The Unlucky Seven: Breaking Down the Most Common Football Injuries
By Stephania Bell, RotoWire Writer & Orthopedic Clinical Specialist Originally published on June 24, 2006
This article is part of our fantasy football help series.
Perhaps the biggest "fantasy" in all of fantasy football is the one team owners experience on draft day, when they envision their full slate of draftees carrying them to the coveted league trophy and earning them bragging rights for a year.
Owners don't want to imagine their key players succumbing to injury at some point during the season. But when reality inevitably intrudes, and players go down, correctly interpreting how a particular injury affects player performance and whether that player will return to pre-injury form is often crucial. After all, you don't want to start a star player who's only healthy enough to serve as a decoy, or a bench player who's questionable all week then goes off for a couple scores.
In this article, we'll look at seven of the most significant injuries that occur on the gridiron and how they affect a player's ability to return to the game. Understanding the full impact of an injury can help fantasy owners make better decisions both on draft day and during the season.
KNEE LIGAMENT SPRAINS
This group of injuries represents everything from minor annoyance to complete devastation for both players and fantasy owners alike. Knee ligament sprains seem to affect every skill position, and though not everyone throws the football, everyone needs to run (yes, even Drew Bledsoe). Therefore, knee sprains can take any player out of the game.
Ligaments are the tissues that connect bone to bone, and they are essential for joint stability. Most of the acronyms are familiar to fantasy owners: ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament) and LCL (lateral collateral ligament – so rarely injured it's barely worth mentioning here).
The ACL is perhaps the most commonly injured, usually on the plant foot during a combined deceleration/directional change maneuver, but sometimes during contact. The PCL can be injured on a forced hyperextension (Ben Roethlisberger) or forced hyperflexion (hyper-bending) injury (such as a hard fall squarely onto the knee). The MCL is most often injured when a player is hit on the outside part of the knee, forcing the knee inward unnaturally.
The degree of sprain (a sprain is simply another term for ligament damage) is indicative of severity. Sprains are graded I (mild), II (moderate) or III (severe – usually indicating complete ligament disruption). A Grade I sprain may result in no lost time up to a couple weeks off, and a Grade III is usually season ending, making these two the easiest to interpret. Grade II represents the broadest spectrum of injury, making it hard to determine how long a player with this diagnosis will be out, but bank on a few weeks minimum. Thus, owners should pay special attention to Grade II sprains.
For lesser sprains that occur during the season, keep an eye on practice reports. When a player returns to running drills that incorporate full sprinting and lateral cutting, which is one of the later activities to be added during rehab, he is close to playing. For the season-enders, it usually takes a full year of being back in the game for a player to return to form after ACL reconstruction (Edgerrin James). This likely will be the case for players such as Braylon Edwards and Javon Walker.
For players who hit the trifecta – ACL, MCL, PCL – their surgery, and thus their rehabilitation, is more complex and time-consuming. Their age, physical condition and style of play helps determine how soon they get their groove back.
Willis McGahee, an amazing athlete, suffered this injury in a college bowl game, but had to sit out the entire 2003 season. For Daunte Culpepper, who was often willing to use his body to make the big plays – will he appear somewhat apprehensive, perhaps opting to unload the ball sooner to avoid a crushing hit? Will Rodney Harrison be willing to deliver the big hit? Will Carson Palmer hesitate to stay in the pocket now? (OK, so Palmer didn't tear his PCL – but he tore the ACL, MCL and dislocated his kneecap – this counts as three injuries.) The athlete's initial protective behavior toward the reconstructed knee, though unconscious, must be overcome, and is part of what takes a player so long to return to pre-injury form.
Exercise caution when drafting a running back or receiver returning from a three-ligament-reconstruction. On the other hand, a quarterback who is returning following a similar injury may return to form as the season goes on, but don't count on him to be productive right away.
This is an injury that has probably been around for some time but has only recently been recognized and named. It is not a true hernia (meaning nothing bulges outward in the groin or abdomen) but it does indicate tearing or disruption of the abdominal wall, especially away from attachments on the pubic bone, thereby rendering the pelvis somewhat less stable. The hallmark features are an inability to run at full speed, if at all, and severe pain when the abdominal muscles contract (required for sit-ups or even to stabilize the trunk when throwing).
There is good news on several fronts when it comes to this injury. It is self-limiting – meaning a player can play as much as he is able, limited only by the amount of pain he can withstand. Although the tear can progress, the injury, once established, ultimately requires surgery. Consequently, a player like Donovan McNabb continuing to play until he just can't take it anymore does not risk worsening his overall outcome.
The other good news is the rehab is relatively quick. Once the surgery is done to repair the tissue, which is sometimes reinforced with a weapons-grade mesh, the athlete can return to full activity in 3-4 months. McNabb got rid of all his pains during the offseason – he should return strong and happy. Tom Brady was playing golf a week after surgery and should have no residual problems.
If one of your players is diagnosed with this injury during the season, track his performance from week to week. As long as there is no drop in speed or mobility, or throwing strength if it's a quarterback, there is no rush to drop this player. However, it is likely that as the season progresses, so will the injury, and the signs will be there. (Remember when McNabb started to lose the ability to throw hard downfield, when getting up was a little slower?) If those signs appear, be prepared to make that roster adjustment.
Concussions, also known as brain injuries, consistently appear on the weekly injury report. Symptoms typically include headache, dizziness and blurred vision. The seriousness of the injury is gauged, in part, by how long it takes the symptoms to resolve. The majority of concussions result from helmet-to-helmet contact (hence the stiff penalties when intentional), followed by another body part to the helmet and ground-to-helmet contact.
The good news is that most concussions resolve quickly, so if your player gets knocked out of a game, he is, based on statistics, more than likely to return the next week. However, a severe concussion is a serious matter, as is the total number of concussions a player has during his career. The brain is a delicate organ, and consecutive trauma means cumulative effects. Players have been known to retire after suffering multiple concussions (Steve Young, Wayne Chrebet, Troy Aikman) because they want to be able to use their brain after football.
Quarterbacks are particularly at risk because the goal is to knock them to the ground. A one- or two-concussion history does not prevent an athlete from returning as a star performer. But if the number is higher (Young had at least six, Chrebet had at least five), the athlete may be just one concussion away from retirement.
HIGH ANKLE SPRAIN
This is the injury de jour in the NFL. No one wants one, yet it seems everyone has to have one. What makes a high ankle sprain special? Why is it so much more dreaded than the garden-variety ankle sprain?
We know that sprains are ligament injuries. The ligaments typically involved in ankle sprains run from one of the leg bones to attach directly onto the foot. The term "high" refers to the fact that these ligaments, the inferior tibiofibular ligaments to be exact, are actually above the foot, connecting the two lower leg bones just above the ankle joint. When these ligaments are injured, weight bearing can cause the gap between those bones to widen, resulting in increased pain and eventually arthritis.
High ankle sprains take longer to heal (hint: usually longer than what is initially reported – remember Todd Heap? Deuce McAllister?), and they can be more problematic down the road. Depending on the severity of injury, treatment ranges from keeping weight off the ankle to casting the ankle for a period, to surgical stabilization to keep the leg bones in the proper position. Consequently, recovery time ranges from six weeks to several months. The offseason is adequate time for a player to recover from this injury, but if he sustains one during the season, count on him being out for roughly six weeks.
ROTATOR CUFF TEAR
Unlike baseball where rotator cuff injuries typically result from overuse, in the NFL these injuries usually come from direct trauma, most often a fall onto the shoulder. The cuff, a group of four muscles that coordinate arm movement and provide shoulder stability, can be bruised or torn when landed on directly, particularly with a few hundred extra pounds of defense on top.
A partial tear may not require surgery, and many defensive players (who also happen to be prone to this injury) persevere despite the pain. A quarterback, however, like a pitcher, is dependent on cuff function to be effective, and even a minor injury can sideline him. The time a player needs to recover depends on the degree of strain. A complete tear generally requires surgery and the rehabilitation is roughly six to eight months.
Chad Pennington, coming off his second rotator cuff repair, likely will be brought through camp slowly, and it remains to be seen how effective he can be. There really is no precedent for a double repair quarterback. Even one-time cuff repair quarterbacks struggle to return (Tim Couch, Jim Miller). Warren Sapp, on the other hand, who does not need to throw and who looks to be on track for camp, should be able to taunt and tackle just like before.
Fractures (broken bones) can happen whenever there is more stress applied to a bone than it can handle. Given the mass of your average lineman these days, it's amazing there aren't more of them.
Some fractures can be complicated. For instance, when a fracture happens through a joint, is accompanied by dislocation of a joint, is compound (bone punctures the skin), comminuted (bony ends are fragmented), or displaced (bony ends are offset), the fracture is messier and it often requires surgery and hardware to repair. This all translates into longer rehabilitation (read: longer time off the field) and these injuries really need to be analyzed on a case-by-case basis.
Most simple fractures however are fairly straightforward. When a bone sustains a clean break, it is like a twig that snaps neatly from a branch. If the bony ends are non-displaced (meaning they remain nicely aligned with one another), treatment generally consists of casting the body part and allowing the fracture to heal – typically about 6 weeks.
In the case of a hand or arm fracture, excluding quarterbacks, players may be able to return sooner wearing some type of protective cast or splint. Obviously if the leg or foot is fractured, the player will be out at least as long as the cast is on.
The biggest problem for athletes who sustain a fracture in the lower leg however is not the bony injury itself, but rather the period of immobilization. Take for example the fairly common fibula fracture. The fibula is the skinnier of the two lower leg bones and it forms the outer portion of the ankle. Casting the fibula requires immobilizing the ankle. The ability to point and flex the ankle or move it side to side is severely limited after casting. Remember this injury for Michael Vick back in 2004? Initial projections for his return after fracturing his right leg ranged from 6-8 weeks. In fact, it took much longer. Why?
One factor surely was that his ankle was casted and had plenty of time to get stiffen. The more mobile the player, the more he relies on agility, acceleration and directional movement which stems largely from the ankle. Consequently the more limited his style of play will be after a long period of immobility. Keep this in mind as the first fibula fracture occurs this season because it's not a question of whether they will happen, it's a question of when and to whom.
There is perhaps no more annoying injury to appear on the weekly reports than a muscle strain. Strains, like sprains are graded in degrees – mild, moderate, severe. Strains refer to muscle injuries while sprains are associated with ligaments. Any strain represents a tear of the muscle, though a mild strain can simply refer to overstretching, perhaps microtearing and mild inflammation. As with sprains, a complete tear usually translates to "season over."
The moderate strain is really the most challenging when trying to gauge the impact on a player. Many times the degree of injury is not even reported. Not that it matters, because it would still be difficult to accurately project time off based on an initial report.
The key to monitoring how a player is progressing is keeping an eye on what his practice activity level is. If it's a leg or abdominal muscle, is he running at full speed? Is he cutting, making directional changes? Unless we're talking about a running quarterback, these injuries are most likely to impact speed players – receivers, running backs, defensive backs, some tight ends – as these are the players who need to accelerate and decelerate quickly, and in the case of receivers or DBs, jump high (think Randy Moss).
The hamstring, no doubt the most commonly strained muscle in these athletes, is also the most problematic in that it can easily become a chronic, nagging problem. Not unlike the rotator cuff strain in throwers, the hamstring strain often recurs, potentially increasing in severity each time. Factor in age (both human years and football years), and this injury can easily move from the realm of annoyance to that of serious concern.
Factors to consider before draft day: Has a player suffered repeated strains to the same muscle, on the same leg, resulting in multiple missed starts? Does that player rely on speed, agility, vertical jump? If the answers to those questions are all affirmative, then a potential starter should look more like a back-up, at least through the first few games of the season. Injuries, like it or not, are a major factor in football – both the reality and fantasy versions. Understanding them ranks right up there with evaluating player roles and skills. If you put all three together, you could find yourself on the way to a league championship.