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Game-time decisions and unknown game-day workloads are among the most frustraing part of setting a fantasy football lineup.
There haven't been many through the first two weeks. But they are here now and if you're lucky enough to avoid the long list of skill position players who will be a late week decision this week, you won't be lucky for long. With certain injuries , it can be very difficult to guess whether the player and his team feel he's ready for his usual workload.
With that in mind, here are three things to consider when considering whether to start a player whose situation is unclear as kickoff approaches.
1. Is the player returning near the early end of his expected time of recovery?
NFL players re-aggravate hamstring injuries nearly 33% of the time, according to this study. Re-aggravations occur most often within the first ten days of return to play and the aggravated strain is often worse than the original injury. That’s likely because an NFL player is generally allowed to return to full football related activity when the injured muscle has recovered to about 95% of full strength (when tested against the opposite side of the body isometrically). A player returning at the early end of his expected recovery, then, is either an extremely fast healer or is pushing the limits of expectation. Without the benefit of hindsight, you’ll not know which. Consider an early return a red flag, unless…
2. Has the player made it through one or more football-related drills or a full practice without evidence of a setback?
A successful return to football related drills doesn’t guarantee that a player won’t re-aggravate a muscle strain. But making it through successive practices is a strong suggestion that the muscle in question has fully healed and is less likely to be prone to inflammation, tightness or more micro-tearing immediately after returning to play.
3. Does the player have a known history of muscle injury, re-aggravations, conditioning issues, or cascade injuries?
Some players are “tighter” than others. There may be a general lack of flexibility, a lesser innate sense of how to protect themselves when a hit is coming or when they extend their bodies, or something in the makeup of their tissue that increases the likelihood that they will tweak a muscle. A player with a long history of muscle strains or a player who’s already had a re-aggravation of his current injury should be considered a higher risk upon his return.
INSIDE THE INJURY REPORT
Reggie Bush | knee injury
It's difficult to draw any conclusions from the injury "information" that comes out of Detroit. Jim Schwartz talks about his player injuries in the deepest shades of gray possible and his players are seemingly under strict orders to do the same. Here's what we know: Bush took a hit to the front of his knee Sunday and the joint hyperextended. He was cleared to return but didn't have his usual explosiveness and called it a day. He's had an MRI that showed "no structural damage" and tweeted four thumbs up shortly before the MRI "result" was reported. The only official word from the team came from Schwartz, who said that the injury won't be a long term issue but "could be medium term." And Bush didn't practice on Wednesday. Just how much of that is meaningful for Bush's Week 3 playing status is hard to say.
The "no structural damage" line we often hear about knee MRIs isn't specific. Generally, it means only that there's no tear in the ACL. It sometimes, but not always, means that there's no other ligament damage. And it doesn't mean that there are no bone bruises around the knee or damage to the cartilage inside the joint. I'm not sure what to make of the "medium term" comment. That leaves open the possibility of an injury that could take 2-4 weeks to heal.
For now, I'm going to hold off on too much speculation. If Bush doesn't practice at all this week and is ruled out before pregame warmups Sunday morning, I'd start to be concerned that it's a multi-week injury (a Grade 1-2 MCL sprain or significant bone bruise). Best case scenario is probably a decreased workload this week after a limited week of practice. Watch the practice participation reports closely or follow my Twitter timeline as the week progresses. I'll have -- hopefully -- a clearer take on Bush in the Sunday Injury Expectations feature this weekend.
Larry Fitzgerald | hamstring strain
Fitzgerald is playing with fire. Players are generally held out of full contact practices and games until their injured muscle is at 90-95% strength when compared to their healthy side. Fitzgerald said that he "wished" he was 80% after failing to finish last week's game. He also said he'll continue to play. Players that aren't near full strength are at significant risk for an aggravation and a higher grade injury. Based on what we've seen and read from Fitzgerald, he probably has a low-mid grade strain. That's an injury that often needs 2-4 weeks to heal. Cross your fingers that Fitzgerald doesn't play himself into an extended absence.
Ray Rice | hip flexor strain
The Ravens are apparently not worried enough about Rice's injury to grade it with an MRI exam. But Rice reacted to the injury as if it were more severe and John Harbaugh has said that Rice may not practice this week. Given the extreme precaution the team would likely take with any meaningful injury, I think the decision -- assuming it's not a misleading bit of information -- is a very positive sign that the strain is low grade. But it's not an injury to fool around with and risk aggravation. It won't be surprising if Rice doesn't see the practice field until Friday, if at all, and if Bernard Pierce is ready to go, we could see the Ravens rest Rice as much as possible this week.
Eddie Lacy | concussion
Andre Johnson | concussion
Though you may hear and read otherwise this week, we no longer grade concussions or classify any head injury as mild, moderate or severe. Instead, think of concussion in terms of symptoms. More symptoms and prolonged recovery from any symptoms means a longer recovery. There are times where a single, non-debilitating symptom that takes longer to clear than expected is more meaningful for recovery purposes than when a player is knocked out on the field, confused for 30 minutes then symptom-free the following morning.
Some teams will tell us where a player is in their recovery and to what stage they've progressed on the return to play protocol. Positive signs for a concussed player might include a quick return to light exercise (i.e. Andre Johnson being cleared to ride a bike on Monday morning) or an indication that a player is scheduled to see an independent neurologist by Friday morning. It's a five step process to gain clearance that relies on a 24 hour interval (minimum, may be longer at the discretion of the team physician) which makes it tough for a player to play the following weekend.
Reading the tea leaves this week, Johnson looks much, much more likely to gain clearance than Lacy. The Packers' Week 4 bye may also play a role in Lacy's recovery timetable. Regardless, a player cannot be cleared for contact until Friday morning after a Sunday game, so nothing will be certain for either Johnson or Lacy until then.
Steven Jackson | quad strain
The Falcons called this injury a bruise on Sunday, but I'm not buying it. It's possible he took a hit earlier in the game and had a contusion that then caused some muscle cramping, but there was no hit to the thigh on his final carry before leaving the game. It looked like a strained muscle. Given Jackson's extensive history of early season muscle strains and the 2-4 week timetable we're already hearing, a quad strain is the likely diagnosis. And the 2-4 week timeframe suggests a Grade 2+ injury. Jackson hasn't bounced back quickly from his previous injuries so it's best to bet on the over right now. The Falcons have a Week 6 bye; I'd put the early line on Jackson's return at Week 7.
Maurice Jones-Drew | foot tendon strain
The television replays didn't show a clear mechanism of ankle injury for Jones-Drew, so it's not surprising that his condition isn't a straightforward ankle ligament sprain or high ankle injury. Think of this injury along the continuum of what Jamaal Charles suffered this preseason. Though we don't have the location of the tendon injured or a grade of injury, early reports suggest it's a low grade injury in a relatively less concerning area of the foot -- i.e. not a midfoot location or related to his early 2013 Lisfranc repair. He's tentatively expected to play this week, but it's likely his workload / effectiveness will be decreased.
Danny Amendola | groin injury
Multiple sources broke news last weekend on the conflicting opinions about whether Amendola's groin injury was a sports hernia (more specifically, a tear of one of the core muscles in his lower abdomen) and would require surgery or not. I'm not certain there's been any clarity on that question, but Amendola has decided against surgery and will attempt to rehab the injury and return in 2-4 weeks. I see multiple reasons for concern here.
Core muscle tears -- and the torn adductors reported by Jay Glazer arguably fall into that category -- can be rehabbed but it's difficult to do so successfully. Most prominent sports hernia surgeons recommend surgery. But it's no surprise that Amendola chose otherwise. We've seen him react very strongly to injuries -- slamming his helmet down after last year's serious sternoclavicular dislocation and telling anyone who'd listen that he'd be back in 1-2 weeks after dislocating his elbow in 2011. The risk here is that Amendola rehabs for 2-4 weeks and isn't able to return or again aggravates the injury shortly after returning. If Amendola needs surgery at that point, you can tack on another 4-8 weeks of rehab.
Supersititious Amendola owners may want to get out their rabbit's foot.
Malcolm Floyd | cervical neck strain
Floyd's injury was scary, but it reportedly didn't involve any damage to the spine itself or result in any swelling in or around the spinal cord. Either of those injuries could have been devastating and ended his career. Despite the good news, Floyd's cervical strain is significant enough to need a cervical collar to assist in healing and there's no timetable for his return. He won't be back until his muscles regain enough strength and range of motion without pain to allow him to protect himself from a similar blow to the head or neck. That may not happen for another 1-3 weeks.
Dwayne Allen | hip injury
Despite the mechanism of injury looking like a contusion (hip pointer), there's clearly something more going on with Allen, who will reportedly need hip surgery and was placed on injured reserve this afternoon. The Colts are more tight-lipped with injury information this year and we may not get a specific diagnosis. Possibilities include a subtle fracture or minor labral tear or a variant of the hip impingement syndrome that we've heard so much about this year with Brandon Marshall and Percy Harvin. Hip surgeries are sometimes associated with delayed complications or unexpectedly long rehab times (see Ed Reed's labral surgery) but Allen should be back healthy for 2014.
AROUND THE TRAINING TABLE
Vernon Davis has a low grade hamstring strain and the team hopes he'll be able to play after a week of treatment. ... Rob Gronkowski continues to progress toward his first playing time of the season, but there's no indication that it'll come before Week 4. ... Hakeem Nicks will be dealing with more pain and swelling this week than immediately after his dislocated finger last week. He's unlikely to practice much, but should be ready to play on Sunday. ... Jermichael Finley was moving well on his turf toe injury last week. There's still a risk of aggravation, but his Week 2 effort is reassuring that the injury won't linger. ... Brandon Weeden has been ruled out this week with a thumb sprain. The injury could linger for another 2-3 weeks. ... Blaine Gabbert needs at least another 7-10 days before his hand will heal well enough to allow him to throw.
IDP ROUNDS
Kroy Biermann and Charles Godfrey are out for the year with Achilles injuries. ... Tyvon Branch (fractured fibula) and Sean Weatherspoon (foot sprain that sounds suspiciously like a Lisfranc injury) are out indefinitely. Weatherspoon was placed on the IR with a designation to return. ... Morgan Burnett continues to struggle to get back with what could be a mid-grade hamstring injury that could cost him another 1-2 weeks. The news is better on Nick Fairley, Manti Te'o, Quinton Coples, Jairus Byrd, Ed Reed and Chris Clemons, all of whom are closer to returning than last week. ... Duke Ihenacho left last week's game with an ankle injury, but he's tweeted that the injury is minor and he expects to play this week. ... Keep an eye on the status of Arthur Brown, who isn't practicing with a pectoral strain.
Follow on Twitter @JeneBramel for breaking injury news, updates and analysis. Check back Sunday morning for my expectations on Dez Reggie Bush, Ray Rice, Larry Fitzgerald and the week's game-time injury decisions.
