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Injury Prone is a Lie: Part I

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Injury Prone is a Lie: Part I

Injury prone is a lie.

When I started saying this is in late 2019, it wasn’t a foreign concept to the sports medicine community. I didn’t invent the wheel. Much to my dismay, it was a new concept to many fantasy players and analysts alike. The term “injury prone” (“IP” moving forward) was and continues to be thrown around consistently in fantasy circles and is used to describe any player who misses even a quarter of game action.

Now, there are certainly instances in which much of this is mental masturbation and really isn’t actionable. For that reason, the goal of this two part series is to first give fantasy players a clear understanding of how to view injury histories from a big-picture perspective and debunk the reductionist mindset of “injury prone.” Then in part two, I’ll present a tangible method to quantify and categorize injuries with expected future impact for the most common skill player injuries will be given in a simple to understand framework. This is meant to be an evergreen article outlining the basics of injury analysis to help gain the upper hand on trade partners, snipe leaguemates on draft day, and be an objectively more accurate fantasy football prognosticator.

So, let’s differentiate between injury narrative and objective sports medicine.

As a full-time physical therapist, I’ve learned that when it comes to communication, it’s just as important to clarify what I’m not saying. In that spirit, what I’m not saying:

What I’m Not Saying

Not Saying: Exceptions Don’t Exist/Patterns Don’t Exist

In Other Words: Anatomical deficits (like limited ankle motion) are real and can help predict downstream injuries. An example of a player who might fall into this category is Jerry Jeudy, who has the nastiest knee valgus this side of the Mississippi. Many individuals with this compensation attempt to make up for lack of hip strength and ankle motion. Yet Jeudy, to this point, is healthy. Furthermore, the research on injury “prediction” and pattern recognition is far from bulletproof. and the variability between athletes makes it nearly impossible to generalize. If LeBron James scored poorly on the Functional Movement Screen, a scoring system that was initially touted to help predict injuries, would it be wise to advise him to change his workout routine or start on a specific prehab program? Probably not.

As it relates to exceptions, there are specific cases in which it’s reasonable to question whether a player is at a higher predisposition for injuries compared to counterparts based on genetic variability and/or medical history (i.e. James Conner). However, to believe that every player falls either into the immortal Frank Gore category or the less fortunate Conner category is a fallacy. Oftentimes players like Conner and Gore are used as standards when in reality, they’re the exception and not the rule. Even players like Tevin Coleman and John Brown, who have the sickle cell trait, have been reasonably healthy in their respective careers despite their theoretical predisposition to “heal slowly.”

How the hell are fantasy players supposed to know which NFL wide receivers lack 10 degrees of dorsiflexion? What if the players who possess an altered connective tissue gene is public information? Even if these genetic and anthropomorphic variations were readily available, how realistic would it be to fade Michael Thomas based on a flimsy theoretical increase in injury risk? The overarching point is this: despite the public perception that future injury is easily identifiable and predictive is flat wrong.

So then what is actionable? Fading narratives.

If anybody outside of a trained medical professional expresses concern for a player’s situation, run for the hills. That’s especially true if the person’s primary evidence echoes something along the lines of “he’s been hurt in the past” or “he’s missed [X] amount of games in [Y] years”.

The Bottom Line: Science is light years away from predicting injuries in a categorical “yes or no” manner. Each situation is unique. For fantasy players, making quick assumptions based on coincidental/unrelated injuries or worse, completely ignoring an injury history, is suboptimal.

Which leads to injury histories.

Not Saying: Injury Histories are Irrelevant

In Other Words: Usually IP pertains to a player with no injury history whatsoever or a player who has a completely random history of injuries. Carson Wentz falls into the latter category. Here’s supplemental reading that dives further into this concept with Wentz as the centerpiece. The bottom line is that when a player has a wrist fracture followed by an ACL tear then later on is concussed, there’s no statistical or scientific pattern to be drawn. That’s bad luck. That’s the game of football. The opposite is also true: a player with a clean bill of health does not make him impervious to contact injuries like ACL tears, MCL sprains, and high ankle sprains. So then when and how do injury histories matter? When viewed with the appropriate context and nuance. In fact, injury history is the best tool available to fantasy players. As it turns out, more games missed in college generally leads to more games missed in the NFL. More specifically, players who miss about three games in their college career are more likely to be drafted and are less likely to have future injuries down the road.

Unfortunately this concept of injury histories has gone the other direction and has been morphed into the wretched “compensation injury” argument. That is, when a player injures an ankle, they’re now liable for a hip injury. The idea is nice but has never been shown to be true. Clinically, after patients alter gait mechanics due to a painful ankle, clinicians do observe more “wear and tear” in other body parts. However, this is the classic “chicken-or-egg” scenario. Did the ankle pain lead to the hip pain? Or did the ankle pain accelerate a hip that was already going to be painful? Furthermore, those types of situations are not well documented and usually involve months if not years of “compensations.”

Elite athletes won’t develop these issues overnight, which lines up with the previously visited idea of anatomical deficits. There’s simply no scientific evidence that demonstrates [X] injury leads to [Y] “compensation injury”. The only pseudo “compensation” injury that actually exists has to do with the 3-6 times increase in soft tissue injury risk when players alter physical workloads in a meaningful way.

An example of a player who may have sustained a quad strain due to the up and down nature of practice-game-rehab is Christian McCaffrey, which is why I’m bullish on him staying healthy in 2021. For example, McCaffrey has been a warrior playing in almost every game in college and in the NFL. In 2020, he sustained a contact injury (high ankle sprain) that was unavoidable and common among running backs. Then he returned and suffered yet another one of those same unavoidable injuries. At that point, the stud RB had gone from an abbreviated camp, to game, to rehab, back to a game. His workloads were insanely volatile. As a response, his body (more than likely) wasn’t able to handle the unseen levels of physical volatility and he strained a muscle. This shouldn’t be an issue in 2021.

I can feel this getting too heady as I type so I’ll bring it back to the main takeaway. When a player sustains an ankle injury here’s what it tells us: that player sustained an ankle injury. If a player missed time in college due to ankle issues, the most likely reason they’ll miss time in the NFL will be because of ankle injuries. (See Leonard Fournette and Saquon Barkley for reference.) The same idea applies to a concussion history like the one Brandin Cooks has. Previous injuries automatically increase a player’s future reinjury risk for that specific issue, not some random unrelated ailment. If you couldn’t tell after this section, things get complicated and nuance very quickly. If you did pick up on the complexities, this is why the phrase injury prone should be banished.

The Bottom Line: Injury histories matter, but the trick is understanding when it matters and to what extent. Sitting at a computer chair on draft day, the best way to know when an injury history matters is to follow an injury analyst you trust. Wink.

Here are some players from whom many might shy away in 2021 whom I’m not particularly concerned of as of today:

  • Deebo Samuel

  • Evan Engram

  • Michael Thomas

  • Saquon Barkley

  • Diontae Johnson

  • Parris Campbell

Not Saying: Injuries Don’t Impact Performance

This one is much easier to comprehend and the easiest way for fantasy football managers to gain an edge on the competition. Know which injuries are the most detrimental. It’s also important to keep proper context such as draft capital, age, and severity of injury. These help predict if a player will perform to pre-injury levels on the field following an injury. Broadly speaking, players will bounce back from significant injuries if the following criteria are present:

  1. < or = 24 years old
  2. NFL draft capital in the 4th round or higher (the higher, generally the better)
  3. Studies indicating the injury is not catastrophic (tendon ruptures)

Specifically as it relates to draft capital, organizations typically have a much longer leash on players they invested so much draft capital on. Whether that’s illogical or not, it tends to be true. Furthermore, these athletes tend to have a better “athletic reserve” following injuries and their rehabs tend to go more smoothly. These underlying principles are the reason why Saquon should come back as a top 5 RB in 2021 but also are the reason why Marlon Mack might never see any fantasy-relevant playing time again the rest of his career. Here’s a list of injuries and surgeries that, in general, will negatively impact most players, especially the older ones with 4th round or later draft status. They’re ordered from most impactful to least (keep in mind part 2 will dive much deeper into these):

The Bottom Line: All injuries are not created equally and some players are more likely to bounce back better than others. Generally speaking, tendon tears and concussions will impact most players across the board equally. After that, look to take advantage of your leaguemates who fade young players with high draft capital and relatively benign injury histories.

Now that you’ve read what I’m not saying, here’s what I am saying about the phrase “Injury Prone.”

What I am Saying

Am Saying: 2.3% of Games are “Injury Free”

I cite this statistic often and it’s really quite that simple. Being injured in the NFL is the norm and health is the anomaly. To blindly assign the term IP to a player without any real investigation is statistically unlikely to be true. Furthermore, not every injury is created equally. If a player misses games because of a collarbone fracture, ACL tear, then a ruptured kidney, it’s self-sabotage to fade that player due to injury concerns. Ask Keenan Allen, who is the proud owner of that very history.

Am Saying: Style of Play and BMI are Virtually Irrelevant

The “style of play” crowd is almost as frustrating as the BMI zealots. There’s no objective definition to determine “style” in the first place. That means there’s no standard for the phrase itself. No standard means no precedent which makes it an invalid argument against players who are injured. Chris Carson who is often pegged as a “tough runner” has, despite some bumps in the road, been generally healthy. The games he has missed are primarily due to his positional demands — not a subjective definition of the way he runs the ball. Similarly, it’s fair to say George Kittle has missed more games than average due to injury. It’s not fair to say he’s missed those games due to “style of play.” As this thread points out here, his significant injuries over the last two years have come as a defenseless receiver or blocker.

Side note: there’s actually data to show that running backs (who are presumably more IP) aren’t actually injured more frequently than other skill players. Instead, they’re more likely to suffer different categories of injuries that require more healing time. However, pass catchers are actually more susceptible to concussions and ACL tears. These are the result of positional demands and something to consider.

As it relates to BMI, there’s no evidence indicating that there’s a difference in injury rates for running backs with a BMI between 29-32 kg/m^2 (5’8” to 6’1” and 207 lbs. to 243 lbs.). As long as a RB meets that threshold, there’s no reason to be concerned about injuries. The same can be said for wide receivers. If a player doesn’t meet the BMI threshold for their given position, the chances of success, not injury, should be the major concern.

The Bottom Line: There’s no real way to quantify “style of play” as it relates to injury risk. It’s purely a narrative. If a player reaches the threshold for BMI at their respective position, there’s no reason to be concerned about their health.

Am Saying: Almost Every Player Will be Injured at Some Point. Keep Proper Context.

As my buddy Jeff will tell you, every injury situation is unique and not all injuries are created equally. In the next part of this series, I’ll dive deeper into quantifying that. For now, understand that players like DJ Chark, who has a history of ankle sprains, is somebody to monitor in 2021. Similarly, Jalen Reagor and Dalvin Cook, who have each had shoulder subluxations/dislocations, don’t come without risk. Conversely, Diontae Johnson, who was beaten up for several games in 2020, should never be one to fade due to injury. Meanwhile, inbetweeners, like {{Austin Ekeler|RB|LAC}}, Calvin Ridley, and Joe Mixon, might require a bit more thought depending on the format of drafts and the context.

As a teaser, here is a list of players my pseudo-scientific “model” identified as physically volatile and therefore were in my “Red Light” Tier for 2020. This could have been for injury concerns or physical volatility. Some of these were more obvious than others but ultimately, I had very minimal personal investment in my own leagues with these players.

  • Sammy Watkins

  • A.J. Green which led to more Tyler Boyd

  • T.Y. Hilton

  • DeSean Jackson

  • Alshon Jeffery

  • Julian Edelman

  • Mark Ingram which led to more J.K. Dobbins

  • James Conner

  • Rashaad Penny (which led to acquiring him in 2020 at a discount)

  • Todd Gurley (which led to an early dismissal from fantasy benches pre-2019)

  • Kerryon Johnson which led to more D’Andre Swift

  • Evan Engram (which led to acquiring him on in 2020 at a discount)

  • Zach Ertz which led to more Dallas Goedert

  • Rob Gronkowski

Lastly, here are the guys who ended up as “chalk” a they were derailed for reasons unrelated to my underlying concerns:

  • John Brown

  • Parris Campbell

In full transparency, here are a few my “model” didn’t like, but ended up being fine.

  • Sterling Shepard

  • Brandin Cooks

  • Anthony Miller

  • Dalvin Cook (the hardest to fade and arguably didn’t work out but the process was 100% accurate)

  • Jared Cook

  • T.J. Hockenson (given the landscape, this was probably wrong process)

Summary

There’s no one right way to view player injuries but there is a wrong way. At its core, injury analysis refines the consensus’ idea on what a player’s floor/ceiling really is. The wrong way to assess these situations is to blindly label players IP. This leads to value leaks across multiple leagues and is suboptimal at best. For an edge on the competition always remember:

  1. Injury prediction is impossible and the data is not actionable. Instead, stay curious and be on the lookout to exploit leagumates who are quick to write off a player due to injury concerns.
  2. Injury history is king. Stay curious and ask yourself (or injury analysts) what a specific injury situation implicates. There’s a massive edge to be had to understand the ceiling and the floor of a player due to injury/performance. Specifically, keep in mind these general rules:

A. < or = 24 years old

B. NFL draft capital in the 4th round or higher (the higher, generally the better)

C. Studies indicating return to previous levels of play are > or = to 50% for the given injury

  • Previous injuries automatically increase a player’s future re-injury risk for that specific issue, not some random unrelated ailment.
  • Avoid narratives like “style of play” and “BMI” as they’re a more discrete version of “injury prone.”
  • Remember that staying healthy in the NFL is a mirage. It’s rare, and eventually, most players are hurt. Keep the proper context and a level head while evaluating rookies and veterans alike.

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.