In this week’s injury mailbag, we try to put a timeline on Joe Burrow’s return (and come up with a very exact number of days until we may see him again), dig into the mysterious shoulder woes of Zach Charbonnet, attempt to figure out what’s going on with Jonathan Taylor’s “back injury”… and more!
First, here’s a quick glossary of terms commonly used by Inside Injuries:
- IRC = Injury Risk Category (three designations: “Low,” “Elevated,” “High”) — the overall likelihood a player will get injured
- HPF = Health Performance Factor (Peak, Above Average, Below Average, Poor) — our metric to predict player performance
- ORT = Optimal Recovery Time — the amount of time a player needs to fully recover from an injury (not the same as how much time they will actually miss.
Q: What’s the realistic time table for Joe Burrow’s return and will his calf injury linger all season? – Chad A.
The most recent update provided by the Bengals indicates that they expect Burrow will miss “several weeks.” While that is a good place to start in terms of expected time missed, let’s look a little more into what a calf strain is to get a better idea of what’s going on.
When we’re talking about calf strains, it’s important to acknowledge that the calf itself isn’t just one muscle. The gastrocnemius and the soleus are the two main muscles that make up the calf and are where we look for strains. The larger of the two is the gastrocnemius, which sits near the top of your calf below the knee. Underneath that is the soleus. Despite the size discrepancy, both play a crucial role in lower body movement and stability.
A strain in either muscle is going to immediately impact a player like Burrow’s ability and skill set. He might not be known for his mobility, but he’s still a young quarterback who scrambles out of the pocket with relative success. It’s not just mobility, though. For a quarterback, a healthy and stable lower half means stronger, more accurate throws. When the calf is strained, it means the muscle fibers or tendons are damaged. Even something low-impact, such as walking, results in stress being put on those damaged structures, which can be incredibly painful.
The good news is that treatment is pretty simple. Generally, the RICE (rest, ice, compression, elevation) method is the go-to. After that, rehab comes into play to help bring back any lost strength and/or mobility. Knowing that both of these aspects will be factored into the total time missed, let’s look at a realistic recovery window for Burrow.
Considering the team said they expect him to miss “several weeks” and based on the mechanism of injury, we believe Burrow is dealing with a Grade 2 strain. Our algorithm predicts he is 34 days away from Optimal Recovery (at the time of writing). Grade 2 strains indicate some tearing is present in the muscle, but there is not a full rupture.
Basically, we expect him to be ready Week 1. That being said, Grade 2 strains do require some comprehensive rehabilitation efforts. It’s not enough for Burrow to just rest and take some time off. Sure, the calf might feel good after a while, but failing to rehab properly opens the door for future injuries. As a result, his Injury Risk will be considered High moving forward, but once we know more about his recovery and rehab plan, we expect it will dip into the Elevated category.
Q: What is wrong with Zach Charbonnet’s shoulder? – Anonymous U.
While the Seahawks remain vague about the injury itself, there are some potential causes. One thing of note is that HC Pete Carroll said the injury “just kind of crept up on him, really […] He didn’t get hit or anything like that. Just all of a sudden, he started to feel something, so we’re just checking him out and being really cautious right now.”
Immediately that makes us think that there wasn’t a dislocation or anything highly traumatic to the area. Instead, it’s likely something that has been steadily getting worse over time. Some potential causes:
- Overuse: This is a pretty straightforward one. Whether it’s breaking tackles, blocking, or just incidental contact, running backs absorb a lot of force with their upper half. These forces can take a toll over time, resulting in pain or discomfort. Additionally, they can cause tendinitis or bursitis. Overuse will be a theme throughout the rest of this list as we get more specific.
- Rotator cuff injury: The rotator cuff is a group of muscles and tendons that sit around the shoulder joint, providing stability and giving the shoulder its expansive range of motion. Strains or tears can occur in any of these muscles/tendons, whether it’s from repetitive motions, degeneration over time, or consistent impact to the area without adequate time to heal.
- Shoulder impingement: At the highest point on your shoulder is the acromion. Beneath that is a narrow space where tendons pass through. When things get congested or too tight in there, it’s called an impingement and it can be highly uncomfortable. The tendons get irritated and inflamed, which limits mobility but it doesn’t really feel painful from external forces (though pressure in the right – or wrong – spot can hurt). Impingements generally rise from overuse.
- Labral tear: The labrum is a tiny piece of soft cartilage surrounding the shallow socket of the shoulder blade. It acts as a bumper, providing cushioning and preventing excessive friction and wear during movement. It can get torn from repetitive motion or overuse.
Without more specific information about the injury itself, we won’t know for sure what the exact issue is. However, we feel pretty confident that it’s not a major thing. That being said, we’ve seen how shoulder injuries can impact running backs in the past — notably Dalvin Cook — so we will be keeping our eye on this.
Q: Can you please break down the calf and Achilles process being overused with players who have torn their ligaments in their knee prior? (Joe Burrow, Tim Patrick). – Cody M.
This is a great question because it really highlights how injuries and recovery — especially at the professional sports level — can be much more complex than most realize. For some background on the two players you mentioned: Tim Patrick ruptured the ACL in his right knee during training camp last year before rupturing the Achilles tendon in his left leg just a few days ago. Burrow ruptured the ACL in his left leg during the 2020 season before suffering a calf strain in his right leg last week.
I’m going to try and cover a lot in as condensed fashion as possible, but the first place to start is by looking at how the body might compensate mechanically after an injury.
In both Burrow and Patrick’s cases, we can identify a significant knee injury (ACL rupture). Both of them underwent surgery and likely followed a strict rehab process until the knee was healed. Even after the knee is healed, though, we tend to see players favor the opposite leg, either on purpose or subconsciously. It might not seem like much, but it means the favored leg has to work a lot harder or more than it’s used to, which can lead to unnecessary, additional stress on other structures, like the calf muscles or Achilles tendon.
Beyond that, during the rehab process after the initial knee injury, players focus their efforts on regaining strength and mobility in and around the injured knee. Unless moderated, this can sometimes lead to the other leg not gaining strength at the same pace, or even losing strength, for that matter.
Once that rehab process is complete, we may also see players try to return to form too quickly. There tends to be this misconception that successfully completing a rehab program means everything is back to original working order — but that’s rarely the case. Nothing truly can simulate in-game action, so a player recovering from a significant injury needs to ramp up their intensity and style of play instead of just going all out immediately. This is more of a note regarding Patrick’s case.
Finally, something to consider is the degenerative change that an ACL rupture may have on the knee itself. There are still studies taking place, however some research has shown that an ACL rupture can lead to things like arthritis in the knee. If this were to be the case, it would be similar to my first point about mechanical adjustments. Basically, if your knee isn’t 100%, forces are distributed unevenly.
In short, the relationship between injuries, recovery, and performance in professional sports like the NFL is often more intricate than it appears. It’s imperative that everyone involved, from the injured athlete to the coaches and medical staff, trust the process and remain diligent throughout.
Q: Is Jonathan Taylor really injured from an off season non football thing, or is this gamesmanship from the Colts? – Unknown
We can’t say definitively if Taylor is truly dealing with something in his back, but there are some very serious implications if the Colts are fabricating the injury.
According to the NFL’s official policy on injury reports, teams are required to provide accurate, timely, and detailed information about player injuries. Now, yes, there may be limits to what the team knows about the injury, but they must meet the aforementioned criteria.
The minimum information required includes identifying the body part (or area on the body) that is injured, the player’s status as a result of that injury, and any changes to the player’s health and/or status. These updates are required to come throughout the week, especially if the injury status changes.
All these rules are in place to keep things fair across the league. They prevent teams from getting an upper hand by hiding a player’s injury or not telling the whole truth about it. Things get even more serious when you factor in betting and sponsorships, which makes the NFL (and the sportsbooks) a lot of money.
If a team is found to have violated this policy, they could face potential penalties from the league, including fines or the loss of draft picks. Therefore, while it’s technically possible for a team to mislead or be vague about a player’s injury, the consequences of doing so really don’t make it worth it.
Circling all the way back to Taylor, his frustration with the Colts seems pretty valid, but that doesn’t mean they lied about his injury, necessarily. He was already known to be dealing with an ankle injury from the past, and it’s possible that the back injury came from this (see response about mechanics above) or it may be completely unrelated.
Additionally, new head coach Shane Steichen stated Taylor is dealing with an issue right now — without further elaboration. Maybe things are being blown out of proportion given the underlying tension, but for now we are considering the back injury to be legitimate, even if we don’t have any details to go on.
Q: What do you make of the Kadarius Toney injury? – Bryton S.
It’s unsurprising to say the least. Toney has been plagued by lower body injuries since entering the league in 2021. The major concern surrounding him thus far has been his history with hamstring strains, but the meniscus injury definitely adds a wrinkle to everything.
The meniscus is a small, C-shaped piece of cartilage that operates as a cushion in the knee joint, sitting between the thigh bone (femur) and shin bone (tibia). It helps absorb the impact on the knees when walking, running, or jumping. There are two menisci in each knee, one on the inside (medial meniscus) and one on the outside (lateral meniscus). Together, they distribute weight evenly across the joint.
A torn meniscus can cause pain, swelling, and restricted movement. Additionally, a lot of people who suffer a torn — or partially torn — meniscus describe a feeling of instability in the knee, as well as the knee “locking up.”
Toney reportedly suffered a partially torn meniscus and underwent repair surgery. Generally, when we talk about meniscus repair surgery, it means the damaged section of the meniscus is either removed or repaired. It will depend on each individual case, however most surgeries aim to preserve as much of the original tissue as possible. This is because of the role the meniscus plays in protecting the knee from wear and tear.
On top of this all, Toney is said to have undergone a different minor procedure on the same knee this offseason. It’s unclear as of now what the purpose of that surgery was. Regardless of the purpose, when a player undergoes multiple procedures on the same knee it indicates they could be dealing with a recurring issue, or possibly that the initial injury — whatever it was — didn’t heal correctly or as expected.
Looking ahead, meniscus tears are a mixed bag, but the long term outlook tends to lean more negative than positive. Last season, Jets QB Zach Wilson missed the first three weeks of the regular season after tearing his meniscus in the preseason. Back in September 2020, Chargers S Derwin James suffered a torn meniscus and missed the entire season.
Combined with his history of hamstring issues, there isn’t much optimism for Toney this year. He may not miss the entire season as a result of the meniscus tear, but it’s near impossible to picture a scenario where he doesn’t get injured again this season. His Injury Risk is High and will remain so until around Week 5 (provided he doesn’t suffer another injury in that time).
Q: How many of the injuries so far can be attributed to the heat wave? Is there anything teams are doing differently this summer accordingly? – Chris K.
While we can’t provide a specific numerical value for heat-related injuries so far in training camp, your question does a great job acknowledging the relationship between heat and player injuries.
Heat is known to exacerbate both dehydration and fatigue. When these symptoms are elevated, we may see an increase in the risk of cramps, muscle strains, and other soft tissue injuries. On top of that, extreme heat can lead to heat-related illnesses like heat exhaustion or heat stroke – both of which are serious. That being said, let’s take a deeper look at what extreme heat does and how it interacts with someone engaging in strenuous physical activity.
- Dehydration: The big one and where it all starts. Everyone gets dehydrated, even when it’s not hot out. We all know that feeling of the sun beating down on us without a bottle of water in sight. The heat that we’re feeling promotes sweating, which results in fluid loss. If these fluids aren’t replaced (ie. drinking water) the symptoms of dehydration begin to set in. Physical symptoms can include reduced strength, speed, and stamina. Additionally, dehydrated muscles are more prone to injury. Mental symptoms can include reduced alertness and decision-making.
- Hyperthermia: During any physical activity the body’s temperature rises, but when the external temperatures are also high, it can lead to hyperthermia (unusually high body temperature). Symptoms can range from mild to severe and have some crossover with dehydration. On the more mild side, we may see slight confusion and fatigue. On the more severe side, we may see heatstroke.
- Muscle fatigue: Like I’ve already mentioned, heat tends to exacerbate fatigue. Now, imagine doing a ton of intense physical activities over the course of hours. Fatigued muscles are more susceptible to injuries, particularly strains and sprains.
We can’t say for certain if any teams have adjusted their heat-management strategies this summer. But even when there is not a heat wave it’s crucial that organizations try to minimize the risk of heat-related injuries. Hydration, rest, acclimatization, cooling strategies, and keeping a close eye on players during these periods reduce the risk greatly.
Q: Last year the Eagles had incredible injury luck. What are the controllable aspects to achieve that same player availability? – Steve J.
While injuries in football are essentially unavoidable due to the nature of the sport, there are a handful of controllable aspects that can (and should) be utilized in an attempt to improve or maintain player availability. These include:
- Strength and conditioning: This is where it all starts. A well-designed, balanced strength and conditioning program is fundamental. From physical resilience to overall performance, a good program will only set you up for success as a team.
- Recovery protocol: This is what takes place after the game or after practice. Ensuring that players are engaging in healthy habits and focusing on recovery is a relatively simple but overlooked aspect of preserving health. Whether it’s sleep, diet, drinking enough water, physical therapy — all of these little things combined together can make a huge difference.
- Load management: What is this? The NBA? In all seriousness, player activity should be closely monitored by team staff. There are so many tools teams have access to that provide a wealth of information regarding usage rates and the load players are under. If the numbers say a guy should have the day off, go ahead and let him rest.
- Medical staff and facilities: This is probably the unit that contains the most responsibility. If you have top-quality medical staff, it’s more than likely that your players are educated on injuries and they trust you enough to come forward if they aren’t feeling 100%. The staff should also be diligent about not missing signs that a player is injured. There are plenty of injuries that could have been prevented if a team’s medical staff picked up on the warning signs early.
All that being said, a lot of it ties back into what you mentioned: luck. A team can only do so much, but if they do it right and do it well, then they’re only making things better for themselves in the long run.
(Top photo: Dylan Buell/Getty Images; inline pic of Joe Burrow: Kareem Elgazzar-USA TODAY NETWORK)
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