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Why Are The First Two Weeks Of Training Camp So Perilous?

I track injuries during the preseason in three phases.

Phase 1: Entrance physicals and roster / PUP decisions.
Phase 2: Reconditioning and return to football-related activities.
Phase 3: Preseason games (a.k.a. "please don't get hurt after you're in condition to play")

Every NFL team has now reported to camp and made decisions on who arrived in condition to practice and who isn't ready yet. We're now traversing the second phase of camp. Most players have been away from the team complex training on their own since minicamps ended six weeks ago. The vast majority will pass team conditioning tests and be cleared to practice. But cardiovascular condition doesn't equal football condition in every case. As players start working through live individual and team drills, their risk of soft tissue injuries increases.

Rick Burkholder, a long time NFL athletic trainer now working with the Kansas City Chiefs, tweeted an interesting fact about returning players last week. He noted that hydration levels "dip to their lowest [on] Day 3 and it takes until Day 11 to normalize." Not surprisingly, he tweeted "we also see significant amounts of soft tissue injuries in that time period."

That's intuitive, of course, but still worth the note. It's frustrating to see so many players held out of practice with tightness or soreness or higher-grade strains this time of year. But Burkholder's tweet is a reminder that it's still a difficult ask to prevent these injuries at the highest level of athletics. Careful monitoring of hydration status by weighing players in and out and monitoring urine concentration, detailed tracking of player movement with GPS data, and judicious use of limited practice reps for some players is still not enough to keep a full 90-player roster free from soft tissue injury.

And, as you'll see in the table below, this preseason will be no exception.

Gurley and Michel Are Practicing

In most seasons, the biggest offseason story is whether an elite player will recover effectively after a major offseason surgery, e.g. Andrew Luck's shoulder, Rob Gronkowski's arm, or the running-back-of-the-moment ACL.

That's not the case this season. The most discussed offseason injury situation has been Todd Gurley's knee injury -- despite Gurley playing in the Super Bowl, not having any offseason procedures, and the Rams continually saying there was little to be concerned about.

The PUP list is a failsafe of sorts for NFL teams. While recent rules allow two players to return from the inseason injured reserve list, the PUP list gives them a buffer as preseason begins. If a team has any reason to believe a player may not be in condition to practice in camp, they'll use the PUP list until they're comfortable with that risk. Activating an injured player to the active roster doesn't mean they're entirely without risk and many active roster talents will rest for some practice reps or entire practice days. But passing a camp physical exam and earning clearance to practice tells us the medical and training staff feels a player is healthy enough to participate.

Gurley -- unlike Antonio Brown and DeAndre Hopkins and Sony Michel and Jerick McKinnon -- passed his entrance physical.

Again, that does not mean Gurley is without risk of aggravation his arthritic knee. But it's clear evidence Gurley and the Rams are comfortable testing the knee in individual drills immediately. And, for the first time this offseason, the Rams discussed their preseason plan with Gurley.

Sean McVay told reporters Gurley was on the veteran player plan, "There will be (days he doesn't practice). There will be some days that -- depending upon his workload and looking toward that (Week 1) Carolina game -- we might look at treating him like we have some of those veteran players." Expect Gurley to rest often during early camp practices. If he conditions well, he'll see more time in contact drills.

Be advised this doesn't mean Gurley's knee troubles are behind him. Inflammation and soreness could recur at any time despite the limited practice time. But it's nice to see Gurley starting camp on the active roster.

All of the above also applies to Michel, who passed a physical and has returned to practice after an offseason procedure to address ongoing soreness in his chronically troublesome knee.

If you're drafting in best-ball leagues, I think it's safe to consider Gurley and Michel a little earlier than their recent ADP. As we approach the redraft season in the coming weeks, I'll have more specific recommendations on Gurley, Michel, and every other murky injury situation in a separate feature.

InJury Rounds

A.J. Green | Ankle sprain | Late July | 6-8 Weeks | doubtful Week 1

Green's ankle injury is a reminder of everything that's frustrating about NFL injuries. Every player is at risk of a serious injury on every repetition from July to January. And that what we know about a player's injury is always an evolving situation.

Over the past 24 hours, we've seen and read reports about Green's frustrated reaction after the injury, his teammates reassuring interviews with local media, and some initial optimism for a short absence from multiple sources. Grainy video suggested a possible high ankle sprain while other sources reported a "rolled ankle" and a low ankle sprain. Finally, on Sunday, Adam Schefter tweeted Green sustained torn ligaments and would miss 6-8 weeks. Tom Pelissero later reported second opinions were likely and surgical procedures could still be under consideration.

Ugh.

While some low ankle sprains involve multiple ligaments and result in unstable joints that may benefit from surgery, the preponderance of evidence suggests Green has a high-grade high ankle sprain. Dr. David Chao believes it's a high ankle sprain based on limited video. High ankle sprains are more often addressed surgically than low ankle sprains.

Schefter's tweet included an expected rehab timetable of 6-8 weeks. That would be consistent with a higher severity mid-grade injury. It's an injury that may straddle the line of surgical interventions. Players choose to avoid surgery when necessary but high ankle sprains in this range may benefit from an earlier surgical decision that allows the joint stability for an earlier and more aggressive rehab. The rehab timetable would likely remain in the 6-8 week range.

For now, expect Green to miss a minimum of six weeks and consider him doubtful for opening week and questionable at best for the rest of September. I'll have more on Green in the coming days.

Sterling Shepard | Left thumb fracture | Early preseason | 4-6 weeks | Probable Week 1

There are many varieties of thumb fracture. Depending on the precise location of the fracture, the stability of the joint, and the type of splint necessary, a player may return sooner than later. Indications are Shepard's injury will not keep him out an extended period and he's tentatively expected to be available in Week 1.

***As noted above, the list of players already dealing with soft tissue injuries is long. The most common injury will be a hamstring strain and we're unlikely to hear much about the severity of a low or mid-grade injury. Currently missing practice are Damien Williams, Jamaal Williams, Duke Johnson Jr, Calvin Ridley, DaeSean Hamilton, Parris Campbell, and Dawson Knox. None are believed to be higher grade injuries, with Duke Johnson Jr likely the most significant of the group so far. Expect teams to rehab these players deliberately. While teams push the limits of recovery during the regular season, risking an aggravation by returning a player on the edge of readiness in early August is unusual.

***Derrick Henry left practice in a walking boot this weekend with a left foot or ankle injury. He's considered day-to-day. A.J. Brown also left with a leg injury that's isn't expected to keep him out long.

***Corey Coleman tore an ACL last week and has already been put on season-ending injured reserve.

Follow Up Appointments

***Jerick McKinnon started camp on the PUP list. Though not entirely surprising after missing OTAs, McKinnon reportedly suffered some sort of "flare-up" in the past few weeks. Kyle Shanahan implied McKinnon's flare-up was due to overly aggressive rehab in preparation for camp. McKinnon's stay on the PUP list is expected to be brief while the medical staff works with him to resolve the inflammation.

***Marquise Brown is again running sprints, with observers gushing about how he looks. Sprints are a far cry from quick change of direction movements and vertical explosiveness in small spaces. But after last week's report that Brown could be a "few weeks" from returning, it's a welcome update. Brown could be cleared for limited practice soon.

INJURED PLAYERS ON ACTIVE ROSTER