The 2023 Injury [Pro]ne Playbook

Injury Prone is a Lie (thesis), TL:DR

Only 2.3% of NFL games end without a player getting injured. It’s rare, and eventually, most players are hurt.

The wrong way to assess injury situations is to blindly label players IP. This leads to value leaks across multiple leagues and is suboptimal.

Injury history is king. Previous injuries automatically increase a player’s future re-injury risk for that specific issue, not some random unrelated ailment.

There’s a massive edge to be had to understand the ceiling and the floor of a player due to injury/performance. Specifically, keep in mind these general rules:

A. ~ 24 years old or younger

B. NFL draft capital in the 4th round or higher

C. Relatively simple injury/surgery

Avoid narratives like “style of play” and “BMI” as they’re a more discrete version of “injury prone.”

Recurrence Rates

There is much, much more to come on this topic. But first, here’s the most important one of all.

Injury Prone is a Lie

Just ask:

• Christian McCaffrey
• Christian Kirk
• Saquon Barkley
• Joe Mixon
• Evan Engram
• Frank Gore
• Brandin Cooks
• Austin Ekeler
• Carson Wentz
• George Kittle
• James Conner (guilty)

Medical staffs adjust. We should too!

When I started saying this is in late 2019, it wasn’t a foreign concept to the sports medicine community. I didn’t invent the wheel. Much to my dismay, it was a new concept to many fantasy gamers and analysts alike. The term “injury prone” (“IP” moving forward) was and continues to be thrown around consistently in fantasy circles and is used to describe any player who misses even a quarter of game action.

Now, there are certainly instances in which much of this is mental gymnastics and really isn’t actionable. For that reason, the goal is to first give fantasy gamers and bettors a clear understanding of how to view injury histories from a big-picture perspective and debunk the reductionist mindset of “injury prone.” Then later in the book, I’ll present my Injury Volatility Tiers which is how I quantify and categorize injuries with expected future impact. This is meant to be an evergreen chapter outlining the basics of injury analysis to help gain the upper hand on trade partners, snipe leaguemates on draft day, and be an objectively more accurate fantasy football prognosticator. So, let’s differentiate between injury narrative and objective sports medicine.

As a full-time physical therapist in professional sports, I’ve learned that when it comes to communication, it’s just as important to clarify what I’m not saying. In that spirit, what I’m not saying:

What I’m Not Saying

Not Saying: Exceptions Don’t Exist/Patterns Don’t Exist

As it relates to exceptions, there are specific cases in which it’s reasonable to question whether a player is at a higher predisposition for injuries compared to counterparts based on genetic variability and/or medical history (formerly James Conner and currently Elijah Mitchell). However, to believe that every player falls either into the immortal Frank Gore category or the less fortunate Mitchell category is a fallacy. Oftentimes players like Mitchell and Gore are used as standards when in reality, they’re exceptions.

So then what is actionable? Fading narratives and properly weighting injury histories.

Which leads to injury histories.

Not Saying: Injury Histories are Irrelevant

In Other Words: Usually IP pertains to a player with no injury history whatsoever or a player who has a completely random history of injuries. Rashaad Penny and Carson Wentz fall into the latter category. Here’s supplemental reading that dives further into this concept with Wentz as the centerpiece. The bottom line is that when a player has a wrist fracture followed by an ACL tear then later on is concussed, there’s no statistical or scientific pattern to be drawn. That’s bad luck. That’s the game of football.

The opposite is also true: a player with a clean bill of health does not make him impervious to contact injuries like ACL tears, MCL sprains, and ankle sprains. The perfect example is Jonathan Taylor who allegedly hadn’t even missed a practice since high school before last season. So then when and how do injury histories matter? When viewed with the appropriate context and nuance. In fact, injury history is the best tool available to fantasy players and sports bettors. As it turns out, more games missed in college generally leads to more games missed in the NFL. More specifically, players who miss three or fewer games in college are more likely to be drafted and less likely to have future injuries in the NFL.

Previous injury is the best predictor for future injury.

And Another Thing

Here’s the thing about “compensation injuries.” Elite athletes won’t develop these issues overnight. There’s simply no good evidence that demonstrates [X] injury leads to [Y] “compensation injury.” The type of secondary injury that does exist has to do with the 3-6 times increase in soft tissue injury risk when players alter physical workloads in a meaningful way. An example of a player who may have sustained a quad strain due to the up and down nature of practice-game-rehab is Christian McCaffrey in 2020 and 2021. Which is why I was bullish on him staying healthy in 2022. He was a lesson in patience.

When a player sustains an ankle injury here’s what it tells us: that player sustained an ankle injury and he’s at risk for another - wait for it - ankle injury (on the same ankle). That’s it! If a player missed time in college due to ankle issues, the most likely reason they’ll miss time in the NFL will be because of ankle injuries. Previous injuries automatically increase a player’s future reinjury risk for that specific issue, not another random unrelated ailment.

Not Saying: Injuries Don’t Impact Performance

This one is much easier to comprehend and the easiest way for fantasy football managers to gain an edge on the competition. Know which injuries are the most detrimental. It’s also important to keep proper context such as draft capital, age, and severity of injury. These help predict if a player will perform to pre-injury levels on the field following an injury. Broadly speaking, players will bounce back from significant injuries if the following criteria are present:

< or = 25 years old

NFL draft capital in the 4th round or higher (the higher, generally the better)

Studies indicating the injury is not catastrophic (tendon ruptures)

Specifically as it relates to draft capital, organizations typically have a much longer leash on players they invested so much draft capital on. Whether that’s illogical or not, it tends to be true.

Furthermore, these athletes tend to have a better “athletic reserve” following injuries and their rehabs tend to go more smoothly.

Now that you’ve read what I’m not saying, here’s what I am saying about the phrase “Injury Prone.”

What I am Saying

Am Saying: 2.3% of Games are “Injury Free”

I cite this statistic often and it’s really quite that simple. Being injured in the NFL is the norm and health is the anomaly. To blindly assign the term IP to a player without any real investigation is statistically unlikely to be true. Furthermore, not every injury is created equally. If a player misses games because of a collarbone fracture, ACL tear, then a ruptured kidney, it’s self-sabotage to fade that player due to injury concerns. Ask Keenan Allen, who is the proud owner of that very history. Allen wasn’t injury prone. He was prone to playing NFL football.

Am Saying: Style of Play is Virtually Irrelevant

There’s no objective definition to determine “style” in the first place. That means there’s no standard for the phrase itself. Football is a violent game. No standard means no precedent which makes it a tenuous argument against players who are injured. For example, it’s fair to say George Kittle has missed more games than average due to injury. It’s not fair to say he’s missed those games due to “style of play.” As this thread points out here, his significant injuries have come as a defenseless receiver or blocker.

There’s data to show that running backs (who presumably are IP) aren’t actually injured more frequently than other skill players. Instead, they’re more likely to suffer different categories of injuries that require more healing time and the positional scarcity makes them more memorable.

However, pass catchers are actually more susceptible to concussions and ACL tears. These are the result of positional demands and something to consider.

Am Saying: BMI is Relative

As it relates to BMI, there’s no evidence indicating that there’s a difference in injury rates for running backs with a BMI between 29-32 kg/m^2 (5’8” to 6’1” and 207 lbs. to 243 lbs.). As long as a RB meets that threshold, there’s no reason to be concerned about injuries. As for smaller RBs under 200 lbs., in theory, they are injured more frequently due to contact injuries but the sample of these players is so small that it’s difficult to draw any sort of conclusions. These players should be analyzed on a case-by-case basis by weighing previous injury history. The same can be said for wide receivers. If a player doesn’t meet the BMI threshold for their given position, the chances of success, not injury, should be the major concern (even though DeVonta Smith says hi).

Player injuries, with appropriate analysis, create a wealth of opportunities to steal players from other nervous managers. However, it’s much easier to calculate a static injury risk quotient than it is to adjust for a player’s physical volatility mid-season. So, it’s important to know timelines and rehab progressions for the most common injuries to exploit market inefficiencies. Below is a list of injuries that are mostly unpredictable but can provide managers with some sweet, sweet fantasy football equity during the season. The tables below contain “Seasonal Recurrence” which is how often an injury can carry over into the next season. Meanwhile “Weekly Recurrence” is how often an injury lingers throughout the season.

Recurrence Rates

Now for Weekly Recurrence:

There will be more nuggets on specific injuries and timelines in the chapter on in-season management.

Summary

There’s no one right way to view player injuries but there is a wrong way. At its core, injury analysis refines the consensus’ idea of what a player’s floor/ceiling really is. The wrong way to assess these situations is to blindly label players IP. This leads to value leaks across multiple leagues and is suboptimal. For an edge on the competition always remember:

Injury prediction is impossible. Instead, stay curious and be on the lookout to exploit league mates who are quick to write off a player due to injury concerns.

Injury history is king. There’s a massive edge to be had to understand the ceiling and the floor of a player due to injury/performance. Specifically, keep in mind these general rules:

A. ~ 24 years old or younger

B. NFL draft capital in the 4th round or higher (the higher, generally the better)

C. Studies indicating return to previous levels of play are less than or equal to 50% for the given injury

Previous injuries automatically increase a player’s future re-injury risk for that specific issue, not some random unrelated ailment.

Avoid narratives like “style of play” and “BMI” as they’re a more discrete version of “injury prone.”

It bears repeating: Only 2.3% of NFL games end without a player getting injured. It’s rare, and eventually, most players are hurt.

Let’s move away from “injuries are random” to using objective data and science to guide decisions that relate to performance and rehab in fantasy football

Missed Games Due to Injury, TL:DR

The top 12 WRs by ADP since 2013 miss no games due to injury 47% of the time. Conversely, just 36% of the top-12 RBs missed zero games.

The amount of missed games due to injury for top 2 WRs by ADP is 1.8 vs. 4.8 for top 2 RBs

Scarcity, not necessarily frequent injuries, makes RB handcuffs lottery tickets

So, I took the first 12 RBs who were drafted according to ADP since 2013 and did the same for WRs. This sample contains 240 total players. Top 12 WRs by ADP miss no games due to injury 47% of the time while RBs avoid all injuries 36% of the time. Worded differently, from 2013 to 2022, there was ~36% chance that the RB you drafted in the 1st round would miss zero time due to injury. For the WRs you drafted in the top 12, that number was 47%. But, from my experience, the rates are much tighter than the general public realizes.

Things get messy for running backs when we hone in on top 2 RBs by ADP vs. top 2 WRs by ADP. The amount of missed games due to injuries for WRs is 1.8 vs. 4.8 for RBs. All of this data indicates that RBs aren’t necessarily injured more frequently than WRs, but RBs are more likely to sustain severe injuries due to contact. A major factor that makes games missed by RBs standout is the scarcity at the position as RBBCs (running back by committee) have taken the league by storm. As a result, fantasy RBs who make a legitimate impact are few and far between. Meanwhile guys like Danny Amendola helped you win a DFS tournament at his near-min salary so you could scrape 2 of the top 5 players on the slate. This brings up the concept of a RB handcuff who is a pure lottery ticket vs. one who, based on their teammate’s injury history, has a chance to provide spike weeks and/or take over a backfield.

Handcuffing by Injury History TL:DR:

Rarely should a fantasy manager handcuff their own starting RB

Teams should use the IR slot for players who are eligible for it and immediately stash another player for upside (in this exercise, a handcuff RB)

Handcuffs can provide legit league-winning value to rosters and is the basis of “Zero RB”

The handcuff should ideally have a clear path to touches like Alexander Mattison over the last few seasons before Dalvin Cook left

If splitting hairs between 2 handcuffs, take the player with a teammate with the riskiest injury profile

Here are a few examples from 2022 who hit. They don’t all hit but stashing several guys in your portfolio should pay off in the aggregate. Especially in bestball. Some examples of backfields who don’t meet these general guidelines include the Cowboys, the Bengals, and the Ravens. If the starter from each of these respective teams goes down, there’s no telling who will carry the load. But what about a guy like Tyjae Spears? Sure, he’s got injury concerns of his own that might come home to roost sooner rather than later but what if Derrick Henry has a foot recurrence? Or another hamstring strain that he can’t play through at 30 years old? Spears as a bench stash is more likely to provide value versus somebody like Tyler Allgeier who would have to wait for the usually healthy Bijan Robinson to require time off and then beat out Cordarrelle Patterson. What about Tank Bigsby? He sits behind Travis Etienne who had Lisfranc surgery in 2021 then had a recurrence in 2022. Here is a complete list of handcuff RBs who I prioritize over the field based on situation and teammate’s physical volatility. Even if these RBs aren’t true handcuffs some players like Rashaad Penny and D’Andre Swift hold hidden equity against each other as both have an injury history. Presumably either would see a significant bump in volume should the other miss time:

Jaylen Warren (one of my favorites)

• Tyjae Spears
• Tank Bigsby
• Rashaad Penny
• D’Andre Swift
• Brian Robinson
• Samaje Perine
• Kyren Williams
• Zach Charbonnet
• Chuba Hubbard

This list will continue to be refined and updated throughout the pre-season.

ACL Management, TL:DR

The following criteria have a high hit rate for identifying outlier RBs who can return in year 1 post-ACL

24 or younger at the time of injury

Selected in the fourth round or earlier of the NFL Draft

Exceptionally athletic, surpassing even NFL standards

A minimum of 9 months post surgery - not post-injury

No PLC or LCL involvement

Lower body injuries post ACL tear are not as common as narratives suggest unless a player has a specific history of that injury previously

29% of RBs do not return to NFL action after an ACL tear putting a damper on the “2nd year after ACL bounceback” narrative.

Only 20% of RBs reach at least 85% of pre-injury fantasy production levels and score at least 10 PPR points per game. The post-injury production dip is only 10%.

61% of WRs who tore their ACL since 2013 never return to 90% pre-injury production

Eight total WRs post-ACL since 2013 have reached at least 85% pre-injury levels. Despite this, the median post-injury production dip is only 10%.

WRs don’t necessarily require elite athleticism like RBs if they show an ability to beat coverage against zone according to Reception Perception

QBs can return from even severe ACL injuries within 10 months historically

There’s about a 19% decrease in rushing production in the 1st year back

There’s a 15% drop in fantasy production post-ACL for QBs

Definition

In short, the ACL (anterior cruciate ligament) is connective tissue that stabilizes the upper leg bone (femur) to the lower leg bone (tibia). When that ligament tears, most athletes will undergo a reconstruction. In my time as an injury analyst, I’ve observed ACL tears are one of the most misunderstood injuries. For that reason I’ll try and provide some clarity and very broad principles medical providers consider while rehabbing an ACL tear:

Chronological recovery time

Functional ability

Time

The average return to sport time for players coming off an ACL tear in the NFL is approximately 11-12 months. However, many NFL athletes return and perform between 8-10 months such as Chris Godwin and Michael Gallup. Most surgeons won’t completely clear a player for game action until at least 9 months as retear rates at 9 months are no different than at 12 months.

In contrast, returning before 9 months has been documented to increase risk of retear rates seven-fold in kids. Now, grown men in the NFL are not kids – but the basic principles of biology and healing still apply.

Function

Even if a player gains momentum throughout the off season and checks functional boxes like power/strength tests, taking contact, and even simulated game action, there’s no replacement for the game. Returning to the field, even if a player feels and seems ready to go, could result in workload related injuries like Chris Godwin or under-performance like with Michael Gallup.

Returning to play is not the same thing as returning to perform.

Running Backs ACL

The Harsh Reality

Since 2010, a total of 34 running backs have torn their ACL and attempted to return the following season. In this group, 29% of players did not return to the NFL and 6% took two or more years to return. This means that over one-third of the RBs that sustained an ACL injury either had their careers ended or dramatically altered.

This puts a damper on the “2nd year after ACL bounceback” narrative. This is also why the narrative that ACL tears are no longer a career-threatening injury is a myth. This injury very much still impacts the career of RBs.

Identifying Outliers

After removing RBs who did not return immediately after surgery, we find that only four RBs reached at least 85% of pre-injury fantasy production levels and scored at least 10 PPR points per game in doing so. But first, an honorable mention:

After Week 4 of the 2021 season, Saquon Barkley was on track to finish as a top 9 RB despite playing only 48% of snaps in Week 1. He missed out due to a fluke ankle injury – where he stepped on a defender's foot and badly rolled his foot – that had absolutely nothing to do with his knee injury.

Now here’s the list of 4 RBs who scored at least 85% of previous fantasy points per game and scored at least 10 PPR points per game in their first season back from ACL:

Adrian Peterson (duh)

Jamaal Charles (double, duh)

Darren Sproles (Kansas State’s finest)

J.K. Dobbins (gasp!)

These are the boxes these 4 check when looking for outliers who can bounce back in year 1 from ACL tears.

26 or younger at the time of injury

Selected in the fourth round or earlier of the NFL Draft

Exceptionally athletic, surpassing even NFL standards

A minimum of 9 months dedicated to rehab

Relatively straightforward surgical procedures (generally speaking means no LCL or PLC involvement)

That criteria is based on a study analyzing 47 NFL players over the span of 27 years. What the authors found was that the following variables were independent predictors of returning to previous levels of performance/NFL longevity:

Age < 25 years old (previous performance)

Offensive players (performance)

NFL draft capital in rounds 1-4 (longevity)

Looks familiar, right? Ostensibly, the younger the player, the more talented/athletic. And the higher the draft capital, the better the chances of an immediate smash return. These players have fewer complications, more front office support, and overall supreme talent. They can progress more quickly through rehab and are least impacted by ACL injuries. This study on NCAA players supports the argument for youth aiding in ACL rehab. Every step matters in the NFL and physiologically, the younger players are in their physical prime.

“Compensation Injuries”

Looking at historical ACL data, we find that 41% of players missed no time after surgery. Players like Lamar Miller who appeared in only 1 game skew the sample but the point remains as Adrian Peterson, Jamaal Charles, and even Giovani Bernard didn’t “compensate”. We also find that 7 of 10 who missed time either started the season on PUP, had a complicated injury, and/or were very old or very young. Simply having an ACL tear doesn’t preclude secondary injury. In fact, there’s an argument that secondary injury is an exception - not the rule.

* indicates athlete had severe injury/ACL+ additional ligament/tissue damage

** indicates athlete was 30+ years old or a rookie

Wide Receivers ACL

Since 2013, 29-of-43 (67%) wide receivers returned in the first year after an ACL injury. As far as 2nd year bouncebacks, well, see for yourself:

That’s right. 61% of WRs who tore their ACL never return to their previous form (relative to 90% of their career baseline production).

Eight total WRs post-ACL since 2013 have reached at least 85% pre-injury levels (in PPR points per game) in their first year post-operation and scored at least 10 PPR points per game in doing so. Here’s the list of receivers:

• Chris Godwin
• Keenan Allen
• Kelvin Benjamin
• Jordy Nelson
• Allen Robinson
• Cooper Kupp
• Julian Edelman
• Jeremy Maclin

Receivers are slightly different from RBs as the specific successful archetype doesn’t necessarily require elite athleticism. Instead, receivers who have had a minimally complex injury, are young, and interestingly average at least 80% success rate against zone coverage (shoutout to Reception Perception and Matt Harmon) have found themselves on this list. Those who didn’t meet the criteria of bouncing back had an average 75% success rate vs. zone. The reason for this success despite no freak athleticism is likely because WRs who don’t use physicality to win the first place (think players like Cooper Kupp and Julian Edelman) are extremely gifted in finding soft spots in the defense. Even if they “lose a step” in that first year back, their ability to “win” remains. Lastly, the average amount of games played among these outliers? 15. Further putting to rest the “compensation injury” argument.

Quarterbacks ACL

In the modern era, big studies like this one have concluded QB play largely does not take a hit after an ACL tears. However, zooming into fantasy relevant QBs paints a slightly different picture. It’s important to note this is a small sample and may not reflect returns overall. However it’s a decent place to start.

First, it is true that QBs have less time to bounce back as illustrated by Joe Burrow who returned in 9 months and 1 week for an injury that would have taken any RB at least 10-11 months to rehab from. Similarly, Robert Griffin III returned in 8 months despite LCL involvement.

Generally speaking, though, QB rush attempts per game do take a hit in this sample. When excluding Deshaun Watson, the average decrease is by about 19%. This results in QBs averaging just 86% of pre-injury levels (fantasy points per game). But again, it’s important to note this sample was taken to compare QBs who were in this era and/or had relatively similar skill sets. A Tom Brady ACL tear from 2008 probably does us no good.

Overall, QBs can return to play at a faster rate but rushing attempts and fantasy points per game could take a hit. Again, the sample size is tiny – so please be careful to not extrapolate this data too far. Of course the better the talent and situation, the better the outcome.

Conclusion

Any player who tears an ACL can return within 9-11 months (8-10 months for QBs) so long as the injury does not involve the LCL and/or PLC and/or additional damage

The younger the athlete, the higher the NFL draft capital, the better

Identifiable outliers exist despite poor outcomes for most after an ACL tear

The “2nd year after ACL bounce back” is mainly a narrative

Compensation injuries after an ACL tear are also an overblown narrative that gamers can navigate skillful

Rushing QBs and Injury Rates, TL:DR

Types of plays that result in most QB injuries to least: sacks + hits in the pocket > Speaking of rushing attempts and quarterbacks

QBs who run more frequently miss 1.6 games per year and their less mobile counterparts miss 1.8 games per year

Hits in the pocket result in more trips to the injured reserve than QB designed runs or scrambles

Hits in the pocket result in more games missed due to injury than QB designed runs or scrambles

A higher QB BMI results in more more missed games due to injury

The myth that rushing quarterbacks are more prone to injury doesn’t seem to hold up to statistical testing

I’m back at it again – here to ruffle the feathers of @runthedamnball69 and @girldad420 on Twitter.

My first publication on this topic suggested that rushing as a quarterback does not preclude higher injury rates compared to less mobile quarterbacks. Usually, I only briefly reference a link but reviewing the conclusions of that previous study is important, so here’s the TL;DR:

Nobody is positing that a quarterback should ram into a defender repeatedly because it’s safer than passing the ball.

From 2016 to 2020, thousands of plays were analyzed, and the study found that dropbacks ending in sacks and knockdowns/hits have the highest injury rates among NFL QBs compared to designed runs and scrambles.

Case studies like Robert Griffin III and Cam Newton are considered outliers, and the running style of quarterbacks like Lamar Jackson indicates that many of their rushes do not result in contact.

Examining the careers of historically “mobile” quarterbacks demonstrates their longevity and success.

The narrative of pocket passers being less injury-prone lacks evidence, and the trend is shifting towards recognizing the value of ultra-athletic quarterbacks in both the NFL and fantasy football alike.

Now, why would you need more evidence than that? Here’s what this new study aims to accomplish:

Find statistical significance and impact of the data

Further define “mobile” and “non-mobile” QB

Identify how many games QBs in each category missed

Account for BMI and age

While it's true that quarterbacks who take hits are at a higher risk of getting hurt, it's essential to understand that being a mobile quarterback does not necessarily mean facing a higher likelihood of injury. In fact, when quarterbacks are prepared to take hits or skillfully avoid them, their injury rates aren't as high as the narrative implies. The goal of this study is to find statistical data to support that hypothesis. Here’s a brief description of the population and methods.

Criteria and Definition

The study examined quarterbacks from 2018 to 2022 who played in at least three games and/or were projected to be the team’s starter that season prior to injury. Players like Jeff Driskel and Taysom Hill were removed from the sample. Sporadic spot starters were also excluded. There were a total of 195 QBs included in the sample.

A designed run includes quarterback sneaks and RPOs while excluding kneel-downs. Scrambles include any time a quarterback leaves the tackle box outside of the play design. Hits are any contact made on a quarterback by a defender while in the pocket that does not ultimately end in a sack (i.e. hit as thrown). Sacks are self-explanatory.

Statistics

None of the correlations ran during this study were bigger than “small,” which is expected as football is a random game that is nearly impossible to predict. However, if a relationship is considered “significant,” that means that the data is giving a signal that is statistically unlikely to be random. The r^2 projects “how much” of the results (i.e. games missed) can be explained by the independent variable (i.e. sacks + hits). In that specific example, it’s estimated that 62% of missed games by QBs can be explained solely by hits + sacks.

Mobile QBs do not miss more games than non-mobile QBs

There were 62 total QBs who met the threshold of > 3 scrambles + designed rushing attempts per game. We’ll consider this the “mobile” group. The rest are considered the “immobile” group as the per game average in designed runs + scrambles was 2.

BMI, Age and Injury

QBs with a BMI of 28 or lower missed on average 1 game per season while those with a BMI above 28 missed an average of 2 games. This flies in the face that mass leads to durability. The theory here is that unless your name is Cam Newton or Anthony Richardson, the more mass a QB holds, the less mobile they are. The less mobile they are, the less time they have to prepare for contact. Really, this ultimately illustrates to us that injuries are much more random and complex than the average NFL fan understands. Lastly, QBs 28 and older missed 1.7 games on average compared to 1.5 for the younger QBs. This also tracks as the the best predictor of future injury is previous injury and as every NFL player ages, they’re nearly guaranteed to have something pop.

Injured Reserve Data

Missed Game Data

Designed Runs vs. Missed Games due to Injury

The data suggests that the frequency of designed runs per game does not significantly impact the number of missed games for quarterbacks. It implies that the act of intentionally running the ball does not inherently increase injury risk.

Scrambles vs. Missed Games due to Injury

The findings imply that the frequency of scrambles does not have a considerable impact on the number of games missed due to injury. In other words, scrambling does not necessarily make quarterbacks more prone to getting hurt.

Sacks/Hits vs. Missed Games due to Injury

The data suggests that the more sacks plus hits a quarterback sustains, the higher the likelihood of missing games due to injury. It's crucial to note that this correlation does not solely apply to rushing quarterbacks, but encompasses all quarterbacks.

All Hits vs. Missed Games due to Injury

Examining all hits endured by quarterbacks, whether from designed runs, scrambles, or sacks, there’s a significant, small positive correlation with missed games. This signifies that all types of hits can contribute to the likelihood of quarterbacks missing games due to injuries. Once again, this correlation is not exclusive to rushing quarterbacks but encompasses the position as a whole.

Placement on the Injured Reserve

Similarly when it comes to injured reserve placement, we find that the most closely associated relationships are “sacks plus hits” and all hits.

Theory and What it all Means

As expected, when taking into account sacks + hits in pocket + scrambles + designed runs, injury rates go up. As you’ll remember, the thesis was never that taking hits is safe. However, the data does suggest that of these 4 possible outcomes for quarterbacks, taking a hit in the pocket and/or being sacked is more tightly linked to injury than any combination of a scramble and/or designed run.

Most of the risk (62%, in fact) for QB injury seems to come while standing in the pocket and taking a shot. This makes sense as players who scramble and run on a designed attempt have at least some semblance of control over whether or not they take on contact. That’s juxtaposed to a sitting duck in the pocket.

Of course, there are always exceptions and the takeaway here isn’t that all quarterbacks should scramble. Take Jimmy Garoppolo as an example. In 2022, he was initially hit in the pocket and technically “scrambled” his way into a season ending foot injury outside of the pocket. Similarly, “designed attempt” doesn’t inherently mean that contact is the culprit of injury, as exemplified by Kyler Murray in 2022. Lastly, being in the “mobile” category does not mean sacks and hits leading to injury won’t happen (see 2022 Lamar Jackson, injured in the pocket). As always, it’s much, much more complicated than this. The only thing we can be relatively certain about is that hits + sacks lead to higher injury rates for NFL QBs.

Conclusion

In summary, the myth that rushing quarterbacks are more prone to injury doesn’t seem to hold up to statistical testing.

This data indicates that designed runs and scrambles have minimal influence on missed games due to injury, while quarterbacks who face a high number of sacks and hits face a significant correlation with increased injury risk.

For fantasy football players, it is crucial to consider a quarterback's ability to avoid hits, their offensive line's performance, and their overall health when assessing injury risk.

Rushing ability alone should not be the sole determining factor when evaluating a quarterback's durability. By understanding the nuances of injuries, fantasy football enthusiasts and NFL fans alike can make informed decisions when drafting quarterbacks and ultimately increase their chances of success.

Foot and Ankle Fractures

Wide Receivers

Foot/ankle fractures are extremely prevalent among wide receivers. More specifically, foot/ankle fractures commonly occur in receivers who are in the first 3 years of their career

Unless a player is already on the last leg of his career and then sustains a Lisfranc, these injuries tend to be a blip on the radar

There is a higher chance generally of sprains and re-injury in future seasons but for top players, it’s not a worthwhile concern unless splitting hairs

The caveat here is that foot and ankle specialists exist for a reason and there are various sub-types and levels of severity so this is intended to be a general overview

WR Fibula fracture:

These fractures can be associated with a high ankle sprain

The timeframe to return is variable ranging anywhere from 75 days to 123 days for all NFL players

Most WRs (75% of the sample) missed at least 12 weeks of time

Players can return in 10 weeks like Randall Cobb did in 2013. The fastest player in my database to return from this injury post-op is Phillip Dorsett in 2015 returning after 7 weeks

The first season after surgery fantasy points per game normalizes to pre-injury levels

With complex injuries the issue can continue to fester despite surgery as it did with D.J. Chark in 2022

WR Jones fracture:

A fracture of the 5th metatarsal as a result of compressive forces through the outside of the foot and/or a stress fracture over time

The timeframe to return is variable due to the significantly different sub-classifications

There are studies to show all NFL players returning from a Jones fracture were at risk for reinjury if returning prior to 10 weeks. 2015 Dez Bryant is an example of this as he tried returning in 6 weeks

Despite this fact, a small scale study with offensive, defensive and non-skill players found that the overall average return time is approximately 9 weeks

More specific to receivers, the return from a Jones fracture is usually between 12-16 weeks

The first season after surgery fantasy points per game normalizes to pre-injury levels

WR Lisfranc Injury and/or Fracture AKA “midfoot” Injury

“Lisfranc” is a very broad term that refers to injuries in the middle of the foot with a whole host of subtypes which can include ligament tears, foot fractures, and joint dislocations

These injuries are a result of forces that compress through the middle of the foot while in the “tiptoe” position

There are many degrees of severity and involvement

Recovery typically takes skill players as little as 6-7 months (less common) but can take up to 11-12 months.

A Lisfranc injury does not always require surgery and can be treated conservatively

There are no known cases that have recurred and required another surgery

As seen with Marquise Brown in 2022, all of the rehab and time in the world can still result in a recurrence

Athletes often elect a second surgery to remove hardware from foot

There are studies that show a decrease in offensive production post-Lisfranc surgery, but the metric used (“offensive power rating”) is imperfect. Here’s the formula:

OPR = Passing yards/20 + Rushing yards + Receiving yards/10 + Passing TDx4 + (Rushing TD +Receiving TD) x 6 - Interceptions

Another study of strictly NFL players found no difference in production using that same metric and showed no impact on career length

There seems to be no further games missed due to complications in the first season back

Lastly, it’s hard to draw reliable conclusions post-Lisfranc as the sample is small and includes WRs in their rookie season, those entering the twilight, and those who were never fantasy relevant. Here’s the list:

Marquise Brown is the most applicable case example of a player returning post-Lisfranc successfully as he played all 16 games and was fantasy relevant

Gamers and bettors should be selective about players coming back from Lisfranc but overall the narrative that Lisfranc injuries are significantly detrimental to young, highly athletic players seems overblown

Running Backs Foot and Ankle

Foot/ankle fractures among RBs are slightly less common than in WRs

Typically RBs sustain fibula fractures but Jones and Lisfranc fractures are less common

As a general rule of thumb, RBs return to sport slightly slower than pass catchers and quarterbacks simply because of the heavy physical demands of the position

RB Fibula Fractures

RBs returning from fibula fractures having undergone surgery (which has happened 73% of the time since 2011 in my database) typically don’t return for at least 12 weeks

It’s possible players may begin to return sooner with a relatively new procedure commonly known as the “tight rope”

The following season after a fibula fracture and subsequent surgery, RBs bounce back and achieve an average of 89% pre-injury levels in PPR points per game with a median of 102%

As with WRs the re-injury rate is relatively low but high ankle sprains and/or re-fractures are not unheard of in the future

RB Jones and Lisfranc fractures

The sample sizes are not big enough to draw conclusions and should be analyzed on a case to case basis. Here are boxes to check when analyzing these players:

Young age (25 years or younger)

A freak athlete/good player

Good front office support with on-field opportunity

At least an average amount of time to rehab without setbacks

Ideally the player checks all or most of these boxes.

Player Profiles

The following profiles are specifically in reference to a player’s injury and/or performance risk. They are not meant to be used as a sole determination of rankings. Pair these profiles with your favorite fantasy analyst’s tiers, rankings, and analysis. Below is the key to risk assignments.

Light Green - Average

Dark Green - Slightly Above Average

Yellow - Significantly Above Average

Red - Extreme

QB Profiles

RB Profiles

WR Profiles

Season Long Playbook

Common Injuries

Here is a list of common injuries with medical definitions (in layman’s terms) if you’re so inclined. This is by no means an exhaustive list as that could be a book on its own (spoiler it’s called medical school). If you’re not interested, skip to the goods.

Concussion AKA TBI

The objective definition of a concussion is a traumatic brain injury

This occurs when the head and brain are moved violently back and forth leading to chemical changes at times damaging brain cells

Every concussion predisposes a person to a subsequent concussion

These injuries are dangerous and some of the least predictable in all of sports medicine

Hamstring Strain AKA “Soft tissue strain”

A group of 3 large muscles in the back of the thigh that bend the knee, help deceleration, and extend the hip

These injuries fall into the class of injuries the fantasy community generally refer to as “soft tissue” injuries

Hamstring injuries cause a large variation in missed time and tend to recur causing objective dips in production with a boom/bust nature once the player returns

The 1st week back from injury is the riskiest time to insert these players into a lineup and challenges the “start your studs” argument.

Symptomatic Knee “arthritis” and/or “Degenerative” knee

Osteoarthritis is a term for an ongoing process that degrades the cartilage within the knee joint but can occur in any joint in the body

The body constantly tells the brain to release a cascade of chemicals to the area and "clear up" an injured body part. These same chemicals signal the brain that there may be damage and the brain can interpret the stimulus as “painful”

O.A. never ends. Due to the constant signaling of damage, the cycle continues to repeat itself.

Lateral Ankle Sprain AKA “Low” Ankle Sprain

A lateral sprain occurs when a player forcefully “rolls'' onto the outside of his ankle/foot.

Ankle sprains are an extremely common NFL injury accounting for 12% of all injuries from 2012-2014

By the time players reach the NFL combine, 13% of running backs and wide receivers and 7% of tight ends have already had some sort of ankle sprain

Player tend to play through lateral ankle sprains but they can be catastrophic as in the case of Saquon Barkley in 2021 and Jonathan Taylor in 2022

Syndesmosis Sprain and/or “High” Ankle Sprain

This tissue is damaged when a player is forcefully compressed while the lower leg is rotated and is usually a contact injury

Imagine staring at an NFL goal post. The uprights represent the 2 lower leg bones and the bottom beam is the top of the foot. If the net is stretched across the front of the uprights, it represents the connective tissue called the interosseous membrane -- the tissue that is injured in a high ankle sprain

These injuries are consistently more debilitating than lateral sprains because the syndesmosis has a poor blood supply and high sprains typically involve a greater volume of tissue damage

Labrum Tear AKA “Shoulder Dislocation”

The best example of a player pushing through several labrum tears is Dalvin Cook over the last few seasons

Some of those games were at critical points in the fantasy season like in the 2019 fantasy playoffs

These injuries have an extremely high recurrence rate

Shoulder A.C. Joint Sprain AKA “Shoulder Separation or “AC sprain”

A very common injury to QBs, AC sprains occur when a player is tackled and taken down forcefully onto the side of his shoulder

They typically cost players 9.8 days per injury

However, quarterbacks miss the most time when severe enough, missing an average of 17 days due to the injury

Recently D’Andre Swift and Mark Andrews had this injury

Timeframe specific to grade II AC sprains: Approximately 2-4 weeks (highly variable depending on positional demands)

MCL sprain

The primary function of the MCL is to resist the knee from caving inward

Logically, this ligament is over-stressed when the knee is forced into valgus and this study on soccer players confirms that 70% of all MCL injuries are from forceful valgus that is contact in nature

It is not uncommon for a high-ankle type injury to be confused on video with an MCL sprain as they can actually occur together

MCL sprains account for 41% of all NFL knee injuries but the injury is rarely season-ending unless coupled with additional damage.

Recently Nick Chubb, Elijah Mitchell (in both knees), and Jarvis Landry have sustained this injury.

Timeframe specific to grade II MCL sprains: Approximately 3-5 weeks

PCL sprain

The PCL is the sister ligament to the ACL and prevents the knee from being forced backwards (among other things)

Recently Julio Jones, Lamar Jackson, and Dalton Schultz have sustained this injury

Timeframe specific to grade II PCL sprains: Approximately 2-4 weeks but highly variable (NCAA offensive players)

Sports hernia AKA Groin/Hip/Abdomen AKA “Soft Tissue Strain”

Sports hernias are muscular strains that may be listed as “hip”, “groin” or “abdomen” and at times may even be listed as “osteitis pubis”.

Severe sports hernias will initially be treated with 4-6 weeks of physical therapy. If this does not solve the issue, players will undergo surgery that will take a recovery time of 58 days if done in any month other than December.

The biggest recurrence for a sports hernia is a previous one. If a player has surgery to correct the problem, they’ll continue performing at a high level but play fewer games per season (12 vs. 14) and last a shorter time in the NFL (3 years vs. 4 years)

Definition and Methods

These studies used the official practice reports of all 32 NFL teams from the 2018 regular season through the 2022 regular season. Players who were on the injury report during that time were identified to calculate performance metrics in the first week back from the most common injuries at the position and/or playing through an official designation on the injury report with that injury. Because this study is meant to analyze players who are fantasy relevant, points per game cutoffs (in PPR scoring) were used at every position listed in the definition tables below. Sample sizes were taken into consideration and if there were not enough players returning after missing time, all players who played throughout the designation but did not miss time were included. This was only done for RB concussions and for all injuries at the QB position. This study is far from perfect and is designed to be a general guide for gamers and sports bettors to use in conjunction with player specific injury analysis. Although I’m still (mainly) a one-man research team, the vision is to continue expanding this guide for years to come and perfect it

*Healthy CV was calculated using PPR points per game of WRs averaging at least 9.5 ppg in 2021

*Healthy CV was calculated using PPR points per game of RBs averaging at least 7.5 ppg in 2021

*Healthy CV was calculated using PPR points per game of QBs averaging at least 7.5 ppg in 2021

Criteria

Met position specific cutoff in points per game

Appeared on team’s official practice report with specified injury

“OUT” was assigned when a player did not register peripheral statistics

This accounts for instances a player is “active’ but was clearly not a part of game plan and/or only was active for emergency purposes

Playbook: Wide Receivers

WR High Ankle

(2014 - 2022 Regular Season)

Highlights

Notably, YAC per reception in the 1st week back dropped by 36%

6/19 (32%) Weekly Recurrence Rate

< 5% Seasonal Recurrence rate

Takeaway

At 66% Points Differential, 59% CV, and a 0% Week Winner rate, high ankle sprains are an extremely volatile injury for WRs to play through and/or return from immediately. However, if a player doesn’t sustain a recurrence, performance does tend to stabilize back to 100% by the 3rd game back from injury.

WR Knee

Highlights

Additionally the median Points Differential is 118%

11% Weekly Recurrence

Seasonal Recurrence Rate of 13%

Takeaway

Despite the high CV, Points Differential and peripheral numbers remain above seasonal average. With a high Stud Rate and reasonable Week Winner rate, WRs coming off a knee issue are relatively low risk/high reward in the 1st week back.

WR Hamstring

Highlights

The median Differential in points is even lower than the average at 62%

The lower targets per game and even targets per route rate imply there could be a game plan adjustment due to their injury otherwise known to as being a “decoy”

• 30% Weekly Recurrence Rate
• 34% Seasonal Recurrence Rate
• Highest rates among all injuries charted
• Takeaway

Re-injury rate is high and the Stud and Dud rates are essentially equal and with an 18% Week Winner rate, WRs off this injury are the definition of boom or bust (with a slightly higher emphasis on the bust). Players with these injuries should generally be avoided in trades or acquisitions in season-long leagues.

WR Foot/Ankle (high ankle excluded)

Highlights

The median Points Differential is lower than the average at 78%

20% Weekly Recurrence Rate

Within that 20%, 71% missed additional time

17% Seasonal Recurrence Rate

Takeaway

Given the relatively stable Points Differential and high Stud Rate, WRs coming off a foot/ankle injury tend to perform decently. This matches real-life experience as almost all athletes push through foot/ankle sprains frequently. There’s risk here but only low to moderate.

WR Concussion

Highlights

8% Weekly Recurrence Rate

11% Seasonal Recurrence Rate

Takeaway

A low Points Differential (average and median), low Week Winner Rate, and CV that’s off the charts, WRs coming off concussions have been extremely volatile and low reward.

Playbook: Running Backs

RB High Ankle Sprain

Highlights

The Points Differential median is nearly identical to the mean at 85%

The average Receptions Differential (112%) appears healthy on the surface but the median Receptions Differential is 76%

Per PFF, the median Missed Tackles Forced Differential is 68%

12% Weekly Recurrence Rate

< 5% Seasonal Recurrence Rate

Takeaway

A reasonable Stud Rate in touches and good Stud Rate in Points salvages below average peripherals for RBs. However the bad Week Winner Rate indicates these players are not likely to win your week

RB Foot/Ankle (high ankle excluded)

Highlights

Median Points Differential hovers above 88% meaning the 100% average is a decent representation of what to expect

11% Weekly Recurrence Rate

15% Seasonal Recurrence Rate

Takeaway

A reasonable 22% Week Winner rate and 50% Stud Rate makes these guys a relatively safe floor bet off injury. As with WRs, RBs seem to play through ankle/foot issues successfully.

RB Shoulder/Ribs/Chest

Highlights

13% Weekly Recurrence Rate

18% Seasonal Recurrence Rate

See Shoulder Injuries for additional context

Takeaway

Shoulder/Chest/Ribs injuries have a high Week Winner Rate and peripherals don’t seem to suffer significantly. However, there is at least moderate risk that they can re-injure in their 1st week back.

RB Knee

Highlights

12% Weekly Recurrence Rate

21% Seasonal Recurrence Rate

Takeaway

Despite targets dipping by about 20%, Stud Rate and Week Winner Rate keep these players afloat. Depending on severity of the injury, RBs can play through this injury without a dropoff.

RB Hamstring

Highlights

Despite the 101% average differential in Points, the median is significantly lower at 82%

There’s a significantly steep median dropoff in routes and yards per route run (24% and 33% respectively)

24% Weekly Recurrence Rate

12% Seasonal Recurrence Rate

Takeaway

The high Weekly Recurrence Rate coupled with a “fine” Week Winner Rate and significant dropoff in median routes and median receiving yards makes RBs coming off a hamstring strain moderate to highly volatile

RB Concussions

Highlights

Somehow, < 5% of players in this sample faced a second concussion within-season or in subsequent seasons

5% seasonal recurrence rate

Takeaway

Given the peripherals along with a reasonable Week Winner Rate, concussions don’t seem to impact RBs significantly. This is the opposite of what we find in WRs after a concussion even after removing RBs who did not miss time prior to returning.

Playbook: Quarterbacks

QB Ribs/Chest/Shoulder

Highlights

The Dud Rate for designed rush yards is extremely high

The weekly winner rate is reasonable despite only an 81% TD Differential while playing through this injury

13% Weekly Recurrence Rate

Seasonal Recurrence rate 19% recurrence over 5 seasons

Takeaway

Rushing production and TD % falls off while playing through this injury but the Stud Rate and Dud Rate remain reasonable. Mix in the high Weekly Recurrence Rate makes these injuries moderate risk/moderate rewar

QB Foot/Ankle

Highlights

18% Weekly Recurrence Rate

Seasonal Recurrence rate 21%

See Injuries for additional context

Takeaway

The Dud Rate in fantasy points (14%) seems to override the low median Rushing Yards Differentia (73%).l

Altogether, QBs are relatively low risk playing through this injury but still may not reach high marks in rushing.

QB Hamstring/Knee

Highlights

14% Weekly Recurrence Rate

24% Seasonal Recurrence rate

Takeaway

The bad TD Differential along with a low rush yards Differential makes this injury volatile for QBs to play through even before mentioning the subpar Fantasy Points Differential and low Week Winner Rate.

QB Concussion

Highlights

Sample of active players who met ppg thresholds was low (12) so it would be dangerous to draw major conclusions

33% Weekly Recurrence Rate

Despite the small sample it’s important to note that 100% of QBs who had a recurrence in the same season as the original injury missed at least 1 game

10% Seasonal Recurrence Rate

Volatility Tiers

Volatility Tiers: What This Is

Simple - green means good, yellow means hesitation, red means generally avoid at ADP depending on circumstance.

Use these tiers as a tiebreaker while drafting between the player you're considering and another similar player or consider pivoting to another position.

An imperfect analysis of the top 100-ish players’ injury risk and physical performance potential using medical research and injury statistics written from a rehabilitation specialist’s point of view. These are separated by position and should not be compared.

A highly-individualized analysis for the 2023 season. These lists will continuously update as necessary

These tiers separate players into tiers based on their physical volatility (i.e. injury and/or physical performance) potential

Generally speaking contact injuries like first-time concussions, high ankle sprains, ACL tears, MCL sprains, AC joint sprains (basically any first time injury) is not accounted for as these are completely random.

This explains why players like Jonathan Taylor were in the Green Light Tier two years in a row before spraining his ankle and missing time last season.

What This Isn’t

An “Injury prediction” chapter

An injury prediction “model.”

An strict evaluation of a player's talent

RB Tiers

Generally a group of players who, aside from a freak/contact injury, have no significant injury history. Again, they’re still susceptible to contact-type injuries etc.

Level 1 Yellow Light: players with an injury history but are at average risk for-injury. Level 2: players either off surgery or have quite literally yellow flags to consider.

The first mini tier includes Rashaad Penny, who even though I believe in, needs to prove it. Similarly from a volume perspective Samaje Perine needs to prove he can handle 200+ opportunities (a number he hasn’t reached since 2017). Joe Mixon’s efficiency and long foot/ankle history along with age is a concern and Alvin Kamara has not stayed on the field of late and will face workload concerns after his suspension. James Conner has been “fine” but misses at least 2-3 games every year in addition to age concerns.

QB Tiers

Green, Yellow, Red

Josh Allen being in the Yellow is simple - he’s had 2 UCL injuries. This is a matter of legitimate wear and tear. Every time he injures the ligament, another re-injury is more likely to occur. Lamar Jackson’s general history has him in Yellow but as you read above, is not too concerning. Russell Wilson isn’t getting any younger and dealt with hamstring and shoulder issues last year. Joe Burrow is obviously dealing with the calf injury and the rest of the Red Light guys are explained above. Keep in mind these should only be used as hair-splitters in drafts.

WR Tiers

Generally a group of players who, aside from a freak/contact injury, have no significant injury history. Again, they’re still susceptible to contact-type injuries etc.

Level 1 Yellow Light: Players with an injury history but are at average risk for-injury. Level 2: players either off surgery or have quite literally yellow flags to consider. Level 3: Players with multiple injuries that have a high recurrence rate and/or show a pattern of injury.

Red Light

These players come with undeniable risk due to repeated soft tissue strains, older age, or both (Mike Evans, Keenan Allen. DeAndre Hopkins). Rashod Bateman nearly snuck into the yellow light tier but needs to return to practice before that level of confidence can be bestowed upon him.

TE Tiers

Unless you have Travis Kelce or Mark Andrews, if your TE has a pulse and is active on game day, chances are you should start him. What you don’t want to have is a guy with a significant amount of draft capital sitting on the bench from a semi-foreseeable injury and/or in your starting lineup for lack of better options.

The big ones to nail here are Darren Waller, Pat Freiermuth, and Kyle Pitts. The upside to Waller is obvious - he’s gonna be the guy. The downside is listed in his profile above. Big Pat is surprisingly already at concussion 3 since entering the league and as a big boy was listed on the injury report with a foot issue. Not something you want. Lastly, I really wasn’t expecting to be this low on Pitts but I’ll say this: I think he’ll start slow and can be fine. The decision to take Pitts will lie in your risk tolerance as a hamstring and PCL repair (potentially more structures were involved) will loom large.

Recurrence Rate Cheat Sheet

Major Injury Histories

Minor Injury Histories