Injury Analysis: Making Sense of the PUP List and IR

NFL teams have trimmed down their rosters to 53 players, with injuries and health influencing countless decisions around the league. For the first in-season NFL injury report, understanding transactional terms used in the process can be beneficial on draft day especially for opportunistic fantasy managers able to draft a player at a discounted rate. 

The first thing to understand for is the Physically Unable to Perform (PUP) list. With training camp over the Active/PUP list is no longer available to teams. Instead, franchises must now utilize the Reserve/PUP list for these designated players. Players placed on the Reserve/PUP do not count toward the team's 53-man roster and cannot appear in the team's first four regular season contests. This season, players can participate in a 21-day practice period while still stashed on the Reserve/PUP list after the team has played in two regular season games. This allows medical teams to better evaluate players in anticipation of their return following the team's fourth game played. If the player is not activated to the 53-man roster during this window, they must sit out the remainder of the year. Notable players starting the year on the Reserve/PUP include Green Bay's Micah Parsons and Seattle running back Zach Charbonnet. Receiver Alec Pierce was activated off the PUP list late last week and is hoping to be ready for Week 1 after undergoing offseason ankle surgery.

If a player is ineligible for the PUP list but becomes injured, teams must now consider using the injured reserve (IR). Like the PUP list, any player placed on the IR must miss a minimum of four weeks. A player can only return from an IR designation twice a season, and each team is granted a total of eight IR-to-return designations for the year. The number grows to 10 if they make the playoffs. Like the PUP list, these players can utilize a three-week window to ramp up their activity level. At the conclusion of the 21 days, the player must be activated, placed on season-ending IR, or be released or traded. Several big names were allotted IR designations entering the regular season including James Conner, Tank Dell, Jordyn Tyson and Christian Kirk. 

IR and PUP list designations may be frustrating, but it does provide a degree of clarity regarding a player's status. Once a player is placed on either list, those willing to invest in him know they will have to proceed without the individual for at least four weeks. The use of the IR can also be used as a good indicator of the health of another player on the team's roster. For example, Conner's designation in Arizona suggests the team feels good about Jeremiyah Love's availability for Week 1. The rookie running back is working his way back from a high-ankle sprain suffered August 13 but is "progressing really well" according to head coach Mike LaFleur.

Turf Burns

Emeka Egbuka: The second-year wide receiver has been sidelined since August 12 when he suffered a toe sprain in practice. Toe sprains, particularly those involving the big toe, can be extremely limiting, especially for wideouts. The big toe is crucial in driving the foot off the ground when running or jumping while also withstanding the high amount of stress that comes with weight bearing. Egbuka's Week 1 availability remains in doubt, and I'm moving him down my draft board just a bit.

Puka Nacua: The Rams wideout has been limited by soreness in a specific muscle in his core. Nacua's injury involves the psoas muscle. The psoas sits just under the ribs at the lower spine. Its fibers run down through the pelvis, anchoring to the upper femur. It merges with another muscle, the iliacus, to form the iliopsoas, one of the primary hip flexors. Based on this location, a psoas injury can result in pain in the lower back, groin or hip, and be very limiting. Fortunately, Nacua was able to return to practice Sunday, and it looks like he will avoid any missed time. Look for the Rams to handle him conservatively in the days leading up to Week 1. 

Luther Burden: In Chicago, Burden is recovering from a groin injury sustained in the early days of training camp. The timeline suggests Burden's injury was a more moderate strain. He has resumed limited practice, and the team is optimistic he will be in uniform for Week 1. 

Chris Olave: Given Olave's checkered NFL injury history, his fans had to hate seeing him leave practice early last week. The team relayed he simply had the wind knocked out of him and it opted to be cautious with his care. He was back at practice the next day and remains the top target in New Orleans.

Wan'Dale Robinson: The Titans receiver appears to have avoided a concussion after taking a hard hit in a joint practice with the Bears. The medical staff will monitor his status for any late developing signs or symptoms, but for now he appears okay.

Zach Charbonnet: We know Charbonnet will miss at least the first four weeks of the regular season as he recovers from the anterior cruciate ligament (ACL) tear sustained in postseason. The timing of his injury made a Week 1 return unlikely, and an exact target date remains uncertain. Rookie Jadarian Price is expected to start for Seattle with George Holani also set for carries. If Price runs well, the Seahawks could opt for an even more cautious approach with Charbonnet's care to ensure his long-term health. As a result, Charbonnet's fantasy value seems tied to the success of Price.

Patrick Mahomes: The former MVP avoided the IR and is on track to start Week 1. As discussed last week, quarterbacks are one of the positions best poised to return to a high level of play following an ACL tear, and I'm bullish on Mahomes entering the year. He may not put up the same numbers he did when he first burst onto the scene, but he remains a reliable fantasy quarterback with a high ceiling. An early season bye in Week 5 should also help him better navigate his comeback.