Inside The Medical Tent: Regular Season Week 7

Presented by The Injured List Podcast and That Sports Podcast Network

Written by Brian Scott and Andrew Leduc

Welcome to The Medical Tent

Welcome back for the third year of “Inside The Medical Tent.” Each week I, Andrew Leduc, will be asking Brian Scott, of “The Injured List Podcast,” injury questions that could have a fantasy impact. Brian will be giving his professional analysis of the injury and potential timelines. I will then turn that around into what you should do with that player and who could be a possible replacement. Check back every Wednesday during the season for all the necessary information before hitting your league’s waiver wire.

This week, however, we are tackling two general topics of discussions at once. The two hardest injuries for us to predict timelines on are hamstrings and concussions. We have been over this year after year and the tricky part is, each player is different. So this week we are going to talk about why and what we may be able to expect out of some of the guys who went down this past week with one of these injuries.

Concussions

-Brian Scott

With the news coming out of Miami that Tua Tagovailoa will not be hanging up his cleats just yet, we thought it was a good time to dive further into why concussions are so unpredictable in terms of their occurrence and recovery. 

While it may seem that concussions in the NFL are a hot topic, in actuality there has been much growing concern for a number of years. It was not that long ago, when I was in college, that the NFL was so concerned that they partnered with USA Football to start a marketing campaign in which they called for kids to practice playing “Heads Up Football”, in an effort to get kids to use proper technique while tackling to reduce risk of head injuries. It also educated parents and coaches about how to recognize signs and symptoms of concussion and also how to properly fit protective gear. 

-Andrew Leduc

How long ago was it really Brian? I graduated college almost 14 years ago. I digress.

-Brian Scott

Much of the research on concussions in sport have found that pre-pubescent youth are at most risk of suffering from mild acute traumatic brain injury (concussion) due to the immature development of the human brain during these stages of life. In helping to curb concussions at a young age, it is thought that this will lead to less frequent and less severe concussive episodes as players mature and progress through their careers. While this all sounds very simple in theory, in practice it is actually much more complex. 

For starters, concussion risk is multifactorial. Age, sex, sport, mechanism of injury, family history, impact frequency/intensity, and time to evaluation/management are some of the criteria to help predetermine risk. Education of players at a young age has been emphasized in an effort to practice safe tackling techniques that are now part of most youth programs. Advanced technology with regards to helmets, mouthguards, and other protective equipment are constantly being studied and upgraded to help reduce risk of acute head injuries as well. Scientists are continuing to develop and implement new neurocognitive exams and tests to help with assessment of signs and symptoms for diagnosis and recovery. 

Despite these efforts, there is still much uncertainty and variability in treatment protocols and return to play criteria. Part of the reason for this is the subjective nature of many of the symptoms that are associated with concussions. Headaches, sleep disturbances, mood/anxiety, visual disturbances, while on the surface seem like they should be easy to evaluate, are all subjective symptoms that patients may not be aware of, or may not correlate with their recent injuries. While some of the neurocognitive tests are used to obtain some objective data, much of the algorithms rely on the majority of the subjective input from the patient/athlete. 

-Andrew Leduc

I would like to add here that a big part of concussion evaluation is the openness and honestly about the symptoms a player might be experiencing from the player themselves. Brian mentions things like sleep disturbances, headaches and visual disturbances. These are all things that really only the player will truly be able to experience and be able to describe to a professional. The problem is, that we have raised up and praised players for being tough and being able to play through injuries. Between that and the pressure of needing to earn their contract and the generational wealth that they make in a lot of cases, it is hard to blame the players for downplaying their symptoms.

-Brian Scott

As a result, there is still much variability in how quickly or slowly athletes recover from their concussive injuries. This makes it especially hard to predict for the team's medical staff. It requires regular assessments, strict adherence to the recommended treatment protocols, and most importantly, time to heal.

-Andrew Leduc

So Malik Nabers probably should have stayed home? Oh wait, I guess I should have kept reading before barging in like this. Please, continue.

-Brian Scott

So, it is no surprise when we see Malik Nabers attend a Travis Scott concert while still in concussion protocol that questions arise. With huge contracts and much riding on individual performance, it can be difficult to sift through the weeds of subjective symptoms and truly know where players are in their recovery. There have been many instances where players do not display any outward signs of their recent concussive symptoms, but yet are not cleared. There are also instances where players seemingly are concussed, but yet return to play almost immediately (Josh Allen recently).  

In the case of Tua, there is much to be concerned about. Subjectivity aside, he has checked all the boxes off when it comes to risk factors. He has had several concussions (that we know of), with less and less force/trauma, and with greater appearing severity. We can only speculate how many concussions he may have had earlier in his career. What we have bore witness to however, is a series of very significant concussions on some innocuous plays where it would seem that he should have walked away just fine, but did not. 

I almost never predict a timetable to return from concussions until I have seen a player step back on the field and exert themselves in some form of vigorous cardiovascular exercise. This is a crucial step towards a complete recovery and if a player exhibits any subjective or objective signs of effects of their traumatic brain injury, then it sometimes can mean they go right back to square one. 

Of course we will be keeping a close eye on Tua’s progress. I have to imagine that this is the last go around for him. Any other form of concussion, be it mild or not, should mean the end of his career as a player. I hope it does not lead to the end of his career altogether.

-Andrew Leduc

Both Brian and myself, along with a lot of others in the fantasy industry, have expressed our concerns over the long-term health of Tua and the desire for him to retire. Now, our opinion obviously means nothing in the long run, but I do believe it is a fair representation of a large portion of football fans. True fans love the game for much more than the physical sacrifice and entertainment because they also understand the meaning and sacrifice there players make. We respect their efforts and truly want them to move on to full and normal lives after their days of playing.

We have seen way too many tragedies over the years that we believe are tied to CTE and other concussion related symptoms in former players. The last thing any fan wants to see is another tragedy in the name of a few entertaining hours on a Sunday afternoon.

Lets quickly talk about some recent victims of concussion.

De'Von Achane - Achane suffered a concussion a few weeks ago and has missed time ever since. If he is coming back to the field we can expect his normal type of production, but that may be limited by the play of Tyler Huntley and the return of Raheem Mostert as well. We will need to see it before we believe it in order to put him in our lineups.

Malik Nabers - As Brian mentioned earlier, the concert was probably not the smartest decision. The word is that he is trending in the right direction for Week 7, but you have to wonder if the concert could have an effect on him passing the protocol and ultimately cost him one more week.

Chris Olave - Olave has already been ruled out on the short week for Thursday night football. With Rasheed Shaheed also out and Derek Carr also still on the mend, this could be ugly for the Saints. Bub Means and Cedric Wilson look to be the main targets for Spencer Rattler. Ultimately, I expect a lot of touches for Alvin Kamara and that be about it.

Marvin Harrison Jr. - With the Cardinals not playing until Monday night, Harrison still has a shot to clear protocol. His injury was sustained after hitting his helmet on the knee of another player. In the terms of severity, this seems low on the scale. With what Brian told us before though, that could mean absolutely nothing. I believe out of all the recent concussion injuries, Harrison has the best shot to play though.

Hamstrings

Another injury that is also very unpredictable is hamstring injuries. There are two main predictors of hamstring injuries and those are age and prior hamstring injury. There have been data suggesting a 30% increase risk of hamstring injury annually after the start of a professional playing career. In other studies, athletes with prior hamstring injury were 2-6x more likely to suffer a recurrent strain with the subsequent injury occurring within the first two months after returning to sport. This risk persisted for up to a year or longer with the risk being as high as 3x more likely for a repeat injury to occur. 

Muscular weakness, imbalances between muscle groups, hereditary factors, inflexibility, sports specific risks, and functional deficits of the kinetic chain (deficits throughout the length of the limb) are all factors that can contribute to hamstring injuries. Emphasis on eliminating/reducing the effects of these factors are the goal in prevention and treatment of hamstring injuries, but the fact remains that re-injury rates are very high. 

As a result, it is one of the more difficult injuries to treat and predict recovery from. Often athletes will feel significantly better after their injury and start to ramp up their activity well before they have adequately addressed any of the factors that caused the injury in the first place. This is a common theme in many of the re-injury scenarios. Subjectively athletes feel better and are able to do most activity pain free and without symptoms. However, the inability to accurately replicate game like conditions and intensity during practice and training sessions is often overlooked and so objectively they are still in some form of deficit, whether it be strength, flexibility, imbalance between other leg, etc. 

This sets up a situation where they return to active competition and then get re-injured. It will always be like this just because of the nature of the anatomy.  Use of more objective measures through testing and examination are helping to curve the re-injury rates. Just ask Christian Watson who spent time this offseason in a University of Wisconsin lab where they have been doing extensive research into hamstring injury prevention and treatment. While it seems to have helped his hamstring, it has not necessarily kept him off the injured list due to an ankle injury (think Kinetic Chain here). 

There will be many casualties as the season progresses. Be sure to monitor your players health and recovery to ensure that you have plenty of available backups on your roster, because even when cleared there is still a strong chance that hamstring injury may recur and you will have to reach deep into the bench for a replacement more than once. 

The Discharge

Come back every week for all of the latest injury updates. If you have other questions we didn’t get to in this week’s edition you can follow us on Twitter below and message us directly.

Brian Scott - The Injured List Podcast - (@injuredlistpod)  https://twitter.com/injuredlistpod

Andrew Leduc - (@theRealMrMallard) https://twitter.com/realMrMallard

If you are interested in Andrew’s weekly rankings as well, follow the link below to TSS Fantasy.

Andrew Leduc’s (Mr. Mallard) Rankings - https://tssfantasy.com/andrews-ranking