Injury Rounds: PUPdates | July 25 - Footballguys

Photo: Brian Spurlock, USA Today Sports

Rookies and veterans report this week for camp. Thirty of the league's 32 teams -- Baltimore and Chicago have been practicing for over a week as they prepare for the Hall of Fame game -- report to camp between Wednesday and Friday. Many of these teams have already put players through entrance physicals and conditioning tests and made decisions on whether to clear players to the active roster and practice or place them to the Physically Unable to Perform (PUP) or Non-Football Injury (NFI) list.

Don’t overreact to these designations.

WHY TEAMS USE THE PUP LIST

Every team uses their PUP list differently. Years ago, players put on the PUP list were those unlikely to be cleared for practice. Most would transition to the regular season PUP list or injured reserve. Now, nearly every team uses the PUP list as medical triage. Players who report out of shape are put on the PUP list until they pass conditioning tests. Players recovering from offseason surgery or an injury during mini-camp are also stashed on the PUP list for a few days to allow medical staff personnel to be certain they are in condition to begin taking contact.

It's usually positive when a recovering veteran starts camp on the active roster, but it’s possible that player’s reps may still be severely limited in the early weeks of camp. And while your spidey senses should be tingling with any player who is a surprise addition to the PUP list or stays on longer than expected, remember that teams will want to keep their PUP and IR-Return options open as long as possible.

Once a player takes part in a practice, those options are limited. If a player participates in a single practice rep, he's ineligible for the regular season PUP or NFI list. A setback would mean the team has only the injured reserve list to stash a player with a multi-week injury. Teams now have the added flexibility to return two players from the injured reserve list during the season, but teams won't close any doors for themselves sooner than absolutely necessary.

Scroll to the bottom of this article to see exactly how the PUP and NFI lists are defined.

ANDREW LUCK | RIGHT SHOULDER LABRUM REPAIR | MID-JANUARY 2017 | active roster | limited EArly in camp

Last summer, every successive update on Luck's surgically-repaired shoulder grew more concerning. Luck started camp on the active roster, but it was clear he was unable to throw a football without pain. This summer, Luck has progressed through his deliberate and careful throwing program without difficulty. He's been optimistic in every interview and will again start camp on the active roster. This time, he's expected to practice immediately.

General manager Chris Ballard told reporters Luck was "good to go" and ready for practice. That's great news. It means Luck has had no setbacks since his limited but positive mini-camp experience. But the Colts will continue to be cautious with Luck. He will not throw on consecutive days early in camp. Though Frank Reich told reporters Luck could play in the team's first preseason game, it's unlikely we'll see him exposed to contact soon.

The goal now is the same as last season: Get Luck to a point where he can consistently throw with velocity and accuracy and without pain. Luck is a much better bet to reach those goals than last year but it remains the biggest injury storyline to follow in camp. For now, it's reasonable to be cautiously optimistic for a successful return in Week 1.

***Update: The first returns on Luck are promising.

Ian Rapoport tweeted the following from his sources on Wednesday: "Sounds like he’s really amped up the throwing, firing several balls in practice. While media has only seen him throw lightly, he has let loose. And, as far as arm strength, he’s close to where he was pre-injury."

That's a great start. Again, temper expectations until we see Luck do this consistently and in contact situations. But Reich may have been aware of Luck's progress when he told reporters his quarterback could see action early in the preseason.

CARSON WENTZ | LEFT ACL RECONSTRUCTION / LCL REPAIR | MID-DECEMBER 2017 | PUP decision pending | limited Early in camp

Doug Pederson wouldn't commit to Wentz's Week 1 availability earlier this month. Pederson told reporters players currently in rehab would not be rushed back "until they are 100%." If that's the bar for Wentz to play Week 1, it's nearly impossible to meet. Wentz may be able to play effectively from the pocket in Week 1. But there's little chance he'll be capable of running and scrambling as he did before the knee injury.

Here's what I wrote about Wentz in June:

In April, Wentz was not expected to participate in off-season training activities (OTAs). I presumed the Eagles' caution would extend through their June mini-camp. But Wentz participated in Philadelphia's June workouts, gradually progressing to more strenuous individual drills before earning clearance for 7-on-7 work at the end of the three-day camp.

Wentz's appearances were extensively documented on videos posted to Twitter. At times, Wentz looked game-ready, moving quickly in multiple directions and releasing the ball without difficulty. Other videos showed Wentz struggling to climb the pocket or move backward toward his blind side without stunted movements. Eagles' receivers were unanimous in their praise for Wentz, noting his velocity and accuracy were not limited.

While those notes may read as contradictions, they are not. Wentz had a complicated multiple-ligament injury. His rehab was complicated by a period of immobilization to protect his lateral cruciate ligament (LCL) repair. His limited mobility during those weeks led to stiffness and a delay in the start of his ACL rehab. Wentz's rehab is likely ahead of schedule. But he should not be expected to be fully comfortable and mobile yet.

And that remains the primary issue facing Wentz in the coming months. Wentz's surgery was performed in mid-December. He's unlikely to be fully recovered for 9-12 months. The individual work he was able to do in June is promising. But it does not guarantee Wentz will be ready to move fluidly in the pocket or return to his pre-injury scrambling ability in September.

Having Super Bowl Most Valuable Player Nick Foles in the huddle should ensure the Eagles won't feel pressure to start Wentz before he can fully protect himself in the pocket. However, while starting training camp on the PUP list seemed a strong possibility in March and April, Wentz now looks likely to continue his individual work early in camp. The Eagles will continue to evaluate in July.

On Wednesday, Ian Rapoport tweeted the Eagles may intend to continue rehabbing Wentz rather than activating him immediately. Though no decision has been made, Rapoport reports, "The most likely, cautious scenario is that Wentz lands on the PUP list."

Kareem Hunt | Hamstring Strain | May 2018 | Full participation in training camp

From my June update:

Hunt missed reps in OTAs and didn't participate in Kansas City's mini-camp. Andy Reid was reassuring in post-practice press conferences, telling reporters Hunt would be "fine for training camp." The Chiefs rarely provide details but are generally straightforward with injury information. And they have every reason to be cautious with Hunt while they wait to see if Spencer Ware or any of their off-season additions can provide more than what last season's backup corps did. If Hunt starts camp on the physically unable to perform (PUP) list or has an early camp setback, it's time for concern.

D'Onta Foreman | Left Achilles repair | Late November 2017 | Likely Start Camp on PUP

Foreman, unsurprisingly, will start training camp on the PUP list. After Luck and Wentz, Foreman has generated the most questions to my inbox this offseason.

I remain hopeful, but skeptical, on Foreman.

From my June update:

An Achilles tear should not be considered a career-ending injury. Many players, including those at positions requiring explosion from a standing position and quick lateral change of direction, have returned to full form. Multiple edge rushers have recovered to produce double-digit sack seasons. Numerous wide receivers have returned to former ability levels. Interior linebackers and safeties have also found success.

But the list of reassuring comps at running back is exceedingly small. Arian Foster did well -- briefly -- before another soft tissue injury finally ended his frustrating final years. The sample size of running backs who suffered an Achilles tear is very small. It predominantly includes players who were not elite talents or at the top of the depth chart when injured. However, until we see a change in trend, it's correct to be skeptical about running back recoveries from Achilles' injuries.

Foreman will be an important case study.

Recovery from an Achilles injury often requires 9-12 months of rehab. Foreman has yet to be cleared for any football-related activity and did not participate in Houston's most recent workouts in early June. While all reports suggest Foreman's rehab is progressing without any setbacks, there remains concern about whether Foreman will be ready for Week 1.

In order to be ready for Week 1, Foreman will need to be cleared to practice by mid-August. That would give him enough time to complete the re-conditioning process and prepare for game action. Starting camp on PUP doesn't mean Foreman won't meet those goals. But it's going to be tough.

There were no concerning developments at wide receiver since the end of mini-camp.

Odell Beckham will report on time and start camp on the active roster. Allen Robinson has been practicing throughout camp in Chicago. Randall Cobb has been seen in Green Bay without the walking boot that raised concern in early July. Demaryius Thomas and JuJu Smith-Schuster are expected to be ready for camp.

Like Carson Wentz, I'm waiting for a formal announcement on the status of Alshon Jeffery. There's a good chance Jeffery starts on the PUP list but he's still tentatively expected to be ready by Week 1.

TYLER EIFERT | MICRODISCECTOMY | LATE OCTOBER 2017 | Likely start camp on PUP

From my June update:

Already arguably late in his recovery process, Eifert's condition drew further speculation when he did not participate in any mini-camp practices in June. Marvin Lewis, per usual, seemed exasperated with questions regarding injured players, essentially telling reporters Eifert wasn't released to practice yet and wouldn't say whether Eifert would be ready for camp.

Players often need 6-9 months before a full-strength return after a discectomy. While a player may be fully healed within 3-4 months, nearly every player has said recovering core strength and returning to pre-injury form takes longer. However, Eifert didn't recover well from his first procedure, found little interest on the free agent market, and now may have had a setback after his second procedure. If he starts training camp on the PUP list, it turns an already-concerning injury red flag to bright crimson.

Now, an article on the team website suggests Eifert won't be ready to practice when camp opens this week. Eifert returned to the Bengals on a one-year deal after attracting very little interest on the free agent market. Eifert has every incentive to show he can be healthy and productive this year. Unfortunately, Eifert's ability to do either in 2018 remains questionable.

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 weeks 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.