rashad Jennings will return this week. The team's injury report lists him as "probable."
- Follow Seattle Seahawks running back Marshawn Lynch's status closely. According to the team's injury report, he only earned a "questionable" tag despite a full day of practice on Friday.
Wide receivers
- Detroit Lions superstar wide receiver Calvin Johnson is back. He eclipsed 100 receiving yards last week. If you didn't follow my advice last week, be sure you start him for Week 11—and until further notice, for that matter.
Tight ends
- According to the Chicago Bears' injury report, tight end Martellus Bennett's practice status trended up all week. His status shouldn't be in question for his matchup against the Vikings.
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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