In this week’s column, Greg Scholz shares a primer on hamstring injuries, discusses timelines and expectations for De’Von Achane and Justin Jefferson and speculates on Tee Higgins’ rib injury. Among other things!
Before we dive in, 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 to do with Justin Jefferson? How realistic is it that he’ll be back after 4 weeks? Can it be a good move to trade him in fantasy? – Benjamin V.
I think trading him would be an understandable move. There is a chance he returns after four weeks, but his Optimal Recovery Time is closer to five or six weeks. Additionally, there is some uncertainty at quarterback with Kirk Cousins’ name popping up in trade rumors.
This is the first hamstring injury we’ve cataloged for Jefferson, meaning a very conservative approach would be best for his long-term health. When a player suffers their first hamstring strain, there’s this sort of natural urge to get them back on the field quickly, especially when the player is young like Jefferson, but I’ll explain the other side of it and why slow and steady is the best option here.
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Earlier, I talked about scar tissue. When muscles heal from strains, this is a normal part of the process, but remember it can be problematic. Excessive scar tissue can and will limit muscle flexibility and function. Slower recovery times and more intensive rehab ensures healthier healing, meaning less scarring.
One aspect of rehab that often gets overlooked is the option for a player to get out on the other side feeling better than before. What I mean is, rehab isn’t always about healing. With a slower rehab, Jefferson can build muscle strength, flexibility, and address any potential imbalances that might’ve led to the original strain.
Additionally, slower rehab can target some of that scar tissue to break it down and improve flexibility and eliminate discomfort. This is where we think Jefferson would benefit the most. For long-term health he needs to target that scar tissue.
Q: Achane — they say “knee” — is it MCL, meniscus, broken kneecap? – James P.
MCL is the answer here, but the good news is that it is reportedly a non-surgical injury (likely meaning a Grade 2 sprain). Basically, this means that once his time on IR is up, he should be good to go. Additionally, Miami’s bye is Week 10, so he’ll get an extra week of rest.
When it comes to knee injuries, there isn’t really a “best” outcome, but in relative terms, MCL injuries are generally better than injuries to the PCL or ACL. This is because the MCL sits on the inner side of the knee rather than within the joint capsule. Sprains (what Achane is likely dealing with) tend to heal within 1-6 weeks, with the first half of that window being Grade 1 and the second half of that window being Grade 2.
We’re categorizing this as a Grade 2, which comes with a High Injury Risk that will remain in that range in the immediate week(s) after his return, and a Below Average Health Performance Factor that should get back into Above Average territory before his stint on IR is up. Our predicted Optimal Recovery Time is 38 days from injury, meaning he should reach ORT just before Miami’s Week 11 matchup against Las Vegas.
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Q: [Can we please get a] Tee Higgins injury update and ROS impact playing with a broken rib? [Thank you very much, I love your work. You are a man of the people] – Erik Z. (Note: Brackets added by the editors to make it an actual question)
Higgins was limited at practice on both Wednesday and Thursday after being forced to miss Cincinnati’s Week 5 win over Arizona. His availability this week, even though it’s limited, is a good sign for him to potentially suit up in Week 6.
There aren’t many major injuries associated with playing with a broken rib (besides not wanting to make the fracture worse, or risk additional fractures), instead, the big thing here is pain management. Anyone who’s had even a cracked rib will tell you how bad it hurts. Everything from breathing to sneezing or laughing causes sharp pain. This is because the rib cage has to expand so that the lungs can fill with air. The inverse is true when it comes to exhaling. All this movement means the fracture is aggravated, causing pain.
In the short term, Higgins will likely opt for a few pain management methods, the most notable being what’s referred to as a “rib block.” These injections target the intercostal nerves, which are located between each rib, with local anesthetic. This is the same sort of injection that Tyrod Taylor opted for a few years ago with the Chargers where he ended up with a punctured lung (that is not a common occurrence, just relevant). His metrics aren’t in a great spot, however, with a High Injury Risk (35%) and a Below Average Health Performance Factor (55%), so expect some limited usage.
For the rest of the season, Higgins should be fine so long as he doesn’t suffer any additional fractures or make the original worse.
Q: Any update on Aaron Jones? Seems like he was expected back earlier, so hoping the Packers decided to err on the side of caution in sitting him through their bye this week. – Mitchell M.
The bye is coming at the right time for him, but that doesn’t mean he should return to practice just yet. Jones has dealt with hamstring injuries since at least 2018, with flare ups coming every few years, resulting in missed time. It’s been a while since I’ve talked about hamstrings in-depth, so let’s dive into why they seem to plague players across the league.
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First off, the hamstring isn’t one singular muscle — it’s three. A professor of mine used to describe them as a sort of relay race team (so credit goes to you Ms. K!) Each muscle has their own role (leg in the race) but they all have to work together to stay in sync in order to finish said race. These three muscles (the runners in the relay) are the semitendinosus, semimembranosus, and biceps femoris. When it comes to their function in our day-to-day lives, they enable us to run, jump, and perform almost every other lower body movement that involves movement of the hip and knee.
Back to the relay race analogy. Say one of the runners is sore. In this case, the team might not be able to finish the race, or if they do, they’re unlikely to win. This sore runner can be treated, but it’s going to take time. Basically, the whole hamstring is compromised even if only one muscle is strained. The desired movement may be completed, but it’s going to be highly limited. When these strains occur, the body creates scar tissue, which is inferior to normal, healthy tissue mainly due to its reduced elasticity and poor blood supply.
If there is a significant amount of scar tissue already built up in the hamstrings as the result of multiple strains, there are going to be several implications, but the two main ones are what I already mentioned: inadequate blood supply and reduced elasticity. This is a major reason why we see these injuries have a sort of snowball effect in players.
Jones is in a spot now where his hamstrings are likely going to be a concern for the rest of his career. His Injury Risk is High (40%) and his Health Performance Factor is Below Average (45%). His Optimal Recovery Time is still 18 days away, so we expect him to be limited in practice ahead of Week 7 with the potential to return, provided he doesn’t suffer a setback while ramping up.
Q: Any update on James Conner? Hearing lots of different stuff – Aaron L.
Conner is likely dealing with a similar injury as Achane: an MCL sprain. He’s going to be out until at least Week 10, but — like Achane — we expect him to be back closer to Week 11. Conner, however, doesn’t have the benefit of the Week 10 bye.
Without repeating myself too much, this is somewhat of a best case scenario (again “best” being relative). The MCL heals well with conservative treatment and generally only requires surgery when there is a rupture present.
Conner’s metrics don’t look as good as Achane’s, though, and a lot of that has to do with his age and history of knee injuries. We have cataloged over 10 lower body injuries and setbacks for Conner since 2019, which always elevates things like Injury Risk.
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Q: Anthony Richardson 😭The floor is yours, Greg…. – Kyle A.
Every injury sucks, but they always seem to hit a little harder when it’s a promising rookie. The good news is that most quarterbacks make a full recovery from AC sprains.
Short for acromioclavicular joint, the AC joint is where the highest point of the shoulder blade (acromion) meets the collarbone (clavicle). A sprain here means the ligaments connecting the aforementioned bones are overstretched or torn. This means that any sort of throwing motion — provided the sprain is in the throwing shoulder, like Richadson’s — is going to hurt, or at least be limited.
Richardson is reportedly dealing with a Grade 3 sprain, meaning there is tearing present in the ligaments surrounding the AC joint. With injuries of this severity, we also look for damage to the ligaments that connect another portion of the scapula, the coracoid process, to the clavicle. If all of these ligaments are torn, Richardson will likely undergo surgery.
As of now, surgery is reportedly still being discussed, with nothing being confirmed yet. The earliest he could return would be Week 10, though it’s more likely that the Colts hold him through their Week 11 bye if he’s ready to go by then.
Our data suggests an Optimal Recovery Time close to seven weeks, so we don’t think his season is over. In the meantime, it’s going to be a slow recovery. They’ll want to target maintaining both strength and flexibility in the shoulder, but under no circ*mstances should he be pushed to return ahead of schedule.
(Photo: Sam Navarro-USA TODAY Sports)
