Injury Report Insight: Week 2

A critical look at this week's injury report.

At the risk of angering the vengeful football gods, I'd say that the NFL opening week was pretty light on injuries. Obviously, that's easy for me to say since I wasn't out there risking my buns, but up until Sunday night it looked like we were going to get through the weekend without much to talk about this week. Then of course Dez Bryant fractured his foot, and the injury coverage went into overdrive. As often seems to be the case, Bryant stole the spotlight, but that doesn't mean that there aren't plenty of other injuries worth taking a closer look at this week. Aside from new injuries, we still have a few holdovers from the preseason where important players should be returning to gameday rosters soon.

Dez Bryant, foot fracture

Late in the Sunday night game, Cowboys wide receiver Dez Bryant fractured his right foot, specifically his fifth metatarsal. Immediately after the game, Cowboys owner Jerry Jones confirmed the fracture and head coach Jason Garrett said that Bryant would return in, "4-6 weeks." The following day, many others were quick to weigh in with their opinions on this return-to-play timeline. Dr. Jene Bramel has said from the start that this is really more like a 6-8 week, injury, but still with a chance that it goes longer than that. That meshes pretty well with historical comparisons that I can pull from my database. Six weeks isn't an unreasonable estimate, but it's certainly a tad optimistic. A few players have come back from similar foot fractures after missing only six weeks, but not many. A more reasonable expectation, at least based on historical examples, is probably something more like 9-12 weeks. That three month mark seems to be a real sweet-spot with a lot of 5th metatarsal fracture return-to-plays. I outlined the historical comparisons in greater detail in a piece I wrote here. Still, the Cowboys seemed to double-down on their illogical optimism, and Ian Rapoport reported that the organization was aiming for a return closer to four weeks than six weeks. By Tuesday, Jerry Jones was finally easing off a little and trying to distance himself from that earlier four week estimate by now saying that bones take about six weeks to heal, and that nobody really has any idea when Bryant will return. Also on Tuesday, Adam Shefter said that an 8-12 week recovery is probably more realistic, at least according to one doctor.

Given all the changes on this timeline, one would be forgiven for being confused. This is even crazier when you consider that we're only a few days into this rehab. If you're searching for a good idea of when Dez Bryant could possibly return, I'd advise you to forget everything you heard at the beginning and just focus on mid-November. Eight weeks post surgery would put us at Week 10, while twelve weeks would put us at Week 14. Hopefully Bryant can come back strong at the early end of the spectrum, but that spectrum doesn't reasonably start until Week 10, or something close to there. Until Bryant is healthy enough to practice, we should all just ignore the optimistic takes.

T.Y. Hilton, knee bruise

I'll be honest here, I have no idea what to make of T.Y. Hilton's knee injury. This one has me stumped. Hilton landed on his left knee while diving for a reception, and to make matters worse, he had the weight of a defender crashing down on him as well. Early fears seemed to be quieted a little when the Colts announced the injury as simply a, "bruised knee," meaning there was no ligament damage. Oddly enough, owner Jim Irsay immediately said that Hilton would miss, "a few weeks."  Only one day later, coach Chuck Pagano called Hilton, "day-to-day." Talk about mixed signals. If this is indeed simply a knee bruise (as opposed to a more debilitating bone bruise) then we could expect that Hilton might be able to play through it. You might remember Jamaal Charles playing through a similar knee bruise last year. But this is one of those injuries where the practice reports will be a better gauge of Hilton's true injury status. Fortunately for Hilton, the Colts play on Monday night, so he has an extra day to recover and hope that the swelling subsides. Unfortunately for us, that means that we won't have our first official practice report until Thursday.

Mike Evans, hamstring strain

Anyone trying to decide whether or not to start Mike Evans last weekend must've been a wreck by Sunday morning. Evans was expected to be a true, "gametime decision," but the speculation swung wildly both ways, even as late as mere hours before Evans was finally, mercifully, ruled inactive. Given that Evans was reported to be so close to returning, most would assume that he's ready to start this weekend. But hamstring strains can be tricky, and we'll need to watch the practice reports for details. Evans was limited in practice on Wednesday, which is a lukewarm sign. In order for me to be confident that he will play, I'd need to see at least one full-participation practice this week.

DeSean Jackson, hamstring strain

While we have plenty of players nearing the end of their rehabs from hamstring strains, Washington wide receiver DeSean Jackson is just starting his recovery. He left Sunday's game with a hamstring strain that , according to Adam Schefter, is expected to sideline Jackson for, "3-4 weeks." Both Jason La Canfora and Will Carroll backed that this was indeed a severe strain. DeSean Jackson's only previous run-in with hamstring strains was back in June of 2014 when he missed two weeks of summer practice, though I can't confirm whether both injuries were to the same leg. Given how severe this current injury is, I think that we can safely rule Jackson out for the next few weeks. Hamstring strains are particularly susceptible to re-aggravation and re-injury, so Washington would be smart to let Jackson have all the time he needs to slowly rehab this injury. I can't see Jackson's recovery stretching as far as Washington's Week 8 bye, but if Jackson is still not fully recovered by maybe Week 6 or so, I could see Washington potentially shutting him down until after that bye. As of now, we have no reason to think that it will come to that, though.

Victor Cruz, calf strain

It's only Wednesday, but it looks like this will be another week without Victor Cruz participating in practice. Until you hear otherwise, just consider Cruz to be inactive. The more I see of these missed practices, the more I'm siding with ESPN's Dan Graziano, who suggested that due to the shortened Week 3 Thursday night schedule, it might be unrealistic to expect Cruz back anytime before Week 4. At this point, even Week 4 might be optimistic, but let's hold off on that until later.

Breshad Perriman, PCL sprain

As of Wednesday, we have no new information on Ravens wide receiver Breshad Perriman and his expected return from a July 30th PCL sprain. Perriman didn't practice at all last week, and reporter Aaron Wilson said that Perriman is expected back, "by October." As Dr. Jene Bramel pointed out on Sunday, PCL recovery timetables are tough to pin down. Historically, my database shows NFL players missing a range of anywhere between zero and eleven games. That's about as much variance as you'll find in football injuries. Return to play from PCL sprains typically hinge upon when the player feels that the knee is stable, and that's about as subjective of a goal as there is. In order to get a sense of Perriman's likely return date, we're left to simply monitor the practice reports. As soon as Perriman is practicing in full, we know that his knee feels stable and that he might be nearing a return. Until then, we're simply left to wait. As of Wednesday evening, Perriman was still not spotted at Ravens practice.

Andre Ellington, PCL sprain

I'm hoping that you read what I just wrote about Breshad Perriman, as this is exactly the same case for Andre Ellington. In Ellington's favor, his PCL sprain was reported as Grade I, which is often casually referred to as, "mild." So far, Arizona head coach Bruce Arians has refused to put a timetable on Ellington's recovery. For the reasons I outlined in Perriman's case, that's a smart move. As ridiculous as it sounds, Ellington will simply be injured right up until the point where he's not injured anymore. Again, that's often just the nature of PCL sprains. Obviously, this is frustrating to football fans, but there's not a lot we can do about that. For now, the general, "2-3 week," estimates aren't a bad place to start. As is the case for Perriman, this could certainly stretch out longer, but for now that's a good enough place to start.

C.J. Spiller, knee scope

It seems that somehow every week is the week that Saints running back C.J. Spiller is slated to return from his August 14th knee scope. We still have no real details on what medical condition Spiller's knee scope was meant to address, and we haven't received any useful updates in the last month. At one point, it appeared that Spiller was almost certain to return in time for Week 1, but then he continued to miss practice and was eventually downgraded to out for that game. This week, we still have exactly zero meaningful updates, so we're left to just examine the team practice report. Wednesday's report lists Spiller as limited in practice, which is at least an improvement over last week. If Spiller doesn't practice in full at some point this week, I'm not sure I would expect him to play this weekend in a sweet, sweet matchup against the Buccaneers.

Reggie Bush, calf strain

San Francisco's Reggie Bush left Monday's game with a calf strain that looked to be pretty severe. Since then, all reports that have come out have been relatively positive, indicating that this is not a significant tear (note, all strains are by definition tears to some degree). Jason Cole has an example of what I'm hearing most often with Bush's injury, in that it is not considered serious, and that Bush is week-to-week. The two don't exactly fit together, as a truly mild strain would leave Bush, "day-to-day," but that's not an irreconcilable difference. Since the 49ers played on Monday, it's safe to assume that Bush will not practice or play this weekend. Beyond that, it's a tough call. Historically, calf strains tend to sideline players for anywhere from zero to four weeks, with a small portion extending beyond that timeframe. This is the same injury that led to the ridiculous, "will he or won't he," chatter about Alshon Jeffery's status last week. Luckily for us, in Bush's case I don't expect the team to intentionally mask the severity the way I suspect the Bears did with Jeffery. Next week's practice reports should give us a relatively straight-forward answer as to whether Bush is ready for Week 3.

Tre Mason, hamstring strain

Rams head coach Jeff Fisher talked about Tre Mason as a, "gametime decision," for Week 1, but even that less-than-optimistic status faded quickly when Mason missed three consecutive practices last week. This week, Fisher says that Mason is, "feeling better." In order to get a more clear picture though, you'll want to keep an eye on the practice reports this week. Mason practiced in full on Wednesday, so as long as he doesn't suffer a setback, he's looking good for this weekend.

Todd Gurley, ACL recovery

Rams running back Todd Gurley is nearing a return from the ACL tear he suffered almost ten months ago. Admirably, the team's medical staff has been careful and delibrate so far with Gurley, and coach Jeff Fisher has avoided any urge to rush Gurley back. Fisher has even gone so far as to rule Gurley out well in advance of games, such as last week when Fisher ruled Gurley out on the Tuesday before the Rams Sunday matchup. Due to this conservative approach, it's notable that Gurley has yet to be ruled out for this Sunday's game against Washington. Also, Gurley has been a full participant in practice. Still, as Rams beat reporter Nick Wagoner points out, we shouldn't get carried away just yet. According to Wagoner, a September 27th return is probably far more likely than this weekend. Wagoner is a great source for all things Rams related, so I respect his opinion. Any sign of progress is a great thing in the case of Gurley.

C.J. Anderson, toe sprain

Perhaps the biggest question mark this week revolves around running back C.J. Anderson. After Sunday's game, Anderson revealed that he played through a sprained toe. Looking deeper, I was alarmed by the following lines from a piece by the Denver Post's Cameron Wolfe:

"A Ravens player rolled up on his toe and ankle after a reception Sunday. He said the injury was painful and it revived ankle issues he's dealt with his whole career."

On their own, I wouldn't be overly worried about either a toe sprain, especially if this is a, "garden variety," turf toe or a vague, minor ankle injury. Both usually respond well to rest, and plenty of players, Anderson included, might still be able to play through them. For what it's worth, Anderson was able to put in a limited practice both Tuesday and Wednesday. Also, the Broncos and Anderson have downplayed the severity of these injuries at every opportunity. Still, the fact that an old injury issue seems to have re-emerged here, and brought a new complication along for the ride, worries me. The Broncos play on Thursday night, so we wont have any more practice reports to check on this week, and Anderson is listed as questionable for that game. I suspect he will play just as he practiced, in only a limited fashion. Going forward, we'll be able to monitor his week-to-week health through practice reports, but this has the potential to be something the Anderson doesn't entirely shake off this season.

Arian Foster, core abdominal surgery

Texans running back Arian Foster will not start Week 2. That much is just about guaranteed, as head coach Bill O'Brien pretty much ruled that out on Sunday. The fans that have been reading optimistic reports on Foster's activity could be forgiven for thinking he might return this week. Same goes for everyone who watched Zack Ertz play last Monday after coming back from a similar surgery. But Foster and the Texans have made it clear all along that Foster will not return until he's absolutely at 100%. Due to Foster's formidable history with soft-tissue injuries, that's a wise move, as an early return would make Foster more susceptible to re-aggravations and setbacks. For now though, we're mostly just left to wait and monitor the practice reports. I wouldn't usually put too much stock in the predictions of one beat reporter, but for what it's worth, the Houston Chronicle's John McClain is as wired into the Texans as any reporter is to any team, and he writes that the most realistic return is probably Week 5 against the Colts. As usual, you'd be wise to wait until you see Foster practicing in full for consecutive days before getting too optimistic about his return. By all signs, Foster has been making an amazing rehab, but not rushing this final step could be the key for his continued success both this year and into the future.

Lorenzo Taliaferro, MCL sprain

By Sunday's kickoff, Talliaferro will be almost one month removed from his August 22nd MCL sprain. The most optimistic news so far came last week when, despite Taliferro's lack of practice participation, ESPN's Jamison Hensley said that he might have a shot to play in Week 2. Since then, there have been no updates, though Taliaferro was seen practicing on Wednesday. From a historical standpoint, Taliaferro should be ready to return soon. Obviously, history has no influence over present injuries, and it would appear that Taliaferro's recovery is now trending toward the long end of the spectrum. Because the Ravens are in the San Francisco bay area to prepare for a game against Oakland, they were not finished practicing by the time the official NFL Wednesday practice report was issued. According to Jeff Zrebiec, Taliaferro was practicing, though I can't determine if it was limited or in full.

Derek Carr, thumb bruise

It looks like the Raiders dodged a bullet with this one. Carr injured the thumb on his right, throwing hand on Sunday, leaving Matt McGloin to take the reins. The initial early fear was that Carr had possibly fractured his thumb. X-rays and an MRI all came back negative though, and the Raiders are calling it a bruised thumb. It's reported by Chirs Mortensen that the Raiders are holding off on signing another quarterback, and it seems they believe Carr has a shot to start on Sunday. Carr was spotted throwing without any bandage or equipment on his thumb at Wednesday's practice, in which Carr was a full participant. Unless we hear otherwise, we should assume that he will get the start on Sunday.

Josh McCown, concussion

On a move that I could only describe as Sage Rosenfels-esque, Browns quarterback Josh McCown executed a helicopter spin and came down hard on his head. He is currently in the NFL's concussion protocol, and we can only wait to see when he emerges. Hopefully, it will not be long, and I have no reason to think that he'll miss this Sunday's matchup against the Titans. On a related topic, don't be alarmed if you also see quarterback Johnny Manziel putting in only limited practices this week, as he did on Wednesday. Manziel has a chronic, sore throwing arm, usually referred to by Manziel as elbow tendinitis. If McCown doesn't get cleared in time, but Manziel doesn't practice in full, it's a non-story. Manziel will be ready if he gets the nod. Or at least as ready as Manziel ever is.

Delanie Walker, hand

Details on Delanie Walker's hand injury are still scarce. So far, all we know is that Walker did not break his right hand. Some reports have him being seen with a cast on his hand, others with simply a splint. No details have really come out to tell us exactly what the injury is. We do know that coach Ken Wisenhunt is optimistic that Walker will play this week, which rules out a lot of more severe injuries. If I had to guess, and I have no other option at this point, I'd say that Walker likely has a severe hand bruise or possibly a mild ligament sprain such as you'd get from jamming a finger or hand. Walker did not practice on Wednesday, so we'll have to watch Thursday and Friday practice reports to get a better idea of whether or not he'll play this weekend.

Brandon Pettigrew, Hamstring strain

Eric Ebron, or even Tim Wright might see some additional play time this weekend, as Detroit tight end Brandon Pettigrew missed Wednesday practice with a hamstring strain. Earlier in the week, coach Jim Caldwell wouldn't even specify what the injury to Pettigrew was, but Wednesday's practice report confirms that it's a hamstring strain. While we might not know much about the severity of the injury, a missed (rather than limited) practice might suggest that Pettigrew is a long shot to play this weekend. In the absence of any coach honesty, we will know more based on how Pettigrew practices Thursday and Friday.

Zack Ertz, core abdominal surgery

I'll tip my cap to Ertz, as he proved me wrong. I didn't think he had any real chance of starting last week, only one month removed from core muscle surgery (also known as sports hernia surgery). Ertz now marks the shortest return-to-play that I have on record for any similar surgery from Dr. William Meyers. What's even more impressive is that Ertz looked good in his return. He seems to have avoided any setbacks or re-aggravation, so I see no reason to think he won't look at least as good, if not better, in this week's game against the Cowboys. I would fear a setback if Ertz were to go back to not practicing this week, but, short of that, it seems as though all systems are go.

Antonio Cromartie, knee

There is still an air of mystery as to what exactly is wrong with New York Jets cornerback Antonio Cromartie's knee. The good news is that Cromartie did not tear his ACL, as was originally feared by viewers when he was carted off the field. Beyond that, there are few details. Adam Schefter says that he sprained his knee, and that seems pretty widely agreed upon around the media. The trouble is, that's not really an exact diagnosis. As someone who lives in the world of NFL injuries, I can tell you that, more often than not, "knee sprain," ends up meaning, "MCL sprain." But that's not always a safe assumption. A sprained knee simply means that a ligament, any ligament, within the knee has been over-stretched and torn to some degree. While the term, "knee sprain," often ends up referring to specifically an MCL sprain, it could also involve damage to the LCL or PCL. An ACL tear is technically a, "knee sprain," though in this case that has been ruled out. If that's not confusing enough, sometimes simple knee hyperextensions are referred to under the umbrella term of, "knee sprain." To get a better idea of when Cromartie will return, we'd really need a more detailed diagnosis. If this is an MCL sprain, I'd expect Cromartie to miss at least one game, possibly up to three or four if it's severe. On the other hand, if this is simply a hyperextension, Cromartie might well play this weekend. Cromartie has suffered two different knee hyperextensions in the past, and between the two injuries, he missed zero games, though he did have a bye to rehab for one of those injuries. Cromartie has until Monday to rehab, but the early reports from Wednesday say that he is not practicing, which does not bode well for this week. Since the Jets don't play until Monday, they will not release their first official practice report until Thursday. As always with Monday games, be sure to check late-week practice reports to get a better idea of how close he might be to returning, but the early sense is that Cromartie might very well miss the first game of his career.

Brandon Marshall, Lisfranc complication

Settle down, I'm talking about the Denver Broncos linebacker, not the New York Jets wide receiver. Marshall suffered a Lisfranc injury late in the season last year and missed the last two regular season games. He was able to return for the playoffs, but then had to have surgery to correct the problem in the offseason. For anyone who is afraid to ask, the term Lisfranc refers to a specific part of the foot, also called the mid-foot. To dumb this down to the level that even I can understand, the Lisfranc joint is where your long toe bones (specifically your metatarsals) connect to your foot (tarus), but not so far back as to be your ankle. It's the general area at the top of the arch of your foot. Any injury at this joint is often called a Lisfranc injury, or sometimes just a Lisfranc. These injuries can be fractures, dislocations, ligament damage, or any combination of all three. If you'd like more specific information, you can get a good summary here. In the case of Brandon Marshall, the closest I can find to specific Lisfranc injury details is in this piece by the Denver Post's Mike Klis, when Marshall says that he had, "extensive ligament damage and shifting bones." In order to correct the bone displacement, surgeons used screws to fixate the bone (or bones) into place.

But that's all in the past. What has me concerned today is that it would appear that Marshall is currently experiencing pain in this surgically-repaired foot. In a Tweet from Broncos beat reporter Troy Reneck, I read this:

Marshall said that screw in his foot is broken.. Can play through it...He will be playing through pain all year. He knows it. He's tough guy

Indeed, Marshall was seen in a walking boot, as reported by ESPN's Jeff Legwold, but Marshall dismissed it by saying it was just to, "settle it down." As that Lisfranc overview piece I linked above pointed out, surgical hardware occasionally breaks, usually due to metal fatigue. That piece also points out that, "Most often surgery is successful even if some of the hardware fails." Marshall gives a few more details in this piece, in which he says that the screws were going to be removed after this season anyway, and that they had already served their purpose in holding things in place while some ligaments healed. What I find alarming is that Marshall is in pain so early in the season, and that he seems determined to battle through it. Marshall might be a true warrior that can fight through the pain, but I wonder if that's really the best course of action for his long-term health at this point. Again, this is all just my opinion though, and perhaps we will hear nothing else about his foot this season. Let's hope so. I should also point out that even though Marshall has been listed on the injury report, he has been practicing in full and his status for Week 2 is not at all in doubt.

 

I will be here at Footballguys every Wednesday to guide you through the injury report. Feel free to contact me on Twitter if you have any questions throughout the week.