10 Critical Training Camp Injury Questions

Thoughts on ten pressing injury questions as training camps open this week

It's time.

The Cardinals and Cowboys have reported to camp, with veterans from the remaining 30 teams scheduled to report over the next 7-10 days. One of their first stops will be the training room, where medical and training staff will perform entrance physicals and various conditioning tests to determine whether players are fit to practice immediately.

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.

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. 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.

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.

INJURY STORYLINES TO WATCH

This was a relatively quiet offseason. We weren't tracking Rob Gronkowski's every move as he recovered from an arm infection or worrying over the latest note on Le'Veon Bell's knee recovery or wondering why Jordy Nelson or Jamaal Charles or Dion Lewis were unexpectedly behind rehab goals. Instead, many players with pressing injury questions were cleared to participate in OTAs and mini-camp on time. Derek Carr and Julio Jones and Cam Newton -- among others -- were cleared for football-related activity well in advance of training camp.

But there are still important and outstanding questions to be answered as players report to camp. Here are ten situations I'll be following closely this week.

Check back next week for a full account of the players who were placed on the PUP or NFI list and how worried we should be.

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