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Offseason Injury Rounds

I'll be updating this feature most Mondays until training camp begins, when I'll return to the usual weekly writing schedule. I'll have blurbs on major injury developments and will keep the table of injuries and expectations updated. The date of the article will update with the article but the link won't change as the offseason progresses.

COVID-19 and the 2020 NFL offseason

The coronavirus pandemic has touched each of us in some way, stressing our medical, behavioral, financial, and economic health. My very best to your families. Stay well. When and where you can, look out for those you know -- and those you don't.

As the country begins to lift restrictions, it grows more and more likely the NFL will work to start the regular season on time. But the offseason timeline has been significantly disrupted and it's still not known how the NFL will approach the remainder of the offseason and training camps.

Two weeks ago, the league asked each team to submit plans for the reopening of team facilities and mandated that all offseason activities remain virtual only through June 1. Although the league delayed the end of summer activities until June 26, it has yet to decide whether teams will return to facilities for on-field workouts but has said no teams will return unless all teams can return.

With the NFL spread across 23 states and the District of Columbia -- and each under varying stages of lockdown -- an on-field June minicamp is still questionable. The NFL's chief medical officer, Dr. Allen Sills, told reporters the league was still evaluating how to approach testing and how to handle exposures and would not commit to a date until the league and players' association were both comfortable with a plan.

The necessary adjustments to the NFL offseason have and will continue to affect how the league handles and shares information about injuries.

***Follow up medical exams after the combine, in-person interviews, and college pro days were all canceled.

***Rookie camps and entrance examinations were all canceled.

***May offseason training activities and access to team medical and training staff and facilities could not occur.

Teams often provide updates on injured players during interviews around draft weekend. Player participation -- or lack of participation -- is frequently noted during May offseason activity. These updates were limited this year.

The long period of time away from team facilities means players and their personal support staff are primarily in charge of conditioning and rehabilitation until much later in the offseason than usual. It's limited the ability of players to meet with team medical staff and the surgeons who performed procedures.

When players do return, these limitations could put added stress on recoveries and reconditioning. If the league does not clear players to return until shortly before training camp in July, it won't be surprising to see a much higher number of players start camp on the PUP list while teams reassess fitness and recovery. There may also be many more reconditioning injuries -- muscle strains in particular -- as players return to football-specific activities.

Expect a flurry of activity and updates when the NFL returns to on-field and in-person work.

Quarterbacks

Cam Newton | Left Lisfranc fixation | Mid-December 2019

May 26: Despite continued attempts to rehab a Lisfranc injury suffered during the 2019 preseason, Newton was finally forced to accept a surgical option last December.

Most athletes are now cleared to run 12 weeks after surgery and Newton reportedly passed a physical arranged by the Panthers and his agent in late March. Prospective trade partners prefer to examine athletes in person, however, and Carolina released Newton soon after the physical.

Though cleared to run, Newton must continue rehab to regain strength and range of motion. It's likely he'll clear those hurdles and be ready for offseason workouts in advance of the regular season. However, when circumstances allow Newton to travel for an examination, he remains in a tough bind. With no obvious starting jobs available, teams may remain leery of bringing in a high-profile, once-elite quarterback and risk controversy.

Ben Roethlisberger | Right forearm extensor tendon release | Late September 2019

May 26: Roethlisberger had surgery to remove scar tissue and reattach multiple tendons on the top of his forearm last September.

Rehab has reportedly progressed as planned and Roethlisberger told reporters he was "throwing without pain" in late March and was on target for a full recovery before training camp. When asked about Roethlisberger, head coach Mike Tomlin told reporters he was "fully confident" Roethlisberger would be ready for Week 1.

There is a risk Roethlisberger could lose some velocity after the tendon procedure. However, he was likely dealing with chronic inflammation limiting his arm strength long before the event that prompted surgery. Barring an unexpected complication, expect Roethlisberger to be able to throw without difficulty in training camp.

Tua Tagovailoa | Right hip dislocation / acetabular fracture / labrum tear | Mid-November 2019

May 26: Tagovailoa dislocated his right hip last November, forcing his thigh bone into and fracturing his hip socket. These fractures involve cartilage in an area of the joint where a relatively poor blood supply can keep the injury from healing well. Poor healing heightens the risk of arthritis and the likelihood of a shortened career.

Thankfully, all indications are Tagovailoa isn't at high risk of arthritic complications. Alabama's medical and training staff quickly reduced his dislocation and his surgeons are adamant that Tagovailoa's successful fracture repair leaves him at little risk. Follow up imaging studies reportedly show no evidence of a poorly healing bone or joint surface and Tagovailoa says he's been cleared for a normal offseason training program.

Restrictions on offseason activities have kept Tagovailoa from team facilities and any visual confirmation he's been cleared for limited work in OTAs. The lack of offseason training may slow Tagovailoa's early progress but his 2020 prognosis looks very promising. If his surgeons are correct, his long-term prognosis and chances of avoiding a limiting arthritic condition are also favorable.

Follow Up Notes From Late 2019

May 26: Patrick Mahomes II (dislocated patella) did not require offseason surgery. Kyler Murray (hamstring strain), Dwayne Haskins (high ankle sprain), and Dak Prescott (right shoulder sprain) are expected to make full offseason recoveries.

Running Backs

Chris Carson | Right hip acetabular fracture | Late December 2019
Rashaad Penny | Left ACL reconstruction and associated injuries | Late December 2019

May 26: Pete Carroll and John Schneider told reporters Carson should be ready to play in Week 1. Although Carson was not cleared to bear weight on his right leg for over two months, he did not require surgery to fix a hip fracture he suffered at the end of last season. Seattle's optimism is notable, as hip joint injuries may not heal well and lead to short and long-term pain and stiffness.

Unlike Carson's relatively straightforward hip injury, Penny had more than an isolated ACL injury. While we don't know the extent of the associated injuries -- other ligaments and meniscus are the most likely issues -- more complicated knee injuries lengthen ACL rehab. Not surprisingly, the Seahawks expect Penny to start the regular season on the PUP list.

Follow Up Notes From Late 2019

May 26: Josh Jacobs (scapula fracture), Mark Ingram (calf strain), Dalvin Cook (sternoclavicular sprain), James Conner (quadriceps strain), and Leonard Fournette (neck strain) are expected to make full offseason recoveries.

Wide Receivers

Jarvis Landry | Hip labrum repair | Early February 2020

May 26: Landry had surgery to repair the labrum in his hip in February. Details on the procedure suggest Landry also had some impingement issues addressed, including shaving down cartilage and removing bone fragments from the labrum. Players usually need a minimum of four months to recover from these procedures. Often, it's closer to six months. Landry told reporters he anticipates returning in August, putting him at risk of starting training camp on the PUP list even if his rehab progresses smoothly.

Julian Edelman | Left shoulder surgery / Left knee arthroscopy | January 2020

May 26: Neither of Edelman's offseason surgeries was expected to require a lengthy rehab. The shoulder procedure addressed ongoing instability in an AC joint he injured early in 2019. The arthroscopic knee surgery reportedly was to remove a loose body in the joint. The wear-and-tear is notable, however, particularly for a 34-year-old wideout now playing for an offense with many significant unknowns.

Marvin Jones | Left ankle injury | Mid-December 2019
A.J. Green | Left ankle surgery | July 2019
Calvin Ridley | Lower abdominal injury | Mid-December 2019

May 26: Whether their respective teams would have updated their injury status had the coronavirus pandemic not occurred will never be known. There has been no discussion of Jones' ankle injury since December. Hopefully, that means Jones did not require surgery or a prolonged rehab period. We're still in the dark on the details of Green's surgery but all involved are adamant Green is now fully healthy. There were no reports of core abdominal surgery for Ridley and he told a radio host in April the injury was well behind him.

Marquise Brown | Screw removal after Lisfranc fixation | February 2020

May 26: Hardware removal in the offseason happens more frequently than reported. In Brown's case, screw removal is a positive development. The location of the screw was likely causing pain and limiting Brown's movement. He will be fully recovered from the procedure by training camp and has already posted videos of himself running routes.

Follow Up Notes From Late 2019

May 18: Mike Evans (hamstring strain), Chris Godwin (hamstring strain), T.Y. Hilton (calf strain), D.J. Moore (concussion), Terry McLaurin (concussion), Tyrell Williams (plantar fasciitis), and Auden Tate (MCL sprain) are expected to make full offseason recoveries.

Tight Ends

Evan Engram | Left Lisfranc fixation | Late December 2019

May 26: Engram did not suffer a fracture/dislocation, the most severe form of Lisfranc injury. However, given the risk of long-term instability in the joint and possible progression to arthritis, he chose surgery to stabilize the joint. As expected, Engram remained in a walking boot 2-3 months after surgery but should be cleared to run and participate in advance of training camp.

Follow Up Notes From Late 2019

May 26: Mark Andrews (ankle sprain), T.J. Hockenson (high ankle sprain), Zach Ertz (rib fracture, kidney laceration), Chris Herndon (rib fractures), and Ryan Griffin (high ankle sprain) are expected to make full offseason recoveries.

Check back for more injury analysis throughout training camp and follow on Twitter @JeneBramel for breaking injury news, commentary, and analysis of injury news around the NFL