This article is part of our Injury Analysis series.
Week 4 in the NFL was quieter than Weeks 2 and 3 but it's nearly impossible to completely avoid injury in a violent sport like football. Ankle injuries have surfaced as a particular problem for fantasy owners as multiple players including quarterbacks, running backs, and wide receivers have all come up limping with damage to the area.
The ankle, the most commonly sprained area in the body, is comprised of four bones forming multiple joints. The primary joint associated with the ankle is the talocrural joint that is formed from the talus of the foot and the two lower leg bones, the tibia and the fibula. The talocrural joint is fortified by ligaments situated on the outside and the inside aspects of the foot. These ligaments stabilize the foot and lower leg during lateral or side-to-side motion. The inside ligament is a triangular band of connective tissue known as the deltoid ligament, designed to help prevent excessive eversion of the foot. The deltoid ligament can be sprained but a medial ankle injury is usually accompanied by an avulsion fracture.
On the outside or lateral area of the ankle sits three ligaments, the anterior and posterior talofibular ligaments and the calcaneofibular ligament. Together they help stabilize the ankle during inversion (moving the foot inward). However this positioning makes them susceptible to injury when the foot is violently twisted or forced inward, like when a player comes down another player's foot. A sprain to the lateral ligaments is the injury that most people think of when they hear ankle sprain. Like all sprains, they occur in varying degrees of severity.
A Grade I sprain is considered minor with partial or micro tearing of the involved ligaments. Grade I sprain are considered mild and often cause a player to miss little or no action. An ankle brace or a tape job can be utilized to help support the affected area. A Grade II sprain is considered moderate and often referred to as a partial tear. The injury is often accompanied by a considerable amount of swelling and requires more intensive treatment and rest. A loss of function also occurs, limiting the range of motion at the joint.
A Grade III sprain is considered a total tear or rupture and generally result in a complete loss of function and stability. They often require a long period of rest and rehabilitation and in some cases surgical intervention.
Grade II or III sprains are particularly problematic because the biomechanical properties of the ligament have been altered. In these sprains, the ligaments have passed their yield point and their strength and integrity remains forever altered. I often compare this to a well-used rubber band. You can't ever get that rubber band back to what it was when it was fresh out of the package. It may still do its job but it isn't quite as effective.
The other commonly mentioned ankle injury is the high ankle sprain. I detailed the injury on September 16 in regards to Jamaal Charles but here's a quick synopsis. High ankle sprains occur at the distal tibiofemoral joint, a totally different joint. Here a strong ligament known as the interosseous ligament stretches across the joint to connect the two lower leg bones while two additional ligaments help stabilize an area known as the ankle mortise. A high ankle sprain involves excessive stretching and disruption of these specific ligaments and often takes longer to heal than your garden-variety ankle sprain.
Teddy Bridgewater, Andre Johnson, Calvin Johnson, Brandon Marshall, and Jamaal Charles
These five players are each currently handling an ankle injury. In Minnesota, quarterback Teddy Bridgewater's professional debut went seamlessly, except for the ankle injury sustained in the fourth quarter. Fortunately x-rays were negative for a fracture and a MRI revealed no extensive structural damage. These test results suggest the injury is a low-grade ankle sprain and should not prevent the rookie from playing Thursday against the Packers, despite the quick turnaround. It may be an issue when he scrambles but there is plenty of reason for optimism.
Texans wide receiver Andre Johnson appears to have avoided a serious injury as well but his situation isn't as quite as fluid as Bridgewater's. Johnson has a history of ankle injuries dating all the way back to 2004. A high ankle sprain in 2010 was particularly problematic and ultimately required a platelet-rich plasma injection and arthroscopic surgery. While the team is downplaying the severity of his current injury, fantasy owners should expect to see this be a factor for the next several weeks. Furthermore, Johnson has a history of lower leg injuries beyond the ankle, including groin and hamstring strains. Any weakness in the ankle musculature or changes in his gait would increase the chances of an injury to a different part of the leg.
The same can be said for another Johnson as Detroit's Calvin Johnson finds himself in a similar situation. A recent ankle sprain is being publically reported as minor though the receiver looked less than 100 percent Sunday. He was limited to a season-low 37 snaps against the Jets and finished with just two catches for 12 yards. The ankle is reportedly improving but don't be surprised if Megatron receives an off day during the week to focus on rehab. Johnson is too good to consider benching but it may be worth shoring up your roster behind him to minimize the impact of a possible dip in productivity.
Chicago's Brandon Marshall provides the perfect comparison for Johnson owners. After sustaining an ankle sprain in Week 1, Marshall's production has been wildly inconsistent, as the injury has lingered and aggravated. He remains limited in practice and the Bears have also closely managed his time on the field on Sundays. He remains a top red-zone target for Jay Cutler but his total yards have suffered. In Chicago's last two outing he has hauled in just three passes for 25 total yards. Expect this trend to continue until at least Week 9 when the Bears get their bye week and Marhsall is allotted extra time to recuperate.
Kansas City's Jamaal Charles appears to be on the tail-end of recovery from his aggravated high ankle sprain. After the injury forced him to the sidelines for Week 4, Charles returned rejuvenated, scoring three touchdowns in the win over New England. The manner in which he played inspires even more confidence than the touchdowns, as he looked spry and nimble, making hard cuts on the effected ankle. The emergence of Knile Davis may eat into his touches but may end up being beneficial. Splitting carries will minimize the wear-and-tear Charles' body endures and could keep him fresh for the latter portions of the season.
Turf Burns
Michael Crabtree and Vernon Davis:Colin Kaepernick's primary targets are both nursing injuries. Crabtree briefly left the team's win over the Eagles with a foot injury. A sideline camera showed the receiver rolling the bottom of his foot on top of a softball. This is a myofascial release technique often used to treat plantar fasciitis. The 49ers have not released the specifics surrounding the injury but, if it is indeed plantar fasciitis, expect Crabtree to be limited for the immediate future.
Davis is now nursing a back injury along with his bruised ankle. The injury is being reported as back spasms, though spasms are a symptom caused by an underlying factor and not a true injury. Downgrade Davis and consider other options for Week 5.
Marvin Jones: Cincinnati is set to welcome back Jones this week after the receiver missed the team's first three games recovering from a fractured fifth metatarsal. Jones could be a nice waiver wire addition but tread carefully here. Fifth metatarsal injuries have a high incident of re-injury and surgical hardware failure.
Mike Evans: Tampa Bay's rookie receiver suffered a Grade 2 groin strain and is expected to miss between two to four weeks. Given the demands of the position, fantasy owners should prepare for Evans' recovery to take the full-allotted time.
Carson Palmer: The Cardinals hope Palmer can practice on Wednesday, paving the way for a Week 5 return. Getting reps on Wednesday and Thursday will be key to Palmer's return and any signs of diminished arm strength would keep him on the shelf.
DeAngelo Williams: The Carolina backfield is being ravaged by injuries as Williams joins Mike Tolbert (broken leg) and Jonathan Stewart (sprained knee) on the sidelines. Williams suffered a right foot injury against the Ravens and his status for Week 5 is doubtful.
