Injury Report Insight: Week 1

A critical look at this week's injury report.

Finally, some real football. More importantly, finally, some real injury reports. Make no mistake, there's plenty of gamesmanship to be had in these reports, but they're still one of our best tools for figuring out how serious an injury is and how close a player is to returning. John Fox can say all he likes about how minor a player's injury is, but if the player isn't practicing, we'll finally have some visibility of that.

Before we dive right in though, I should probably introduce myself. I'm an NFL injury blogger, if there is such a thing. I'm always quick to point out that I am not a doctor. I've learned everything I could about the medical side, but my true focus is in adding historical comparison to injuries and projecting realistic return-to-play estimates based on these historical trends. The cheat-sheet I often work from when doing this is a database that I built, which currently has more than 4,000 NFL injuries, mostly from 2010 to present. I've always followed and admired the work of Footballguys in-house doctor, Dr. Jene Bramel, and I'm hoping that I can add a perspective that is complimentary to his already great injury coverage. Dr. Jene will still be doing plenty of injury coverage, so don't fret if you're a big fan of him. Now let's jump right in and discuss some of the big injury concerns for Week 1.


LeSean McCoy, hamstring strain

There are disputing reports about the severity of LeSean McCoy's hamstring strain. ESPN's Josina Anderson reported that an MRI revealed a small tear. But then she went on to say that the tear was in a good location, "kind of high up, surrounded by stronger muscles in the glutes and things like that." As Dr. Jene Bramel pointed out when he diagnosed a high hamstring strain by video, high is not good. Strains that occur towards either end of a muscle are more likely to involve tendon damage, and tendon damage can take longer to heal. McCoy suffered the injury on August 18th, and sat out the final three preseason games. Has that extended absence been long enough for McCoy to rest and rehab? As of Wednesday, Rex Ryan seemed to think so, stating that McCoy would be, "ready to roll." The most objective answer though might be in the injury report. Wednesday's Buffalo injury report indicates that McCoy put in a full practice. At this point, I'd say that in order to be confident that McCoy will return to a full role, we'd want to see him participate in full for at least one more practice this week. As it stands now, McCoy's status is more optimistic than I would've thought just a few days ago. There's still the chance though that McCoy only receives limited carries and shares the load a little.

Karlos Williams, undisclosed operation

Karlos Williams is not the sort of player that would usually get thrown into the injury spotlight, but he has some importance this week, as he's LeSean McCoy's primary backup in Buffalo. McCoy is looking better than we might've expected, but we should still take a minute to look at the next man up. Williams was sidelined the last three preseason games with a mystery medical condition which was usually only referred to as an, "undisclosed operation." Personally, I suspect it was a testicular torsion, and I wrote about that in more detail here. Regardless of what the underlying medical condition was though, Karlos Williams is no longer listed on the latest Buffalo practice report with any injury. That is a great sign, as it indicates that his injury isn't limiting him in any way. Perhaps it's safe to wonder if either running back will get a full load of snaps, as it might be better to turn to a running back by committee since McCoy and Williams both have such recent injuries.

Alshon Jeffery, calf strain

The Bears fooled me. I was sure that Jeffery was dealing with a serious calf injury and would not play this week. Jeffery didn't play the entire preseason with a calf strain that the Bears general manager Ryan Pace categorized as mild. Jeffery was spotted wearing a walking boot and using crutches back on August 14th, and that's never a great sign. Perhaps the Bears were just being cautious with Jeffery's recovery. Maybe I'm still just a tad suspicious because the Bears denied the extent of Kevin White's injury for so long. But from a historical perspective, I can tell you that Jeffery really should've been back by now if this injury was as minor as the Bears were saying. Of all the calf strains that I have logged in my database, less than 20% of them missed this much time, though I need to point out that the other injuries I'm comparing it to generally occurred during the regular season. As we all know, preseason absences don't necessarily mean much. To make things even more confusing, Ian Rapoport reported on Tuesday that, "Jeffery is progressing well from his calf injury. The hope is he'll play Sunday vs GB & he's making strides to get there." This report was of little help to us, as it didn't outline exactly what strides Jeffery was making. When Rapoport tweeted that, Alshon Jeffery was still not practicing and still not talking to reporters. The fact that he missed practice Monday is more telling than anything else we've heard. Just when I was ready to make the pessimistic call on Alshon Jeffery though, he practiced. He was able to practice on Wednesday, but it appears he was limited, as he wasn't in full pads. Now I don't know what to make of this situation. I still think the Bears were intentionally downplaying the severity of Jeffery's injury. But that might not matter, as he might finally be ready to play now. As with plenty of other injuries in the NFL, we will have to watch what happens the next two days to really get a better idea of Jeffery's health. If he continues to put in only limited practices, it's hard to imagine him getting more than limited playing time on Sunday. If he is able to practice in full, even just once, it bodes much better for his chances to really show up on Sunday. Don't bother listening to what John Fox has to say though, as he's proven that he probably is not someone to trust when it comes to injury clarity this season. 

Joique Bell, Achilles surgery, knee surgery

Bell has been on the shelf all preseason as he recovers from two surgeries. I originally felt that the more serious concern was an Achilles surgery from either January or February, as it might indicate future Achilles problems. Dr. Jene Bramel went a different route, and did some injury sleuthing that frankly made me envious. He seems to feel that the most likely limitation Bell is currently facing is his recovery from a January knee operation, which Dr. Jene hypothesizes to be a microfracture procedure. His reasoning is solid, and I'm inclined to agree. Microfracture surgery might not be the death sentence it once was for athletes, but it's still mostly a last-ditch effort to squeeze some remaining miles out of an aging player. The procedure involves intentionally damaging the interior of the knee in an attempt to stimulate the knee to produce new cartilage in order to heal itself. This is the same surgery that Vontaze Burfict and Jadeveon Clowney are currently rehabbing from. Obviously, no two injuries or players are exactly alike, but it's notable that Burfict and Clowney, even if they return as soon as expected, will both be more than nine months removed from their surgery. Exact dates with Joique Bell are unknown, but the earliest reports of any knee surgery were mid-January. Projecting that forward with a nine-month return-to-play (which is still optimistic based on historical comps) would put Bell returning sometime around mid-October. Obviously, recoveries don't listen to my projections, so take this all with a grain of salt. But, based on that background, I'll believe that Joique Bell is ready to play when, and only when, I actually see him play. In the meantime, rookie running back Ameer Abdullah might have all the time he needs to cement himself as a legitimate starter. In an odd twist, I see that Joique Bell wasn't even listed on the most recent Lions practice report, meaning that he is no longer injured. Even if Bell's knee is feeling better, I would expect him to see limited snaps, as microfracture surgery return is not something that any team would rush.

Arian Foster, core abdominal surgery

It seems like the outlook for Arian Foster changes every week, whether there's a good reason or not. Foster underwent surgery for a sports hernia back on August 7th, though people still seem to enjoy arguing about whether this was a sports hernia surgery or a groin surgery. I'm here to tell you that, in terms of his expected return-to-play, it doesn't really matter so much exactly what we call the procedure. Also, those distinctions are splitting hairs, as sports hernia surgery, groin surgery, and core abdominal surgery are all on the same spectrum. The medical expert in this realm is Dr. William Meyers, and he is the one who performed Foster's surgery. Plenty of players have had the same procedure from Dr. William Meyers, which makes it easy for me to shed some light on the typical return-to-play for this procedure. From a recent historical standpoint, the most appropriate estimate here would be that Foster would return after missing 5-8 weeks. A lot of estimates tend to be, "4-6 weeks," but, historically at least, very few players hit that four week mark. Projecting this 5-8 week estimate forward, that would mean that, barring any setback, Foster would likely return around Week 2 to Week 5. This is pretty much in line with what Dr. Jene Bramel has been saying from the start. Unless there is a reported setback, just stick with this time frame and tune out any random updates you might hear.

Zach Ertz, Core abdominal surgery

Similar to Arian Foster and Jason McCourty, Eagles tight end Zach Ertz is rehabbing a sports hernia surgery. In fact, just as with Foster, Ertz's surgery was performed by Dr. William Meyers. While Foster had his surgery on August 7th, Ertz's surgery wasn't until one week later, on August 14th. Yet somehow we're already hearing reports that Ertz has been cleared to practice and might play in Monday night's game at Atlanta. Why the difference in possible return between the two players? Well, for one, it's thought that Ertz's injury was a little less severe, as written about by Jeff McLane. Also it doesn't hurt that the Eagles don't play until Monday, giving Ertz an extra day to possibly practice. But remember what I said about how few players ever return right at the four week end of the, "4-6 week," estimate? It's a great sign that Ertz is cleared for practice. But in reality, he's far more likely to come back in Week 2 or even Week 3 than he is to make his return on Monday. Since the Eagles don't play until Monday, the team's first official practice report won't come out until Thursday. I would expect it to have Ertz getting in only a limited practice. Once he starts practicing in full we can get a better idea of when he'll truly be ready to play.

Mike Evans, Hamstring strain

Tampa Bay wide receiver Mike Evans suffered a hamstring strain on August 24th in a Week 2 preseason game. All reports, such as this one from Lovie Smith, were that it was minor, and that Evans' absence from the remainder of the preseason was nothing but precautionary. That all sounds legit, and it would be the smart way to treat a hamstring strain. Recent practice news though makes me think this injury might not have been as mild as reported though. Evans missed practice on Monday and Wednesday (no Tuesday session) so it's hard to imagine that he'll be in the lineup on Sunday. Beyond that, it's too soon to tell. If Evans gets practices in any capacity on Thursday or Friday it might give a glimmer of hope that he'll play, but I'd stick with a healthy dose of skepticism on this one.

Victor Cruz, calf strain

Finally, an easy one. Victor Cruz, in an attempt to return from a torn patellar tendon, can't seem to get his legs healthy. This isn't uncommon with recoveries from injuries as drastic as the one Cruz suffered. The Giants have labeled Cruz's leg ailment as cramps, inflation, and now a strain. No matter what they chose to call it, Cruz isn't practicing, and coach Tom Coughlin doesn't seem to have any idea when that might change. Until Cruz starts stringing together some consecutive practices, even in limited capacity, we can safely assume that he won't be playing. To make matters even more pessimistic, ESPN's Dan Graziano points out that, due to the Giants having a Week 3 Thursday game, there are not a lot of practice days left in the near future. As Graziano speculates, that could mean that Cruz's most optimistic return is now the Week 4 game at Buffalo.

Tre Mason, Hamstring Strain

Rams running back Tre Mason suffered what was called a mild hamstring strain back on August 29th. Mason then missed the preseaon finale, which wasn't a cause for alarm at the time, as Mason's roster spot was secure. The odd development came when head coach Jeff Fisher stated that Mason was questionable for the season opener two weeks in advance. Hamstring injuries have a habit of lingering, and Fisher's cautious approach was certainly the responsible way to handle this injury. Still, calling a player questionable that far in advance due to a muscle strain is rare in the NFL world. Fisher has not really changed his tune since then. Mason did not participate in Wednesday practice, so we have no reason to think that he'll play this Sunday. Luckily for Mason, Todd Gurley has already been ruled out, so the chance of Mason getting Wally Pipped is low.

Devonta Freeman, Hamstring strain

As with many of the other hamstring strains in this article, Devonta Freeman's injury was originally downplayed as relatively minor. Freeman's injury was enough to keep him out of all four preseason games, which certainly makes it seem like it might've been more severe than originally thought. One thing that Freeman has going for him though is that it has been reported that he has been practicing since about mid-August. There are no practice reports during the preseason, so we can't confirm the level of Freeman's participation. Also, since the Falcons don't play until Monday night, they have yet to file an official practice report for Week 1. They will do so on Thursday, and hopefully we will see Freeman listed as a full participant, or perhaps we won't even see his name at all on the report. If either of those are the case, he will certainly play on Monday. Unfortunately for Freeman, the Falcons have already announced Tevin Coleman as their starting running back, which makes me suspect that Freeman is still not ready to play.

C.J. Spiller, knee scope

Saints running back C.J. Spiller has a mysterious knee injury, and we have yet to receive any information that gives us clarity. We know that Spiller underwent a knee scope procedure back on August 14th. But we still have no idea what the purpose of the procedure was. It's very possible that this was a relatively minor, "clean up," procedure in which a doctor removes loose bodies or trims a meniscus. These procedures are common in the NFL. But the fact that Spiller has yet to practice in any capacity is starting to make me wonder. We're nearly at the one month mark since his surgery, and he seems nowhere close to returning. There are reports that he will be back for Week 2, but at this point, they're only that... reports. If Spiller is not practicing next week, I think it's fair to wonder if his knee procedure was either more extensive than we thought (such as a meniscus repair) or that Spiller is not responding well to the treatment and possibly suffered some sort of setback. I'll be keeping a close eye on the Saints practice reports next week.

Randall Cobb, AC sprain

Green Bay fans and Cobb owners can finally exhale and relax. All accounts so far seem to indicate that Cobb escaped with only a minor injury and that he should be fine to play Week 1, as well as the rest of the year. AC sprain recoveries usually revolve around pain management and tolerance, so when Cobb is back, he's back. This is not an injury that typically involves a lengthy rehab or surgery. In fact, most players simply chose to play through minor AC sprains, so Cobb's two weeks off should be more then plenty to allow him to return at 100%. There is an increased risk of re-injury with AC sprains, but Cobb's time off should help to alleviate that concern at least a little. Cobb put in a limited practice session on Wednesday, and while I'd be more comfortable if he had practiced in full, I see nothing alarming here. Limiting Cobb's practice is a smart, conservative move, as it reduces the chances of him taking a hit and re-injuring his shoulder. He should be ready to go for Sunday, even if he never gets a full practice under his belt.

Michael Floyd, dislocated fingers

I nominate Arizona wide receiver Michael Floyd for the grossest injury of the year, or at least the preseason. On August 5th, Floyd suffered a gruesome injury in which three fingers on his left hand were dislocated and punctured through the palm of his hand. This is the kind of injury that leaves me dumbfounded when asked what sort of return-to-play we might be looking at. No other NFL players that I know of have had this sort of injury. Because of the unique nature of this ailment, we're left to just monitor the practice reports and see where Floyd is currently at in his activities. On Wednesday, Floyd put in a limited practice. On it's own, that means little, but when you combine it with a report from last week that Flyod was catching, "light passes," you can figure that he's getting close to returning. Without having a few full participation practices behind him, I'm not comfortable saying that Floyd will return for any significant playing time, but he could certainly be ready for a small number of snaps in order to gauge how comfortable he is with his hand.

Breshad Perriman, PCL sprain

Ravens wide receiver Breshad Perriman injured his right knee back on July 30th. After a few weeks of, "injury musical chairs," the Ravens finally diagnosed Perriman's condition as a PCL sprain. He has yet to practice this season, and ESPN's Jamison Hensley guess that the earliest we might see Perriman return is October. I can tell you that, from a historical perspective, PCL sprain recoveries are tough to predict. Some players miss zero games with PCL sprains (Trent Murphy, Stephen Bowen twice no less!) while others miss up to eleven games (Todd Heap). Another problem in trying to speculate with this injury is that it's just not that common. Within the knee, the PCL is stronger than the ACL. Often, a force that is traumatic enough to injure the PCL also tears the ACL, resulting in an extended rehab. PCL sprains without additional ligament damage are somewhat rare in the NFL. To make matters even more confusing, Baltimore coach John Harbaugh has done nothing to shed any light on the subject. In another piece from ESPN's Jamison Hensley, Harbaugh said that there's no timetable for return, but then immediately muddies the waters by saying that he thinks Perriman's return isn't far down the road. So which is it? As Dr. Jene Bramel has pointed out when talking about Perriman, these are the situations where you need to ignore all the words and simply focus on the practice reports. Once you see Perriman putting in consecutive full practices, that's when he's finally close to returning. He did not practice on Wednesday, so obviously we're still a ways off.

Lorenzo Taliaferro, MCL sprain

This weekend, Taliaferro will be three weeks removed from an MCL sprain he suffered during the preseason. MCL sprains typically come with a return-to-play estimate of about 2 to 4 weeks. That meshes pretty well with the numbers in my database, though this in an injury that varies pretty widely, so you'll find plenty of players that missed no time, and more than a handful that missed in excess of four weeks. Without knowing more details about Taliaferro's specific rehab, I'd think that we're right in the sweet spot for him to return to play. Trouble is, at least as of Wednesday, Taliaferro still isn't practicing in any capacity. As with many of the others in this piece, I'd say that Lorenzo Taliaferro can safely be ruled out until we've seen him put in some solid practices.

Bryan Stork, Concussion

I wouldn't usually spend much time breaking down offensive line injuries, but I see some possible implications in this one. Consider this the, "dark horse injury of the week," I guess. New England center Bryan Stork missed the entire preseason with a concussion this year. It seemed as though Stork had recovered fully and been cleared for contact before he suffered a setback and reentered the NFL's concussion protocol. On Wednesday, the Patriots sent Stork to the injured reserve, designated for return list, meaning that Stork cannot return until Week 9 at the earliest. This is scary stuff, and even scarier when we're reminded that Stork missed two games with a concussion last season. It's tough not to be pessimistic as to how much time Stork might need to recover this time around. Beyond Stork's health though, this loss creates a less-than-ideal situation for the Patriots offensive line. Facing the Steelers Thursday night, the Patriots will be forced to either start undrafted free agent David Andrews at center, or to shift Ryan Wendell over from guard. Wendell is a versatile player, but there's a reason that Stork beat him out of a job back in 2013, thereby pushing Wendell to guard. Even if the experienced Wendell does start at center, that still leaves an unproven rookie to fill in at guard, either in Shaq Mason or Tre' Jackson. The Patriots weathered some big offensive line changes in the past, but this is certainly a rough time to start a makeover.

Footballguys will have all the injury angles covered for you during the regular season. In addition to a daily wiki of players in the news and current injuries, we'll have a review of the week’s injuries on Monday, a discussion of the first injury report of the week on Wednesday and an assessment of the fantasy expectations of all the key injured players on Sunday morning. Our twitter feeds -- @JeneBramel and @CraigZumsteg -- will also be active throughout the week with breaking injury news and analysis.