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Injury Analysis: The Preseason PUP List

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

At long last NFL training camp has arrived and players around the league are putting on their helmets and strapping on their pads, well most of them anyway. Several players are still recovering from offseason injuries while others are already nursing fresh wounds.

To kick things off for the new season, let's start by looking at the Preseason Physically Unable to Perform (PUP) list. The preseason PUP is utilized for players limited by football-related injuries. By placing a player on the PUP they are taken off the active roster and are not allowed to participate in training camp practices. The player can be moved to the active roster at any time but once the athlete in question has participated in a practice they cannot go back on the preseason PUP.

This year's PUP list is littered with several high-quality fantasy options. Let's take a look at some specifics.

Adrian Peterson
Much to his chagrin, the Vikings have elected to start Peterson on the PUP as he rehabs from a torn anterior cruciate ligament (ACL) and torn medial collateral ligament (MCL) in his knee. The injury occurred in a game against the Redskins on December 24 and surgery was performed on December 30 by renowned orthopedic surgeon Dr. James Andrew. His rehab and recovery have been well documented by multiple media outlets, including a very open Peterson on Twitter. The reports are all positive as he resumes his rehab with head athletic trainer Eric Sugarman after a scary allergic reaction to seafood. His primary goal is be ready for opening day but he has hinted he would like to see action in the preseason.

Despite all the positive vibes, I'm still advising fantasy owners to tread carefully. Facts are facts and Peterson is just seven months post-operation. While some athletes are pushing the envelope and returning six to eight months following surgery, most players do not return to their original form for at least a year. Part of the reason maybe that remodeling of the ACL graft is not complete until roughly 12 months following surgery.

Minnesota's first game is September 9 versus Jacksonville, meaning nine months will have elapsed since Peterson's operation. I suspect he will be in uniform but questions about his productivity will remain. I'm targeting him in the late second-to-third round in hopes he bucks the trend.

Jahvid Best
Another NFC North running back sits on his team's PUP as Detroit's Best continues to recover from a concussion sustained almost 10 months ago. Last season he suffered a concussion in the preseason and second one in October. He never returned to the field and still has not been cleared to play. Best's problems are not limited to his pro career either, complicating the issue.

While at Cal, Best suffered a significant concussion diving into the end zone. He landed on his head and his upper extremities instantly became rigid in what is known as the fencing response. This abnormal posturing is a neurological motor response resulting from a head injury. The main problem facing Best stems from the fact that the effects of multiple concussions are cumulative, meaning the effects from each head injury must be considered as a whole. This detail also means that any head injury Best suffers in the future would compound the problem.

Best's injury risk is extremely high and fantasy owners would be taking a major gamble by selecting him and the same is true for his backfield mate Mikel Leshoure. Leshoure has yet to play a down in the NFL, since tearing his Achilles prior to last season. Achilles injuries can rob a player of his explosiveness and speed and very few effected individuals return to their original peak performance.

Hakeem Nicks
Nicks is another high-profile name starting the year on the PUP. Nicks, recovering from surgery to repair a fractured fifth metatarsal in his right foot, recently began running and hopes to begin making aggressive cuts in the near future. Nicks broken foot required the insertion of a surgical screw to help with a condition known as a Jones fracture. He is targeting a mid-August return but, like Peterson and Best, I remain skeptical.

Refractures of the fifth metatarsal are common and occasionally, dependent on the size of the screw, the surgical screw can fail. Nicks' teammate Ahmad Bradshaw knows all about these problems, as a screw placed in his fifth metatarsal to repair a similar fracture became a serious issue during the middle of last season. He missed four games and opted for an additional procedure this offseason to help stimulate bone growth in the area.

Given the associated risk of his surgery I've got Nicks outside the top 10 in my list of wide receivers. There are safer picks and, with the emergence of Victor Cruz and the addition of Martellus Bennett, the Giants may not feel rushed to get Nicks back on the field.

Turf Burns

Andre Johnson: If Johnson is trying to shake the injury prone moniker that he earned last season, he isn't off to a great start. After playing just seven regular season games last year due to bilateral (both) hamstring strains and an ankle problem, Johnson will miss a week's worth of time with a mild groin strain. I'm not a big fan of players with multiple lower extremity muscle problems, especially a receiver that just turned 31.

DeMarco Murray and Felix Jones: The Cowboys backfield is littered with injury question marks as both backs look to bounce back from surgery. Murray needed surgery to repair a fractured right ankle suffered in Week 14 while Jones required offseason shoulder surgery for his chronically unstable shoulder. Early reports have been positive for Murray but not for Jones, who failed his first attempt at the team's conditioning test. The safest thing would be to handcuff the two and insure you aren't burned if either goes down.

Ben Roethlisberger: Big Ben isn't doing much to earn the trust of fantasy owners either as he recently revealed he has a small tear in his rotator cuff. A tear in this area can be very painful and limiting and would alter his delivery of the ball. He has reduced his throwing in practice but that may affect his timing with his receivers. Downgrade Roethlisberger in all early drafts.

Jeff Stotts is a Certified Athletic Trainer, MAT, ATC and PES.

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