Front office personnel, coaches, and players do not have to disclose injuries or provide detailed updates in the offseason. What is reported is often vague or incomplete. Sometimes, it's altogether misleading.
That's why the start of training camp is such an important benchmark for injury analysis.
Players are assessed by the team's medical staff when they report and go through a conditioning test. If they're not ready for football activity, they're stashed on the physically unable to perform (PUP) list. It's a valuable roster tool for teams and our first indication of whether a player recovering from surgery or an undisclosed offseason injury is progressing as planned.
Even if a player is healthy enough to practice, how a team manages their early camp workload -- and how long that management continues -- also provides valuable information on how successful and productive they may be in the early weeks of the regular season.
More on these benchmarks in the discussions on Saquon Barkley, Amari Cooper, and Michael Thomas.
Unfortunately, two critical offensive players have suffered injuries affecting their 2021 outlooks.
What You Need to Know
- Carson Wentz is having surgery to remove a bone fragment from the outside of his foot. Early return estimates are vague, with a best-case scenario of 5-6 weeks.
- Saquon Barkley is progressing well but still needs time to recover from his complicated injury. The Giants plan to limit his touches until he's ready.
- Cam Akers tore his Achilles tendon just before camp began. His 2021 season is over and the long term track record of running backs with Achilles injuries isn't reassuring.
- Michael Thomas didn't have surgery to address a chronically unstable ankle until June. He'll start the season on the PUP list and may not be ready until November.
- Amari Cooper started on the PUP list after experiencing irritation in his ankle after a January surgery. The Cowboys expect him to be ready for Week 1.
Injury Rounds
Cam Akers | Achilles tendon tear | July 2021 | Active-PUP | 2022 return
Akers tore his Achilles tendon while training away from the team. The short-term implications are clear: Akers will have season-ending surgery and require 8-9+ months of rehab.
The long-term prognosis is more worrisome. The NFL has never seen a running back regain his pre-injury form after Achilles’ repair. The list includes young and talented players (MiKel Leshoure and Cadillac Williams) and established veterans (Arian Foster and Isaiah Crowell) and at least a dozen others over the past 15 years.
Surgical techniques and rehab protocols continue to improve. Many edge rushers and wide receivers – who also rely on vertical explosion and lower leg mobility – have recovered successfully over the same time period. And Akers may be the best mix of talent and youth at running back yet.
Until someone – hopefully, Akers himself in 2022 – proves otherwise, the odds are clearly against a running back returning to a consistently productive 12-15+ touch workload.
Carson Wentz | Left metatarsal avulsion fracture | July 29 | 5-12 Weeks | Doubtful Week 1
Wentz felt a pop in his foot during practice last week. Initial reports are vague, but the consensus is Wentz is dealing with an injury that involves both bone and ligament. A consult with Dr. Robert Anderson, sports medicine’s pre-eminent foot surgeon, is planned. Surgery is a possibility.
Wentz’s specific injury has yet to be reported. Early speculation suggested Wentz could have a Lisfranc injury or a Jones fracture in the foot. Neither is likely. Surgery would be indicated for both – either to fixate the broken bone in the Jones fracture or to address an unstable Lisfranc joint (implied by bone and ligament injury).
It’s more likely Wentz is dealing with an injury around the base of his big toe. These turf toe-like injuries often involve bones on the underside of the foot. The most recent comparison is Jordan Reed, who fought through a chronic fracture in a sesamoid bone with orthotics and PRP injections in 2017 before finally choosing surgery after the season to have the bone removed.
Still, that remains speculation.
The most recent reporting has Wentz choosing to rehab rather than have surgery. A brief period of rest to allow pain and inflammation to calm down before reassessing his progress is reasonable. Taking 7-10 days to re-evaluate won't significantly change his return timetable if he chooses surgery soon.
If Wentz doesn't choose surgery within two weeks, his chances of playing in Week 1 greatly increase. But it's rare to have an in-person second opinion with Dr. Anderson without a discussion of the benefits of surgery. And -- if Wentz's injury does involve the sesamoid bone and surrounding ligaments -- it's notable that Dr. Anderson's published preference is to treat surgically.
In any scenario, expect Wentz’s mobility and his rushing upside to be limited. That's a significant part of his appeal to NFL offenses and fantasy rosters.
Should Wentz choose surgery, he's optimistically looking at a 10-12 week recovery.
Aug 2 Update: Not surprisingly, Wentz chose to have surgery on Monday after further consideration. Adam Schefter further clarified the injury as a bone fragment from an old fracture on the outside of Wentz's foot. That's a completely different area of the foot and less likely to require a more extensive surgery to address ligament or tendon damage.
Early reports of a 5-12 week recovery still reflect some uncertainty about what surgeons may find while treating the injury. If the procedure only involves removing the bone fragment and the initial healing process is smooth, Wentz could begin rehabbing within two weeks with the intent to return within 4-6 weeks. The Colts expect to know more after 10-14 days.
Dak Prescott | Right latissimus muscle strain | July 28 | Day-to-Day | Probable Week 1
Prescott’s recovery from last season’s ankle dislocation and fracture was complicated by additional surgery to further stabilize the ligaments around the ankle. Rehab was smooth and successful and Prescott passed his pre-camp physical.
He's fully recovered and there should be no issue with Prescott’s mobility and rushing upside.
Unfortunately, Prescott suffered a right latissimus muscle strain last week. Originally described as shoulder soreness, this muscle wraps around the back and under the shoulder. While not a long-term concern, the Cowboys will limit Prescott’s throwing until he fully heals to prevent an aggravation that could threaten his availability for Week 1.
For now, the team is saying Prescott could begin throwing again in “a couple of days” but it's possible Dallas will be more cautious than that. Even if Prescott's absence stretches into the second week of August, expect him to be fully healthy for Week 1.
Follow Up Appointments
Michael Thomas | Syndesmosis and deltoid ligament repair | June 2021 | 3-4+ months | Active-PUP | Out Week 1
Thomas struggled to recover from a high ankle sprain in 2020. In mid-January, Adam Schefter reported Thomas was “likely to have surgeries on the torn deltoid and other injured ligaments in his ankle.”
That surgery – repairing the ligament between the two lower leg bone and tightening and re-anchoring the large group of ligaments on the inside of the ankle – is extensive and generally requires at least 4-6 months of rehab. So, it was surprising to see Thomas on the field for OTAs.
Now we know why. Thomas chose to continue to rehab rather than surgery. The approach was not successful and Thomas had surgery after June minicamp.
Although players often return to football-related activity within four months, recovery from ankle surgery is difficult. It usually takes players six or more months to return to their pre-injury form.
Thomas will start the regular season on the PUP list and be eligible to return in Week 7. But it could be November before we see him return to practice. Unfortunately, it’s also possible he’ll not return to his usual form until much later in the season.
Saquon Barkley | Right ACL reconstruction and meniscus repair | Active-PUP | Week-to-Week | Probable Week 1
Not all ACL injuries are alike.
When forecasting rehab and recovery timetables after ACL reconstruction, it’s critical to know whether a player suffered additional injuries to other ligaments, meniscus, or cartilage in the joint.
Barkley’s knee injury was complicated. In addition to the ACL injury, he suffered a torn MCL and meniscus. Surgery was delayed for six weeks and included a meniscus repair in addition to the ACL reconstruction.
Repairing the meniscus damage is clearly better for the long-term health of Barkley’s knee. But it limits the early rehab of the ACL, risking scar tissue and delaying recovery of the stabilizing quad muscles around the knee.
Videos of Barkley running on the beach are impressive. They tell us Barkley has been cleared for athletic activities. But they tell us nothing about his range of motion, quad strength, or comfort level with his knee responding to live stress and contact.
The Giants have consistently said they plan to limit Barkley’s early-season workload. They placed him on the PUP list to start camp. That’s not a sign Barkley’s rehab is progressing poorly. It’s a realistic assessment and expectation for Barkley 9-10 months after surgery.
It’s too soon to know whether a limited workload means a rotational 10-12 touch role, a high-leverage passing down and goal-line role, or more. Though unlikely, it’s still possible Barkley will be ready for a full workload in early September.
I’ll continue to update Barkley’s in-season expectation with more specific recommendations on how to handle his current ADP as the preseason progresses.
Amari Cooper | Arthroscopic right ankle procedure | January 2021 | Active-PUP | Week-to-Week | Probable Week 1
Recovery from ankle surgery isn’t always a smooth process. Every year, we hear about players struggling to recover from what’s described as a minor procedure. They’re frustrated at the slow return of strength and range of motion of the joint and sometimes take longer than expected to return to form.
Video of Cooper’s Week 17 injury was consistent with a high ankle sprain and he’s had foot and ankle difficulties frequently in recent seasons. It’s likely he had multiple issues in his ankle addressed.
Five months into his rehab, Cooper felt irritation during offseason activities and the team shut him down for the rest of the offseason. He starts training camp on the PUP list.
Cooper is currently expected to begin participating soon and is likely to see a full Week 1 workload. But watch his first 1-2 weeks back closely. Any setbacks during his re-conditioning phase would be a major flag for his early-season productivity.
Fast Track News and Notes
Joe Burrow (November 2020 ACL reconstruction) – Lobbied successfully to participate in early offseason activities and fully participating in training camp.
A.J. Brown (January 2021 arthroscopic knee surgeries) – Procedure to address ailments in both knees went well. Fully participating in camp after Titans rested him through OTAs.
Calvin Ridley (June 2021 foot surgery) – Postseason foot surgery described as minor, cleared for full participation in camp.
Antonio Gibson (2020 toe sprain) – Worried observers in May after suggesting his late 2020 toe injury was still an issue. Fully participated in minicamp and looks healthy in camp thus far.
Odell Beckham (November 2020 ACL reconstruction) – Earning praise as a “freak of nature” for the speed and success of his recovery from ACL reconstruction.
Courtland Sutton (September 2020 ACL reconstruction) – Cleared for camp participation but still working through the last stages of rehab. Not currently in playing form but expected to be ready to start Week 1.
DeVonta Smith (Aug 2021 MCL sprain) -- Injured during an early camp practice, Smith's Week 1 availability will depend on the severity of the strain and whether he can avoid any reconditioning injuries later in camp.
Antonio Brown (May 2021 arthroscopic knee surgery) – Cleared to return after May scope to address irritation in his knee.
Marlon Mack (September 2020 Achilles tendon repair) – Colts are not limiting his camp participation. Early reviews are positive, says he’s growing more comfortable with each practice.
Will Fuller (undisclosed) -- Reportedly day-to-day with an undisclosed injury during July 29 practice.
DeVante Parker (undisclosed) -- On PUP list with an undisclosed injury.
Curtis Samuel (groin strain) -- Limited early in camp with a groin injury. Expected to be day-to-day.
Parris Campbell (September 2020 PCL repair) -- Described as "big, strong, and healthy" during early camp practices.
Jeff Wilson (May 2021 meniscus repair) -- Likely to start season on PUP list after surgery and 4-6 month rehab.
Fully Participating after Injuries / Surgeries
Quarterback: Patrick Mahomes II (plantar plate repair), Tom Brady (knee arthroscopy), Matthew Stafford (thumb ligament repair), Trevor Lawrence (left shoulder labrum repair)
Running Back: Joe Mixon (midfoot sprain), Zack Moss (syndesmosis repair), James Conner (plantar plate repair), Rashaad Penny (ACL, knee arthroscopy), Rex Burkhead (ACL reconstruction)
Wide Receiver: Cooper Kupp (complicated bursitis), Julio Jones (aggravated hamstring strains), Kenny Golladay (hip flexor strain), Tyrell Williams (shoulder labrum repair)
Tight End: O.J. Howard (Achilles tendon repair), C.J. Ozumah (Achilles tendon repair)
Injured Players on Active Roster
Quarterbacks Injured | On the Active Roster
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Player
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Team
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Injury
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Date
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Player/Team Says
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Training Camp Usage
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FBG Week 1 Expectation
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Carson Wentz | Phi | Left metatarsal avulsion fracture | July 29 | 5-12 Weeks | Not practicing | Doubtful |
Dak Prescott | Dal | Right latissimus muscle strain | July 28 | Day-to-Day | Limited participation | Full workload |
Running Backs Injured | On the Active Roster
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Player
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Team
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Injury
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Date
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Player/Team Says
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Training Camp Usage
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FBG Week 1 Expectation
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Saquon Barkley | NYG | Right ACL reconstruction / meniscus repair | Oct-2020 | Active - PUP | Active - PUP | Probable |
Cam Akers | LAR | Achilles repair | Jul-2021 | Active - PUP | Active - PUP | 2022 return |
Tarik Cohen | Chi | Right ACL reconstruction | Sep-2020 | Active - PUP | Active - PUP | Questionable |
Jeff Wilson | SF | Meniscus repair | May-2021 | Active - PUP | Active - PUP | PUP |
Wide Receivers Injured | On the Active Roster
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Player
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Team
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Injury
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Date
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Player/Team Says
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Training Camp Usage
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FBG Week 1 Expectation
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Michael Thomas | NO | Syndesmosis / deltoid repair | Jun-2021 | Active - PUP | Active - PUP | PUP |
Amari Cooper | Dal | Right ankle arthroscopy | Jan-2021 | Active - PUP | Active - PUP | Probable |
Will Fuller | Mia | Undisclosed | July 29 | Day-to-Day | Not Practicing | Probable |
DeVante Parker | Mia | Undisclosed | Active - PUP | Active - PUP | Probable | |
Preston Williams | Mia | Right foot surgery | Nov-2020 | Active - PUP | Active - PUP | Questionable |
Curtis Samuel | Was | Groin strain | Day-to-Day | Not Practicing | Probable | |
DeVonta Smith | Phi | MCL sprain | Aug 1 | Week-to-Week | Not Practicing | Questionable |
DWayne Eskridge | Sea | Toe injury | Active - PUP | Active - PUP | Probable | |
Tight Ends Injured | On the Active Roster
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Player
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Team
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Injury
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Date
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Player/Team Says
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Training Camp Usage
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FBG Week 1 Expectation
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Blake Jarwin | Dal | Right ACL reconstruction | Sep-2020 | Limited Participation | Probable | |
O.J. Howard | TB | Right Achilles repair | Oct-2020 | Limited Participation | Probable | |
Cameron Brate | TB | Undisclosed | Active - PUP | Active - PUP | Probable | |
Albert Okwuegbunam | Den | Right ACL reconstruction | Nov-2020 | Limited Participation | Probable | |
Kyle Rudolph | NYG | Foot surgery | Mar-2021 | Active - PUP | Active - PUP | Questionable |
Injured Players Not on Active Roster
Notable Quarterbacks on PUP or NFI or IR
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FBG Expects
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Notable Running Backs on PUP or NFI or IR
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FBG Expects
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Notable Wide Receivers on PUP or NFI or IR
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FBG Expects
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Notable Tight Ends on PUP or NFI or IR
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FBG Expects
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DECIPHERING THE ALPHABET SOUP OF INJURY LISTS
Players not ready for camp practices are placed on one of two lists – Physically Unable to Perform (PUP) or Non-Football Injury/Illness (NFI).
Physically Unable to Perform (PUP)
Active/PUP – Preseason only list. Once a player participates in any part of a scheduled training camp practice, they are ineligible for this list. Players can be activated from this list at any time. This list is commonly used for veterans still recovering from injury and those who fail conditioning tests before camp begins.
Reserve/PUP – Regular season only list. Players still on Active/PUP at the end of camp are eligible to move to Reserve/PUP. Players cannot practice with the team until after Week 6. Teams then have six weeks to evaluate the player before moving to the active roster or to season-ending injured reserve.
Non-Football Injury / Illness (NFI)
Active/NFI – Preseason only list. Once a player participates in any part of a scheduled training camp practice, they are ineligible for this list. Players can be activated from this list at any time. Only veterans with a non-football related injury or rookies injured before the NFL draft are eligible for this list.
Reserve/NFI – Regular season only list. Players converted from the Active/NFI list to the Reserve/NFI list are out for the entire season.
Injured Reserve – Return Designation
Each NFL team can return two players to the active roster from injured reserve. Teams are not forced to designate this player at the time of the move to injured reserve. Players designated to return can begin practicing six weeks after being placed on injured reserve and are eligible to return to the active roster eight games after being placed on injured reserve. This rule allows a team to continually evaluate the rehab and recovery of their injured players and provides roster flexibility should teams have multiple key injuries early in the season.
Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the off-season.