Are Some Players Injury Prone?

A deeper look into the term injury-prone and why it can be so misleading

Athletes frustrate us for many reasons. Inconsistent performance. Off-field transgressions. Failure to reach their potential. But the inability of some players to stay healthy for a full season may be the most maddening of all.

Coaches sometimes openly complain that a player is taking longer to return than expected. Injured players often confidently predict that they'll beat even the most optimistic return to play estimates. Though there's often little clarity on the severity of a player's injury or when he'll be back on the field, one thing is certain. In the tough guy culture of the NFL, no one wants to be labeled "injury-prone."

The Injury prone player: perception vs reality

Are certain players more prone to injury than others? Can you measure how injury-prone a player may be? Is it predictable? How many injuries does a player have to suffer before earning the injury-prone label?

It's plainly obvious that some players get injured more often than others. If you were to ask a room full of team physicians, athletic trainers, and physical therapists, "Are some athletes more prone to injury than others?" every single one of them would say, "Yes."

But it isn't easy to reliably identify the most fragile players. If you said to the same room of team physicians, athletic trainers, and physical therapists, "Tell me which of your athletes will be injured this year." you'll get a room full of professionals talking about unknown variables, relative risk, and other responses making it clear that no one was comfortable giving a straight answer.

Why the difference in confidence level? While it may be clearly evident that a player HAS BEEN prone to injury, it doesn't necessarily follow that the same player, now healthy, WILL BE prone to injury in the future.

Yet, the term injury-prone is more often used prospectively rather than retrospectively -- and at times, I believe, unfairly.

Identifying the highest injury risks

There are many objective reasons why a player who has had a history of injuries may be prone to future injury. I think it's reasonable to consider players in the following categories as more likely to suffer a future injury:

  • A player with a smaller frame, greater than average laxity in his joints, or less than average tendon flexibility
  • A player with poorer strength, poorer conditioning, or less endurance than his competition
  • A player with below-average bone density or differences in the microscopic makeup of his connective tissue
  • A player with poor biomechanics or technique, especially when performing repetitive motions
  • A player with poorer reaction time or slower neuromuscular processing speed
  • A player more willing to take chances or put himself in a position to be injured
  • A player who has had repeated injuries to the same area (e.g. scar tissue, cartilage loss, overuse syndromes)
  • A player more willing to play through pain that limits his conditioning, flexibility, reaction time, etc.

There are undoubtedly many others. But, in many cases, putting a number on the risk of future injury is difficult, if not impossible. Those inside the locker and training rooms, with access to a full medical file on a player who trusts them enough to accurate self-report symptoms may be able to identify these issues in advance. 

Even in those cases where a team may be aware of an issue (e.g. joint laxity, scar tissue, conditioning concerns), reporters, analysts, observers, and fans are almost certainly not.

Assessing the importance of missed offseason workouts

Every offseason, blogs and Twitter are abuzz with news about players missing offseason training workouts and minicamp with injuries. Teams are even less forthcoming than usual about the severity of these injuries and purposefully vague about when they expect their players to return.

There are times when something just doesn't add up -- e.g. Kevin White missing more than four weeks with "shin splints" -- and those missed workouts are an ominous sign for the future. More often, however, a team exercising caution with an injured player they expect to be a major part of their offense or defense is doing exactly and only that.

Deciding which players to downgrade

So, if it's difficult to know which players are truly prone to injury and impossible to know what the truth is about an offseason injury situation, when should you downgrade a player's future expectation due to injury concern?

First, ask yourself if the story being told is believable. Is it plausible that a team might hold its stud offensive talent out of meaningless OTA practices when their depth chart is shallow and the offensive coordinator and playbook hasn't changed? Absolutely. Should you worry if a coach is optimistic about a player returning soon but is continually evasive about his third knee surgery in two years when asked why he isn't practicing? Absolutely.

Many situations are going to be more murky. But there are some subtle clues you can use to your advantage. A player who cannot make it through consecutive practices two to three weeks into training camp should raise a red flag. A player who was once practicing regularly and now is not should raise a red flag. A player whose injury or surgery does not match the recovery timetable the team gives the media should raise a red flag. Players who reaggravate an injury or have begun to show signs of repeated injuries to the same body part after fully healing also deserve a red flag.

There will be times when a player will fit into none of those categories or are entering camp with promises of being fully healthy for the first time in months or years. And there will always be players whose situation won't be clear until well into camp, e.g. Victor Cruz. Approach these players based on your own philosophies of risk tolerance and how much you believe a player's past injury report informs the future.

be consistent and avoid recency bias

Arian Foster suffers a new muscle strain with the change of the seasons. He gets labeled injury-prone every year. Odell Beckham has had multiple hamstring injuries in this 18 months as a professional. He gets the benefit of the doubt. Le'Veon Bell has had midfoot sprains and knee hyperextensions but no one seems to mind. DeMarco Murray was the poster player for the injury prone player alongside Darren McFadden two years ago. Now, Murray is an ironman after a strong 2014 season. Adrian Peterson has had clavicle fractures and sports hernia surgeries and a torn ACL and multiple ankle injuries and hasn't played competitively in 12 months. He's considered to have a red cape.

It makes sense that a player who's been recently injured is at higher risk of injury now. But if that player has fully recovered, how much higher is the risk? How do you know if he's fully recovered? Realize that you probably don't know. Recognize the role recency bias plays into the injury prone conversation. And, whatever your personal philosophy on injury risk may be, be consistent. Apply an unbiased process to your thinking and your results will thank you for it.

Check back for more injury analysis throughout training camp and the regular season. Also, follow on Twitter @JeneBramel for breaking injury news, commentary and analysis of this injury and others around the NFL.