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.
1. Is Andrew Luck ready to throw?
I've been surprised Luck's recovery hasn't been a bigger offseason story. After struggling with a labral tear in his throwing shoulder for most of two seasons, Luck chose to have surgery requiring a careful and prolonged rehab that would take his recovery right up to the start of training camp. There was some poking around the story in April and June, but less than you'd expect from a franchise quarterback recovering from surgery. Tom Brady's concussion and Kirk Cousins' franchise negotiation were bigger stories.
The Colts and Luck have controlled the story well. Jim Irsay gave just enough details in April -- though some were initially misleading -- to allay concern. The team allowed Luck to address the media twice in June and his comments on why he was yet to throw -- though defensive and not fully reassuring -- again seemed to allay concern and there's been no new reporting since the end of June.
Here's what Luck told reporters at the end of June:
"When the time is right for me to start throwing, I'll start throwing."
"If I'm ready for [the start of training camp], great. If not, then that's the way it is."
Luck had a repair of his shoulder labrum. Most rehab protocols suggest 12 weeks -- three months -- is the earliest an overhead throwing athlete could be cleared for sport-related activity and preparing to throw. But the majority probably reach that target between 4 and 6 months after surgery. Luck's surgery was in mid-January. He's not necessarily behind in his rehab protocols.
I think you can read Luck's comments two different ways.
Scenario 1: His rehab has progressed exactly to plan and there have been no setbacks. Luck and his medical staff are proceeding with extreme caution, striving to squeeze every possible recovery in range of motion and strength before he starts his throwing program and minimize the risk of inflammation and delayed return. In other words, Luck could have been throwing weeks ago.
Scenario 2: Luck's recovery has gone slower than expected and could not be cleared to throw in June.
I think the first scenario is more likely. The Colts have every reason to be cautious. There's no added incentive to have Luck ready for the first week of training camp. And I see no reason the always quiet Colts would have allowed Luck to speak with the media in June if there was a setback. It's also reasonable to read the quiet offseason as a "no news is good news" situation. Last year, there were multiple media hints that Jordy Nelson and Dion Lewis weren't right. That hasn't been the case with Luck.
However, until Luck throws and shows his arm strength and accuracy have returned, monitor his recovery closely.
2. Does Jaylon Smith have any chance of returning to pre-injury form?
The short answer is yes.
Smith's recovery has been slow. But each report over the past 12 months has been positive. Last week, the Cowboys said Smith's nerve function was continuing to show improvement. Smith was not working in the most restrictive orthotic brace during OTAs. He's not on the PUP list to open camp, with the Cowboys planning to allow him to practice every other day.
However, Smith is not yet fully recovered and still requires some support to prevent his left foot from dragging when he moves. Despite the recent and steady improvements, there's no guarantee his nerve will recover to pre-injury function. Smith may be able to find ways to overcome his deficiencies, but he'll be at risk of compensatory injury.
I'm hopeful Smith will provide the same kind of anomalous positive data point Jimmy Graham has for patellar tendon recovery. He'll be fascinating to follow this preseason.
3. Will Sammy Watkins be pain-free throughout camp?
There's no good choice for injured players. Despite the best surgical teams and physical therapists, surgery is something to be avoided. But playing through pain and risking ineffectiveness and additional or compensatory injury isn't attractive either.
Watkins knows this well. He's battled through pain over the past two seasons, sometimes playing at an elite level, other times needing many weeks of rest and recovery after a foot fracture. Watkins eventually chose revision surgery in January -- a surgery many wide receivers with metatarsal fractures have returned to form after in recent years -- but the Bills didn't pick up his fifth-year contract option.
Watkins returned to take first team reps in non-contact OTA practices in June but was officially considered limited. Unlike last summer, despite videos of Watkins moving well, there were frequent reports of foot soreness. Though Watkins himself has not discussed his injury, that hasn't been the case this offseason. One beat writer wrote, "Watkins should be close to 100% when camp starts," recently, but don't read too much into the "should" in that sentence.
The Bills may continue to be cautious with Watkins early in camp, but the track record of recovery after metatarsal revision surgery and his return in June are both reassuring.
4. Has J.J. Watt recovered enough to wreak havoc again?
Watt pushed the limits of recovery last season. He was anatomically recovered from his microdiscectomy when he returned eight weeks after last year's first surgery. But his core strength and conditioning were nowhere close to his pre-injury form. Most players -- including defensive linemen -- who underwent similar procedures say it takes 4-6 months to feel full strength again.
Watt has had nearly 10 months to recover from his second back surgery. He was fully cleared in February and participated in all offseason practices. All reports described him as dominant. Degenerative back conditions requiring surgery are always a concern, but Watt remains in the prime of his career and has fully rehabbed from the second surgery.
Watch for any evidence Watt struggles during full contact camp practices in the heat, but it's reasonable to expect a full return for Watt this year.
5. will tyler eifert practice immediately?
Eifert had surgery to address a herniated disc in late December. He's yet to return to football-related activity, doing light rehab on the sidelines during the Bengals' OTAs and minicamp. In mid-April, he told reporters he was still working to regain strength after surgery. As noted above with Watt, players can require six months to recover core strength and flexibility. Eifert wasn't cleared to run and change direction until April, as the Bengals return to him slowly.
There doesn't seem to be any concern around the team but Eifert has not been a quick healer and the back injury was considered a compensatory injury while recovering from last season's ankle surgery. I don't anticipate Eifert starting camp on the PUP list but it's possible the team will choose to take extra time to ensure Eifert is in condition to practice before clearing him.
6. How much will Teddy Bridgewater do in training camp?
Bridgewater continues to progress in his rehab. He was cleared to do light throwing in April and multiple videos showed him doing pocket drills and throwing to receivers during minicamps. He has not yet been cleared for contact. Whether that happens when camp begins is not known, but Bridgewater is currently expected to start on PUP. If Bridgewater has any chance to serve as Sam Bradford's backup to start the year, he'll need to be cleared for contact quickly and prove he can be effective in the pocket.
And -- despite the optimism reports of him working without a brace generated last month -- expect Bridgewater to play with a brace when he returns. It's very unlikely the team will be comfortable allowing him to play without one on his front and plant leg in game action.
7. Will Mike Williams respond to his second steroid injection?
Many NFL players have steroid injections to relieve inflammation around a herniated disc, as medical staffs work to keep them healthy enough to play. It's generally considered safe to have up to three injections over some months before a player must consider surgery. Williams had his second injection recently after not fully responding to the first injection this spring. A report from Adam Schefter had Williams and the Chargers concerned about impending surgery. Other reports from Ian Rapoport and Mike Garafolo shortly after Schefter's report were more reassuring and suggested that Williams has seen improvement since the second injection.
The consensus is that Williams will start camp on PUP and continue to rehab. There's concern that surgery would end Williams' season. We've seen players return in 10-12 weeks (or less in Watt's case) from similar procedures. But, even if surgery is decided soon, the Chargers may not want to push Williams to return later in the season. The lost reps and conditioning aren't helping Williams.
Hopefully, any pain and/or weakness from the herniated disc improves quickly and Williams is ready to practice before the season begins. As we've seen with many players, however, symptomatic herniated discs that cost multiple weeks of practice time can be tough to overcome without surgery.
8. Will Adrian Peterson put his latest injury behind him?
Peterson has made a second career of recovering from serious injury. His return from a torn ACL was the stuff of legend, with Dr. James Andrews marveling at the state of the cartilage in his knee and Peterson resetting the optimistic range of rehab at six months. He was practicing in anticipation of returning from last year's meniscus repair well in advance of expectation. He was nearly able to complete a record-setting rushing season while playing through multiple core abdominal muscle tears some years ago. So, it was no surprise to hear excitement over Peterson's work during OTAs.
Now over 10 months removed from a surgery that usually requires 3-4 months of rehab and already showing signs of full recovery, expect Peterson to be ready for contact as camp begins.
9. Is MIke Pouncey healthy enough to start camp on the active roster?
One of the most critical offensive line storylines this preseason is Pouncey's ongoing and complicated recovery from last preseason's hip injury. After trying to return from a "small hip fracture" early last season, Pouncey suffered a setback in November and was placed on injured reserve. At the time, Pouncey was expected to be available for offseason activities. But he was still on crutches in April after a stem cell injection and his status remains unclear entering camp.
Stem cells are gaining favor as a treatment to stimulate healing. It's not known where Pouncey's fracture was and whether the stem cell treatment was to address poorly healing bone or related cartilage damage, but neither will be easy to treat.
Adam Gase told reporters Pouncey was on a "really good track" in late June and there are reports he may be ready for Week 1. But there were no followup reports on a recent re-examination. Pouncey is a critical part of Miami's rushing attack. Both Jay Ajayi and Ryan Tannehill's statistical upside will be affected by Pouncey's health.
10. Can Jamaal Charles return to form after multiple meniscus surgeries?
Charles continues to be positive as he prepares for camp following meniscus surgeries on both knees last season. He believes he's back to cutting and moving as he was before his knee problems limited him. Acceleration isn't likely to be a problem for Charles this summer. Change of direction and his ability to recover between practices are the primary keys to Charles' return to form. The Broncos aren't expecting Charles to be anything close to a full time player for them. But they'll need to know if he is healthy enough to be a contributing member of the offense in the early days of camp.
If Charles misses multiple practices or isn't reported to be moving well in contact practices early, he'll face an uphill battle to make the roster.
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.
