NFL injury mailbag: David Montgomery recovery expectations, a hip-drop tackle explanation and more

In this week’s column, Greg Scholz explains the hip-drop tackle that the NFL is considering banning, offers his expectations for David Montgomery’s rehab from a ribs injury and more!

Before we dive in, here’s a quick glossary of terms commonly used by Inside Injuries:

  • IRC = Injury Risk Category (three designations: “Low,” “Elevated,” “High”) — the overall likelihood a player will get injured
  • HPF = Health Performance Factor (Peak, Above Average, Below Average, Poor) — our metric to predict player performance
  • ORT = Optimal Recovery Time — the amount of time a player needs to fully recover from an injury (not the same as how much time they will actually miss).

Q: David Montgomery and his cartilage/ribs injury… Do you expect him back before or after his Week 9 bye? Do you anticipate any performance issues upon his return? — Chris H.

From an Optimal Recovery Time standpoint, Montgomery should not return until after the Week 9 bye. From a performance standpoint, there isn’t much concern, but there are some things that the Lions will have to consider.

It doesn’t take much explanation, but running backs take a lot of hits every week. We track injuries to every position group on the field and the running back position consistently ranks at or near the top of that list. Rib injuries, while not as common as something like a hamstring strain or ankle sprain, pop up every year and almost always guarantee at least a week of missed time. A lot of these injuries are to the rib bones, which are diagnosed pretty easily using x-rays. Rib cartilage injuries, on the other hand, can go under the radar due to the fact they often require an MRI for a clear diagnosis.

Rib cartilage connects the ribs to the sternum, facilitating the expansion of the rib cage during breathing. Recovery from damage to this area can span from weeks to months. I mentioned it in a previous mailbag, but anyone who’s dealt with a rib injury will tell you how excruciating the pain can be. Everyday actions like laughing or even light breathing can hurt, let alone the intensified breathing during strenuous activities like football. Now, imagine the added pain from impactful tackles during the game.

The good news is that most players make a full recovery from these sorts of injuries with little complication. There’s always the potential for lingering pain or discomfort, but that can be managed by wearing a flak jacket (think Kirk Cousins), taking appropriate medication, or making some adjustments to play style.

In short, we aren’t too concerned about Montgomery once he returns. He’ll have an Elevated Injury Risk, but his Health Performance Factor will be Above Average to Peak. The big thing will be focusing on recovery and getting back to 100%.

Q: Justin Fields’ dislocated thumb is said to be a pain management issue but this sounds like a multi-week absence. How long until he’s likely to be at the necessary level to play, and could surgery be an option down the line? — Mario L.

Recovery times vary significantly, with mild (Grade 1) dislocations generally healing in 2-4 weeks, while a more moderate (Grade 2) dislocation can take up to six weeks. Beyond that, if the ligaments are severely damaged, surgery comes into play, which can take up to 12 weeks to heal fully.

For those playing the IR game at home, you probably noticed that each recovery window laid out extends to or past four weeks, meaning a trip to the IR is a possibility. That said, based on what the Bears have made available, we don’t anticipate that’s the move Chicago will make unless surgery is a necessity. Currently, we have his Optimal Recovery Time at 35 days, however we anticipate he’ll likely regain enough thumb strength to return somewhere closer to the range of 21-28 days.

Your point about pain management is a good one because there likely will be some pain that Fields has to play through. As I mentioned, thumb strength is the key to returning here, and that strength can only be applied correctly if the pain is manageable. If the pain prevents him from maintaining enough strength to hold the ball during his throwing motion, he won’t be able to play.

Q: Do you think Rhamondre Stevenson has ever been near healthy this year? — Raymond M.

Heading into this season, there wasn’t much concern surrounding Stevenson. The major issue we saw was his ankle sprain from December 2022. Other than that, he looked good. So, to answer your question, yes, we considered him healthy to start this season.

Looking at his injuries thus far in 2023, he’s battled a few Grade 1 things, notably to the thigh in Week 5 and now the ankle/head with Week 7 around the corner. Neither injury has forced him to miss a game, however he’s been on and off the practice report and seen some limited game action as a result.

It’s never a good sign when a player, especially a running back, suffers a series of lower body injuries in such a short window of time. However, we aren’t seeing anything too concerning just yet. That said, we are keeping a much closer eye on him than we were in Week 1.

Additionally, New England’s inefficient offense doesn’t help when we try to evaluate in-game health, but Stevenson doesn’t look slower or less agile to the extent that it would be considered problematic. His Injury Risk is going to be Elevated in the short term, but his Health Performance Factor is in Above Average territory. In short, if Stevenson is on your fantasy team, his mediocre production appears to be more scheme related rather than injury related.

Q: Any word on Treylon Burks’ knee? It feels like this one has been swept under the rug a bit. — Kurt S.

The Titans have been pretty quiet regarding Burks, but the decision to not play him in Week 6 wasn’t all that surprising considering Tennessee’s Week 7 bye.

Burks is likely still battling some complications from the sprained LCL he suffered in training camp. Whether he simply aggravated it or it was more serious than originally thought, the good news is that his metrics are tracking well for a Week 8 return. He’ll need to log a full practice, but right now he should be back with a slightly Elevated Injury Risk and a Peak Health Performance Factor.

Q: With recent talks about player safety and the NFL’s concussion protocol, are there any changes or additions to the protocol that you would like to see moving forward? — Jeremy C.

I think some of the big ones are trending in the right direction, such as research into better helmet technology as well as attempting to eliminate helmet-to-helmet hits. Other than those two, to me, it would be great to see some additional focus on player education and post-career support. Additionally, I think the NFL would benefit from being more transparent with their research and findings.

The difficult thing with player education is that it starts well before a player makes it to the NFL. I can only speak for myself and people I grew up with, but I was not aware of what a concussion was until I was maybe 12, and even then I didn’t know how serious they were. Frankly, I thought the sound of the helmets hitting one another was cool, so even then it didn’t really impact how I played the game — that’s not me blaming anyone, rather just the reality of my experience. To really start to educate players, it’s going to take a lot of work to really emphasize the damage that can be done by concussions and eliminate any sort of “I’m an outlier mentality,” because at the end of the day, it’s a violent sport, and that’s part of the appeal.

Post-career support to me is pretty simple. The NFL is a money-printer and they can certainly afford to shell out more money for players who want medical assistance after their career is over. I believe this would also help eliminate some of the stigma surrounding players who may fear how they’re perceived by their peers for seeking out medical care. If it’s made more available and there are less hoops to jump through, the thought process could shift more to, “it’s free, I might as well speak with someone.”

Finally, as a multi-billion dollar entity, the NFL has to operate behind closed doors for certain things — player safety should not be one of those things. The goal here would be to ensure there are no conflicts of interest and that the most accurate, unbiased information is available to players and the public, even if that information is ugly.

Q: Could you perhaps give some insight into the mechanism and injury risk of the “hip-drop tackle” that the NFL is reportedly considering banning? — Ben G.

Absolutely! The hip-drop tackle basically involves a defender grabbing onto the ball carrier at the waist or shoulders, then pulling their own legs up off the ground, resulting in the ball carrier being dragged with the full body weight of the defender landing on the carrier’s legs and pinning them down. Oftentimes, this includes a sort of twisting motion by the carrier. The primary concern here is to the knee and ankle joints.

This pinning, and the subsequent twist, can — and has — lead to a variety of injuries. For example, we tend to see a lot of ankle sprains. Beyond that, the knee is especially vulnerable if the ball carrier twists their body, with the risk of ligament tears such as the ACL or MCL. This can also lead to potential cartilage or meniscus tears. Going ever further, we’ve seen fractures to the foot or ankle, and a few knee dislocations.

Q: How long do you see Justin Fields, Deshaun Watson and Daniel Jones being out, and how effective do you think they’ll be in their return? — Daniel C.

I gave a more detailed Justin Fields response above, so I’ll focus on Watson and Jones here.

After missing last week against the Bills, Daniel Jones still hasn’t been cleared for contact, which might sound scary, but it’s not that surprising considering the team still has Friday practice coming up. If he isn’t cleared for contact on Friday, then it’s unlikely he plays in Week 7. His metrics right now aren’t great, but they’re passable. His Injury Risk is Elevated and his Health Performance Factor is Peak. We still have his Optimal Recovery Time as eight days away. The good news here is that this is unlikely to be related to his offseason surgery. Once he returns, there isn’t much concern about his effectiveness.

Watson returned to practice on Thursday, which is always a good sign. A recent MRI showed some tearing in his rotator cuff to go with the previously diagnosed contusion. Basically, that means that some of the muscles or tendons that stabilize the shoulder are bruised and overstretched. In terms of effectiveness, we are considering his Health Performance Factor to be on the high side of Below Average, meaning we’d expect some limited production (quick, short throws.) If he can log a full practice on Friday that should be enough for him to bump up into Above Average territory. His Injury Risk is on the lower side of High and his Optimal Recovery Time is 12 days away. That said, we expect he will play in Week 7.

(Kevin Sabitus/Getty Images)

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