Injury Profile: Trey Sermon


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Injury Profile: Trey Sermon


  1. Trey Sermon has suffered a back fracture, two MCL sprains, a complete LCL rupture, and a posterior dislocation of the SC joint since 2015.
  2. The above injuries as standalone events are not a concern; however, collectively all of these injuries involve connective tissue which can be a problem for a RB.
  3. The positive side is that Sermon only missed a total of 5 games over his 4 years in college, which is average.
  4. RB injuries involve primarily connective tissue structures in the NFL, so Sermon will immediately get to prove whether he’s a steal at his RB60 ADP or if the connective tissue woes will continue.

The Timeline

In 2015, Sermon fractured a vertebrate bone in his lower back. This happened, presumably, on a contact play as Wes Huber points out in his breakdown here. It’s not a terribly common injury among running backs, but it isn’t unheard of. Then, Sermon was relatively healthy until April of 2018 where he injured his MCL against TCU. Later that year in October, he had a similar injury to the same ligament. Even to this point, Sermon’s back-to-back knee injuries in the same year aren’t a cause for concern. Contact injuries in awkward positions happen and he didn’t have a complete rupture which would be a red flag. Then in November of 2019, Sermon had a peculiar injury to his LCL, the MCL counterpart that prevents the knee from collapsing outward. This article specifically points out that the injury was not to the ACL despite conflicting reports. This is the most difficult situation to decipher as there’s a massive swing in implications for LCL vs. ACL. In this case, the assumption moving forward is that this was an LCL tear. Finally, in 2021, everyone witnessed the Tyreek Hill like injury to Sermon’s SC joint/collar bone. An injury that once put back in place, is not life-threatening (or recurrent). In 2019, Dalvin Cook suffered a similar injury but that was not a complete dislocation.

What it Means

As it relates to the big picture, Sermon ended up missing 1, 0, 4, and 0 games throughout his career. The cutoff, according to the literature, is 7 games. In other words, in a sample of 2,000+ NCAA football players from 2009 to 2014, the average number of missed games ranged between 3 and 7 games. Sermon is not an outlier when it comes to missed games. However, the type of injuries he’s had consistent problems with all include connective tissue - ligaments and joint capsule. For a running back who needs to take contact, that could be a problem. James Conner is the poster-child for bad luck with connective tissue.

To be clear: this is not to compare Sermon and Conner. It’s just an example of the potential that Sermon’s bad luck might be revealed as a pattern.

Starting with the low back fracture, it’s a bit concerning that this happened in the first place, as only 0.3% of low back injuries are fractures. Luckily, fractures haven’t followed him though, and because it was while he was still in high school, we’ll chalk this up to lower bone density as a teenager. Even the two MCL injuries, on video, are pretty flukey as he falls awkwardly both times. I get it--the same knee in one season can’t be all coincidence and I sort of agree. However, for an injury that is extremely common in RBs, it’s less concerning as he didn’t fall into the < 5% who require surgery group after this injury (like James Conner did). Next on the list is the LCL injury, which is extremely rare when isolated. So that’s the bad news. The good news is that compared to an ACL tear, which happens inside the knee joint, the LCL is outside of the joint. That means there’s less of a chance for long-term arthritis issues like Todd Gurley faced. Lastly, the dislocation of the clavicle was straight-up awful and weird. The prevalence of this injury is so low, there’s no research on it outside of case studies. When this injury occurs, it can be life-threatening if not treated immediately as the connective tissue/capsule holding the joint together is ruptured and leaves major blood vessels and the esophagus vulnerable to the jagged edge of the clavicle. It’s not a generally recurrent injury; however, when combined with other connective tissue injuries--the 2 MCL and LCL injuries--it begs the question: does Trey Sermon have connective tissue dysfunction? I think it’s something to keep in mind but with his current ADP as RB60, there’s virtually no risk in stashing Sermon to see if he emerges from that San Francisco backfield.


Trey Sermon has a history of injuries that, in a vacuum, aren’t a big deal. Additionally, he’s not an outlier in terms of games missed from a quantitative perspective. However, qualitatively it’s perfectly reasonable to question his body’s ability to withstand hits given his positional demands. AC joint and shoulder injuries in general as well as high ankle sprains are connective tissue in nature - will he suffer these kinds of injuries early in his career or will he buck the trend in 2021? Consider Sermon a moderate to high-risk player from a health perspective until he proves differently.

Edwin completed his Doctorate of Physical Therapy education in 2020. His expertise is in all thing’s orthopedics, injury recovery, and he has a special interest in human performance. Edwin’s vision is to push injury advice past simple video analysis and into the realm of applying data from the medical literature to help fantasy players make informed start-sit decisions.