The risk of another neck injury for Peyton Manning is actually low. But that doesn't mean he's safe.

Safety is an elusive, nearly extinct creature in fantasy football. We want the guys who won’t get injured on our team, but then all the guys who were supposed to stay healthy sustain all of the injuries, and you’re left as the proud owner of Jamaal Charles or Darren McFadden, both of whom were cursed by the mighty hand of injury death early last year.

Drafts are over now, so you’re aware of the frailty of a reliance on non-frailty. That very subject — the matter of injury proneness, and if a player really is or isn’t injury prone — was recently the center of an interesting discussion around the online fantasy community. Jene Bramel, a pediatrician and an injury expert who provides analysis of all the strains and tears around the league for the Football Guys, argued that while the instinct to be hesitant with someone like McFadden is understandable given his recent history, classifying him as an injury threat is often arbitrary, and is based on the assumption that there’s a pattern connected to a completely random and sudden event (a hit which causes an injury).

In a digital exchange to kick off what will become a weekly Wednesday post, I asked Bramel to expand on those thoughts, and whether or not medical research will ever reach a point where a player can legitimately be deemed injury prone. But first I picked his brain about a few of the primary injury concerns for fantasy owners as we continue to roll towards opening night, and the opening weekend.

1. Two prominent running backs (Jamaal Charles and Adrian Peterson) are returning from ACL tears. Is there a higher risk of re-injury to the same knee and the same ligament following an ACL tear?

Studies report a wide range of failure rates after ACL surgery, anywhere from a 1-3% risk up to more than 15%. There are lots of variables involved – type of graft, associated injuries, age of the athlete, etc – so it’s very difficult to figure the risk for any single athlete. The risk is almost certainly different for Charles, who had an isolated ACL tear, than Peterson, who had a MCL tear and meniscus damage in addition to his ACL injury. Charles was also injured three months earlier, so it’s no surprise that he’s further along in his recovery process.

2. How about Peyton Manning? There’s obvious concern about his neck due to his multiple surgeries, but what’s his risk for re-injury?

There is a risk for an injury near the fusion site or a level above or below if he takes the right kind of hit to that area, but the risk is probably low. The primary concern for Manning is whether the strength in his arm will continue to improve or whether he’ll have to compensate for some residual weakness in the arm.

The process of nerve regeneration is still ongoing. Spinal surgeons generally expect much of that regeneration to occur in the first six months after the fusion procedure, but allow for two years of gradual improvement. Though it’s possible that Manning could take a hit that causes a similar injury at a different spot in his neck, it’s not likely that another injury will affect the regeneration process. A compensatory injury in his shoulder or elbow is more likely.

3. Back to the running backs. Trent Richardson has now had two knee procedures since last January. Is there any concern about this becoming a lingering issue?

Since he’s needed more than one surgery to clean up the meniscus in that knee, I think it can already be considered a lingering issue. As he did after the January procedure, Richardson is reportedly healing quickly and well after the more recent surgery. That’s a good sign, but it doesn’t completely rule out the possibility that he’ll need future procedures.

For now, there doesn’t appear to be any concern that he’s developing a chronic cartilage problem.

4. Injury worries around this time in the NFL calendar often center around the risk of re-injury and the possibility of a problem to nag and hinder performance, and we’ve discussed three examples. Which common football injury comes with the highest risk of re-aggravation? Miles Austin and his hamstring battle is surely up there, right?

Muscle strains are very commonly re-aggravated. Most players are allowed to return when the injured muscle recovers to 90-95% of the strength of the healthy muscle on the other side of the body. Studies report a significant risk of re-aggravation of a muscle strain in the first 7-14 days after a return to football activity.

Often times, the aggravated muscle strain is more severe than the previous strain. Andre Johnson was a good example of that last season. Austin is clearly at risk of a re-aggravation upon his return and you can be sure that’s a big part of why the team held him out of the preseason.

5. Lastly, there’s recently been a discussion in the fantasy football community regarding the “injury prone” label, and the ease with which it’s slapped on certain players. You’ve written that while there are players who deserve that label, it’s difficult and nearly impossible to quantify injury proneness. Do you see that changing? Will there come a time when we can judge the likelihood of a player getting injured with any degree of accuracy?

Medical science may progress to a point where genetic and biometric testing could reliably determine whether one player may be more likely to be injured than another. But there’s more to predicting injuries than knowing whether an athlete has an increased anatomic, biometric, or physiologic risk of injury.

For now, I think it’s important to realize that some players are labeled injury prone despite injuries that are largely out of their control. And that just because a player has been prone to injury doesn’t necessarily mean he will be prone to injury.

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