Understating Injuries
By Mark Wimer
July 14th, 2011

Every year, injuries play a part in determining fantasy championships in every sort of league, whether it is a neighborhood "trophy league" or a big money contest like the Fantasy Football Players Championship. In order to make good decisions regarding players and their injuries during both the draft and in-season, it is necessary to have a grasp of the different sorts of injuries/the severity of injuries that regularly occur among NFL players.

There is a huge variety of possible injuries, from very minor ones like bruises, to a catastrophic paralyzing or fatal injury like a broken neck. One could have enough space to write a textbook on injuries and still not cover every specific sports injury. Therefore, the article that follows has been arranged by grouping similar sorts of injuries - within each category, examples of current, fantasy-relevant players who are rehabilitating (or have rehabilitated) such injuries are presented. Not every fantasy-relevant NFL player who is currently battling an injury is listed here - that is covered in another ongoing article series called, appropriately, the Injury Report. Instead, the aim of this article is to provide the reader with the tools to evaluate any particular player's injuries - present and future.

Concussions

One of the most common injuries suffered in the NFL is the concussion. Football is a collision sport, and sometimes a player's head gets slammed into the turf (or another player's helmet) hard enough to traumatize his brain. The aftereffects of concussions include problems like nausea, dizziness, and memory loss - repeated concussions can lead to brain damage. Another reason that a concussion is cause for concern is that, once a player has suffered a concussion, he is more likely to be concussed the next time his brain is traumatized. In other words, the damage from concussions is cumulative - the more concussions a player has suffered, any future concussion is likely to be even more debilitating. Indianapolis' Austin Collie suffered three serious concussions last season and ended up appearing in just nine games during 2010 as a result. The NFL has mandated a relatively new process of assessment for players who suffer a concussion, and the process has tended to add to the amount of time a player is off the field after suffering a concussion.

A big red flag should be raised in your mind by players with a history of multiple concussions - like Collie. In extreme circumstances, players are forced into retirement due to a susceptibility to concussions - the Jets' former receiver Wayne Chrebet is one example of a player forced out of the league due to concussions. He reportedly suffers from memory loss, headaches, lethargy, and other post-concussion symptoms brought on by his series of brain traumas. Brett Favre couldn't finish the season for Minnesota last year due to suffering a concussion late in the season. After the concussion he couldn't pass the post-concussion tests mandated by the NFL, and Favre has since retired from the NFL.

Neck/Spinal Column Injuries

Neck and spinal column injuries (pinched nerves also known as stingers or burners; bulging disks or herniated disks in the spine) are injuries that can cause a player ongoing problems. Stingers/burners tend to recur, and can lead to numbness in a player's extremities (which will often sideline a player). Damage to the disks (the flat, gelatinous cushions between back/neck bones that allow the spine to flex) is painful and can be dangerous to the spinal nerves, sometimes costing a player his season.

This offseason we are watching Peyton Manning very closely due to his second neck surgery over the past 15 months - the procedure was needed to fix a disc-related issue in his neck. Manning hasn't thrown the football at all since the surgery and is waiting until after the lockout is over when he can confer with team therapist Erin Barill before beginning any work on his passing mechanics/on-field exercises that might interfere with the ongoing rehabilitation of his neck. Due to the ongoing NFL lockout, Manning is barred from meeting with Barill.

Broken Bones

Some broken bones can be played through, but severe breaks or breaks in important regions of the body (like Frank Gore's broken hip from last season which landed him on IR November 30th of 2010) can knock a player out for a season. Many players play through stress fractures, which are a small crack in a bone. The key that determines length of recovery from a broken bone is how serious and complex a particular break is - if a player needs surgery with plates/pins inserted to stabilize the broken bone(s), he's likely to miss a lot of time. WR Deon Butler of Seattle suffered a gruesomely broken leg during week 14 last season, and had surgery on December 12th, 2010 that included inserting a rod into his broken leg to stabilize the double fracture he incurred. Though Butler's rehabilitation is reportedly going well, he acknowledges that he is probably not at the speed he was before the injury. Butler's career is threatened due to this particular instance of a broken bone. Another factor is involved is whether the break's location is critical to a particular player's position (defensive backs and linemen can sometimes play with a cast on their hand, for example, while wide receivers can't).

In the long term, properly-set broken bones don't usually lead to future problems (as meniscus injuries can, see below) - once a broken bone is healed, it is usually actually stronger in the area around the break than it was formerly, due to the extra calcification the body generates in the region of the break during healing.

Ligament/Tendon Injuries

Ligaments and tendons are known collectively as connective tissues; they hold our skeletons together and the muscles to the skeleton. Ligaments are tough bands of tissue that connect bones together. When you hear someone report that their elbow or knee is "sprained" or "strained" they mean that the connective tissues have been stretched, which causes discomfort and swelling in the joint. One common connective tissue injury is dislocation of the knee cap, which may cause tears in the ligaments attaching the kneecap to the leg, and may also generate "loose bodies" - chips of bone and chunks of torn cartilage "floating" in the joint - that irritate the joint and cause pain and swelling. The commonly heard term "arthroscopic procedure" refers to a surgery to remove loose bodies which relieves the pain and swelling. Players usually return fairly quickly after a joint is "scoped", as long as there are no complications. QB Jason Campbell dislocated his knee cap during the final weeks of the 2007 season - yet he played a full season with Oakland last year and is expected to be the starter during 2011.

Turning specifically to the knee joint, there are 4 ligaments in the knee. The anterior cruciate (ACL) and the posterior cruciate (PCL) are in the middle of the knee and provide stability to the joint, while the medial collateral ligament (MCL) is a broad ligament on the inner knee and the lateral collateral ligament (LCL) is the ligament on the outer part of the knee. WR Arrelious Benn of Tampa Bay is currently rehabbing a torn ACL suffered during week 16 of the 2010 season. Benn said on June 29th, 2011 that he is ahead of schedule in his rehab from the torn anterior cruciate ligament and expected to be at full speed at the start of training camp. "I'm past where I should be. I'm where I want to be. I can't be any better than where I am now. I definitely envision me being full strength and full tilt for training camp. I'm able to cut a little bit and get out there and run a little bit. I want to take it easy. It's still early. I feel good, but things in my knee still need to heal."

The elbow has its own set of ligaments that are subject to similar injuries, but they don't occur as often as knee injuries, since the legs bear the body's weight. The term 'dead arm' often is used to signify a problem with the connective tissues in a quarterback's throwing arm/elbow.

Looking at the shoulder, this joint has four muscles and their tendons which connect to the arm-bone/collarbone. The term "rotator cuff" applies to the set of muscles and tendons surrounding the shoulder. A tear of the rotator cuff means that one (or more) of the tendons has partially or completely separated from the bones or that the muscles have torn, or both - this can be cured by as little as a few weeks of rest or may require surgery and a long recovery. There are also ligaments in the shoulder which hold the bone in the socket. When someone has a dislocated shoulder, it means that the bone has squeezed out past the ligaments/socket, and needs to be popped back into the socket. Because the shoulder has a wide range of motion, the ligaments are stretchy - a dislocated shoulder does not automatically mean that the ligaments have been torn. However, if torn, the ligaments tear at the labrum, and have to be reattached. Carolina QB Matt Moore saw his season end November eighth last year due to a torn labrum in his right shoulder and the subsequent surgery to repair the injury.

A familiar ligament injury in football is the sprained ankle. Occurring when the foot is "rolled over" - bent beyond its natural range of motion - one or more of the many ligaments in or around the ankle are over-stretched or torn. Once a player suffers a sprained ankle, they are more likely to occur again. Many NFL players sprain their ankles during a typical season - recovery time can range from a week to months, depending on the severity of the sprain/tear. New Orleans WR Robert Meachem played in all 16 games during 2010, yet he underwent offseason surgery on his ankle to repair damage in the joint.

A high ankle sprain is a sprain/tear of the large ligament above the ankle that holds the two bones of the lower leg together. There are numerous examples of high ankle sprains suffered during the past season - Kansas City WR/RB Dexter McCluster suffered a high ankle sprain that caused McCluster to miss five games during the middle of the 2010 season, and he reportedly didn't have the same quickness and speed after returning to action. He hopes to have his ankle fully recovered by the start of the 2011 season.

The Achilles' tendon (the tendon at attaches the heel to the lower leg) can suffer injuries ranging from a sprain that causes pain and aggravation, but which can be played through - Carolina RB Jonathan Stewart has battled a sore Achilles for several seasons since joining the NFL, though he is reportedly finally healed heading into 2011 - to a torn tendon. A torn Achilles' tendon is a serious injury that requires surgical repair - Denver WR Demaryius Thomas is currently rehabbing a torn Achilles that was repaired February 14th, 2011, and he is not expected back on the field until after midseason (at the earliest).

Plantar Fasciitis is an inflammation of the plantar fascia - a thick fibrous band of connective tissue originating on the bottom surface of the heel bone and extending along the sole of the foot towards the five toes. This painful injury sidelined San Diego TE Antonio Gates for approximately half of the 2010 season (he appeared in 10 games, but wasn't able to play the full 60 minutes in some of them). The only treatment for plantar fasciitis is rest and recuperation off a player's feet.

An uncommon foot injury which can keep a player from placing any weight on the injured foot is the Lisfranc sprain, which is an over-stretching or tearing of a ligament in the foot. The injury can range from a mild sprain, treated by rest, to fracture-dislocations that require surgery and a long recovery.

Meniscus Cartilage Injuries

The meniscus is a plate-like slab of gelatinous cartilage that cushions the knee (there are two in each knee, actually), keeping the bones from banging together. If the meniscus is torn or ruptured, "loose bodies" - bits of cartilage and/or bone chips - can irritate the knee joint causing swelling, pain, or even "locking up" the knee. Arthroscopic surgery removes the loose tissue from the knee, reducing swelling and pain. WR Terrell Owens had knee surgery on December 20th, 2010 to repair torn meniscus cartilage in his left knee - he was placed on IR December 21st, 2010 (and has subsequently also had surgery to repair the ACL in his knee). The term "micro-fracture surgery" describes a surgical technique that creates many small fractures in the knee bone in an attempt to regenerate meniscus cartilage - New Orleans wide receiver Marques Colston is in the process of rehabilitating from a micro-fracture surgery in his knee during the 2011 offseason.

Bursal Sack Inflammation

A bursa is a pad-like sac found near a joint - there are hundreds of them throughout your body. Knee bursae are soft sacs in the knee area filled with lubricating fluid that facilitate motion and decrease friction. When a bursa becomes inflamed, the condition is known as bursitis, and the bursa loses its function of facilitating motion. Bursitis caries in degrees from a mild irritation to an abscess that causes excruciating pain, and the infection can lead to other problems if not properly addressed. Usually inflamed bursal sacks are treated with anti-inflammatory medication, but occasionally excess scar tissue may have formed in/around the bursa causing physicians to opt for surgical removal. This year, Green Bay WR Jordy Nelson is working to recover from a burst bursal sack in his knee that he suffered during the 2011 Super Bowl - "It's been fine," said Nelson on June 14th. "It was just a matter of time for the body to absorb all the swelling. I ruptured my bursa sac. I pretty much just popped a bubble full of fluid and it swelled up really bad. It's not preventing me from doing anything."

Hernias

Hernias are an injury of the groin. In severe cases, the abdominal muscles tear and the internal organs (intestines) exude out through the tear, which can cause intense pain. A serious hernia needs to be surgically repaired immediately, while less serious hernias (when the intestine can be pushed back into the body) aren't emergencies but will still require surgery to repair. Any hernia surgery would be likely to cost a player most or all of a season. Ex-Washington RB Clinton Portis was placed on IR November 24th, 2010 due to an abdominal/groin injury that was surgically repaired shortly after he went on IR.

Sports hernias are a chronically painful muscle tear in the area next to the pubic bone, and the buildup of scar tissue due to the injury can cause persistent pain if the player continues to practice/play in games. Rest can correct the condition, but as soon as heavy activity resumes, the pain usually returns. Treatment with medication or other procedures can help a player play despite the pain. Eventually, surgery will probably be required to repair the condition, with a recovery period measured in months. Arizona WR Early Doucet has spent the current offseason recovering from a surgery to correct a sports hernia - as of May 5th, 2011 Doucet was still dealing with the offseason sports hernia surgery/rehabilitation and was not attending teammate Larry Fitzgerald's workouts. Doucet was reported to be making progress in his rehabilitation, but he did not want to try to do too much, too soon.

Pulled Muscles/Hamstrings

Another common injury in the NFL is the pulled or torn hamstring. The hamstring is actually a group of muscles that run from the back of the thigh to the shinbone, and function to make your knees flex/straighten while running. The injury is a tear of the muscle, ranging from a microscopic tear (Grade I, least serious) all the way to a rupture of one or some of the muscles (Grade III, most serious). Symptoms include bruising, swelling, muscle spasms or an inability to contract the muscles. A player afflicted with a grade III tear or rupture may be unable to use his leg at all. Sometimes the tendon that attaches a muscle to bone is torn free - these sorts of serious muscle injuries will often require surgery to correct.

Other muscles are subject to tearing/rupturing - biceps, triceps and pectoral muscles are often torn by offensive and defensive linemen. Ex-Colts' S Bob Sanders suffered a torn biceps last season which required surgical repair and didn't play again during 2010 or in the postseason.

Conclusion

Clearly, it is critical to have solid backups on your fantasy roster, and to know when an injury is going to cost a starter playing time. Most experienced fantasy football owners draft the backups to their top draft picks as injury insurance, depending on their particular league's roster size and rules.

One thing is almost certain - at some point during 2011, your fantasy team will suffer a key player injury. Being prepared to fill the gap with another solid player will increase your chances of taking home the league trophy. On the other hand, failing to actively manage your roster of backup players (or missing out on a hot waiver-wire pickup due to some other owner's injury woes) could very well knock your club out of contention. Draft day is an exciting event, but it is far from the final effort necessary to ensure a winning fantasy team in the vast majority of cases. Keep your bench stocked with quality backups from week 1 forward, and you'll be ready for the almost-inevitable injuries that come along in every owner's fantasy season.

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