CHECK ME OUT EVERY WEEK ON FANTASYPROS.COM

Don’t forget to check me out over at FantasyPros.com every week for “Put him in the game OR Sit him on the bench” to get the latest take on the injured players of the week!

If I don’t cover the player you are interested in, contact me @DrPettyIRD before game time to get expert injury analysis that may save you from that poor performance or goose egg out of your fantasy player.

Good Luck!

ADRIAN PETERSON OUT 2-4 WEEKS? (Update: Peterson out 3-4 months)

(Update: after publishing this, reports confirmed that Adrian Peterson would miss 3-4 months. It is clear that Peterson must have suffered injury to the portion of the meniscus that has little blood supply and needs surgery to repair. I had already suggested that this may be the beginning of the end, but with this news it may just be THE END!)

Adrian Peterson is reported to have a right knee meniscus tear and the timetable for his return seems to be unclear. Many of the injuries we see in the NFL have little tells and clues that allow me to make a very educated guess on how it will play out, but a meniscus tear may be one of the trickiest injuries to forecast without explicit details.

There are two menisci in the knee, the medial meniscus (inner part of the knee) and the lateral meniscus (outer part of the knee). These structures are fibrocartilage that basically serve as the pillows for the knee-joint and act as joint stabilizers. When the knee is straight, the menisci are typically at little to no risk as they are safely tucked into the knee-joint space. As the knee transitions to a bent position (usually for a squatting or lunging like motion) while the foot is in contact with a surface (usually the ground), the menisci assume a position in which they seem to peek out of the joint. During this peek is when most meniscus injuries occur. Adrian Peterson demonstrated this well if you watch the position of his right knee as his injury occurred.

this image shows a tear to the medial meniscus
Medial meniscus tear

The problem with speaking about a meniscus injury that you do not have intimate knowledge of is that the variables are countless. The details of the tear is important with a meniscus, as the inner 2/3 of the meniscus is avascular, meaning it has no blood supply. The outer 1/3 has blood supply and therefore typically has a better healing prognosis.  Aside from the site of the tear, the size of the tear and the subsequent position of the torn tissue are other factors that play a big part in giving a prognosis for recovery.

I can see how some may believe that Mike Zimmer is just playing injury report games by not ruling Peterson out for next weeks game vs. the Carolina Panthers, but meniscus injuries have a broad enough range that Peterson could play next week or this could effectively end his career. The answer is likely somewhere between.

The fact that surgery has not been mentioned suggest that this is likely an injury to the vascular outer third of the meniscus, which means there is a chance that Peterson will only need conservative interventions such as Physical Therapy and modalities to heal. On the other hand the optics of Peterson being carried out, being unable to even touch the ground with his right foot leads me to believe the tear may be more significant. I have treated patients who are in and out in a matter of weeks for meniscus injuries, patients who take months to get back on track, and the worst are the ones who you think are healed and months later they’re back. When a meniscus is torn it may have significant symptoms such as pain and clicking which is usually the torn tissue getting caught in the knee-joint as the joint bends and straightens, but for some the torn tissue is in a good spot and doesn’t cause any interference with joint movement. The most annoying part about a meniscus is sometimes you get both sets of symptoms. One day there is no clicking and no pain, and one squat or bend later, the torn tissue is caught between the femur and tibia and the patient can’t stand to bend their knee.

The meniscus has an annoying quality of re-injury and symptom fluctuation. Based on the position of the cartilage and its peekaboo type movements during bending, many people who have to return to repetitive bending activities will eventually catch the meniscus peeking too long and suffer some level of setback.

If I had to give a ball park guess, I would guess Adrian Peterson will be out for two to four weeks. The problem is that an NFL running back won’t be able to avoid forceful bending, which means that upon his return, the chances of re-injury are higher than most.

When you consider the elephant in the room that he is a 31-year-old running back, and that productive running back play after 30-years old is rare; my advice is find a strong plan B for Adrian Peterson as this may very well be the beginning of the end. 

Dion Lewis highlights a Fantasy Football commandment!

Just so it doesn’t look like I am a Monday morning quarterback, here is a Tweet from about 10 days ago in response to a question I received about the injury outlook for Dion Lewis. I did not write a full piece on Lewis at the time as I simply did not think the interest was there. I assumed everyone was like me and disregarded New England Patriots players not named Tom Brady or Rob Gronkowski. Now that I know that some of you are interested, here it is.

The reason I said that Lewis was off-limits until 18 to 24 months after his surgery is because that is how I feel about nearly all running backs returning from ACL repair. Lewis suffered his ACL injury last November, and not even a year later he seemed to be pushing to get back on the field. I feel that this approach will often be unsuccessful and I generally avoid players who return from injuries too quickly. The only reason to accelerate the rehab process is if that player is preparing for a conference championship or a Super Bowl, but players who rush back to take part in regular season games are simply playing the risk to reward game poorly.

Now that Lewis appears to have had a “clean up” in his knee, I think it is safe to say that “risk” defeated “reward” once again. A clean up likely means that his knee was suffering from excess inflammation, scar tissue, fluid or any combination of the three; and in this case the surgeon can go in with an arthroscopic approach and clean up whatever should not be in there. This is a fairly minor procedure in most cases, and Lewis should feel better after surgery.

The reports have him out for another 8 to 10 weeks after this procedure, but I would say that this should have been the length of time he would have been out regardless of this procedure. I don’t think I have to give my opinion any further on Lewis, as I can’t imagine anyone would invest in him beyond a daily fantasy play late in the season or possibly a late season pick up in a deep league.

I am happy to keep answering these questions about running backs coming off ACL repair, but I think that I will start sounding like a broken record. I am on record in a number of articles about my feeling on waiting until the second season following ACL repair; but I would contend that running backs are the absolute worst pick ups in fantasy football after an ACL injury.

acl

If you have ever experienced or monitored an ACL recovery, you can attest to the long period during which you simply don’t use the injured leg like you normally would. I won’t bore you with an ACL protocol, but you can search for it and see the specific time points in which these athletes are typically allowed to resume certain activity. The bottom line is that any living thing that takes almost a year off from what it usually does will have an adjustment period to resume functioning properly. The ACL is no different!

As for the specific reason that running backs are the worst after this injury; the running back is maybe the only offensive positions that is more reactive than proactive. A running back must react to blocks and defenders in a similar way to defenders reacting to the offense. The wide receiver has the luxury of knowing where they are going and planning their moves; the quarterback more often than not knows exactly how many steps they will take before releasing the ball on a well executed play; and offensive lineman almost always know their first step and the direction they will go on the snap. The running back has to cut, juke, jump, and accelerate based a number of factors that happen after the ball is snapped. For those who have played football, you know that the running back rarely ends up exactly where the play designs him to be.

The frequency and the severity of the reactive movements that a running back needs to make depends on supreme biomechanics and reaction time, and having the Anterior Cruciate Ligament take a year off does not bode well for this to exist within the first 18 months after repair. Cruciate actually describes the shape of the ligament, but I like to think of the word “crucial” when considering the role of the ACL. Without the ACL, the mechanics of the knee-joint changes significantly and once it is repaired and healed, that significant change must be overcome. Many of us walk around and do not realize the precision that is needed in order for the human body to work. For an NFL running back this precision is at a higher level than the average person and is developed over years; when an injury as significant as an ACL tear occurs this precision must rebound. Particularly running backs that depend on agility will suffer with slower cuts and acceleration which will surely decrease their productivity. Bigger backs who are more straight line runners are more likely to retain a larger percentage of their skills and their productivity. I think Lewis definitely falls under the agility back designation and will see his skills suffer when he takes the field some time in November.

I know there are some fantasy football commandments out there, but to my knowledge there are none that specifically address this from an injury perspective. So here is your first ever fantasy football commandment(Injury Science edition): Thou shall not draft running backs coming off ACL repair prior to their 18 month recovery mark!