1. Watkins had broken his foot about one month ago
2. Watkins had surgery which involved inserting a screw into his foot
3. Watkins recovery time was ballparked at 6-8 weeks
4. The Bills were targeting a Week 1 return for Watkins

Although no exact details have been released, I tend to agree with those who are more qualified than myself (such as Dr. Jene Bramel) and believe that this is most likely a Jones fracture. Jones fractures are not uncommon with wide receivers, as we’ve seen them most recently in Dez Bryant, Julian Edelman, and DeVante Parker. A Jones fracture isn’t a minor injury, but it’s not the worst injury to have, especially so early in the offseason. Watkins has time to be conservative in his recovery, and while I seriously question the lower end of that, “6-8 week,” spectrum, there’s no reason to expect that he wouldn’t be ready to be eased back into preseason action in August, 4 months removed from surgery.

That’s not to say that recoveries from Jones fractures are a slam-dunk. Dez Bryant had a pretty poor recovery last season, though that was likely due to him rushing back too soon. Marvin Jones was similarly plagued by trying to come back too soon in 2014. As for WRs who suffered the injury during the offseason, Demaryius Thomas stands out to me. He fractured his foot in February of 2010, and didn’t play until Week 2, a full 7 months post-surgery. Thomas even had his surgery from Dr. Robert Anderson, who is the gold-standard for foot issues among athletes. I can’t tell you what specific setbacks Thomas might have suffered, but I bring him up as a way of pointing out that these things don’t always go according to plans. In fairness, Jones fracture treatment has advanced since 2010.

But the real issue here might be Watkins’ exact injury. If it was indeed a Jones fracture, then we should have more clarity on how close he is to returning by the time camp is wrapping up or the preseason is starting. But there’s a chance that this injury is something more severe. I think it’s a small chance, but let me throw this out there. One early report from the almost-always reliable Ian Rapoport mentioned that the fracture was to a, “small bone,” in his foot. In injury terms, “small bone in the foot,” is worrisome as it often indicates a midfoot injury. Midfoot injuries, a blanket category that includes Lisfranc injuries, can be notoriously slow healers, and frequently knock players out for longer, unpredictable lengths of time. Add to this the fact that the Bills have set a Week 1 return expectation, which is roughly 5 months after Watkins’ surgery, and things start to look a little differently. Personally, I think that the most likely scenario here is that Rapoport’s report is slightly flawed (or just oddly worded) and that the Bills are setting a very conservative return date because that’s just the smart way to handle this. But until we hear a specific diagnosis, this is still a fluid situation and it bears watching. Should any future clues lead us closer to the diagnosis of a midfoot injury, then Watkins’ Week 1 status could be seriously in doubt.

The post The case of Sammy Watkins appeared first on Questionable To Start.

Zach Binney is a Ph.D. student in epidemiology, which is a branch of medicine dealing with the incidence, distribution, and patterns of health events (such as injury or disease). That’s exactly the sort of person who should be combing NFL injury data. Thankfully, Football Outsiders has an impressive database of NFL injuries, and Zach did some great work with them that I think is worth a read. He did a four-part series that really clearly breaks down some great injury data. It was good enough that I actually read it with a little of that sinking, “holy shit, THIS is what I should’ve been doing!” feeling. If you’re interested, give his stuff a read and see what you think.

NFL Injuries, Part I: Overall View.

NFL Injuries, Part II: Variation Over Time.

NFL Injuries, Part III: Variation by Position and Age.

NFL Injuries, Part IV: Variation by Position.

That’s a lot of data, a lot of charts, and a lot of text. But I think it’s all done very well. I think it’s digestible and compelling, which is a really tough line to walk with data like this. I have more thoughts, but I don’t want to make this about me. Nice work Zach Binney.

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If nothing else, at least we finally have an idea of why Peyton Manning played such a stinky game against the Chiefs. NASA reported that you could see the stink-lines from space. Today, ESPN’s Adam Schefter reported that Manning suffered a partially-torn plantar fascia in Week 10. The plantar fascia is a ligament that runs from your heel to your toes, basically following the curve of your foot arch. What’s more, it’s been reported that Manning had plantar fasciitis (inflammation of the same ligament) for about the last two weeks, and was attempting to play through it. Ugh. This is why I hate seeing players try to, “tough it out,” and play through injuries.

But none of that really matters. What matters is when Manning might reasonably come back. Fellow Footballguy Ari Ingel pointed out to me on Twitter that San Diego Charger Antonio Gates dealt with a partial plantar tear back in 2010. I have other examples, but there’s something I love about the Gates comp, so let’s roll with that one here. Gates was diagnosed with plantar fasciitis (again, that lesser version… no tear, just inflammation) in May of 2010. He rested up, which is what you do with this injury. Things seemed better. Then, in Week 8, Gates suffered a partial tear and missed the next three weeks (a bye sandwiched by two games). Gates tried to come back and finish out the season, but then missed the last four games. As if that wasn’t enough, the same injury sidelined him during the 2011 preseason, and eventually caused him to miss another 3 games during the regular season, as the scar tissue kept tearing.

Yes, I know what you’re going to say. Peyton Manning doesn’t need to move like Antonio Gates. True. But Peyton still needs solid footing in order to plant for his throws. Plus, he’s almost 10 years older than Gates was when he was injured. That’s significant. In my opinion, it’s the ugly comps like this that really highlight the possible severity of Peyton’s recovery. I’ll point out that there are a few other players that missed just a week or two, plus a few others that missed no time. TE Jimmy Graham missed no games with this injury in 2013, but it clearly effected his play. So really, it’s tough to tell how Manning will respond and heal. But a comp like Gates is useful for reminding us that, even if Manning comes back quickly, this injury might not be done with him.

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The biggest thing I’ve been watching this week (besides season two of Z Nation) has been the drama of Ravens RB Justin Forsett. He injured himself in last week’s game, and everyone seems to be pretending that he’ll be just fine for this Sunday’s game against the 49ers. I’m generally a pessimistic guy when it comes to NFL injuries, and this one has been screaming danger since Sunday, at least to me.

One of the awesome things about working over at Footballguys is that I have a team of coworkers, so it’s not just me sitting here cultivating my madness. I can only be pessimistic on so many injuries before I start to wonder, “hey, is it just me? Why am I the only one?” Thankfully, I’m not the only injury guy seeing trouble with Forsett, which makes me think at least I’m not the only crazy one. Footballguys has a writer who is also a doctor, and he’s a great resource. In fact, he’s how I ended up writing over there, but I followed his work long before they hired me. His name is Dr. Jene Bramel, and you can find him here on Twitter. Worth a follow. Anyway, he wrote up some great lines about why he’s also pessimistic on Forsett, and you can find them (behind a paywall) here.

If you don’t want to pay, I’ll boil at least a little bit of it down for you. But it’s worth paying for. Anyway, the mechanism of injury (how the injury occurred), as shown on broadcast, makes it look like it’s most likely a high ankle sprain. If you read my stuff, you know that that’s often a multi-week injury. Coach John Harbaugh has stated that Forsett avoided a high ankle sprain. First of all, Harbaugh (any Harbaugh) is not known for injury honesty. Even this season, Harbaugh has already been caught in at least one injury lie. Second, take a look at this photo that Dr. Jene posted on Twitter:

When I say player reaction, here’s where Forsett grabbed — over shin, not outside of ankle. More c/w high ankle. pic.twitter.com/houRhLRxZu

— Jene Bramel (@JeneBramel) October 12, 2015

How can you look at that and not suspect a high ankle injury?

As if that wasn’t enough, Forsett did not practice on Wednesday or Thursday. He put in a limited practice on Friday, and everyone seemed to be like, “Whew, looks like he’ll be fine for Sunday!” Except me, of course.

I should admit that I have some baggage here due to my own bias. Something about this situation reminds me very much of last season when Giants RB Rashad Jennings insisted that, despite not practicing, he would be fine for Week 14 with a similar, “don’t call it a high ankle sprain,” injury. He was officially active, but he was in too much pain to do anything, and Andre Williams took the reins, handing in a 24/131/1 performance before being banished back to RBBC purgatory the following week.

Using that one, biased comparison, I’d point out that even if Justin Forsett is active on Sunday, (which people are just now Friday evening becoming less optimistic about) he might not see much/any action. Rookie Buck Allen might get the call, and on a team with an absolute depth chart vacuum, there wouldn’t even be anyone around to vulture Allen’s goal line carries.

If Forsett is active and plays a halfway decent game, I’ll apologize to him and Harbaugh personally (with a small editorial comment below of course) for ever doubting their words. Game on.

Edit, October 19th: Ah nuts. I was wrong. In week 7, Justin Forsett posted 17 carries for 62 yards and caught 7 passes for 39 yards. You win this round, Harbaugh. It appears you were honest and I was too pessimistic. I’ll get you next time! Wait, this is supposed to be an apology, not a challenge. Sorry.

The post Why Forsett can’t be trusted appeared first on Questionable To Start.

After the case of Rodgers, we now had two recent examples of fractured, non-throwing collarbone QB RTPs. One was 7 weeks, one was 8 weeks, but with a setback and IR, however you want to score that. I could go 8 weeks or I could go 10 weeks, or 10+ weeks for Romo; they’d all be shades of correct. Given all that, I was perplexed when Eagles QB Nick Foles, after suffering the same injury in 2014, was given an initial timeline of, “4-6 weeks.” I blasted everyone online, and read up on that here if you like. Despite the optimism, Foles missed 8 weeks, and then the season ended. Had the Eagles made the playoffs, Foles might’ve returned.

But of course the big question is what we should reasonably expect for a Tony Romo return. Obviously, I don’t know for sure. I have no details of his injury, and I can’t tell you how it compares to the exact details of Rodger’s, Foles, or Romo’s previous collarbone fracture. But what I can tell you is that anything shy of, “6-8 weeks,” is probably ridiculously optimistic. Using history as my guide, I’d spitball a best case scenario return for Romo at Week 10, November 15th, after missing 7 games. He could prove me wrong and come back a little earlier, but it wouldn’t be much earlier. If things don’t go well though, Romo could easily miss 8 or 9 weeks, even longer. Some of this might become more clear as more news leaks out. All I’m here to say is that if anyone tells you an estimate that is closer to one month, you have my blessing to laugh in their face.

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#Cowboys plan: For Dez Bryant to have surgery as soon as possible, likely today. Belief is rehab will have him ready closer to 4 than 6 wks

— Ian Rapoport (@RapSheet) September 14, 2015

On the other end of the spectrum is the reality of how quickly players actually come back from similar foot fractures. Turns out there’s a big difference between the two camps. Historically, very few players miss less than 7 weeks. In my database, I have two recent players with similar injury that returned after missing exactly 6 weeks, and neither were wide receivers. I have not been able to confirm any NFL players who returned from this exact injury at anything less than 6 weeks. Beyond that, the more reasonable RTP seems to be in the “8-12 week,” range. But it should also be noted that there are plenty of examples where players take 3 months or more to recover, and often continue to have trouble afterwards, such as WR Hakeem Nicks. Others, like WR Marvin Jones, suffered related setbacks that kept them on the shelf even longer.

If history isn’t enough for you, then you can also listen to medical experts. As Dr. Jene Bramel pointed out on Twitter, “Dr. Robert Anderson, leading foot surgeon to NFL players, quotes 6-8 week recovery after 5th metatarsal fixation.” Dr. Robert Anderson is exactly the guy we should be listening to here, and it’s notable that he doesn’t include timelines as short as four weeks as anything realistic. In fact, we have no details yet, but there’s a good chance that Bryant will have his surgery done by Dr. Anderson in the next few days.

Who are we to believe? I can’t tell you why everyone in Dallas is so optimistic. Perhaps they have detailed information that leads them to be confident in this being only a four week injury. But without sharing that info, I have no reason to believe them. I don’t love always being the skeptical one in the room, but I feel like until a player can prove historical comps wrong, I’ll stick with history. In the case of a fifth metatarsal fracture, that history is telling me that a ballpark of, “8-12 weeks,” is probably the more likely outcome here. In my opinion, 4 weeks is entirely out of the question, and 6 weeks is probably still a little delusional. With a return being so far down the road, it’s safe to wonder if the Cowboys would consider using their IR/DFR tag for Bryant. Or maybe just plain-old IR. But the way they’re spinning this, that seems unlikely.

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Earlier today, Adam Schefter tweeted this:

Vikings’ C John Sullivan underwent a lumbar microdiscectomy Weds and has been placed on IR designated to return. Out until at least week 9.

— Adam Schefter (@AdamSchefter) September 10, 2015

As I am apt to do, I immediately disagreed. Not with the story… Shefter doesn’t get too many wrong. But with the Vikings use of the DFR (designated for return) tag. Teams only get one of those per year, and it seemed odd to me that the Vikings would burn theirs here. What stood out to me was that a lumbar microdiscectomy rehab doesn’t seem to mesh well with having a player return during the season. I always point out that I have zero medical background, so I relied on the internets to do some digging. Sure enough, the always-useful Medscape put an RTP at no less than three months. Even better, a study published in the American Journal of Sports Medicine showed that professional athletes return to play from this exact same surgery in an average of 5.8 months. To be fair, there’s a little difference between those two sources, as the study showed about 50% of the players returning at the three month mark. As an interesting aside, I also found a study that focused on how many NFL linemen (offensive and defensive) return to play after this surgery. By that, I mean how many come back, EVER. It’s about 86%. But the numbers I was finding weren’t exactly unanimous in this 3 month outlook. Footballguys’ Dr. Jene Bramel passed this one along, which shows an RTP of 6-8 weeks as a possibility.

With all the dispute here, it’s worth taking a look at my database to get some historical perspective. I’ll have to point out first that back surgeries are one of those areas where I can’t always be certain that I’m comparing apples to apples. A lot of times, the only details you can find are that a player had, “back surgery.” Details like the ones Shefter included are rare. But I have some examples. And I can safely include others where it was known that it was back surgery to correct a herniated disc, which is what Sullivan’s was.

The two best-case ones I have on record are T Eben Britton who missed 5 weeks in 2011, and C Barrett Jones who missed just over 2 months in 2014. Both were detailed only as “minor” back surgeries to fix a herniated disc, so I’m hesitant to include them. But I’d be lying if I threw them out just to fit my argument, so there’s that. Aside from those two, I have six players that fall right in line with the, “3+ months,” that I was reading. One of those, WR Kevin Walter, even goes on the PUP list to start the season, but is unable to ever get back onto the roster. The worst-case scenario was G Eric Steinbach who had surgery in August of 2011 (at the age of 31) and never played another down again.

So where does this leave us? I’m not entirely positive. If we start with that 3 month timeline and project it forward, we’d be looking at Sullivan returning for a December 10th, Week 14 game. It’s hard for me to believe that a team would use their sole DFR designation on a non-QB that they’re not expecting to return until December at the earliest. That leaves me to consider the possibility that I don’t know what I’m talking about. I’m not always right with these things, as evidenced by my stance that Pittsburgh wouldn’t use their IR/DFR on Maurkice Pouncey, which they immediately did. Of course, we won’t know who was right about either Sullivan or Pouncey until they actually come back off the shelf and play. But, as it stands now, I feel like I must be missing something on the Sullivan case. Perhaps the team has details that lead them to believe he’ll be back sooner. If so, I just wish they’d show their math.

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I love me some mysteries. And in my line of work, there’s nothing more mysterious than when a player has what is only called an, “undisclosed injury.” That’s when you know it’s something juicy. Such a scenario unfolded lately with Buffalo Bills RB Karlos Williams, and today I finally have enough to make a reasonable guess. Back on August 16th, it was reported that Williams had been hospitalized with an unspecified illness. The only detail that leaked out was that the issue was, “serious.” No help there. Then his injury was just vaguely called an, “illness.” Finally, it was called an, “undisclosed operation.”

At last, today we have some clarity. Or at least enough clarity for me to confidently connect some dots. Here’s what Williams said in an interview with ESPN’s Mike Rodak (who used to do awesome work on the Patriots beat circuit):

“But no, it was kind of a freak accident that kind of happened. A lot of pain. The trainers definitely took care of that. They found out what it was, got it taken care of and had a quick surgery. And actually a pretty quick recovery. I’m just happy to be back from that. But it was a very, very delicate situation.”

And then this single sentence follow that quote:

Coach Rex Ryan has previously referred to Williams’ injury as being to a “sensitive” area.

Anyone able to tell me what we’re talking about here? Yup, it was his testicles. As always, I’ll point out that I can’t prove this. But obviously, he has to be talking about his junk. At first it made me wonder if we were talking about a fusilli Jerry situation here, but the more likely culprit here is testicular torsion. This is an injury that is very painful, very critical, requires surgery, and is located in a, “sensitive area.” Fits the bill alright.

If you’re a sicko and want to read up on this injury, I can recommend this piece at Gawker. I’m the kind of guy who gets squeamish reading stuff like that, and I can remember that I thought I was going to throw up the first time I read that piece. In fact, I actually had to walk away and come back to it a few times. But in the end, it was worth it, because it helped me sleuth out this whole Karlos Williams injury.

The next question is, if I’m right about the injury, what can we expect from Karlos Williams as far as a return-to-play. Truth is, I have no idea. I have zero players with this injury. General (non-football) info I see online says that one should wait, “several weeks,” before returning to any strenuous activity. I hate terms like, “several weeks.” I can tell you that Williams has sat out the last three weeks. Whether or not that’s enough time, I don’t know. I suspect it is, but when you ask me to show my work on that guess, I’ve got nothing. I do know that with Williams being the next man up behind an injured LeSean McCoy, this will be a situation worth monitoring. The next clue we’ll get is when we see what the Bills practice reports look like next week.

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The earliest anyone comes back from a William Meyers core muscle surgery, according to my database, is after missing five weeks. This surgery is often reported to as, “4 – 6 weeks,” but, in my records, I’m seeing that a better ballpark would be, “5 – 9 weeks.” I’d accept, “5-8,” if that makes you feel better. But there’s no reason to include four in there anywhere, as it simply doesn’t happen. Okay, it happened once, with WR Brad Smith in 2014, but the injury was reported as minor compared to most core muscle injuries, and I can’t confirm that it was done by Dr. William Meyers (which might indicate it was less severe). So let’s assume a best-case scenario that aligns to historical rehabs, and imagine that Ertz comes back after missing only five weeks. That would have him back on Friday September 18th, two days before the Week 2 game against the Cowboys. Maybe he’s even up to speed and able to play by then. But if I were a gambling man, and I so am, I’d say that we’re probably looking at Week 3 being the first realistic game Ertz could be coming back.

As always, my records only indicate what has happened in the past, not what will happen in the future. Maybe Ertz is the one who beats my estimate. Maybe Jay Ratliff thought the same thing before he missed more than a calendar year after his core muscle surgery. Just ask yourself who you should believe, history or Chip Kelly’s guys.

Update: Would you look at that? He did it, and he proved me wrong in the process. Ertz played Week 1, making his rehab the shortest sports hernia rehab I’ve recorded yet from Dr. William Meyers. Nice work Zach.

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I have a hunch that Pittsburgh Steelers center Maurkice Pouncey is done for the year. Over the weekend, he injured his left ankle pretty badly. In the most detailed report so far, the Pittsburgh Post-Gazette’s Ed Bouchette said that Pouncey fractured his fibula above his ankle. Other reports have been less specific, making it hard to verify exactly what’s going on with Pouncey. Until we hear otherwise though, let’s just stick with that fractured fibula (aka fractured ankle… it’s really the same thing in this case).

One could be forgiven for thinking that Pouncey might make it back this season. A fractured fibula/ankle like this can sometimes be rehabbed in as little as six weeks. I mean, it’s rare, but it happens. Donovan McNabb missed only seven weeks with this in 2002, and Terrell Owens missed only six weeks with it in 2004. (Total credit to Footballguys injury czar Jene Bramel for pointing those two examples out to me.) But I can also tell you that based on my own database, which tends to focus on 2010 to present, these returns are rare. As in, I have zero. Sure, there’s an occasional judgement call that could go either way, such as RB Charles Sims who suffered an ankle injury in the 2014 preseason and returned to play in Week 10. Sims either fractured his ankle or had severe ligament damage, or both, depending on which reports you read. Or there’s DB Mistral Raymond (no, I didn’t reverse the first and last name, so don’t bother telling me I did) who missed only six games with an ankle injury that was reported as everything from a bone bruise to a dislocation to a fracture. But these are odd, sloppy, murky examples that I’ve given up on making heads or tails of. When it comes down to actual fractured fibulas, or the more vague fractured ankles, or the even more vague ankle surgery, the results are mostly similar, and they’re mostly all bleak. Season ending IR.

This is an interesting intersection of sports medicine and NFL roster management. An optimistic rehab on a fractured fibula near the ankle, assuming there is no other damage, might run as low as six weeks. Maybe eight weeks would be more realistic. But that means that there’s still a decent chance of ten weeks, depending on how everything progresses (and again, assuming there is no other damage). Now put yourself in the place of a head coach or team medical staff. A solid (but I would argue not outstanding) center like Pouncey fractures his ankle. What do you do with him? You only get one injured reserve, designated for return (IR/DFR) slot all year. Just the one. In Pouncey’s favor is the fact that the injury happened so early in the preseason. Players can come off the IR/DFR shelf and play again eight weeks after being put on IR (which in this case would have to be done after the preseason, on the first day of the regular season). So Pouncey could play again as early as Week 8. Depending on the extent of his injury, that might be realistic. But do you really want to use your only IR/DFR slot for him? What if a more valuable player, such as Le’Veon Bell, comes down with a serious, but not season-ending, injury? Or what if Pouncey doesn’t recover as you expected? And again, all this assumes that Pouncey’s injury is only a simple fractured fibula. You see the dilemma here?

I can’t tell you exactly how much goes into making decisions like that. But what I can tell you for certain is that in the recent past, when this exact decision has been made, it has almost always resulted in season-ending IR. Right or wrong, that’s just how it’s panned out. I don’t see any reason that it won’t play out the same way in Pouncey’s case.

Update: On September 6th, Pittsburgh ignored my unsolicited advice and placed Pouncey on IR/DFR. I cannot wait to see if he does indeed come back this year, and when.

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