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. 

NFL Draft Alert: Who Is The Injury Bust Drafted In The Top Ten?

April 30, 2016

The NFL draft is one of the few things in life that is graded strictly from the perspective of guessing and potential. No matter how many drills and interviews these players go through; there is always the chance of the first pick being Jamarcus Russell or the 199th pick being Tom Brady. I think most smart people would agree that the draft is mostly luck, THERE IS NO SCIENCE HERE!

On the other hand, determining the probability of a player getting injured is a Science. I like to call it Injury Science. Physics gives us formulas to determine how much force a player will generate based on size and speed; Physiology helps us predict the thresholds that a player can endure before their bodies begin to underperform or fail; and past performance data gives us the data to predict how similar players will react to certain conditions. This does not mean that Injury Science will predict every injury, but similar to the Las Vegas predictions; Injury Science will be right on many more occasions than it is wrong.

The 2016 NFL draft is off to a very entertaining start and as usual fans are pumped up about their teams early first round picks. Although I strongly believe the draft is luck, there is evidence to show that these top picks are more likely to at least contribute to their teams in some capacity. With that said, the biggest threat to a team who is getting one of these top 10 players is taking a player who will be plagued by injury. The first 10 picks consist of 2 quarterbacks, 1 running back, 2 offensive tackles, 2 defensive ends, 1 linebacker, and 2 corner backs.

For those who have followed me for a while, the high risk player in this mix should stand out like a Dallas Cowboys fan at a Philadelphia Eagles game. The easiest place to start to predict a higher risk for injury is to ask if the player is the one doing the hitting or the one getting hit. The obvious higher risk is with the players who are getting hit which helps rule out the 5 defensive players. The next easiest position to rule out for injury bust is the quarterback position; as quarterbacks are only allowed to be hit at the nipple line in todays NFL and if you use more than 10 lbs of force to hit a quarterback, they make you walk the plank. Needless to say that the quarterback is the least likely position to be an injury bust. That leaves us with 2 offensive tackles and a running back. Even if you are not a football fan, everybody knows that for the most part you hit the man with the ball, and offensive tackles never have the ball. So while offensive tackle is no cake walk they are generally looking for a defender to block, while defenders try to get away from them. This leaves us with the most dangerous and short-lived position in all the 4 major sports–the running back position.

Ezekiel Elliot is the obvious pick for most likely to be an injury bust just by the position he plays, BUT I think it is much more than his position that elevates his risk. Elliot is definitely what I would classify as a “Freaky Talented” athlete. There are many ways to identify these athletes but I will tell you an easy way that doesn’t need any real research. I learned this early in my high school football career from a running back named Eddie Gaskins. When you see someone with a chubby face and a six-pack for abs, you are in trouble. I think this is some type of “Freaky Talented” trait that I don’t understand yet, but it is one of my unofficial ways of designating these athletes. As for the official way of designating these types of athletes, I simply look at the measurables. Ezekiel Elliot is 225 lbs, which is considered big for a running back as the average running back in the NFL weighs about 215 lbs. Despite that size, his 40 yard dash time is an impressive 4.47 seconds. That combination of size and speed is really all he needs to get the “Freaky Talented” designation from me. If that is not enough for you, just watch any of the Ohio State Buckeyes games from the past 2 years and you will be convinced. I can definitely see why my arch-enemy Dallas Cowboy fans are excited. However, those Cowboy fans may not be as excited about this next part.

Part of determining how someone will perform is to find comparable players. Player that are the same speed, body type, and position is a good start in evaluating what a players injury risk may be. I evaluated my SEP Reliability Ratings for the running backs from last year to see which running backs compared most favorable to Ezekiel Elliot and then looked at them as rookies to make sure the comparison still lined up. After reviewing all the current NFL running backs, the two that compare most favorably to Elliot were Ryan Matthews of the Philadelphia Eagles and Chris Ivory who is now playing for the Jacksonville Jaguars. Matthews came in the league at 218 lbs and running a 4.46; and Ivory came in the league at 222 lbs and running a 4.48. They both have a style like Elliot where they choose to run defenders over rather than go around; and the absolute clincher was that they both have the chubby face trait with body builder bodies to match (although Ivory has put on a few since his rookie year). While these are pretty good comparisons for Elliot, as both these players are at least still in the league as productive players, their first 3 years collectively look like this:

Injuries-ankle sprain, calf strain, concussions, broken clavicle, MCL sprain, hamstring strains, Lisfranc fracture, sports hernia, etc.

Games missed (between both Matthews and Ivory) – 34 games in 3 years (plus extra time missed during the games they did play in)

If an average of almost 1.5 injuries per year and over 5 missed games per year is even close to what Ezekiel Elliot is in for, I don’t think Jerry Jones and Cowboy fans will be too happy. The fact is that a big body with that much speed in todays NFL is an injury waiting to happen as lots of mass and lots of speed equals lots of force (literally: force = mass x acceleration squared). I don’t wish injuries on anyone (even Dallas Cowboy’s), but it is very likely that Elliot’s body will not be able to keep up with his talent which will cause something to eventually fail; and if his own body doesn’t get him, he has all the high-speed collisions with linebackers and safeties to play clean up. This may not be enough to truly call him a bust, but what do you think the SanDiego Chargers think about drafting Ryan Matthews now? Does anyone even remember that Chris Ivory played for the New Orleans Saints?

Just like Vegas I could be wrong. Buster Douglas knocked out Mike Tyson and Ronda Rousey almost got her face kicked off; but those buildings in Vegas are big for a reason. They use data and processes to figure these things out, in other words they use a science. The Injury Science here definitely points to Ezekiel Elliot having an injury plagued career.

The Boston Celtics and Isaiah Thomas better watch for the hook

April 27, 2016

The hook here is not the Atlanta Hawks closing out the series against the Boston Celtics. The hook I am referring to is the one that may be coming for Isaiah Thomas after the 2 jabs he has taken with ankle sprains in consecutive games. With game 4 and game 5 concluding with Thomas experiencing a “tweak” to his left ankle, you can almost feel the knock out blow coming.

I love boxing and I love boxing analogies. I am currently reading Gary Vee’s book jab, jab, jab, right hook; I hit the heavy bag 2 or 3 times per week; and look forward to boxing matches more than almost any sport aside from football. The beauty of boxing is that once you really understand it, you can predict what is coming. For me, injuries are very similar. When I see a good boxer working their jab all fight; I know a straight right is coming. Once the straight right starts landing, you can expect the left hook. It’s a natural progression in the combination.

With Isaiah Thomas who seems to have a weak left ankle, there is also a natural progression. An ankle that proves to be weak will ask for help. This help may come in the form of taping or bracing; it may come in the form of asking his other joints to chip in a do a little more work. Either scenario will eventually end poorly. A joint that is helped too much causes an overall disruption in the chain of joints and heightens the chance of injury. A joint that is injured and not supported enough to protect it from further injury will eventually suffer a more serious injury. This means that Thomas is likely headed for a more serious ankle sprain or possibly a knee or foot injury on that left side. His probability of this happening will continue to progress if the Boston Celtics season can be extended and Brad Stevens continues his trend of playing his guards for huge minutes.

If you are investing in Thomas for fantasy basketball or picking the Celtics to tie this series up; I would at least consider that Isaiah Thomas is approaching red flag territory with his injury probability; and without him the Celtics do not have much of a chance.

Remember that Injury Science is real and these injuries are not just bad luck or random. While I may not have a hard data print out to show you Isaiah Thomas’ exact risk for injury (yet), you can trust that all the warning signs are there. The best thing for Thomas’ ankle will be a long rest. So while his mind will be pushing for game 7, his body may be shutting down for the off-season.