Welcome back to Matt’s Medical Tent Talk. It seems the NFL season has kicked off with a slew of scary hits, requiring carts and stretchers to be rolled out. The latest hit saw Steelers quarterback Mason Rudolph get knocked out cold before eventually being able to walk off with assistance. We all see players with concussions come out of the game, go to the tent, go to the locker room, and then maybe come back in street clothes. But what is the process like besides the protocol, what are concussions like for the players? Well, like I said last week, concussions are individualized experiences. For instance, my first concussion (of course playing football) was in high school where I was driven away in an ambulance where, apparently, I told the paramedics they were in the wrong profession. My concussed mind believed it would be best if one paramedic were to become a taxi driver, and the other to work at Disney World…yep. So, yes, individual experiences, and therefore we should not ASSUME each player will fly through the concussion protocol in a week or two just because SOME do. Recent research tells us that those who suffer concussions will return to sport faster the quicker they begin aerobic exercise. Using Mason Rudolph as an example, even after we watched him get knocked out on Sunday, if he gets through the protocol, he can play this coming weekend. That being said, it is also possible he misses one week, two weeks, or more. It’s possible, though unlikely with top-notch medical care, that he develops post-concussive symptoms and misses MONTHS, again, UNLIKELY. All this to say that, in the culture of fantasy football, we seemingly forget the realism of injuries, as real people, and focus on our lineups. But, injuries, especially concussions, are to be viewed as serious injuries, and even if we can’t see their impact now, what they leave over can last a long, long time. Each week, just like last week, I’ll have a section on the fantasy-relevant concussed players from the previous week, with the included protocol from the NFL, and there’s a lot of big-name concussions this week. So, before we dive into the rest of the injuries from week 5, let's lighten the mood and remember…I told paramedics that they would be better off driving taxis and being frickin’ Mickey Mouse. Let’s get to it!
Patrick Mahomes, QB, KC – Ankle
During Sunday night’s upset loss to the Indianapolis Colts, Chief’s All-World quarterback Patrick Mahomes aggravated a previous left ankle injury, not once, but twice over the course of the game. The initial aggravation did not look like much based-on video replay, as we saw him limp around for a few plays before the half and then saw him come back with a heavily taped left ankle after halftime for stability. The second “tweak” occurred late in the third quarter as Mahomes’ own offensive lineman stepped on his ankle which actually re-created the initial mechanism of injury from a few weeks ago. I believe this second aggravation was significant and will significantly hinder his mobility going forward. Considering Mahomes’ ability to play through this injury already, I would not expect him to miss any time, but I do expect his mobility to be limited, thus making his patented, dazzling, throws on the run much more difficult. I see him in a similar vein to Russell Wilson a few years ago when he was hampered by his own ankle injury and limited him to a pocket passer for the majority of the year. While Mahomes has a higher passing ceiling than Wilson, I believe that ceiling has dropped a bit as his mobility, a staple in his game is diminished.
Prognosis: Day-to-day in practice, likely no missed game action, hindered mobility
David Johnson, RB, ARI – Back
Arizona Cardinals’ coach cliff Kingsbury reported Monday that his star running back’s back “locked up” during the Sunday’s game against the Bengals. When we hear about a player’s back “locking up”, the first thought is back spasms or a muscular disturbance that requires some rest and rehab, but ultimately not a significant issue. While we know little more than this subjective report from Kingsbury, other than Kingsbury also not ruling out that Johnson could miss Sunday’s tilt with the Falcons, I lean toward this not being a significant problem. Unless reports come out describing any type of severe or radiating pain, with difficulty moving, walking, or performing football-related activities, I would chalk this up as a muscular tissue that is likely a result of overuse. Considering Johnson has shouldered a significant portion of the load for the last few years when healthy, look for the Cardinals to potentially use more of their talented young back Chase Edmonds to carry some of the between the tackles work, while keeping Johnson fresh, utilize his receiving talent and getting him the ball in space.
Prognosis: Day-to-day, monitor practice reports for symptom updates
Josh Jacobs, RB, OAK – Elbow
One of the biggest surprises of week five, other than five players dropping over 40 fantasy points(!!!), was the success Josh Jacobs had against the vaunted Bears defense, as he racked up 143 total yards, 123 of which came on the ground. Jacobs gave fantasy owners a brief scare during the game with what was reported as an elbow injury that caused a short absence from the game. Thankfully, Jacobs returned to the game quickly, with seemingly no serious injury. Considering Jacobs’ returns to the game with no lingering impairments. While on the sideline, medical staff likely cleared Jacobs of any elbow instability or potential fracture, and I wouldn’t be surprised if he had a precautionary X-ray just to be sure. Jacobs and the Raiders have a week to get healthy before squaring off with the Packers suspect run defense in week seven.
Prognosis: Day-to-day, most likely clears up over the bye week
Jaylen Samuels, RB, PIT – Knee
We learned early Monday morning that Steelers do-it-all back Jaylen Samuels had a knee scope and, according to Mike Tomlin, would be out “at least a month”. This report took many, including myself, by surprise as there seemingly had not been anything noticeable during the game that would lend to an arthroscopic procedure being required. Tomlin himself even discussed how the injury showed up late after the game, which likely means Samuels knee must have swelled up a considerable amount requiring the procedure. Even though arthroscopic surgery is minor, it is still a traumatic event for the knee requiring holes to be cut on both sides of the knee (one for the instrument, and one for the camera). The surgeon will drain the excess fluid and then assess if there is any additional repair required, for instance, clean up of a frayed meniscus is a common occurrence. Typical healing timeline includes decreasing post-surgical swelling, regaining a full pain-free range of motion, start pain-free strengthening, and then performing pain-free football activities. Other players with the same procedure include D.K. Metcalf and Michael Gallup, both of whom returned in under one month.
Prognosis: 2-4 weeks
Sammy Watkins, WR, KC – Hamstring
After showing up late on the injury report with a shoulder injury going into Sunday night, Sammy Watkins crossed us up and pulled his hammy, performing a classic Sammy Watkins move, of getting hurt just minutes into the game and throwing up a tasty donut on the stat sheet, yum. Hamstring strains have various grades and can occur in various locations along the muscle from close to the origin point at the mid-butt, down through the muscle belly, and into the tendon. If we had to choose a place of injury, it would be right in the middle as research tells us return-to-play is significantly shorter. Unfortunately, we will likely never know the location of the injury on the hamstring, and we probably won’t get a grade, therefore monitoring practice reports and updates from Andy Reid will be critical in trying to gauge a potential timetable. Considering Watkins left the game early and was almost immediately downgraded to OUT, this may be a significant strain. At the very least, I would not expect Watkins for week six, and potentially longer. As I said, practice and injury reports from Reid will give us some clues going forward. Stay tuned.
Prognosis: 2-4 weeks
Marquise Brown, WR, BAL – Ankle
After taking a shot on his touchdown reception against the Steelers, Hollywood Brown hobbled off the field and we didn’t see much of him after that point as he was obviously limited playing only 46% of the total offensive snaps. Thankfully for fantasy owners, Hollywood was nice enough to score his touchdown while injuring his ankle, salvaging his stat line. Looking at the ankle, there wasn’t much video evidence to demonstrate any significant injury that would keep the young speedster out for any significant amount of time, and for what it’s worth, the Ravens aren’t too concerned about it either. Hollywood will be another one to track during the week. I would expect a few limited practices, but, at this point, I do not believe he is in danger of missing game action.
Phillip Dorsett, WR, NE – Hamstring
On a short week, against a team where he likely won’t be needed, I think it is doubtful Phillip Dorsett suits up Thursday for New England after already missing two practices this week. Dorsett, like Watkins (see above for additional information relating to hamstrings), also injured his hamstring on Sunday. Dorsett is another player we don’t have much information to go on, so we’ll have to look out for practice reports and injury updates. But, considering the Patriots will have 11 days rest after Thursday night’s game (don’t play again until following Monday night), Dorsett has a chance to heal up and get right for week seven MNF. Though hamstrings, along with calf strains, have the highest re-injury rate, and should not be rushed to prevent season-long aggravations.
Prognosis: Doubtful Week 6
Evan Engram, TE, NYG – Knee
After initially being qualified as “a little game soreness” by Giants head coach Pat Shurmur, Giants’ stud tight end Evan Engram is evidently dealing with “a little” more than just soreness. Early on Tuesday, Adam Schefter reported Engram is dealing with an MCL sprain. The MCL gives the inside of the knee stability and prevents it from buckling inward. Early reports are that the sprain is mild which is good news as Engram was even able to practice in a limited fashion on Tuesday. A grade one ligament sprain typically does not have any significant structural instability but is quite painful. While a low-grade sprain typically tends to heal well and fairly quickly, four days is not quite enough time and would put Engram at further risk of injury. Even with a limited practices, I would expect the Giants to protect one of the bright spots on the team and let’s be real here, unless Eli sprinkles some fairy dust on Danny Dimes, the Giants, with nearly all of their weapons OUT, will lose this game. Look up the spread for this game, and whatever it is, take the Patriots to cover.
Prognosis: 1-2 weeks (Out Week 6)
NFL’s Concussion Protocol – Criteria for Return-to-Play
1.) Rest and Recovery – Player is prescribed rest until his signs and symptoms return to baseline.
2.) Light Aerobic Exercise – As soon as able, players will begin LIGHT exercise, for example riding a stationary bike at a low resistance.
3.) Continued Aerobic Exercise & Introduction of Strength Training – Progress aerobic activities as tolerated, and introduce strength training.
4.) Football Specific Activities – Player continues to progress aerobic and strengthening exercises as tolerated, and introduces NON-contact football activities
5.) Full Football Activity / Clearance – Player is cleared by the team physician and examined by an independent neurological consultant (INC). If INC agrees with the team physician, the player may return to full-contact practice and games.
Brandin Cooks, WR, LAR
Brandin Cooks made one heck of a catch last Thursday night. Unfortunately, that one catch was his only catch as Cooks suffered a concussion on the same play. There has been no additional information as coaches are unable to speak on player progress through the concussion protocol, therefore we can only follow practice reports for clues on progress. Will monitor.
Wayne Gallman, RB, NYG
After getting his chance to shine, Wayne Gallman suffered a concussion very early in the Giants’ week five loss to the Vikings. Considering the Giants play on Thursday, there simply is not enough turn around time for Gallman to clear the protocol. With 10 days off after their matchup with the Patriots, the Giants have a chance to get Gallman back for week seven. All this may be irrelevant as it is also quite possible that Saquon is back for week seven. How? No idea. Demigod is my best guess.
Sterling Shepard, WR, NYG
The final player of our Giants trio is also the player who may be out the longest. Shepard suffered his second concussion in less than a month on Sunday which is never good. It is very likely Shepard’s brain was not fully recovered from the initial concussion, even though he was able to perform well enough to clear the protocol. Multiple concussions in a short period of time can result in longer-lasting and more severe symptoms. For this reason, and to ensure Shepard is fully healed, I would not expect to see Shepard for a minimum of one month, but a timetable can not accurately be set as like I’ve said many times, concussions are individual experiences and no two-act alike.
Mason Rudolph, QB, PIT
Finally, we have the scariest hit of the week as we saw Steelers’ quarterback Mason Rudolph get knocked out as I discussed in the introduction. There is an extra sense of caution regarding brain injuries whenever there is a loss of consciousness as this indicates a more severe trauma to the brain. In addition to the initial hit that knocked him out, Rudolph then free-fell to the ground and sustained another significant hit to the head. Current reports suggest Rudolph is doing well, so we will have to see how he progress through the protocol as he has yet to be ruled out for week six. Additionally, regarding some of the commotion about Rudolph not being carted off. I don’t believe it is necessary for a player to be carted off after every crushing hit. It’s a rough game, but do I believe Mason was at greater risk because he was not carted off? No. Carts are utilized for players who are unable to move extremities (ie. significant fractures or instability) or for players who should not move due to potential for a spinal cord compromise. The hit on Mason Rudolph did not compromise his spinal cord, and since he was able to get up, interact, and function without significant medical assistance, he was allowed to walk off.
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