Monday Injury Rounds: Running Back Update

How concerned should you be about Todd Gurley? Examining the recovery of Derrius Guice and Bryce Love. Full review of running back injuries around the league.

During the regular season, details on player injuries are now reported on a seemingly minute-to-minute schedule. Information is less readily available through March. But as teams get closer to free agency, the draft, and post-draft mini-camps, new details emerge.

Players must make final decisions on surgical interventions to give themselves enough time to finish rehab before the end of training camp. Coaches and players are more readily available for questions at the scouting combine, the draft, and mini-camps. And the decisions front offices and coaching staffs make in free agency and the draft sometimes hint at where teams believe their injured veterans may be in their recovery.

Over the next few weeks, I'll be reviewing player injuries by position. I'll examine critical or confusing situations in depth. Expectations on all relevant injuries will be included in a table at the end of each article.

I'll keep each feature up-to-date through OTAs and minicamps, then combine all positions into one feature as training camps and the regular season approaches.

Quarterback Update
Running Back Update
Wide Receiver Update
Tight End Update

Running back update

Todd Gurley | left knee inflammation | recurrent 2018 | Ready for training camp

The Rams spent the last two months of 2018 arguing Gurley's left knee was fine -- just "soreness" and "inflammation" in the joint. At times, he wasn't listed on the team injury report. Their actions during their most critical games suggested otherwise.

They were worried enough about Gurley's ongoing knee issues to send him for an MRI after Week 15. Though the results were reportedly reassuring, Los Angeles rested Gurley in Week 16 and 17. Though Gurley looked healthier in the Divisional Round against Dallas (18 touches), he played just 57% of the team's snaps. In the NFC Championship and Super Bowl, Gurley played 46% and 66% of the snaps, with 7 and 12 total touches in those games. To be clear, C.J. Anderson was effective in Week 16 and beyond. But Gurley had been the team's lead back throughout the season. In the Rams' first 15 games, Gurley routinely played between 80-90% of the offensive snaps, falling short of 70% in only two games -- blowout wins in Weeks 2 and 7.

The Rams have spent the months since their February Super Bowl loss arguing Gurley's knee is fine. They have resisted labeling Gurley's injury as anything more than "wear and tear" with Sean McVay saying Gurley is "in a good place" and likely to be a "focal point" of the offense.

But the team moved up in the draft to take Darrell Henderson in the second round and are reportedly contemplating a two-back offense and are already discussing limiting Gurley's workload. Anderson told reporters in February that Gurley was "more hurt than ... what everybody in the building thought." There have been rumors Gurley may be seeking out stem cell therapy for his knee and McVay told reporters Gurley might benefit from "new methods and advances."

Gurley himself says he is "feeling pretty good" but doesn't know "how I'm going to be feeling six months from now."

Although the Rams refuse to use the word arthritis, it's reasonable to come to the conclusion Gurley is dealing with a chronic, degenerative condition.

Many ACL injuries are associated with some cartilage damage (Gurley tore the ACL in his left knee in 2014). A reassuring MRI study usually means no ligament or meniscus injury requiring immediate rehab or repair to return. Most players have some degree of "wear and tear" in their joints. Stem cell therapy is controversial, poorly studied, and generally ineffective -- but often sought out by players looking to heal or regenerate poorly-healing tissue. And May discussions about managing workloads in a player who's already admitting he won't know how he'll be feeling after the season begins further underlines the concern.

I'm not painting a rosy picture here. However, while it's very likely the length of Gurley's playing career will be shortened by the condition of his left knee, it's still entirely possible he'll be able to play effectively in the short term. We don't know how significant Gurley's cartilage loss may be. Many NFL players -- including running backs -- manage cartilage loss and chronic inflammation well enough to remain effective.

But it's a near-certainty we'll see Gurley on the injury report frequently in the future. The Rams are already committed to limiting Gurley's practice workload and have already identified a talented back to limit his in-game workloads. 225-275 effective and possibly elite touches is still a reasonable projection. Unfortunately, it's unlikely Gurley can manage a 275+ rush and 80+ target season.

May 28 Update: Add Jay Glazer to the list of media members concerned about Gurley's future. When asked if Gurley's arthritic knee was a real concern, Glazer replied that the response of Gurley's knee to early season work would be key. There's no news here but it's notable to read another NFL insider share more concern than the team has publicly.

June 3 Update: Not surprisingly, Gurley is not participating in OTAs. Assuming the trend continues and Gurley also sits through June minicamp workouts, our next data point will be whether Gurley is healthy enough to start camp on the active roster.

Derrius Guice | Left ACL reconstruction / Post-surgical infection | Mid-August 2018 | Probable for training camp
Bryce Love | Right ACL reconstruction | Mid-December 2018 | Questionable for training camp

Washington has two running backs recovering from 2018 ACL injuries. One is much closer to returning than the other.

Guice suffered his injury in August and after some unusual diagnostic uncertainty -- a physical examination is usually very accurate in determining whether an ACL is intact -- had surgery soon afterward. Unfortunately, Guice's knee was infected after surgery. He needed three additional procedures to flush infected fluid from his joint and two months of intravenous antibiotics.

Infection puts the graft and other tissues in the knee at risk but Guice has reportedly recovered briskly and successfully. He was cleared to sprint by early February -- four months after his course of antibiotics ended -- and is reportedly ahead of schedule and could be cleared for individual drills during OTAs. He could be fully cleared for camp.

Love injured his ACL in December. Despite his proclamations of health and his own projection of a mid-training camp return, a seven-month recovery from ACL reconstruction remains the exception rather than the norm. Like Guice, there are concerns with Love's post-surgical course. Tom Pelissero reported teams were worried about stiffness in Love's knee during medical exams in April. Dr. David Chao reviewed video on Love and came to similar conclusions.

That's critical. Rehab protocols after isolated ACL reconstruction prioritize the quick return of range of motion. The lack of range of motion raises concerns for scar tissue around the graft and other limiting factors. It's possible Love's rehab will eventually conclude successfully. It's also possible Love will need additional procedures to allow him to reach his previous NFL potential. Regardless of the outcome, it looks unlikely Love will be ready to participate in training camp. Expect him to start camp on PUP and it's possible Love may not be ready until 2020.

Matt Breida | Pectoral muscle tear | Mid-May 2019 | Probable for training camp

May 28 Update: Breida was absent as San Francisco began their first offseason workout. Kyle Shanahan revealed Breida was rehabbing after suffering a pectoral tear. Shanahan told the media Breida would be ready in camp, which suggests the injury is a muscle tear (which can be rehabbed) rather than a tendon tear (which would require surgery and a much longer rehab period).

Running Backs
Player Team Injury Date Player/Team Says FBGs Expects Notes
Todd Gurley LAR Left knee inflammation Recurrent 2018 Not participating in OTAs Probable for training camp
Christian McCaffrey CAR Shoulder surgery Early offseason 2019 Ready for training camp Ready for training camp
Devonta Freeman ATL Core abdominal muscle repair Mid-October 2018 Participating in OTAs Ready for training camp
Ito Smith ATL Left knee meniscus repair Mid-December 2018 Ready for training camp Ready for training camp
Derrius Guice WAS Left ACL reconstruction Mid-August 2018 Ready for training camp Probable for training camp Individual work in OTAs?
Bryce Love WAS Right ACL reconstruction Mid-December 2018 Questionable for training camp PUP to start camp
Phillip Lindsay DEN Right wrist fracture / ligament sprain Late December 2018 Limited in OTAs Probable for training camp
Aaron Jones GB Right MCL sprain Mid-December 2018 Expected in OTAs Ready for OTAs
Kerryon Johnson DET Left knee sprain Mid-November 2018 Ready for OTAs Ready for OTAs
Jerick McKinnon SF Right ACL reconstruction Mid-September 2018 Did not participate in OTAs Probable for training camp
Matt Breida SF Pectoral muscle tear Mid-May 2019 Did not participate in OTAs Probable for training camp
Raheem Mostert SF Right forearm fracture Early November 2018 Did not participate in OTAs Probable for training camp
Bilal Powell FA Cervical microdiscectomy Late October 2018 Cleared to return Ready for training camp Free agent
Frank Gore BUF Left foot sprain Mid-December 2018 Ready for OTAs Ready for OTAs
Chris Carson SEA Knee procedure Offseason Did not participate in OTAs Probable for training camp
C.J. Prosise SEA Core abdominal muscle repair Early December 2018 Ready for OTAs Ready for OTAs
Miles Sanders PHI Hamstring strain June 2019 Limited in OTAs Probable for training camp
Josh Adams PHI Shoulder labrum repair January 2019 Questionable for training camp Questionable for training camp
Corey Clement PHI Right knee sprain Early December 2018 Questionable for training camp Ready for training camp
Isaiah Crowell OAK Achilles tendon repair Mid-May 2019 Injured reserve Injured reserve Out for 2019 season
Kenneth Dixon Bal Undisclosed June 2019 Not participating in OTAs Questionable for training camp
Jeremy Hill NE Right ACL reconstruction Early November 2018 Questionable for training camp Questionable for training camp
Jay Ajayi FA Left ACL reconstruction Early October 2018 Questionable for training camp Questionable for training camp Free agent
Rodney Anderson CIN Right ACL reconstruction Late September 2018 Ready for training camp Probable for training camp

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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