There are multiple chapters to every injury story.
The story begins with the mechanism of injury. Sometimes, the medical staff sees the injury happen but they must often rely on the player's story and (at higher levels) a look at the television replays. A clear idea of the mechanism can help target the on-field or locker room exam. From there, decisions on imaging studies, bracing and taping and whether or not a player can return to the game are made.
Following the game, the same process occurs. More exams, more imaging studies and early treatment plans are put into place in the training room after the game and early the next morning. Still more specific imaging studies, specialist visits, surgery and the beginning of the treatment process follow. And there are regular reports on the rehab and recovery process in the days and weeks that follow.
As fans and observers, we get the Dead Sea Scrolls version of the book. Entire chapters are missing. Even when part of the story has been nearly entirely preserved, a phrase key to the translation is gone. When we ask questions of those involved in the excavation and translation, we're sometimes deliberately sent to the wrong cave or a public relations liaison makes a mistake and we're unintentionally given a misleading translation.
With luck, the more translations you see and the more mysteries you solve, the better you become at filling in the details to the story. That's my goal with this feature each week.
inside the injury report
Danny Amendola | strained groin
I wrote Monday that I strongly doubted that Amendola would be able to play Thursday night. A number of readers and Twitter followers sent me messages challenging that speculation, correctly noting that Amendola played very well through the injury and was a vital part of the New England comeback in Buffalo.
That, of course, cannot be denied. But it doesn't mean that Amendola's injury is minor. Here's why.
Studies on NFL players with muscle strains -- hamstrings in particular, but the physiology applies to all muscle injuries -- show that players are at highest risk of aggravating their injury in the first 7-10 days back to play and that the vast majority of aggravated muscle strains are worse than the initial injury. That's not a new statement to those who have read this column in past seasons.
I think it was evident that Amendola looked progressively more limited as the game progressed. How did he play through an injury that could limit him more significantly later? Adrenaline, pain tolerance and guts play a big role. But a warm muscle can function reasonably well before inflammation and swelling set in. That's why you see players on the exercise bike during games. That only works for low grade injuries and it's a great long-term sign that Amendola was able to play through his injury. But it's extremely difficult to successfully treat the inflammation and muscle spasm that inevitably occurs after the player cools down in a span of 3-4 days.
If you're an Amendola owner, you don't want him on the field this week risking an even worse aggravation. And you should be hoping that the injury is still low grade enough to allow him to practice and play in Week 3. That's not guaranteed either.
Dez Bryant | sprained foot
In the opening to this week's column, I wrote about the many factors that go into diagnosing an injury and formulating a return to play plan. Well, carrying on a tradition I learned from listening to Bill Cosby as a kid, I told you that story to tell you this one.
Though we never get complete information from the player, team or media in the early stages of an injury, there are clues that can narrow things down. In Bryant's case, what was first called an ankle injury would later be reported to be a foot sprain after his negative x-rays. The mere whisper of a foot sprain causes conniptions now (another Cosby term), especially when it's associated with the phrase "awaiting an MRI." The immediate concern becomes midfoot, Lisfranc, etc.
But as we saw with Jamaal Charles this preseason, all foot sprains are not to the midfoot. And I think that's the case with Bryant. The mechanism of injury was more consistent with an injury to the outside of the foot or ankle and the quick tape job Bryant returned to the field with suggested the same. Acknowledging that midfoot injuries are difficult to diagnose on the sideline, I think it's unlikely Bryant has that type of injury and I think we can reasonably consider Bryant day-to-day until we see practice participation evidence to the contrary.
Get a plan B in place for Bryant this week just in case and I'll have more updates on Twitter throughout the week and in the Sunday AM notes column.
I still use quotes from that Bill Cosby bit every week, by the way. There may be funnier comedians, but I'm not sure any comedian was a better storyteller.
Shane Vereen | wrist injury
On Monday, I was reluctant to offer a specific timetable for Vereen. There are multiple bones in the wrist and some heal more quickly than others. There can also be a big difference in the repair and recovery of a fracture versus a dislocation. While we still don't know specifics on Vereen's injury, the Patriots were worried enough about his timetable after surgery to put him on the injured reserve list with a designation to return. That means Vereen cannot return to practice until Week 8 and he won't be able to play until Week 10. Since the Patriots have a Week 10 bye, the earliest we'll see Vereen in uniform is Week 11. That narrows down the timetable some, but it's not definitive.
The Patriots have enough nagging injuries that carrying Vereen on the active roster for an optimistic 4-6 weeks wasn't a good option. More likely, it means that Vereen's injury carries a 6-10 week recovery timetable. If that's the case, it will be critical to see if Vereen is cleared for practice in Week 8. If he isn't, we could see his absence stretch toward the ten week range. The good news is that Vereen will not be at high risk of re-injury whenever he returns. If you're deep enough to carry Vereen as a RB5 through the bye week portion of your schedule, hold him. Otherwise, you'll have a much tougher decision.
Roddy White | high ankle sprain
I wrote lots of editorial thoughts on the Sunday developments on White in the Monday column, so I'll keep today's entry short. All evidence now suggests that White had a mid-grade high ankle injury. He's over four weeks into his recovery and should be getting close to a full return. However, until we see him practice fully for consecutive days or see evidence that the Falcons trust him to run his full route tree, he's an extreme boom-bust fantasy play and should probably be avoided for any receiver likely to see more than 4-5 targets.
Reggie Bush | strained groin / thumb dislocation
Bush minimized his injuries in early week press conference, suggesting they were just another day in the life of an NFL running back. Although the Lions under Jim Schwartz have never been straightforward with the media regarding injuries, there's enough evidence to be reassured here. I listed Bush's groin injury as a strain, but it could have been nothing more than some general soreness and mild cramping. He didn't appear to be limited at all when he split the Minnesota defense on a short pass play and ran away from everyone late in the game last week. And there's been no indication that the thumb injury involves a serious ligament sprain or fracture. The major risks this week would be missed snaps if the groin tightens up and possible ball security issues due to the thumb injury. Barring a pessimistic week of practice, plan on Bush getting enough playing time to be used in fantasy lineups as usual.
Rob Gronkowski | herniated disc
I wouldn't have been surprised if the Patriots accelerated Gronkowski's timeframe given the injuries to Amendola, Vereen and Zach Sudfeld. But they're sticking to whatever game plan they have for Gronkowski. There's no indication that he's preparing for the Thursday game and New England added a tight end off the practice squad this week. Hope to see Gronkowski back -- and in form -- by Week 3 or 4.
Tony Romo | rib contusion
This is the third consecutive season that Romo has taken a damaging shot to his rib cage. Two years ago, Romo was limited by cracked ribs and a collapsed lung on his right side. Last year, he cracked ribs on his left side. This year's injury isn't as significant -- tests showed no broken ribs or deeper injuries -- but it will still be painful to play through. Romo's numbers weren't as good in the week after his rib injuries in each of the past two seasons. While Romo is very likely to take a pain-killing injection and play in Week 2, you may want to consider other options in your lineup this week. The Cowboys go on the road to face a Kansas City front seven that dominated the Jaguars' offensive line last week.
Jamaal Charles | quad injury
Charles was also checked for a concussion on the sideline last week. He was cleared, so that should be a non-issue this week. Will Carroll has Charles' injury as a contusion rather than a strain. Though contusions can bloom into painful and longer-lasting injuries within the first 48 hours, they're generally associated with quicker recoveries and carry less risk of aggravation than muscle strains. If Charles is practicing fully by the end of the week, you can trust him in your fantasy lineup.
Le'Veon Bell | foot sprain
Local writers in Pittsburgh reported earlier this week that Bell had yet to return to individual drills yet. It's not surprising. Some skill position players progress quickly through non-weight bearing rehab for midfoot sprains. Others recover more slowly. The latest report from the Tribune-Review quotes a source that says Bell does have a Lisfranc injury. I'm surprised he was allowed to weight bear as quickly as he was if that's the case, but it's a pessimistic report. Bell's practice participation is a good benchmark for his progress. Until he begins doing more strenuous football-related activity, consider him at least two weeks from returning. Recovery timetables for midfoot injuries are always fuzzy. Bell's just got even fuzzier. At this point, it's very unlikely we'll see him before Week 6. The bigger issue may be the state of the Pittsburgh offensive line. There may not be much running room or enough touches for Bell to hold RB2 value when he returns.
around the training table
I'm waiting to hear more on Daryl Richardson, who left briefly to have his toe taped last week. He finished the game, but toe injuries can be problematic for running backs. ... We're still waiting for a verdict from Dr. James Andrews on Mark Sanchez. If a labral tear is confirmed, Sanchez will be out for an extended period and possibly for the season should he elect to have surgery. ... Dwayne Allen's injury sounds like a hip pointer (contusion). Some of those are more painful than others, but early reports suggest he'll try to practice and play this week. ... Heath Miller is increasing his practice participation as he reconditions for a return. He has a better chance that Bell to make it back before the team's Week 5 bye. ... Jacoby Jones will be out for at least a month with a mid-grade MCL sprain. Marlon Brown is a strong boom-bust pick in his absence.
IDP rounds
I'm awaiting practice reports on Cliff Avril, Anthony Spencer, Pat Angerer and Morgan Burnett. None are guaranteed to be ready this week. ... Barkevious Mingo had reassuring followup scans and has been cleared for contact. He'll need to recondition and won't see many snaps until he's back in full form. ... The Bengals are calling Vontaze Burfict's injury a thigh injury. Local reports are calling it a deep muscle bruise. He'll have an extra day to recover before Monday night, but have a hedge in place. ... Larry Foote is done for the year with a ruptured bicep. The Steelers may turn to a committee to replace him. ... Morris Claiborne may not have any collateral damage to his shoulder after last week's dislocation, but it's a stretch to think he'll be able to play cornerback with a harness this week.
Follow on Twitter @JeneBramel for breaking injury news, updates and analysis. Check back Sunday morning for my expectations on Dez Bryant, Reggie Bush and any other game-time injury decisions.
