Will Carroll's Midseason NFL Injury Review

Will Carroll@injuryexpertSports Injuries Lead WriterOctober 30, 2013

Will Carroll's Midseason NFL Injury Review

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    Injuries are up this season, but the perception is even higher. As teams lose player after player and the attitude of "next man up" is tested tome and again, NFL teams and fans might wonder why.

    Losing talents like Reggie Wayne, Julio Jones and Percy Harvin for the bulk of the season costs not only a lot of dollars for the players, but a lot of opportunities. Some of those could come in January.

    It's difficult to discern any patterns in all the injuries we've seen, especially this close to it. Traumatic injuries make up the bulk of NFL injuries by design. There are fewer wear-out injuries than in baseball and, less predictability, than in the NBA. Reduction and prevention are watchwords rather than elimination.

    There's always some injury that seems to be more recurrent. A couple seasons ago it was Achilles tears. Those still happen, but it's less noticeable for some reason (unless you're Vince Wilfork). This year seems to belong to the ACL, with many taking the simple route of blaming the excessive punishment on hits to the head. The problem with that is that the bulk of knee injuries are non-contact or happen almost randomly rather than as the result of targeting.

    There aren't easy answers when it comes to reducing the number of injuries in the NFL, but the defeatism and anti-science bias has to be overcome. While injuries are part of the game, they can and must be reduced. The first team to do that is going to have a significant advantage, and once it's carried out to the rest of the league, we all get a better product.

    American sports have always been about bigger, stronger and faster; it's time that we add smarter and healthier into that mix. In the meantime, let's take a look at some of the injured players who we've lost for the season and see what we can learn.

Reggie Wayne

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    The Colts have had their share of injuries again this season. The team is regularly at the bottom of Football Outsiders' Adjusted Games Lost stat, never finishing out of the bottom third since the boys started tracking it. Jim Irsay is more focused on Twitter than injuries, it seems, but why is it that that team loses more to injuries, including big names like Reggie Wayne and Dwayne Allen this season?

    First, the team acquires risk a lot. The focus on smaller, faster players during the Tony Dungy era may have led to more injuries, but we're past that enough to put that theory out to pasture. Now the answers come down to bad luck and questionable decisions.

    Of course, it's tougher to tell with the Colts than most. Wayne and Allen have both had surgery to correct their issues, but the team has yet to acknowledge it. There's not even a simple statement on the Colts website that Wayne had successful surgery yet, almost a week after the surgery happened! Wayne should come back from this well. Most have forgotten he had ACL issues in college, and no, age (35 in November) shouldn't be a big factor in his return.

    All that doesn't help Reggie Wayne. One wrong step snapped his ACL, costing him the season and Andrew Luck his most effective target. T.Y. Hilton and Darrius Heyward-Bey will have to step up and become more consistent. But, behind them, there's not much help. The Colts are going to figure out how good Andrew Luck is in a hurry, or they'll have to figure out why Trent Richardson isn't working in the "run-first" offense even more quickly.

Ahmad Bradshaw

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    Reggie Wayne is far from the only injury the Colts have dealt with this season. 

    Ahmad Bradshaw barely played, but with his incentive-laden and team-friendly deal, the opportunity cost is much higher than the real cost. The Colts were very conservative with Bradshaw's foot problems. Bradshaw missed the entire preseason, but the Colts insisted this was by design. (I'm not so sure.) When he did play, he did so in very limited fashion, so it's impossible to tell just how the Colts' plan worked.

    The neck injury (in Week 3 against San Francisco) came on a play that looked scary. Bradshaw looked concussed, wobbling and falling, but it was more spinal concussion than brain trauma. While the Colts have been typically tight-lipped, the surgery was likely a fusion, similar to what Peyton Manning had done a few seasons back. Bradshaw won't have the arm-strength issues, but it will be a tough comeback given the sheer number of hits.

    Bradshaw rolled the dice on a one-year deal that he hoped could showcase his talents. Now, he'll have to find a team willing to let him do that again and hope that he can overcome another in a long line of injuries. Bradshaw will have the chance, but I don't think he'll have many more. 

Julio Jones

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    "Think of it like a coat hanger," the doctor told me. "If you can snap one in half with your bare hands, you're probably playing middle linebacker. For most of us, it's not happening. But if you bend it a bit, back and forth, it will weaken and eventually you can snap it and use it to get at the keys you locked in the car."

    The analogy is a bit tortured, but that's why Julio Jones is sidelined. The wire in his foot, placed there just before the NFL draft in 2011, bent just a bit and ended up breaking in the team's loss to the Jets. This isn't normal, but it's hardly fatal either, unless you mean to the hopes of the 2013 Falcons. 

    Jones had the bone re-fixated, which is a technical way of saying that he's back to where he was in 2011 and 2012. Jones hasn't been exceptionally durable, but he has been productive. If the worst-case scenario is that he's back on a surgeon's table in a few years, Matt Ryan would likely take that trade-off. (And you know Jones probably would as well.)

    Jones is a freakish athletic talent, and there's no reason to believe that the fixation will cost him any more steps or hops than it did in 2011. In fantasy, he's a great keeper candidate and likely to be undervalued on draft day next year for those who don't understand the medical issues that kept him from producing in 2013.

Jeremy Maclin

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    Jeremy Maclin might have made a huge difference for Chip Kelly in 2013. He's the prototype Kelly WR, much more than DeSean Jackson. Maclin's absence exposed the lack of receiver depth in Philadelphia from day one, which in turn exposed the poor fit of the QBs. The fact that he's a UFA in 2014 makes things a bit more complex for Maclin, his agents and for the Eagles. 

    Maclin's ACL sprain is a garden variety. He had it repaired, and due to the timing, he'll have a full season plus the offseason to recover (which should put him in minicamp with Kelly and Kelly's next QB). With ACL sprains, the question is more about function, which Maclin should have a bit of bonus time to deal with.

    In essence, Maclin should be able to start 2014 where he started 2013. He'll have a better handle on the offense and the Eagles will have a better understanding of his rehab status than anyone else.

    If Maclin is comfortable with how his rehab was handled, a one-year deal is possible to give the 25-year-old wideout a chance to reestablish himself as healthy and productive in a tailor-made offense. Expect to see Maclin back in Philly and a solid WR2 behind Jackson's big cap number. 

Malcom Floyd

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    Malcom Floyd had one of the scariest-appearing injuries of the season Week 2 against the Eagles. Like Jermichael Finley, Floyd had a spinal cord contusion. Floyd's was caused by an axial load, which is one of the most dangerous types of spinal injuries. (Dr. Dave Siebert has a great article on this injury here.) 

    Floyd should be fine in the long term, but this kind of injury is definitely problematic on a number of fronts. First, he has to decide if it's worth it to be out there now that he understands the risks. Most will return.

    Then, there's a confidence/reluctance continuum that he has to overcome. That takes a bit, but since Floyd's neck is stable, there's as little chance this will recur as it was to happen in the first place. Some worry; some start thinking lightning doesn't strike twice. 

    Floyd's neck has plenty of time to heal up, though time isn't the major concern. With his 2013 over, he'll have nearly a full year before he takes serious contact. There are not stability concerns, so unlike those who have had fractures or even disc problems, there's no increase in issues if it were to recur (which again, is unlikely). 

    While dramatic injuries like this are hard on the athlete, it's also hard on the fanbase. We see something that could have been much worse and remember the dramatic image. There's no reason to think that Floyd won't have every opportunity to come back. Paired with Keenan Allen and giving Mike McCoy another year of install, Floyd is likely to be an undervalued asset in next year's fantasy WR market.

Dustin Keller

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    Dustin Keller was brought in by the Dolphins to solidify the TE position and to give Ryan Tannehill a good checkdown option in his second season. Instead, a devastating multi-structure knee injury kept Keller from ever touching the field in the regular season.

    While Charles Clay has been a nice find for the Dolphins (which makes you wonder a bit what they didn't see in him), Keller offered a different skill set. An athletic tight end, Keller was expected to be used in the hybrid role that we've seen pioneered by Dallas Clark and evolved into monsters like Jimmy Graham.

    The knee injury tore up almost everything in Keller's knee, but there was no nerve damage. That means he does have a chance to return. Keller's athleticism will help, but any loss of that athleticism will cost him since he relied on it so much. 

    Expect Keller, 29, to showcase himself in the spring, looking for another opportunity like the one he had in Miami this season. If the knee holds up, he could be a nice comeback story, but the list of players who have come back from this bad a knee injury is very short. 

Brian Cushing

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    Brian Cushing's injury has been widely reported as a knee sprain and a leg fracture. While neither is wrong, neither is precisely correct either. Cushing's knee gave on that low hit by Jamaal Charles, but in a way that's very unusual. The ligament held with very little damage, but it pulled from the lower end, where the LCL attaches to the fibula. The bone gave, pulling some away on the intact ligament. 

    That made the surgery a bit different. Instead of replacing the ligament, Dr. James Andrews was able to simply repair it, according to multiple sources. It's the key word "repair" that makes this a bit unusual and should make the rehab a bit easier.

    Cushing came back from ACL surgery on the same knee, but that reconstruction held well and there was no damage in the latest incident. Cushing won't have an easy rehab, but it could be a bit quicker than normal.

    That could have Cushing back for minicamp and certainly by the opening of camp next July. Two knee surgeries isn't a good thing to have on file, but Cushing has a good chance of returning as well from the second as he seemed to from the first.

Vince Wilfork

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    Vince Wilfork's absence is noticeable in the middle of the Patriots defense, and not just because of his size. But that size might be an issue in getting him back on the field.

    After rupturing his Achilles earlier this season, the surgery was successful. But unlike some others who have come back from the injury, Wilfork's bulk will make it even harder for him to come back. While his body has adjusted to some extent to the size, the tension and load the Achilles is under is greater for Wilfork than most.

    Add in that his position and stance is going to tax the Achilles—part of the issue in the first place—and mix in that he's over 30, and a comeback isn't automatic. Wilfork should be able to return, but the next time he pushes a linemen back, he'll have 600-plus pounds of force at minimum on the repair. That's a load, figuratively and literally. 

    Wilfork has one season left on his contract, and while there's some dead money there, the Pats are going to have a hard decision on their hands. Of all the rehabs discussed here, Wilfork's comes with the most problems and one of the highest price tags. 

Backup QBs

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    Kevin Kolb and Brian Hoyer didn't have the seasons they expected. Hoyer, with a knee sprain, will at least have a chance to come back. For Kolb, things get trickier.

    Having the injury du jour isn't a plus when it's still du jour. Concussions are rightfully getting more attention than ever, so Kolb's series of concussions is getting more attention than it would have just a couple seasons ago. Kolb himself is proof of that. What was once ignored is now career threatening.

    As with a player like Austin Collie, Kolb is going to have to make the decision about whether he wants to come back. The window has likely closed on him starting, but he knows that he's an injury away from the opportunity. There will be teams that will give him the chance if he wants it.

    Hoyer is more clear-cut. An ACL sprain takes about a year to come back from, but Hoyer isn't a mobile QB to begin with, so he has less to lose. He could come back in any number of situations, and his limited showing with the Browns will keep the door open, especially if there's a team with a Belichick connection somewhere.

    Whether it's in the backup role, the placeholder role that the Browns will need if they get their future QB in the draft, or whether Hoyer tries to go the Matt Flynn route, there will be plenty of opportunities for him. Physically, there's no reason to think that he can't get back to where he was. 

On Track to Return

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    Jay Cutler

    The Bears are making some noise that the four- to six-week injury that Cutler suffered is actually going to be more like two. Don't believe the word games that Marc Trestman is playing with Week 9, but 10? That's plausible, if not likely. The question is function.

    Cutler will have a hard time with dropbacks, but he's not mobile anyway, so the adjustment isn't outrageous. Josh McCown's play will likely give the Bears more of an idea about the timeframe. 

     

    Randall Cobb

    Cobb's broken leg will heal in time for him to get back for the playoffs, which is what the Packers want. Jarrett Boykin has filled in well, but the lack of depth is getting extreme. Aaron Rodgers will welcome back Cobb with open arms and targets. The broken fibula shouldn't have much affect on Cobb's game once it heals, but confidence may be an issue. 

     

    Percy Harvin

    Harvin could be back as quickly as Week 9, a full month ahead of the expected schedule. It's a small sample that's the basis for the timeline, so let's not make this out to be a miracle.

    Harvin is running, but the hip labrum is going to be taxed more on stopping and hard cuts than speed, so even when Harvin is back, there's a big chance for setback or for adjustments that lessen his effectiveness. He's valuable even if he can just run go-routes, but not a game-changer.

     

    Michael Crabtree

    The 49ers medical staff may end up being the team's MVP if it can get all the injured players back on schedule while keeping the on-field team relatively healthy.

    Crabtree is coming back from an Achilles rupture, which will definitely be tested by a return this season. Don't expect full function, but we've seen other players like Terrell Suggs coming back well from this type of injury. Eighty percent of Crabtree is something Colin Kaepernick will gladly take.

     

    Mario Manningham

    Manningham is actually closer than Crabtree and was hoping to come back in Week 9. Week 10 is more likely, but Manningham is close. He's shown good running ability after ACL/PCL reconstruction, and that's the biggest test. Manningham could surprise people early, since they'll think his lateral motion and cuts will be affected, but he's a good stash who you won't have to stash long.