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We're barely into the first week of training camp and already have our first season-ending injury. Sadly, it's unlikely to be the last.
Kenneth Dixon | Meniscus Repair | Late July | likely injured reserve
Dixon injured his knee training this week and had his medial meniscus repaired today. Though some players choose to have the injured meniscus trimmed or removed, repairing the meniscus is better for the long term health of the knee. Unfortunately, repairing the meniscus requires extensive rest to increase the chances of proper healing. Rehabilitation requires a minimum of 3-4 months and often stretches to 5-6 months. Ian Rapoport reported a timetable of 4-5 months and the expectation that Dixon's season is over.
It's not known which knee Dixon injured. Last preseason, Dixon sprained his left MCL, then aggravated the injury shortly before the preseason started. There were no reports of a meniscus injury last season, but it's something worth tracking. If Dixon's recovery goes smoothly, he should be ready well in advance of training camp next summer.
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.
Mike Pouncey | Hip Injury / Stem Cell Injection | April | Decision Pending
I covered offseason developments on Pouncey here this weekend. Beat reporters in Miami asked Adam Gase for an update today in advance of the team's entrance physicals on Wednesday. Gase didn't provide any additional helpful details, saying only that Pouncey wants to practice but could miss the entire preseason and still be available in Week 1.
I think we'll see Miami leave their roster options open by starting Pouncey on the PUP list. The Dolphins can be a tough team to read and it's tough to speculate whether Pouncey is truly on track for Week 1 or we're hearing false optimism.
Taylor Decker | Shoulder labrum repair | Early June | Active-Pup
Decker is one of a small handful of offensive tackles who had shoulder surgery late in the offseason. Despite the early -- and standard -- rehab estimate of 4-6 months, the Lions are hopeful Decker won't miss the entire season. Tuesday's official NFL transaction report lists Decker on the Lions' Active PUP list. Expect Detroit to move him to the Reserve PUP list at the end of the preseason.
Reuben Foster | Right Shoulder Rotator Cuff Repair | Early February | Active Roster (expected)
Though there were reported concerns that Foster's first rotator cuff repair was not successful and could require additional surgery, Matt Barrows reported today that the Niners are expected to clear Foster to practice fully after the team reports for physicals later this week.
Foster's health is a key story for San Francisco. He'll be competing with NaVorro Bowman for playing time at inside linebacker. If Foster proves ready for full contact and Bowman continues to be slowed after a knee reconstruction and Achilles tendon repair over the past three years, the Niners could choose to release Bowman and give Foster the job full time.
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.