Training Camp Injury Storylines

Examining the most important injury storylines as teams report to training camp

It's time.

After seven long months of rest, recovery, rehab, surgery -- expected and unexpected -- we're soon to find out which players are conditioned and ready to practice and which are not. Veterans will begin reporting to camp on Monday, July 25th (Green Bay) with a steady stream of teams reporting later in the week. 

Each NFL front office, in consultation with their medical staff, must first decide whether a player is fit to practice.

DECIPHERING THE ALPHABET SOUP OF INJURY LISTS

Players not ready for camp practices are placed on one of two lists – Physically Unable to Perform (PUP) or Non-Football Injury/Illness (NFI).

Physically Unable to Perform

Active/PUP – Preseason only list. Once a player participates in any part of a scheduled training camp practice, they are ineligible for this list. Players can be activated from this list at any time. This list is commonly used for veterans still recovering from injury and those who fail conditioning tests before camp begins.

Reserve/PUP – Regular season only list. Players still on Active/PUP at the end of camp are eligible to move to Reserve/PUP. Players cannot practice with the team until after Week 6. Teams then have six weeks to evaluate the player before moving to the active roster or to season-ending injured reserve.

Non-Football Injury / Illness

Active/NFI – Preseason only list. Once a player participates in any part of a scheduled training camp practice, they are ineligible for this list. Players can be activated from this list at any time. Only veterans with a non-football related injury or rookies injured before the NFL draft are eligible for this list.

Reserve/NFI – Regular season only list. Players converted from the Active/NFI list to the Reserve/NFI list are out for the entire season.

Injured Reserve – Return Designation

The NFL changed the IR-Return rule this offseason. Previously, a team was allowed to return one player from their injured reserve list each season. That player had to be designated at the time he was placed on injured reserve. This season, teams will no longer be forced to designate a player to return at the time of the move to injured reserve. While each team can only return one player from their injured reserve list, they can choose to activate any player who has spent at least six weeks on the injured reserve list. The player designated to return can begin practicing six weeks after being placed on injured reserve and is first eligible to return to the active roster eight weeks after being place on injured reserve.

The new IR-return rule will give more roster flexibility to teams. Coaches and medical staffs can now put multiple players on injured reserve and re-evaluate their recoveries on a regular basis. Teams won't be put to a tough decision in the early weeks of the season on a marginal starter. Only one can be returned to the active roster eight weeks after the injury, but we're likely to have a handful of teams with questions over which player gets returned off injured reserve and when. More flexibility never means more clarity.

WHY TEAMS USE THE PUP LIST

Don’t overreact to these designations. Every team uses their PUP list differently. Years ago, players put on the PUP list were those unlikely to be cleared for practice in camp. Most would transition to the regular season PUP list or injured reserve. In recent seasons, many teams make heavy use of their PUP list. Players who report out of shape are put on the PUP list until they pass conditioning tests. Players recovering from offseason surgery or an injury during mini-camp are also stashed on the PUP list for a few days to allow medical staff personnel to be certain they are in condition to begin taking contact.

It's usually positive when a recovering veteran starts camp on the active roster, but it’s possible that player’s reps may still be severely limited in the early weeks of camp. And while you’re spidey senses should be tingling with any player who is a surprise addition to the PUP list or stays on longer than expected, remember that teams will want to keep their PUP and IR-Return options open as long as possible.

Once a player takes part in a practice, those options are limited. If a player participates in a single practice rep, he's ineligible for the regular season PUP or NFI list. A setback would mean the team has only the injured reserve list to stash a player with a multi-week injury. The new IR-return rule provides added flexibility, but teams won't close any doors for themselves sooner than absolutely necessary.

RISE OF REHAB ON SOCIAL MEDIA

From Le'Veon Bell to Jamaal Charles to Sammy Watkins, more and more players are sharing videos of their rehabilitation with fans on social media platforms. We've seen Bell post multiple videos of himself sprinting and cutting, Charles post a video of himself performing a ladder drill, and Watkins post a video of himself doing 25-yard sprints.

With rare exception -- Jaylon Smith posted a video that clearly showed the nerve in his injured knee was still in the early stages of recovery at best -- players post these videos to show confidence in their recovery process. But don't jump to any conclusions. These videos tell us the player has been cleared to do position-specific drills and is actively working to regain necessary conditioning. That's a critical part of the final rehab stage. However, these videos do not necessarily mean a player is close to being cleared for contact.

But we'll find out soon enough.

COMPENSATORY INJURIES, aka "OH NO, WHAT NOW?"

Major injuries like the ACL tears suffered by Jordy Nelson and Kelvin Benjamin last summer are the worst fear come true for fans and fantasy owners. But they aren't the only injuries that can linger well into the regular season. Seemingly innocuous but frequently insidious soft tissue injuries should have your spidey senses tingling, too.

Sometimes these "tweaks" will be exactly that -- a relatively meaningless hamstring cramp or quad tightening. But all too often, what's initially billed as a low grade, day-to-day muscle strain will become a multi-week absence and lengthy rehab process that costs a player all of training camp. Last year, Chicago head coach John Fox stood in front of the media and termed Alshon Jeffery's hamstring strain day-to-day -- for over three weeks. If the Giants are to be believed, a full recovery from multiple calf strains is just around the corner for Victor Cruz -- some 12 months later.

Players most at risk of these injuries are those already rehabbing another injury. Subconsciously favoring one side of the body, these players overcompensate with another part of their body and the additional stress increases the risk of a breakdown. One study of NFL players showed a 33% risk of aggravating a hamstring injury within 7-14 days of returning from the previous strain. Victor Cruz's calf strain was likely related to his recovery from his patellar tendon tear.

Players not in good cardiovascular condition or ready for the rigors of full contact practices are also at high risk. Teams generally know who these players are after an intake physical assessment. But even subtle differences in symmetry can lead to a Jenga-like cascade effect, especially when those deficiencies get magnified when a player is fatigued.

So remember to include compensatory injury next week while you're crossing your fingers against catastrophic ligament and tendon tears.

INJURY STORYLINES TO WATCH

I've been tracking the rehab and recovery of nearly 50 skill position players this offseason. You can find post-OTA news and breakdowns on those injuries here. Many of those players returned during offseason practices and should be good to go for training camp.

I'll update this list again next week after PUP decisions are formalized and address any fallout from players who report to camp with an unexpected injury, but here are the storylines I'm following most closely just ahead of training camp. To be clear, while I'm ending each blurb with a prediction for how each team will handle player recoveries, it's an exercise only. Next week's column will include more formal expectations for the remainder of the preseason.

WILL LE'VEON BELL BE READY FOR CONTACT IMMEDIATELY?

Bell has yet to have a fully healthy offseason. He suffered a midfoot sprain in August 2013, a knee hyperextension in December 2014 which required a lengthy rehab, and needed surgery and another extended rehab for an MCL/PCL sprain last October. Yet, it's rare to hear anyone cry "Injury Prone!" on the all-around running back talent. Despite a lack of clarity on his status this offseason, he continues to be either the first or second running back off the board in fantasy leagues.

And that may prove to be the correct approach.

Bell was seen running pass routes in individual drills in May OTA workouts. He posted videos of himself cutting at full speed in June. He's been nothing but optimistic with reporters over the summer and all expectations are that he'll be ready to participate in training camp. All signs point to Bell starting camp on the active roster, although he may not be immediately cleared for full contact practice.

But it'll be nice to get confirmation on that next week. Even more reassuring would be an early indication from the Steelers that Bell will participate in at least one series of one preseason game. That's not necessary for Bell to have an effective season, but it would tell us Bell's knee is seen as fully healthy and the team expects no conditioning setbacks.

Prediction: Bell starts camp on the active roster but won't take part in full contact practices until later in camp.

WILL THOMAS RAWLS START CAMP ON THE PUP LIST?

As Craig Zumsteg and I discussed last month, it's very likely Rawls had surgery to fix a broken ankle and torn ligaments last December. David Chao strongly believes that to be the case, too. In July, those details don't matter as much as they did in March or April, when we were still actively trying to determine whether his recovery timetables made sense or not. Now, we simply need to know whether Rawls is far enough along in his rehab to practice with the team.

Rawls says he is. We'll soon find out if the team agrees. Should Rawls start camp on the PUP list, we'll be left trying to decipher any comments on how long the team expects him to be there.

Prediction: Rawls starts camp on the active roster and is cleared for contact practices early in camp.

JUST HOW ROUTINE IS ACL REPAIR AND REHAB NOW?

Jordy Nelson (August), Jamaal Charles (October), Dion Lewis (November), Kelvin Benjamin (August), and Joe Flacco (December) are all expected to be ready well in advance of Week 1. Nelson was running routes at speed last winter. Charles and the others have been reported to be well ahead of schedule in rehab throughout the offseason.

It's seemingly a foregone conclusion now. With two caveats -- isolated ACL injury only and acknowledging the known risk of re-injury to either ACL -- it's rare to see a player not recover to his previous form within 8-9 months of his ACL injury. It's a testament to modern orthopedic surgical technique and rehab protocols that we're on the verge of barely questioning whether a player with multiple ACL tears can fully recover.

The Chiefs have hinted they'll return Charles to full practice slowly. The Patriots are always tight with injury information, but a gradual return for Lewis also seems likely. But none of these players seems in any doubt of assuming a full workload in Week 1.

Prediction: Nelson and Benjamin are cleared for full participation in practice immediately, though both may get some veteran days off early in camp. Charles and Lewis start camp on the active roster and are eased into contact practice slowly, though I won't panic if either spends a handful of days conditioning on the PUP list. Flacco is cleared for practice immediately but won't be put in any live contact situations until later in camp.

should we worry about the three wide receivers recovering from metatarsal fractures?

In general terms, wide receivers recover from surgery to repair broken fifth metatarsals well. Many later require a revision surgery, but studies on NFL players undergoing additional surgery later in their careers also show very high success rates.

But none of Dez Bryant, Julian Edelman, and Sammy Watkins had a standard repair and recovery. Bryant had a second stem cell injection within a month of surgery, clearly tried to return too soon, was never effective, and had a revision surgery immediately after the season ended. Edelman didn't push as hard as Bryant, but also required a revision procedure in May. (At least I think Edelman's rehab was more standard than Bryant's. The Patriots (who probably have a dungeon in Foxboro for anyone who breathes a word about injuries) and Cowboys (where Jerry Jones will spill his guts to anyone who'll listen) couldn't be more different with injury discussion.) Watkins also tried to play through his injury only to have a late repair after the bone didn't heal properly.

Again, revision surgeries carry a high success rate. But this is an area of the foot with a poor blood supply that doesn't always heal well. There's a reason there are so many revision surgeries with this particular injury. All three receivers could recover as Julio Jones did two years ago after his revision procedure. But the details are just different enough to warrant close attention over the next days to weeks.

Prediction: Bryant is cleared for full practice participation immediately, but Dallas limits his practice time to assure his conditioning is appropriate before contact. Edelman starts camp on the PUP list, is activated quickly, but doesn't participate much during the preseason. Watkins starts camp on the PUP list and is activated within 10-14 days.

WILL THE BENGALS LOOSEN THEIR LIPS ON TYLER EIFERT?

The Bengals are master dissemblers. While the Chicago media got John Fox to at least address injuries last year, the Cincinnati media has all but given up trying to get Marvin Lewis to say anything useful. We were lucky to get some usable information on A.J. Green's midseason injury last year -- but that was Green and his agent feeding Bob Holtzman directly.

Earlier this month, Geoff Hobson of Bengals.com got Director of Player Personnel Duke Tobin to hint the team isn't planning to have Eifert in Week 1. That's really no surprise. The 3-4 month return estimate originally provided marked early September as an optimistic ask. But Tobin's comment tells you the team sees the first month of the season as the best case scenario. I wrote in June that I felt Adam Schefter's initial tweets on Eifert's injury said the same.

We may hear some optimistic notes that Eifert is week-to-week during camp. But I'm hoping we get a peek behind the curtain sometime during camp that guides us on whether Week 1 or Week 4 is the more likely return date.

Prediction: Eifert starts camp on PUP and the Bengals don't make a decision on when to activate him until very near the deadline at camp's end.

CAN ARIAN FOSTER AVOID ANOTHER PRESEASON SOFT TISSUE INJURY?

It's unfortunately easier to list which body parts Foster hasn't injured over the past few years. Many of Foster's injuries have occurred during the season, including the Achilles' tear from which he's currently recovering. Just as concerning is Foster's list of preseason injuries, which includes multiple core abdominal tears last year, a mid-grade hamstring strain the year before, and a mid-grade calf strain three years ago.

I've often argued against over-reacting to Achilles tendon tears. And, although there are no positive comps to highlight as the centerpiece of the argument, I'm not specifically worried about Foster recovering his former explosiveness and lateral agility. What I am concerned about is Foster's inability to avoid soft tissue injury, especially during the critical last phases of rehab of other injuries.

Foster passed his physical in Miami last week. Passing the final hurdles of reconditioning may prove as difficult.

Prediction: Foster starts camp on the active roster but will have his camp practices managed very carefully until late in the preseason.

IS MELVIN GORDON OVER HIS KNEE TROUBLES?

From meniscus damage to cartilage defects, Gordon has struggled with knee problems that frequently become chronic. What was initially billed as a meniscus repair was later reported to be microfracture surgery later in the offseason. I don't think it was a coincidence that those critical details were withheld until Gordon began to show he was far enough along in his rehab to be cleared to do individual football-related work.

The Chargers told reporters Gordon's cartilage defect was small and in an area of the knee where cartilage has the best chance to regenerate following surgery. Gordon's relatively quick and successful rehab supports their argument. But Gordon's knee will never be what it was pre-injury and surgery. Whether it's good enough to hold up over the short (or long) term remains unknown. Like Travis Kelce, you can begin to be reassured on Gordon if he's able to tolerate consecutive practices without pain, swelling, or stiffness. While the Chargers may ease him back slowly, his promising offseason suggests that he should be ready for full practices by mid-camp.

Prediction: Gordon starts camp on the active roster and is cleared for full contact practices sometime in the first 1-2 weeks of camp.

WILL JIMMY GRAHAM OR VICTOR CRUZ BECOME THE FIRST TO RETURN TO FORM AFTER PATELLAR TENDON REPAIR?

There have been a handful of players who have returned to play in the NFL after a patellar tendon tear. Nate Allen and Morris Claiborne are two examples of players who recovered well enough to earn a starting role for their teams. Claiborne may yet recover well enough to be considered an above-average talent. But no skill position player has ever returned to an elite level of play. To be fair, the sample size is small and spread over many seasons. 

Cruz is the most recent hopeful candidate. His rehab reportedly went well last offseason, but multiple high-grade compensatory calf strains derailed the later stages of his recovery. He's still being carefully managed by the Giants and not guaranteed to participate in practice early in camp.

Unlike the relative pessimism that surrounded Thomas Rawls, the Seahawks and head coach Pete Carroll have been consistently telling reporters all offseason that Graham will be ready for Week 1. The target date for Achilles' recovery is nine months. That would be the end of August. If Graham hits that estimate, it'll be an important outlier. But an outlier nonetheless.

Prediction: Graham starts camp on the PUP list and is monitored carefully while the Seahawks delay a decision about regular season PUP until close to the deadline. Cruz is on the active roster to start camp.

Check back for more injury analysis throughout training camp and follow on Twitter @JeneBramel for breaking injury news, commentary and analysis of injury news around the NFL.