Adrian Peterson and Peyton Manning had dramatic recoveries from severe injury last year. Their successful seasons have set an optimistic bar for the rest of the league. But it's too soon to assume that every elite player who suffers a career-threatening injury will return to form at the most optimistic end of their timetable for return.
Were Peterson and Manning outliers or the beginning of a new paradigm for injury recovery? There are a number of critical cases to watch this summer.
Robert Griffin III (ACL/LCL/meniscus repair; January 2013)
Griffin's injury was significant. Not only did Dr. James Andrews repair an ACL that had already been grafted once, he also needed to repair a torn LCL that likely had not healed from a late season sprain and meniscus damage. Though the news on Griffin's rehabilitation to date has been overwhelmingly positive, Griffin must still clear a number of rehab hurdles before earning clearance for contact in camp.
There are a number of parallels between Peterson and Griffin -- both suffered a multi-ligament injury and meniscal damage, both had their knee reconstruction performed by a surgeon with a proven track record of success (Andrews), and the rehab process for both has been openly and frequently praised. There's definitely room for optimism, but don't project Peterson's recovery onto Griffin yet.
Once Griffin is cleared for contact, his coaches and medical staff will be closely watching for subtle signs that he may not be ready. Griffin's injury is to his back leg. While he won't have to worry about a dirty pocket as much as he might if his front plant leg were injured, his power and accuracy could be affected if he doesn't trust his base. He will also be watched when he leaves the pocket. An important, but overlooked part of the recovery from an ACL injury is how quickly the body regenerates the connections between the ligament and the brain that help a player know where his knee is in space. A slower than expected recovery could affect Griffin's confidence and effectiveness as a runner.
Expect Griffin to start training camp on Washington's PUP list. Beyond that, it's too early to set a date for his full return to form. Based on Andrews comments and the successes of many recent elite athletes, there's a strong chance that Griffin will return to form early this season. But the LCL and meniscus damage and history of prior ACL tear to the same knee remain reasons for long term concern.
Rob Gronkowski (fractured forearm and infection, back surgery; June 2013)
It has been a complicated offseason for Gronkowski and we are no closer to knowing when he'll be cleared for contact than we were in January. Multiple surgeries to address his broken arm and associated infections delayed his recovery and prevented him from rehabbing his injured arm until June. If that wasn't concerning enough, a mid-June back surgery will reportedly keep him out at least 12 weeks. Both injuries put his regular season debut in doubt and could keep him on the New England PUP list to start the regular season.
Gronkowski's troubled offseason is worrisome for multiple reasons. It's likely the muscles in his injured arm have weakened and they may not be at full strength this season. If the weakness persists, it could affect his separation from tight coverage, particularly in the red zone. Gronkowski should have enough time to heal the fracture in his arm after his most recent surgery, but any recurrence of infection will mean multiple addtional months of treatment and rehab. But it's the back surgery that should have your attention. Until we hear clear confirmation that the procedure was as "minor" as was reported -- removing a small amount of inflamed herniated disc tissue without any additional work necessary -- and hear that he's been cleared to begin lifting and running, there's no guarantee that he'll be able to meet his 12 week rehab goal.
Gronkowski will start camp on the PUP list. Even if the Patriots elect to start the season with him on the 53 man roster, he may not be himself for a number of weeks. That's maddeningly vague, but it's simply too soon to be more specific. As with Griffin, expect near weekly updates on Gronkowski's status in July and August.
Arian Foster (calf strain; May 2013)
Houston head coach Gary Kubiak tried to remain optimistic, but his expectation that Foster will need the eight weeks before training camp to recover suggests that Foster's strain is a mid-grade injury. That should be enough time for Foster to fully recover, but there are reasons for concern.
Mid-grade muscle strains must be fully healed before returning or re-injury and a significant setback are possible. Also, the weeks leading up to camp are an important conditioning period for NFL players. Missing that vital period may leave Foster at risk of a compensatory injury in his first practices back. Expect the Texans to bring Foster along very slowly in August. Don't be alarmed if Foster isn't cleared for consecutive practices or preseason game action until the third or fourth week of camp.
Foster missed time with a hamstring injury in 2011 and still managed nearly 1850 total yards on 325 touches in 13 games. Despite the high number of touches in the past three seasons and the variety of soft tissue injuries in his career, Foster has been productive. The third week of camp will be critical. If Foster can practice fully and participate without restriction by the third preseason game, the Texans -- and, by proxy, prospective fantasy owners -- should be comfortable relying on him early in the season.
Trent Richardson (leg injury; May 2013)
The Browns are calling Richardson's injury a muscle strain but the details reported over the past weeks aren't consistent with a strain. Strains generally do not occur when a player is stepped on, the front of the shin doesn't have much muscle tissue, and muscle strains aren't at all likely to progress to stress fractures if not allowed to heal properly.
It's possible that the mechanism and location reported by multiple media members and the anonymous source raising the stress fracture concern are wrong and Richardson has a minor muscle strain of no concern. I think it's more likely, though, that Richardson has a bone bruise in his shin, an injury that better fits the reports. The eight weeks before camp should be enough for Richardson to make a full recovery, so the exact diagnosis may be not be meaningful. What's important is how quickly Richardson will be cleared to resume strength and conditioning workouts. Like Foster, running backs entering camp with conditioning and compensatory injury concerns bear close watching in August.
Maurice Jones-Drew (Lisfranc repair; December 2012)
Jones-Drew admitted in January that he should have had surgery immediately after his injury, but continued to deny that his fracture was at the Lisfranc joint until March. Though the rehab from his surgery usually takes 6-7 months and expectations are that he'll be fully cleared to begin workouts in advance of training camp, the delayed surgery is reason for concern.
The delay in fixing the Lisfranc joint may increase the risk of long-term instability or loss of range of motion in the joint. Those changes could have a cascade effect on a knee joint that has troubled Jones-Drew in the past. With Jones-Drew already struggling with conditioning (he reported to OTAs out of shape) and possibly a few weeks behind his expected rehab schedule (he had hoped to be running at near full speed by late May and isn't yet), he may not be full speed until well into training camp.
Pierre Garcon (torn plantar plate; August 2012)
The reports on Garcon's injured foot have been, at best, uninspiring since the end of last season. Garcon told reporters that he first started having pain in training camp last year, but tried to play through it. He's repeatedly refused surgery noting that doctors have said that a procedure would not guarantee a full recovery. He's frequently hedged when asked if he'll be ready for the 2013 season, saying he'll be "healthy enough" or that "he could play if there was a game this week." And he revealed in early June that he's getting special shoes made for this season and is still learning about running on his injured foot.
Pain and difficulty changing direction are two common issues for players who try to play through these injuries. If the injury doesn't fully heal -- and Garcon is still not 100% ten months after first feeling pain in his foot, an aggravation could occur at any time. Finally, there's a significant risk of a serious toe dislocation and a prolonged absence. Wait and see how much Garcon can practice in camp before drafting him with the expectation that he'll be a safe, every-week starter.
Michael Crabtree (torn Achilles; May 2013)
There are two opposing schools of thought on Crabtree. Some see his injury as career-threatening and even career-ending, ignoring the recent successful returns of Demaryius Thomas, Mikel Leshoure, Terrell Suggs. Others cite the Thomas and Suggs cases and the faster and better than expected recoveries of players with other injuries that had once ended careers as evidence that Crabtree will return to full form as early as late 2013. Crabtree's outcome likely lies somewhere in the middle.
Thomas could be a very reassuring comparison for Crabtree. Unfortunately, reports suggest (though do not confirm) that Thomas' injury was a partial tear. Crabtree's injury has been confirmed as a complete tear. It's an important difference. Thomas also said that it took him nearly 18 months to feel he had fully recovered. And while Suggs' six month return could be a sign of things to come as Achilles tendon repair and rehab progresses, his tear was also partial and he wasn't himself when he returned.
I think there's a very good chance that Crabtree will join those players who have made a successful recovery from an Achilles tear. But I strongly doubt we'll see him healthy enough to see the snap count, target and reception numbers he was producing in 2012 this season.
Eddie Lacy (toe fusion; January 2012)
Lacy wasn't drafted until then end of the second round, with multiple running back needy team choosing other options. It's not difficult to see why. A lingering hamstring injury that limited him in his Pro Day workout may have heightened questions about his conditioning and durability. But his medical report also contained information about a toe injury that may not have added up for medical staffs around the league.
Lacy was reportedly diagnosed with a turf toe condition in 2011 and had a toe fusion procedure early in 2012. Generally, it's the joint between the big toe and the foot that is fused for turf toe. That procedure would greatly limit the range of motion in the toe and an option of last resort. Lacy's fusion was done at the joint in the middle of the big toe, underneath the base of the toenail. It's an unusual approach to turf toe, but one that allowed Lacy to function well enough to put up big numbers in his final college season. Still, there was clearly debate among many medical staffs about how long Lacy could perform and whether his turf toe issues were fully behind him.
There's big immediate upside for Lacy in Green Bay, but the multiple durability issues in college, yet to be determined long term viability of the toe condition, and presence of Johnathan Franklin make his long term expectation muddy at best.
Around the Training Table
Hakeem Nicks had early offseason arthroscopic surgery on the left knee that limited him last season. His diagnosis and procedure are still unknown but Nicks is optimistic that he'll be full go at training camp...Ben Roethlisberger had surgery on his right meniscus in early June. The 4-6 week return to play expectation suggests a minor repair and he should be ready for training camp...Tony Romo had surgery to remove a cyst from his back and was expected to miss all of OTAs and minicamp. Though there have been no specifics released on the type of cyst, all reports are that his absence was precautionary rather than evidence of a condition that would affect his arm strength or range of motion long term.
I'll have updated thoughts on these storylines throughout the offseason in the Footballguys Interactive Magazine and on our injury-centric Second Opinion blog at Footballguys.com. You can also follow me on Twitter @JeneBramel for the latest injury updates and commentary.
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