Monday Injury Rounds: Preseason Week 1

Making rounds on key preseason injuries, including Jamaal Charles, Jordy Nelson, Tyler Eifert, Dion Lewis, and many others

Many of my friends in the medical field hate the word "quiet." To even whisper the "Q" word will bring the wrath of friends and colleagues who don't want a good thing tested unnecessarily. But I've never cared. When it's quiet, it's quiet. I choose to celebrate the quiet. 

And it's been quiet -- thankfully -- on the injury front through the first two weeks of the preseason. We've yet to see a devastating skill position injury. There have been refreshingly soft tissue injuries to worry over. The most concerning injury storylines are related to players already on their team's PUP list.

It won't stay that way. Football is a traumatic sport and there are injuries coming. Let's enjoy the quiet while we can.

Jamaal Charles | Right ACL repair | PUP | Week-to-Week

Dion Lewis | Left ACL repair | PUP | Week-to-Week

I am often pessimistic on NFL injuries. Players tell reporters they'll return sooner than even the most optimistic recovery timetables. Teams may not outright lie about player injuries, but they aren't exactly providing accurate information either.

But I tend not to worry about veteran players rehabbing on the PUP list. That is, until and unless we're given new, specific, and actionable information from a trustworthy source. The context behind Thomas Rawls' perceived longer than expected stay on Seattle's PUP list made sense. The context on Jordy Nelson's placement on the PUP list did not. (Why would the Packers clear him to participate in June minicamp workouts, then put him on PUP to start camp in late July?)

The context clues on Jamaal Charles and Dion Lewis are a little hard to read, but I'm not ready to panic over either player yet.

In recent seasons, players with isolated ACL injuries and favorable rehab reports usually return to practice within 8-9 months. Charles had his ACL repair nearly ten months ago, Lewis's surgery was nearly nine months ago. So, we're not far outside the range of expectation. Both the Chiefs and Patriots hinted throughout the offseason that they planned to limit the preseason (and, possibly, inseason) workload of their top running backs. Another clue that matches the reality of both players remaining on the PUP list as we enter the third week of the preseason.

Last Wednesday, Chiefs' general manager John Dorsey told reporters he expected Charles to be "ready to suit up in pads" in the "next couple of weeks." It's a vague comment, but it puts a hard range on Charles' timeline and it fits the offseason narrative. Giving Charles 2-3 weeks of preseason conditioning and practice time before the season begins should be sufficient. If he's not back to practice by the end of next week, it's time to worry.

Lewis' situation is a little different. He's rarely been seen around the practice field since camp began and Ben Volin caused a Twitter stir last week by writing a column saying Lewis may not come off PUP at all during the preseason. Volin's report was later panned by two other Patriots' beat reporters, but the waters are more choppy here than in Kansas City. The timeline for concern is the same for me here, however. If Lewis isn't activated to begin individual drills and on his way to be cleared for full contact drills by the end of next week, it'll be time to start worrying about Week 1.

Jordy Nelson | Left knee tendinitis | PUP | Week-to-Week

Nelson threw reporters a bone as camp opened when he revealed he was put on PUP due to tendinitis. While providing those limited nuggets -- he didn't say where the tendinitis was located or provide much guidance on a recovery timetable -- he told them he really didn't want to talk about his condition. When pressed last week in the locker room, Nelson would only say, "I'm good." Without the earlier context, Nelson's short answers could be read as frustration at slow progress or his clamming up about a condition that he knows will limit him into the regular season.

That's still one way to read Nelson's responses, but I'm preaching patience on Nelson, too.

As with Charles and Lewis, the next 7-10 days are critical to Nelson's Week 1 availability. If we don't see Nelson cleared to begin working with the team by the end of next week, it'll be time to worry.

Tyler Eifert | Deltoid ligament repair | PUP | Week-to-Week

There's more information coming out of Cincinnati on Eifert this month than I expected. Last week, Eifert was seen without a walking boot and Marvin Lewis told reporters Eifert was beginning more functional work in rehab over the next "three weeks or so." Jay Morrison -- the same reporter who provided a crucial detail about the location of Eifert's surgery -- posted a video of Eifert walking downhill with a pronounced limp. Each of those details provides more support for what I argued last week: Eifert's rehab timetable is closer to 5-6 months than 3-4 months.

While there may be an outside chance Eifert is cleared for contact in the next 4-6 weeks, it's extremely unlikely. The rehab protocol favored by his surgeon says 5-6 months to full recovery. It includes eight weeks of rehab in a walking boot (Eifert was cleared to come out of the boot last week -- at eight weeks post surgery) and a slow and gradual return over a 4-8 week period with a specific focus on range of motion (consistent with Lewis' comments).

Until we see very clear evidence otherwise, don't expect to see Eifert until October.

Ladarius Green | Headaches | PUP | Indefinite

Though Green had been seen fully weight bearing over the past 3-4 months, it was assumed that he was still rehabbing on the PUP list 7-8 months after ankle surgery. Last week, multiple reports revealed Green has been having recurrent headaches and was in the return to play protocol. There have been no reports of a new injury to Green, who had multiple concussions last season, and no reports connecting last year's concussions to Green's current headaches. But the clear implication here is that Green's headaches are keeping the Pittsburgh medical staff -- which includes some of the foremost concussion researchers in the nation -- from clearing him for contact.

And that puts us very near Jahvid Best territory. If a player is having ongoing symptoms -- or symptoms that are preventing clearance for contact -- this far removed from the last known injury, it's hard to see the recovery timetable as anything other than indefinite. That's not to say Green cannot be cleared soon and I think the reports of Green being forced to retire are a bit premature, but it's impossible to put an expectation on his return.

Ezekiel Elliott | Right hamstring strain | Day-to-Day

Elliott is one of many skill position players working through a soft tissue strain. It's impossible to gauge the severity of most of these injuries. Teams use words like tweak, tightness, day-to-day, minor, and many other terms that mean little when trying to figure out whether a muscle strain is truly low grade or not.

ESPN's Stephania Bell got Dallas head coach Jason Garrett to open up a bit on Elliott last week, however, and there's enough context in Garrett's comments to be reassured on the rookie running back. Garrett told Bell the team was trying to "keep something that might only require a week or so to get better from turning into an injury that lasts four weeks or longer." Those are the exact words an athletic trainer, physical therapist, or team physician would use when arguing that a player with a low grade muscle strain needs to be allowed to fully heal or risk aggravation.

It will still be possible for Elliott to aggravate his strain when he returns, but it would appear the Cowboys are working to minimize the risk as much as possible.

Matt Forte | Hamstring strain | Day-to-Day

Forte did some limited positional work during Sunday's workouts, but there wasn't much optimism from Todd Bowles after practice. Bowles said Forte was day-to-day, but noted that Forte would likely be in treatment for most of the week. It's looking like Forte aggravated an injury early in camp. As often is the case, the aggravation is of a higher grade and Forte's return to play will ultimately be in the 3-4 week range before he's completely cleared to return.

Steve Smith | Right Achilles tear | Week-to-Week

Smith continues to rehab. The Ravens remain hopeful Smith will return for Week 1, but the nature of Smith's "double rupture" makes that a tough ask. More on the severity of Smith's injury and difficulty of surgical repair in last week's PUPdates feature here.

Jordan Matthews | Knee contusion | Week-to-Week

Matthews reportedly suffered a bone bruise near his knee after colliding with a defender over a week ago. The Eagles have said Matthews will be out 2-4 weeks. That's not an unreasonable expectation, but bone bruises heal at different rates. Conditioning will be a concern when Matthews is cleared to return.

Sterling Shepard | Groin strain | Day-to-day

Victor Cruz | Groin strain | Day-to-Day

Shepard suffered a strained groin in his first preseason game, but was back on the practice field this weekend without concern. Cruz missed multiple days with a strained groin after minimizing the injury earlier in the week. Cruz was also able to do limited work in practice this weekend but head coach Ben McAdoo told reporters the injury was still bothering Cruz and he'd be reassessed early this week. Cruz wasn't separating himself from the second and third tier roster hopefuls earlier in camp, so this is a terrible development. It's way too early to consider, but some observers are beginning to question whether Cruz will make the final roster.

Corey Coleman | Left hamstring strain | Day-to-Day

Josh Gordon | Quad strain | Day-to-Day

Coleman returned to a light weekend walk-through session, after missing about ten days with a hamstring strain. Gordon has yet to participate in a camp practice. The Browns are being ultra-cautious with both receivers in the hopes of limiting their risk for aggravation.

Danny Amendola | Knee/Ankle surgery | Day-to-Day

Malcolm Mitchell | Elbow dislocation | Week-to-Week

This weekend, Belichick called Amendola day-to-day in his ongoing recovery on the PUP list. There doesn't appear to be any concern from the team's beat writers and Amendola has been seeing conditioning during camp. While dangerous, I'll take Belichick at his word and hope to see Amendola activated this week. Mitchell dislocated his elbow during a very promising effort in his first preseason game action, but a weekend MRI showed no associated damage around the joint. Many players with Mitchell's injury -- including Amendola -- have returned in four weeks or less.

Breshad Perriman | Left partial ACL tear | Week-to-Week

Josh Doctson | Achilles tendinitis | Week-to-Week

I think both of these young receivers are having their injuries minimized by their teams. Doctson has been dealing with tendinitis since May and is still immobilized every other day in a walking boot. Reports on Doctson have suggested he'll return in two weeks -- in each of the past two weeks. At this point, it's fair to wonder if Doctson will see much work during the preseason at all. Perriman has thus far avoided surgery and the Ravens remain positive about his recovery. But until we see Perriman prove his knee joint is stable enough to cut at speed and take contact, his return isn't guaranteed.

Jeff Janis | Hand fracture | Week-to-Week

Janis fractured multiple bones in his hand during practice last week and was wearing a cast last weekend. It's not known whether he required surgery, but it's likely he'll need 4-6 weeks to recover enough to catch passes.

Carson Wentz | Rib fracture | Week-to-Week

Wentz has a hairline rib fracture. The Eagles plan to be cautious with him and have given no timetable for his return. He'll have to be comfortable enough to throw with his usual motion to avoid compensation injuries and heal fully enough to be cleared for contact. Expect him to need at least two weeks to clear both rehab hurdles. Wentz has said his goal is to return to play before the preseason ends.

Other stories to watch early this week include Jeremy Hill (bruised hand), Kelvin Benjamin (conditioning -- at risk of muscle strain), Jared Goff (sore shoulder), Tajae Sharpe (concussion), 

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.

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