The 2024 Injury [Pro]ne Playbook

TL:DR

Only 2.3% of NFL games end without a player getting injured. Eventually most players are hurt.

The wrong way to assess injury situations is to blindly label players' injuries prone.

Injury history is king. Previous injuries automatically increase a player’s future re-injury risk

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)
• Keenan Allen (guilty again(

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.

The goal here 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.

What I’m Not Saying

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

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 Joe Burrow). However, to believe that every player falls either into the immortal Frank Gore category or the less-fortunate Burrow category is a fallacy. Oftentimes players like Burrow and Gore are used as standards when in reality, they’re exceptions.

Not Saying: Injury Histories are Irrelevant

Usually IP pertains to a player with a minimal injury history or a player who has a completely random history of injuries. (James Cook and Joe Burrow, let’s update names) fall into the latter category. The bottom line is that when a player has a hand fracture followed by an MCL 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 the 2022 season.

So then when and how do injury histories matter? When viewed with the appropriate context. 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.

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). 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

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)

Organizations typically give a much longer leash to players they invested high 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.

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. FYI, Allen played 78 of the next 81 games for the Chargers after these injuries.

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-foot-8 to 6-foot-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 – even for De’Von Achane and Jahmyr Gibbs. 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.

Note: these are numbers through 2022 and will be updated in the Draft Guide which will be published before Week 1 of 2024

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 leaguemates 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 more discrete versions 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 by ADP

TL:DR

Top-12 WRs by ADP miss no games due to injury 47% of the time

Top-12 RBs by ADP missed no games due to injury 36% of the time

Top-2 WRs by ADP miss an average of 1.8 games per season

Top-2 RBs miss an average of 4.8 games per season

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

Worded differently, from 2013 to 2022, there was ~36% chance that the RB drafted in the 1st round would miss zero time due to injury. For the WRs drafted in the top 12, that number was 47%. The rates are much tighter than the average drafter realizes.

Things get messy for 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 stand out is the scarcity at the position as RBBCs (running back by committee) have taken the league by storm. Case and point: 2023 was the first time since the turn of the century that no running back in the league carried the ball 300 times.

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 two of the top five 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 for Injury Upside

TL:DR

Rarely should a fantasy manager handcuff their own starting RB

Use the IR slot for players who are eligible 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”

Handcuffs should have a clear path to touches like Kyren Williams last season before Cam Akers was cut

If splitting hairs between 2 handcuffs, take the player with a teammate who has the riskiest injury profile (i.e.take Blake Corum instead of Tyler Allgeier)

Most of these guys don’t hit but stashing several of them can pay off in the aggregate - i.e. Kyren Williams.

Here’s the recommended players from 2023

Tank Bigsby (whoof)

Rashaad Penny (whoof)

Samaje Perine (whoof)

Zach Charbonnet (whoof)

Jaylen Warren (ADP RB45 finished RB33)

Tyjae Spears (ADP RB57 finished RB43)

Chuba Hubbard (ADP RB59 finished RB35)

Kyren Williams (ding-ding-ding)

I’ll say it again - you can see that most of these guys don’t hit. Williams was obviously an outlier but having multiple irons in the fire improves your odds of hitting. Remember from last year guys like Charbonnet, Warren and Spears were “just” ADP beaters but the logic remains: they had a highly attainable ADP lowering opportunity cost and probabilistically had league-winning upside. The fact that catastrophic injury didn’t hit doesn’t make the process wrong!

Here are handcuff targets for 2024 based on presumed workload, ADP and teammate injury risk.

• Ty Chandler (Aaron Jones’ age and hamstring history)
• De’Von Achane and Raheem Mostert (Achane’s size, Mostert’s body)
• Jerome Ford (Nick Chubb’s knee)
• Jaylen Warren (Najee Harris’ foot/soft tissue history)
• Dameon Pierce (Joe Mixon’s knee and foot history)
• Brian Robinson (Austin Ekeler’s age and hamstring history)
• Blake Corum (Kyren Williams foot/ankle history)
• Zach Charbonnet (Ken Walker groin history)

QB Injuries: Fantasy Impact

TL:DR

More QBs in 2023 than usual missed 40% or more of the season despite “minor” injury rates being relatively static

When a starting QB was injured, team pass catchers, even the alphas, were generally more volatile in fantasy scoring

If a starting QB is injured, rostering the average to good RB1 of that backfield is more likely to pay off than a pass catcher. Even the alphas

Ceiling games are less likely to come for pass catchers as evidenced by guys like DJ Moore, Justin Jefferson and Ja’Marr Chase in 2023

The dude throwing the ball is going to directly impact the dudes catching it. The backfields, however, are generally more predictable and should be targeted

QB injuries were a hop topic in 2023. But were there really more injuries than usual? Yes and no.

Even though the number of starting quarterbacks who missed time due to injury was nearly identical to last season – 20 QBs vs. 19 in 2022, respectively – passers this season missed a whopping 102 total games.

In 2022, starting quarterbacks missed 88 games. That means there was a 15.9% increase year-over-year in total games missed among starting signal-callers.

Joe Burrow (calf/thumb), Kirk Cousins (Achilles), Daniel Jones (neck + ACL), Anthony Richardson (shoulder), Deshaun Watson (shoulder), and Aaron Rodgers (Achilles) combined to miss a total of 67 games on their own. Woof.

The Impact of QB Injuries

The downstream effects are just as jarring. It seems obvious, but bears repeating that highly drafted skill players were also impacted.

Among the teammates of QBs who missed at least seven games, these skill players were drafted in the top 6 rounds per August Underdog ADP:

• Ja’Marr Chase
• Tee Higgins
• Joe Mixon
• T.J. Hockenson
• Alexander Mattison
• Saquon Barkley
• Darren Waller
• Michael Pittman
• Jonathan Taylor
• Nick Chubb
• Amari Cooper
• Breece Hall
• Garrett Wilson

There are plenty of knits to be picked with some of these players. And some of them had injuries of their own. But the point is that several offenses had to endure tectonic shifts in game planning and overall infrastructure.

Here are the skill player teammates of QBs who missed 3-6 games due to injury:

Garrett Wilson (again after Zach Wilson took over)

Breece Hall (again after Zach Wilson took over)

Amari Cooper (again after Cleveland discovered DTR wasn’t that guy)

• DJ Moore
• Keenan Allen
• Austin Ekeler
• Mike Williams
• Najee Harris
• Diontae Johnson
• George Pickens

Saquon Barkley (again when Tyrod Taylor took over)

Darren Waller (again when Tyrod Taylor took over)

So how did this impact the backfields and pass catchers? To answer that question I used the incredible FantasyPoints data suite (seriously, if you can swing it, this is the best data package in the game). First, every team who had a starting QB go down with injury in 2023 were identified. Then, team backfield fantasy points per game and team pass catcher points per game respectively were calculated pre and post QB injury. For example the average amount of fantasy points per game that Colts’ pass catchers with and without Anthony Richardson were calculated. The same was done for the Colts’ backfield. Then the average post-injury was divided by the average pre-injury. The exact same was done for backfields. Backfield example:

IND backfield fantasy ppg without Anthony Richardson / IND backfield fantasy ppg without Anthony Richardson = delta fantasy ppg

Results

Below are the raw numbers for how pass catchers and backfields fared. The percentage represents how much a team improved or worsened based on when the starting QB was active by calculating the difference in fantasy production.

For example, the first number represents that the Chargers saw a (-) 21% dip in fantasy points from pass catchers without Justin Herbert active. That was the worst in the league, by the way.

Team Pass Catchers PPG Delta

Team Backfield PPG Delta

Entire Sample PPG Delta

The table above represents the average change for the entire sample. Backfields who played without the starting QB improved by (+) 14% on average from a fantasy points per game perspective. Pass catchers dipped by (-) 1%.

Pass Catchers

Overall, 6 of the 12 teams’ pass catchers worsened in fantasy points per game. Those teams were:

• Chicago
• Las Vegas
• Houston
• Minnesota
• NYG
• LAC

Chicago is a great place to start as an example as to why this exercise is imperfect on the surface. Overall, the Bears’ pass catchers only dropped (-) 2% in overall production. However, DJ Moore averaged 20 points per game with Justin Fields (which included a 49 and 27 point explosion).

With Tyson Bagent under center, Moore averaged fewer than 10 points per game - a drop of more than (-) 50%. The takeaway is that Moore’s ceiling and floor were negatively impacted after Fields was injured. The flip side is that Cole Kmet’s average with Bagent jumped from 11 to 13. Additionally, 2 of Kmet’s 3 best fantasy outings came with Bagent at QB. The real kicker? The Bears' pass catcher ppg was unchanged as a whole! This is the perfect example of how a change at QB impacts players’ floor/ceiling - for better and worse depending on the system.

Another case to look at is Davante Adams with the Raiders. He went from 15 ppg with Jimmy G to 16 ppg. Adams is simply built differently. The Raiders’ offensive ecosystem rightfully revolved around him regardless of who was under center. So, even though Adams’ production was technically “better” the Raiders’ pass catchers overall saw a negligible 6% decrease overall.

So if a true generational alpha WR sees his QB miss time, the offense shouldn’t skip a beat, right? Not so much. In 9 games with Joe Burrow, Ja’Marr Chase surpassed 12 fantasy points (sem-arbitrary) 66% of the time. Without Burrow, he crossed that 12 point mark just once or 20% of the time.

Next, let’s dig into Justin Jefferson who, for all intents and purposes, was healthy by the time he returned from his hamstring injury. The result? JJ went from the WR3 averaging 22 ppg all the way to WR21 (that’s twenty-one) averaging 14 ppg. Even though a guy like Jefferson can go off at any time (see Week 18) and even though we’ll take 14 points any day of the week, without Kirk Cousins he didn't pay off anywhere near his 1.01 ADP. Unsurprisingly, the Vikings’ fantasy ppg from pass catchers dipped by (-) 19%.

Lastly, looking at the data for teams whose pass catchers only improved (so excluding teams who were worse), we see that overall that improvement was modest at (+) 11% and was bolstered by a single outlier. This will come into play while looking at the backfields.

Backfields

Here are the teams whose backfields worsened in fantasy points per game. Again, some of these were small samples so keep that in mind:

• Houston
• Seattle
• Indianapolis
• Cleveland
• LAC

If you’re wondering, the only 2 teams who worsened in both backfield and pass catcher ppg were the Chargers and Texans.

Overall, backfield fantasy points per game improved by (+) 14% across the board. The improvement amongst teams who did get better was high at (+) 49%. This stands to reason: when the starting QB goes down and a team can #EstablishIt even a little, they will. This stat passes the eye test when looking at Pittsburgh, Chicago and New York (Giants).

When it comes to team management while dealing with real life NFL QB injuries, it pays to roster the average to good RB. To further this point, look at Joe Mixon after the Burrow injury. After Burrow went down, Mixon averaged 18 ppg. Before, Mixon averaged just 13 points per game. The Bengals saw a commensurate (+) 70%(!) increase in backfield production.

Another example: in games without Jimmy G, Josh Jacobs’ average fantasy points per game were 16 and 17 respectively as compared to 13 and 11 with Jimmy G. Now, theoretically Jimmy G was just benched but philosophically, the point remains. When the Raiders decided to establish it, Jacobs fantasy managers reaped the rewards.

Takeaway

Overall, there were more QBs in 2023 than usual who missed ~40% or more of the season despite “minor” injury rates being relatively static. The skill positions were impacted in opposite and generally expected ways. When a starting QB was injured, team pass catchers, even the alphas, were generally more volatile in fantasy scoring. When it comes to team management while dealing with real life NFL QB injuries:

Rostering the average to good RB1 of a team backfield is more likely to pay off than a pass catcher

As for pass catchers who lose their starting QB, ceiling games are less likely to come by as evidenced by guys like DJ Moore, Justin Jefferson and Ja’Marr Chase.

Overall, these results make sense: Any “improvements” in receiving points per game we observed this year were modest and in reality much less predictable. The dude throwing the ball is going to directly impact the dudes catching it. The backfields, however, are generally more predictable and should be targeted.

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 4th round or earlier of the NFL Draft

Exceptionally athletic, surpassing even NFL standards

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

No PCL or LCL involvement

Lower-body injuries post ACL tear are not as common as narratives suggest

29% of RBs do not return to NFL action after an ACL tear

80% of RBs fail to reach at least 85% of pre-injury fantasy production

The post-ACL production dip is only 12%

61% of WRs never return to 90% pre-injury production

Eight total WRs 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 severe ACL injuries within 10 months

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

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

Definition

Medical providers consider hundreds of factors while rehabbing an ACL tear. For fantasy purposes, here are the 2 most important ones:

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

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

The Harsh Reality

Since 2010, a total of 36 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 who 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 careers of RBs.

Identifying Outliers

After removing RBs who did not return immediately after surgery, we find that only five RBs reached at least 85% of pre-injury fantasy production levels and scored at least 10 PPR points.

Here’s the list:

• Breece Hall
• Javonte Williams
• Saquon Barkley
• Adrian Peterson
• Jamaal Charles
• Darren Sproles
• J.K. Dobbins

These are the boxes these five 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 nine months dedicated to rehab

Relatively straightforward surgical procedures (generally speaking means no LCL or PCL 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”

Since 2008, 48% of RBs miss no time after ACL surgery. Additionally, 71% of those RBs who did miss time due to lower-body injuries either started the season on PUP and/or had complications due to the knee itself. Only 19% of the sample sustained a non-knee lower-body injury. Those RBs were identifiable in the preseason. Simply put: an ACL tear doesn’t preclude secondary injury. Here’s the sample just since 2012.

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

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

Wide Receivers

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

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 take 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 bounceback” is mainly a narrative

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

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 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 toward 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 kneeldowns. 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 run 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.

Enter questions about Anthony Richardson.

Both injuries Ant sustained were on designed runs. Should he take on contact at the goal line and put himself at risk for a concussion? No. Was his shoulder injury a complete fluke? Yes.

The expectation is that the coaching staff and management have had that conversation and I expect Richardson to be more selective with his rushing and sliding in 2024.

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 commonly occur in WRs 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

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

75% of WRs miss at least 12 weeks

Players can return in 10 weeks i.e. 2013 Randall Cobb

The fastest player to return from this surgery 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, i.e. DJ Chark

Jones fracture:

A fracture of the 5th metatarsal (pinky toe side)

The timeframes to return are highly variable

There are studies to show all NFL players returning from a Jones fracture were at risk for reinjury if returning prior to 10 weeks i.e. 2015 Dez Bryant

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

For WRs 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

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

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 i.e. 2023 Rashod Bateman

A Lisfranc injury does not always require surgery i.e. 2020 Joe Mixon

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 the 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/ankle fractures among RBs are 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

Fibula Fractures

RBs returning from fibula fractures having undergone surgery typically don’t return for at least 12 weeks

It’s possible players may return sooner with the “tight rope” procedure

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

Unless your name is Tony Pollard in 2023. Pour one out.

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

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.

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.

Player Profiles

Risk tier: Average

Risk tier: Slightly Above Average

Risk tier: Significantly Above Average

Risk tier: Extreme Risk

Season Long Playbook

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.

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.

Shoulder/Ribs/Chest

Highlights

16% Weekly Recurrence Rate

21% Seasonal Recurrence Rate

See Shoulder Injuries for additional context

Takeaway

The small sample means we should be cautious drawing major conclusions but overall, it seems ribs/shoulder/chest injuries have minimal impact on WRs. Notably the median for YAC per reception does drop by 18%.

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 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.

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.

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

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.

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.

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.

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.

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

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.

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 reward

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%).

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

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.

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

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 in 2022.

What This Isn’t

An “Injury prediction” chapter

An injury prediction “model.”

A strict evaluation of a player's talent

Green Light

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.

Yellow Light

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.

Red Light

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. (NOTE: Since this page needs to be updated, I think this copy should be more generic like the others. Or updated to the players included)

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.

Green Light

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.

Yellow Light

Yellow Light Cont.

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. (NOTE: needs update based on players)

Green, Yellow, Red

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, Pat Freiermuth, and Kyle Pitts. 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.