Injury Rounds | PUPdates | July 25

Who is active and practicing -- and who is not -- as training camps begin

Rookies and veterans report this week for camp. After their entrance physical and conditioning test, each player will either be cleared for the active roster or moved to the PUP or NFI list. Scroll to the bottom of this article to see exactly how those lists are defined. 

Don’t overreact to these designations. 

WHY TEAMS USE THE PUP LIST

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. Now, nearly every team uses the PUP list as medical triage. 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 your 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.

Check back daily at the Footballguys Injury Page for the latest articles on injuries throughout the preseason.

PUPdates

As training camp practices begin, new injuries will unfortunately occur. I'll be covering those in this space, too, as they occur. These feature articles will go live every evening after the NFL's official transactions are released. If you're interested in breaking analysis and discussion, follow my Twitter timeline or check out our new and exclusive Footballguys Channel on Sleeperbot, a desktop and mobile app where you can set up push notifications to get breaking news updates sent to you.

Andrew Luck | Active - PUP | Right shoulder labrum repair | mid January

I wrote extensively on Luck yesterday, speculating on how to parse reports on his progress from the spring and early summer. Today, the Colts placed Luck on their PUP list and provided some meaningful context on where his rehab currently stands.

General manager Chris Ballard told reporters Luck had begun throwing last week. More importantly, he stressed Luck "has not had any setbacks at all in his rehab process or with his surgery," and his deliberate rehab is "just part of the process ... his doctor and our trainers have set for him." In short, the Colts are maintaining that six months of strengthening before throwing has been the rehab plan from the start. As discussed yesterday, there's no reason to think this isn't a reasonable approach. Why rush your franchise quarterback in any way, knowing that any setback during the throwing program could jeopardize his availability for Week 1.

The Colts recognize, however, that Luck still "has to work on getting his throwing motion [and] all his strength back." It's clear the Colts are trying to hit a difficult sweet spot here with Luck's rehab. They've held Luck back as long as possible and successfully prevented any inflammation or soreness thus far. But they have also limited Luck's time to regain arm strength, throwing accuracy, and timing to a razor thin margin.

Multiple beat writers read Ballard's comments to mean the Colts would not risk Luck in any preseason games but expect him to be available to play Week 1. Luck isn't far enough along in the throwing stage of his rehab to project his return with certainty, however. I'll continue to update Luck's progress as further reports warrant.

Jaylon Smith | Active roster | Left peroneal nerve palsy / ACL/LCL reconstruction | January 2016

Smith continues his recovery from a very difficult knee injury. All recent reports suggest Smith is continuing to see improvement in nerve function. In time, Smith may fully recover. However, a video posted today clearly shows Smith isn't there yet. Watch carefully and you can see Smith is compensating for his inability to lift his left foot by pulling his lower leg along with his foot pointed outward. You can also see the difficulty he has lifting his foot to keep from tripping when slowing down. It's not a good sign for Smith's ability to play sideline to sideline against the run and change directions in coverage in pads as the Cowboys' prospective middle linebacker. It shouldn't stop you from rooting for Smith to overcome his injury but he's not there yet.

Teddy Bridgewater | Decision pending | Left knee dislocation / Multi-ligament repair | Late August 2016

Mike Zimmer told reporters today that Bridgewater was expected to be placed on the team's PUP list. Today's transaction list didn't include Bridgewater. That's likely just a formality, though. The Vikings' veterans don't formally report for practice until Wednesday. Bridgewater has done some light positional work thus far but isn't likely to be cleared for contact yet. And there's no reason for the team to limit their roster options by adding Bridgewater to the active roster until they know with certainty he can backup Sam Bradford in game action.

Latavius Murray | Active - PUP | Right ankle surgery | Late March

The Vikings placed Murray on their PUP list today. Murray told reporters his "health is really good" and "progress is coming along." Specifics on Murray's surgery were never reported, but he's four months into rehab and not yet cleared to return. Dr. Robert Anderson performed Murray's surgery and commonly prescribes a five month rehab period for more involved ankle reconstructions. The Vikings have stated Murray is expected to be available during training camp. We'll see how long he remains on PUP. He'll need to be moved to the active roster before the third preseason week to limit the risk of compensatory injury by trying to return to football conditioning quickly.

Derrick Johnson | Active roster | Left Achilles tendon repair | Early December 2016

Add Johnson to the list of players proving that Achilles tendon injuries should not be considered career-ending. Johnson was participating in OTAs and the Chiefs are reportedly planning on having him immediately active and practicing in camp.

Deone Bucannon | Active - PUP | Ankle surgery | Mid May

Bruce Arians has expressed optimism Bucannon will miss little time in the regular season but ankle surgeries often require 4-5 months of rehab. Don't expect to see Bucannon during the preseason. He'll need to continue to rehab without setbacks to have a chance at coming off PUP before the season begins.

Max Unger | Active - PUP | Lisfranc repair | May
Terron Armstead | Active - PUP | Shoulder labrum repair | June

There were reports in May that Unger would return during the preseason and was aiming for a Week 1 return. That's an extremely optimistic expectation after surgery to repair a Lisfranc injury. Most athletes with surgical Lisfranc injuries aren't cleared to weight bear without a boot for three months and additional rehab to regain strength, stability, and enough range of motion to play can take many months longer. The Saints left the door open Unger to come off PUP before the regular season, but early September is possible only if Unger is seen without a boot soon. 

Armstead underwent labral repair in June, a procedure that will require multiple months of rehab. Early expectations had Armstead starting the season on the PUP list and returning midseason. That remains the most likely outcome, though the Saints have Armstead on the active-PUP list for now.

Clayton Geathers | Reserve - PUP | Cervical discectomy / fusion | mid May

Geathers is recovering from a cervical discectomy and fusion in May. Rehab usually takes 4-6 months after these procedures, with the most optimistic return date for Geathers in mid-late September and more likely later. The Colts took Geathers off the active roster today, and Geathers will miss the first six weeks of the season.

Other transactions of note: Travis Kelce (Active roster), Jalen Ramsey (Active - PUP), Dont'a Hightower (Active - PUP), Sidney Jones (Active - NFI), Jake Butt (Active - NFI), Chad Kelly (Active - NFI), and Sharrif Floyd (Active - NFI).


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

Each NFL team can return two players to the active roster from injured reserve. Teams are not forced to designate this player at the time of the move to injured reserve. Players designated to return can begin practicing six weeks after being placed on injured reserve and are eligible to return to the active roster eight weeks after being placed on injured reserve. This rule allows a team to continually evaluate the rehab and recovery of their injured players and provides roster flexibility should teams have multiple key injuries early in the season.

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

There will be major injuries -- ACL tears, high grade muscle strains, and more -- during training camp. But it's also important to carefully follow the seemingly minor injuries.

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. One particularly aggravating example occurred in 2016, when 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. 

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. Friend and RotoViz contributor, Dr. Jeff Budoff, recently shared a study of professional Australian footballers that highlights how common compensatory and cascade injuries are. Of 543 players who suffered an injury during the season studied, 247 had a subsequent injury. That's nearly 50%.

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.

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.