Every year, injuries play a part in determining fantasy championships in every sort of league, whether it is a neighborhood "trophy league" or a big money contest like those detailed in our article "Spotlight on High Stakes Contests". In order to make good decisions regarding players and their injuries during both the draft and in-season, it is necessary to have a grasp of the different sorts of injuries/the severity of injuries that regularly occur among NFL players.
There is a huge variety of possible injuries, from very minor ones like bruises, to a catastrophic paralyzing or fatal injury like a broken neck. One could have enough space to write a textbook on injuries and still not cover every specific sports injury. Therefore, the article that follows has been arranged by grouping similar sorts of injuries - within each category, examples of current, fantasy-relevant players who are rehabilitating (or have rehabilitated) such injuries are presented. Not every NFL player who is currently battling an injury is listed - instead, the aim is to provide the reader with the tools to evaluate any particular player's injuries - present and future. Finally, we'll look at some statistical data provided by Footballguys.com's Dr. Doug Drinen to view the question of injuries from a broader perspective, so that you can be prepared to face the challenges injuries bring to fantasy owners during your coming fantasy draft and the following regular NFL season.
Concussions
One of the most common injuries suffered in the NFL is the concussion. Football is a collision sport, and sometimes a player's head gets slammed into the turf (or another player's helmet) hard enough to traumatize his brain. The aftereffects of concussions include problems like nausea, dizziness, and memory loss - repeated concussions can lead to brain damage. Another reason that a concussion is cause for concern is that, once a player has suffered a concussion, he is more likely to be concussed the next time his brain is traumatized. In other words, the damage from concussions is cumulative - the more concussions a player has suffered, a future concussion is likely to be even more debilitating. Carolina Panther's WR Steve Smith suffered a concussion in the preseason opener vs. Indianapolis, to name just one marquee fantasy talent who bears watching due to suffering a concussion in training camp this year.
A big red flag should be raised in your mind by players with a history of multiple concussions - QB Trent Green of the Rams is one current player taking the field with a history of serious concussions. In extreme circumstances, players are forced into retirement due to a susceptibility to concussions - LB Dan Morgan of the Carolina Panthers is one such player forced from the league in part due to repeated concussions, and current Cowboys' LB Zach Thomas missed a good portion of the 2007 season (eventually landing on IR) due to migraines and other post-concussion symptoms brought on by a series of brain traumas.
Neck/Spinal Column Injuries
Neck and spinal column injuries (pinched nerves (stingers/burners), bulging disks or herniated disks in the spine) are injuries that can cause a player ongoing problems. Stingers/burners tend to recur, and can lead to numbness in a player's extremities (which will often sideline a player). Damage to the disks (the flat, gelatinous cushions between back/neck bones that allow the spine to flex) is painful and can be dangerous, sometimes costing a player his season.
Last season Buffalo Bills' TE Kevin Everett suffered a "catastrophic" neck/spinal injury in the September 9th regular season opener. Everett's neck was dislocated between the third and fourth vertebrae; the bones were pinching his spinal cord; the ligaments and tendons holding the vertebrae were destroyed - the only things holding his head on his shoulders were his skin and muscles.
Thanks to some cutting-edge medical treatment that was administered shortly after the injury, Everett avoided the outcome initially feared for him (paralysis from the neck down) and after extensive surgery and rehabilitation has been able to learn to walk again. However, he'll never play professional football again thanks to the severe injury.
Broken Bones
Some broken bones can be played through (Jet WR Laveranues Coles plays on a broken big toe because doctors have told him corrective surgery could end his career). Many players play through stress fractures, which are a small crack in a bone. WR Donnie Avery of the St. Louis Rams is currently fighting to get back on the field after suffering a stress fracture in his pelvis during training camp. However, other breaks cost players their seasons - TE Jeremy Shockey of the New Orleans Saints was unable to play during the Giants' playoff run last year due to a broken leg suffered in December of last year, and QB Matt Leinart sat out the majority of the 2007 season due to a broken collarbone. The key determining length of recovery from a broken bone is how serious and complex a particular break is - if a player needs surgery with plates/pins inserted to stabilize the broken bone(s), he's likely to miss a lot of time. QB Charlie Batch of Pittsburgh (broken collarbone, out a minimum of 6 weeks) and Seahawks' WR Bobby Engram (cracked shoulder bone, out 6-8 weeks) are two players who have suffered broken bones during this year's training camp. Another factor is involved is whether the break's location is critical to a particular player's position (defensive backs and linemen can sometimes play with a cast on their hand, for example, while wide receivers can't).
In the long term, properly-set broken bones don't usually lead to future problems (as meniscus injuries can, see below) - once a broken bone is healed, it is usually actually stronger in the area around the break than it was formerly, due to the extra calcification the body generates in the region of the break during healing.
Ligament/Tendon Injuries
Ligaments and tendons are known collectively as connective tissues; they hold our skeletons together and the muscles to the skeleton. Ligaments are tough bands of tissue that connect bones together. When you hear someone report that their elbow or knee is "sprained" or "strained" they mean that the connective tissues have been stretched, which causes discomfort and swelling in the joint. One common connective tissue injury is dislocation of the knee cap, which may cause tears in the ligaments attaching the kneecap to the leg, and may also generate "loose bodies" - chips of bone and chunks of torn cartilage "floating" in the joint - that irritate the joint and cause pain and swelling. The commonly heard term "arthroscopic procedure" refers to a surgery to remove loose bodies which relieves the pain and swelling. Players usually return fairly quickly after a joint is "scoped", as long as there are no complications. QB Jason Campbell dislocated his knee cap during the final weeks of the 2007 season - he has not had any further issues with the injury as of training camp this year, thankfully.
Turning specifically to the knee joint, there are 4 ligaments in the knee. The anterior cruciate (ACL) and the posterior cruciate (PCL) are in the middle of the knee and provide stability to the joint, while the medial collateral ligament (MCL) is a broad ligament on the inner knee and the lateral collateral ligament (LCL) is the ligament on the outer part of the knee. Reggie Bush of the New Orleans Saints is dealing with complications (swelling) from the formerly-torn PCL in his knee, a holdover complaint dating to the end of last season which was aggravated in the first preseason game. ACL tears are generally the worst news, and need surgical repair and a long rehab - Ronnie Brown of the Miami Dolphins is one NFL RB attempting to return to action this year after suffering a torn ACL last season. The elbow has its own set of ligaments that are subject to similar injuries, but they don't occur as often as knee injuries, since the legs bear the body's weight. However, Jake Delhomme is one high-profile NFL and fantasy QB who did suffer torn ligaments in his throwing arm elbow, and had the "Tommy John" surgery to repair his elbow injury early on during the 2007 season.
Looking at the shoulder, this joint has four muscles and their tendons which connect to the arm-bone/collarbone. The term "rotator cuff" applies to the set of muscles and tendons surrounding the shoulder. A tear of the rotator cuff means that one (or more) of the tendons has partially or completely separated from the bones or that the muscles have torn, or both - this can be cured by as little as a few weeks of rest or may require surgery and a long recovery. There are also ligaments in the shoulder which hold the bone in the socket. When someone has a dislocated shoulder, it means that the bone has squeezed out past the ligaments/socket, and needs to be popped back into the socket. Because the shoulder has a wide range of motion, the ligaments are stretchy - a dislocated shoulder does not automatically mean that the ligaments have been torn. However, if torn, the ligaments tear at the labrum, and have to be reattached. Miami's new QB Chad Pennington has had a history of problems with tearing the labrum in his throwing arm shoulder, but he is free from that complaint this year. Another injury that can occur in the shoulder is separation of the A/C joint (where the collar bone meets the shoulder), which causes weakness in the joint and problems elevating the arm.
A familiar ligament injury in football is the sprained ankle. Occurring when the foot is "rolled over" - bent beyond its natural range of motion - one or more of the many ligaments in or around the ankle are over-stretched or torn. Once a player suffers a sprained ankle, they are more likely to occur again. Many NFL players sprain their ankles during a typical season - recovery time can range from a week to months, depending on the severity of the sprain/tear. Both Chad Pennington and Giants' WR Plaxico Burress played through torn ankle ligaments during the 2007 season.
A high ankle sprain is a sprain/tear of the large ligament above the ankle that holds the two bones of the lower leg together. There are numerous examples of high ankle sprains suffered during the past season - ex-Seahawk WR D.J. Hackett (now with Carolina) missed several games during 2007 due to a high right ankle sprain that was prone to flaring up throughout the year.
An uncommon foot injury which can keep a player from placing any weight on the injured foot is the Lisfranc sprain, which is an over-stretching or tearing of a ligament in the foot. The injury can range from a mild sprain, treated by rest, to fracture-dislocations that require surgery and a long recovery. Indianapolis' star DE Dwight Freeney suffered a Lisfranc injury in his left foot midway through last season that required surgery - he has yet to return to action with the Colts and began the preseason on the PUP list as a result of the ongoing rehab of his left foot.
Hernias
Hernias are an injury of the groin. In severe cases, the abdominal muscles tear and the internal organs (intestines) exude out through the tear, which can cause intense pain. A serious hernia needs to be surgically repaired immediately, while less serious hernias (when the intestine can be pushed back into the body) aren't emergencies but will still require surgery to repair. Any hernia surgery would be likely to cost a player most or all of a season.
Sports hernias are a chronically painful muscle tear in the area next to the pubic bone, and the buildup of scar tissue due to the injury can cause persistent pain if the player continues to practice/play in games. Rest can correct the condition, but as soon as heavy activity resumes, the pain usually returns. Treatment with medication or other procedures can help a player play despite the pain. Eventually, surgery will probably be required to repair the condition, with a recovery period measured in months. Eagles' QB Donovan McNabb and TE L.J. Smith have both dealt with sports hernias during recent seasons.
Pulled Muscles/Hamstrings
Another common injury in the NFL is the pulled or torn hamstring. The hamstring is actually a group of muscles that run from the back of the thigh to the shinbone, and function to make your knees flex/straighten while running. The injury is a tear of the muscle, ranging from a microscopic tear (Grade I, least serious) all the way to a rupture of one or some of the muscles (Grade III, most serious). Symptoms include bruising, swelling, muscle spasms or an inability to contract the muscles. A player afflicted with a grade III tear or rupture may be unable to use his leg at all. Sometimes the tendon that attaches a muscle to bone is torn free - these sorts of serious muscle injuries will often require surgery to correct. WR Jerry Porter of the Jacksonville Jaguars had surgery early on in training camp to repair a torn hamstring tendon (the hamstring pull was so severe it tore the muscle off the bone).
Other muscles are subject to tearing/rupturing - biceps, triceps and pectoral muscles are often torn by offensive and defensive linemen. Dolphins' RB Ricky Williams is returning to action this season after tearing his pectoral muscles last year.
Meniscus Injuries
The meniscus is a plate-like slab of gelatinous cartilage that cushions the knee(there are two in each knee, actually), keeping the bones from banging together. If the meniscus is torn or ruptured, "loose bodies" - bits of cartilage and/or bone chips - can irritate the knee joint causing swelling, pain, or even "locking up" the knee. Arthroscopic surgery removes the loose tissue from the knee, reducing swelling and pain. St. Louis' WR Torry Holt suffered from swelling in his knees during 2007, and may be subject to the problem again if his meniscus continues to degenerate. WR Reggie Williams of Jacksonville had a knee scoped early in training camp after the joint had problems with swelling caused by "loose bodies" generated when his meniscus cartilage tore.
Bursal Sac Inflammation
A bursa is a pad-like sac found near the joint - there are hundreds of them throughout your body. Knee bursae are soft sacs in the knee area filled with lubricating fluid that facilitate motion and decrease friction. When a bursa becomes inflamed, the condition is known as bursitis, and the bursa loses its function of facilitating motion. Bursitis caries in degrees from a mild irritation to an abscess that causes excruciating pain, and the infection can lead to other problems if not properly addressed. Usually inflamed bursal sacs are treated with anti-inflammatory medication, but occasionally excess scar tissue may have formed in/around the bursa causing physicians to opt for surgical removal. Of course, the most obvious example of this situation is Indianapolis QB Peyton Manning, who is recovering from having an inflamed bursal sac removed from his left knee on July 14th.
Some Interesting Statistical Data Relating to Injuries in General
There is a reason that depth and good waiver-wire transactions are crucial to winning fantasy championships - injuries occur in the NFL often enough that you are sure to need more than just your starting lineup in the course of the season in order to win your league. In order to get a birds-eye view of just how likely any particular fantasy team is to need their backup players, I surveyed some results of statistical studies completed by Footballguys.com's Doug Drinen and abstracted them below. For the purposes of this article, I limited the scope to considering running backs and wide receivers (within certain limits described below) because A). Dr. Drinen advised me that there are too many benchings (not injury-related absences) polluting the quarterbacks' results - which means that the study I asked for is not actually revealing anything meaningful about injury risk and B). because the results from the pools of running backs and wide receivers illustrates the point that injury risk needs to be actively managed quite clearly and convincingly on their own.
About a decade ago, Dr. Drinen undertook a statistical study of NFL players (those who had a reasonable fantasy value - only players who played at least 8 games and averaged at least 6 fantasy points per game were included in the study) during 1988-1998 for his classic "Everybody is an Injury Risk", giving us a statistical picture about the reality of injuries in the NFL. In preparing to write/expand this article, I asked Doug to take another look at NFL players as a group for another set of years (1995-2006; he opted to define the pool as those with a minimum of 8 games played and 8 fantasy points per game) and to let me know how the numbers looked for that time frame, as well. This time, he limited the data set to players 28 years old or younger as a way to limit the number of retirements that pop up in the data.
The results for running backs are eye-opening. Running backs that play a full slate of 16 games in one year have about a 50% chance to repeat that feat the next year (the most recent data set came in at 49%; the first study from 1988-1998 came in at 47.6%) - if they do not play in 16 games, they should, statistically speaking, manage about 14 (13.6 ('95-'06) and 13.7 ('88-'98)). Guys who missed a game here and there the previous year (played in 13-15 games) have a roughly 40% chance of playing a full slate of games the next year (41% in the '95-'06 data set; 40.1% in the '88-'98 study), and average about 13 games in the subsequent campaign (12.9 and 13.1, according to the 2 studies, respectively). In other words, even the sturdiest NFL running backs are likely to miss 2-3 games in any given NFL season, even if they have previously not been injured or only suffered minor injuries in the past.
There has been a big shift in the data over (approximately) the last 10 years when it comes to NFL running backs who managed a part-time season in one year - from 1988-1998, players who were on the field between 8 and 12 games in a previous year averaged 12.4 games the subsequent year, and 35.5% played a full season in the next campaign. Between 1995 and 2006, those numbers fell drastically, to an average of 10.2 games in the subsequent year and just a 13% chance for playing a full season in the next campaign. In other words, statistically speaking, these days once a NFL running back begins to miss more than 4 games in any given season, his chances for playing a full slate of 16 games the next year appear to go down dramatically (at least, they did during the years 1995-2006). Whether this speaks to a change in coaching/front office philosophies (teams may be cutting their losses and moving on to new players more quickly these days) or if it is a result of a change in medical practices (more players opting to come back from injuries more cautiously, or perhaps end their careers after injury more often) or attributed to some other cause is unclear, but the 13% result speaks for itself. For whatever reason, it seems that for running backs, missing more than 4 games in a season is a warning sign that a particular player is very unlikely to play a full slate of 16 games the next year. The aforementioned Ronnie Brown would be one of the running backs entering 2008 off a much-shortened 2007 campaign.
The picture is slightly more rosy for wide receivers, although a fantasy owner is still very likely to need to call up his benchwarmers at some point during the coming campaign. During the period 1988-1998, wide receivers who played a full slate of 16 games had a 64.8% chance to play a full 16 games the next season; from 1995-2006 the average was 56%. Players who did play 16 games in a previous year averaged 14.5 games the subsequent year for the '88-'98 group, while the number declined slightly to 14.1 in the '95-'06 time period. In both groups, players who played between 13-15 games the previous year averaged 14.1 games the next year, with a slightly better chance for a full season during the '95-'06 sample (57% vs. 51.6% during '88-'98). In other words, healthy or only slightly dinged-up wide receivers from 2007 (those who played between 13-16 games during the previous year) have a very good shot at playing 14 games this year, and somewhere between a 55-65% chance to play a full 16 games.
Not surprisingly, wide receivers who averaged between 8-12 games in previous seasons during the sample time frames could expect to play less games the following season (12.6 during '88-'98; 12.9 during '95-'06), with a 40.5% and 48% chance to play a full slate of 16 contests, respectively. If you draft a wide receiver who missed more than 4 games during 2007, it looks like you've got less than a 50-50 shot at getting 16 games from him this year.
Conclusion
Clearly, it is critical to have solid backups on your fantasy roster, and to know when an injury is going to cost a starter playing time. Most experienced fantasy football owners draft the backups to their top draft picks as injury insurance, depending on their particular league's roster size and rules.
One thing is almost certain - at some point during 2008, your team will suffer a key player injury. Being prepared to fill the gap with another solid player will increase your chances of taking home the league trophy. On the other hand, failing to actively manage your roster of backup players (or missing out on a hot waiver-wire pickup due to some other owner's injury woes) could very well knock your club out of contention. Draft day is an exciting event, but it is far from the final effort necessary to ensure a winning fantasy team in the vast majority of cases. Keep your bench stocked with quality backups from week 1 forward, and you'll be ready for the almost-inevitable injuries that come along in every owner's fantasy season.
