Week 6-Doubtful, Questionable, and Probable (DQP) Players

October 11, 2014

Here is how we see this weeks big injuries playing out.  No need to list the players who are ruled out as we already know they won’t play.  Let’s take a look at the DQP players, so you can hit the waiver wire or your bench for a winning line up.

Doubtful

optimus and megatron
Down goes Megatron!

Calvin Johnson (You should plan to be without him for 2-3 weeks….even if he suits up!)

 Megatron is the only player of significance on this list and frankly I am tired of talking about him.  So, I won’t.   If you follow me, then you saw Johnson going down before he actually did; and if you continue to follow me, I will let you know when he will return as a productive part of your fantasy team.  Until then, just sit tight.  Bonus: For those who go a little beyond fantasy players, the Detroit Lions very well may not win a game until he returns.

Questionable

A.J. Green (Trade him)

Im not sure why Green is even listed as questionable.  I know the designations for injuries can sometimes be chess in the NFL, but I think we are all pretty confident he doesn’t play.  If he plays, I think that A.J. Green and the rest of the Bengals organization should all be on the injury list for concussion like symptoms. In case you missed it, go to http://theinjuryreportdoctor.com/2014/10/10/trade-a-j-green-today/ to check out why you should trade A.J. Green now.

Carson Palmer (NO!)

If you are desperate for a QB on a bye week, I could see how this could be on your radar.  I don’t plan to see Palmer play well any time soon, if ever.  You will have to look elsewhere to fill in your QB stats.

Joe Haden (Start who ever you can on the Steelers offense)

joe haden and antonio brown
This would have been a nice matchup for week 6 but Im sure Antonio Brown won’t miss Joe Haden when he gets to the end zone on Sunday.

Now because we are mostly focused on fantasy, you may not see many defensive players make our stories.  Since defenders do not typically contribute individually to fantasy scoring (unless your name is J. J. Watt), we usually stick to offense.  However in the case of Cleveland Browns cornerback Joe Haden, there are a few notable implications.  First and foremost, his absence makes the Browns defense “unstartable” ( I know that is not a word).  Furthermore, I think it makes Antonio Brown a bigger stud than he already is; as well as making Big Ben, Heath Miller and just about the whole offense of the Steelers have increased value this week.  Also, Ive heard a lot of predictions that the Brown will win this game and while I don’t care enough to make a pick on this game; I believe that Haden being out may change some tunes.  The Browns are quiet on the exact injury to his hip, but a broken fingernail against Antonio Brown would be too much.  I either expect him to not play or not play well.  You can do a lot with this information with the fantasy players and the game itself, but the best value is likely in Big Ben and Antonio Brown against a talented but not ready rookie cornerback in Justin Gilbert.

Vernon Davis (You may have to carry 2 Tight Ends for a while)

Davis is listed with a back injury that he suffered 2 weeks ago when he played with an ankle injury that was barely healed.  The good news is Davis has practiced 3 days in a row.  In my opinion the bad news is that all of these practices have been non contact.  The quotes that Davis has given locally and the nature of his injuries tell me that he will either not play or not play well.  My guess is that one good hit to his back or a hard fall sends him back into spasms and even without being hit, I doubt he can perform like the Vernon Davis we know.  Because TE is such a tough position to get production from, I think I would still hold on to him.  In this very unique case, carrying a second tight end until Davis can get another healthy chance is probably the best move.  I expect Davis to still have a couple of big days in him this year once he has time to heal.  I think the wisest move for the Niners would be to rest him until week 9 (after their bye) and finish the year strong.

Probable

All of the notable Probable players are not worth your time or mine, as they will all play.  That includes Julio Jones, Dez Bryant, Percy Harvin and others.  I expect all of the notable players on the Probable listing to play like their healthy, as none of the injuries appear to be serious.

Good Luck!

Trade A.J. Green Today!

A. J. Green is out with a toe injury that is being described as “a little bit more than turf toe” by the Bengals.

 

 

turf_toe_okung-e1388779617894
Figure 1: The structures listed on the right side of this picture are the problem for A.J. Green

 

 

The Science

Lets start by saying that “turf toe” is awful.  “Turf toe” is just a quick term used to describe a Metatarsophalangeal joint (MTP joint) strain/sprain injury.  Without making it complicated, an MTP sprain/strain is very much like any other joint sprain/strain injury that we have talked about in the past, in terms of the science.  The injury is graded as a 1, 2, or 3; with 1 – indicating over stretching with swelling and pain; 2 –  indicating small tears to the structures as well as pain, swelling and possibly some instability and loss of strength; and 3 –  indicating a complete tear.  The grade on Green’s toe has not been publicized, but I think it is safe to say that it is beyond a grade 1, as he is seeing multiple specialist and likely to miss the game this week.  It is also safe to say it is not a grade 3 as this would have caused a more definite time-table for his return and may have required surgery.  Therefore, I come to the conclusion that we are dealing with a grade 2 sprain/strain injury for his big toe.

While I say that this is still a sprain/strain injury similar to those that occur at other joints such as your knee or ankle,  the difference with “turf toe” is that the joint and its ligaments/tendons are  small enough to make adding support very difficult, but important enough to hinder almost everything you do on a football field.

The Plantar plate in figure 1 actually represents the ligament in this area while the Flexor hallucis represents the tendon in this area.  This is why we can consider this a sprain/strain injury, (remember sprains are for ligaments and strains are for muscle and tendon) as in most cases both of these structures are suffering as well as the actual joint.  If you put your hand on the ball of your foot on your big toe side and go forward just a little until you hit the crease that separates the ball from your toe, you can feel the area that is irritated with this injury.  If you then stand up and walk, you will  notice how much bend and push-off you get from that joint.  Hopefully from doing this you can somewhat appreciate how this injury can make walking painful and difficult, but now imagine running at the speeds of an A.J. Green.

turf toe active
Figure 2: Here is an illustration of what happens during walking and running during the push-off phase

The functional issue comes down to push-off (Illustrated in figure 2) which is powered at the MTP joint and by the Flexor Hallucis Longus which crosses the joint.  Most of us don’t think about walking as a sequence or pattern, but it is.  In short, we do a number of things during walking that we take for granted and one of the crucial stages of gait (walking) is pushing off of the balls of our feet and toes to allow our foot to propel off the ground into a swing forward motion to take a step.  Without this action, your walking would be dysfunctional and you would either be walking with a limp or with an assistive device like a cane or a walker.  Running is just a faster and more forceful version of walking; and this same push-off is essential.  In theory, these freaky fast athletes are creating more force in a shorter amount of time during their push-off as compared to the non  athletic population.  This may be a gift and a curse as the force that their talent produces on their joint, ligaments and tendons is not alway supported by these structures.  I believe this is why the most elite, most talented athletes are at higher risk for injury.  Similar to the cars driven in Nascar being at higher risk for malfunction, these athletes are built better than the norm; they receive more attention than the norm; but just like those cars they are pushed to the limit and therefore repairs are needed often.

Sticking with the car analogy, A.J. has a busted tire and unfortunately he does not have the option to switch tires.  Similar to most other sprain/strain injuries, he should be looking at about a 3-6 weeks to heal.  His attempts to play through the injury have already failed and if he comes back too quick again, he may risk missing the rest of the season or at least under performing for the rest of the season.

One of the most important things to understand with this injury is that healing occurs in stages.  While with knee or ankle sprain/strain injuries, I have supported athletes returning early; when it comes to this injury, an early return could spell disaster.  The 3 stages of healing are inflammation, repair and remodeling.  With those knee and ankle injuries, it is not always essential to get to the remodeling phase before the player returns to play, as the injured structure can be still healing while I send the player out with a tape job or a very supportive brace that will replace the function of the injured structure.  In the case of turf toe, I need the entire healing process to run its course as bracing or stabilizing the joint is not an effective option at this level of athleticism as it takes away the push-off that makes A.J. Green the fast and explosive receiver that he is.  One of the hardest things to manage with this injury is that the mechanism of injury occurs during a motion that IS supposed to happen, although not to the degree of force and range that is encountered  during the injury.  When you compare this to other ligament or tendon injuries that occur during motions that are not supposed to happen at all, you can see why stabilizing or bracing against those motions is a more straight forward approach.   “Turf toe” gives us the unique task of limiting a joint movement to a very precise range that optimizes performance but prevents injury.

If this all sounds confusing then use this analogy:

Problem: You want to stop eating potato chips.

Option A: stop eating them by simply not buying any at all.

Option B: stop eating them by buying a bag of chips but stopping at 5 chips per day(for the sake of this analogy, lets say that eating 6 or 7 would cause an all out disaster in your body)

I think most of us would choose option A as an easier and more realistic option as stopping at 5 chips with an entire bag in front of you is tough (or maybe its just me).  The point is, in order to play on a “turf toe” injury you would be asking the ligaments and tendons of the MTP joint to do the same thing that option B ask you to do.  Your toe would have to extend to just the perfect point (5 chips) and then stop before crossing the threshold of stretching and irritating the ligaments, tendons, and joint (6 or 7 chips).  With a knee sprain to a ligament like the MCL, I can use option A by simply using a brace with extra medial support to stop the knee from receiving valgus force (outer to inner) on the knee which in turn would significantly protect the MCL from receiving any motion that would stress the area (0 chips).  I give this analogy to simply say that managing this injury while the athlete continues to play is very difficult and likely unsuccessful, similar to option B with the chips.  Therefore, A.J. Green is likely on the option A path, which means not playing at all.

The NFL has all types of interventions to help Green heal at an optimal rate, but if I am the Bengals, I expect him out for at least a month.

What You Need To Know

deions toe
Deion Sanders suffered turf toe on his second toe. Hopefully A.J. can avoid this type of deformity.

Two Hall of Famers come to mind when I think of “turf toe”.  Jonathan Ogden the hall of fame Offensive tackle went out with turf toe, but athletically that doesn’t quite relate to A.J. Green.  However, the second, who in my opinion is the greatest athlete of all time (on the football field)  was also chased out of the game because of his toe–Deion Sanders a.k.a. “Prime Time”.  Now, Sanders was near the end of his career anyway, but my guess is that before the “turf toe” Deion was still in the top ten in regards to speed in the league and still a top defensive back.   The injury simply took him out after failed conservative management followed by a failed surgical attempt.  I say all of this to say that even though it is a toe injury, it is a very serious threat to a receiver that relies on his athleticism.

aj green hurt

I do not see a risk of Green retiring from this injury, but I do think that after trying to play through this injury he will have a healthier respect for the injury and sit out for a good while.  I would be surprised if Green played before week 10 and even when he returns, I expect he will be rusty.  Keep in mind that resting this injury stops him from nearly all weight bearing activity on that foot which is a very big deal.  So for fantasy owners, I am expecting that A.J. Green will not be his normal self until deep into the season and barely ready for fantasy playoffs.  With that said, I would trade him now!  There is a good chance that this story will look scarier to your fantasy league after all the Doctors visits are done and A.J. starts missing practices and games; and then you may have a hard time trading him.  If you trade him now, there is a good chance that many  devalue the significance of this injury and give you good return for him.  If it had been a little earlier in the season, I might say keep him but I just don’t think anyone is worth a roster spot if they can not produce for 4 weeks or more, as we know it doesn’t take much to fall out of playoff contention.  A.J. Green will be of no use to you in week 11 or 12 if you are already mathematically out of the playoffs.   In any case, the roster move is your choice; but the chances of a productive A.J. Green before week 10 at the Browns is slim.