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.
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.
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.
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