The Dynasty Doctor: Running Back Injuries

Editor’s Note: Injuries are a huge part of winning and losing each year in fantasy leagues. Staying abreast of injury situations is key, as knowing what to expect from your players health-wise in the short term can help you make educated decisions in managing your team. Lucky for us, we have a Doctor in the house. Dr. Scott Peak is an ABPN board certified neurologist and neuro-oncologist. He is also a dynasty football addict and a Senior Writer for Dynasty League Football. He’s excited to lend his expertise in medicine with hopes he may help the DLF Team and its followers better understand medical conditions and injuries that may impact NFL players and dynasty football owners.  

If you have a question for The Dynasty Doctor, just click here. Please remember The Dynasty Doctor is geared towards questions regarding medical science, injuries to players and their collective impact in fantasy football.

In this installment of the Dynasty Doctor, Thomas submitted a question to Dynasty Doc. We will do our best to answer it.

Which of the following running backs will have the best bounce-back season: Jamaal Charles, Le’Veon Bell, DeMarco Murray, or Eddie Lacy?

Le’Veon Bell, RB PIT

Bell is recovering from a significant knee injury – a tear of the medial collateral (MCL) and posterior cruciate ligament (PCL). Vontaze Burfict tackled Bell and rolled up on the back of his right leg. The hit was clean, but Bell’s right lower leg bent laterally and in a manner that would place stress on the MCL.

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The MCL helps to resist valgus movement in the knee, which is lateral or outward bending of the lower leg. Bell’s lower leg twisted in a valgus manner, enough to tear the MCL. PCL injuries usually occur with a direct blow on the front of the knee. Excessive flexion of the knee can also stress the PCL. Bell could have injured his PCL when his right knee hit the ground, and force was applied onto the tibia anteriorly. His knee didn’t appear to be hyper-flexed.

Bell underwent surgery and this implies something more than a grade I or II injury. Grade III MCL injuries are a complete tear of the ligament and are often repaired surgically for athletes. It’s been reported that both the MCL and PCL were surgically repaired. Typically, grade I or II PCL injuries are not surgically repaired, so this might imply a grade III injury, and surgery for multi-ligament injuries is commonly needed. Following surgery for a multi-ligament injury, return-to-sport can take 9-12 months. Bell injured his knee in week eight, and he will be under a tight timeline to return in week one of the 2016 regular season. It is possible, but he will have to avoid setbacks to do it.

Bell will have to demonstrate good quadriceps/hamstring strength, be able to jog, cut, show effective lateral movement and rise from a squat position without difficulty. The good news is, Bell has already posted video of himself jogging, sprinting and performing lateral movement drills. Bell was recently quoted as saying he’d be ready for training camp.

Bell has a history of injuries. Bell had a mid-foot sprain in 2013 and missed three games. Bell hyper-extended his right knee in 2014 and missed the playoffs. Bell was also suspended four games in 2015 for marijuana possession, and missed a total of ten games after his week eight MCL/PCL injury.

Bell has sustained two significant right knee injuries since 2014. It’s a stretch to call Bell injury-prone, as both knee injuries were contact-related and unavoidable. Still, it’s fair to be concerned about the long-term ramifications of two significant injuries to the same knee in such a short period of time.

Jamaal Charles, RB KC

Charles suffered a torn right anterior cruciate ligament (ACL) last year and missed 11 games. Charles tore the left ACL in 2011 and missed 14 games. Charles tore his ACL in week five last season, and given the timeline for isolated ACL injuries is 6-9 months, he stands a good chance to be available for training camp. He seems to be on track with his rehabilitation. I wouldn’t be at all surprised if he doesn’t play much in preseason games. He was a limited participant in OTAs and taking it slow with him is understandable.

One item to note with Charles is that both ACL ruptures were non-contact injuries. This isn’t a big surprise as most are non-contact in origin (~70%). Athletes who tend to land in a hyper-valgus manner, with the lower leg bent outward relative to the upper leg, are at higher risk of ACL injury. Whether or not Charles’ running-style places him at higher risk for ACL injury is hard to confirm, but it is possible. It’s not a reason to sell him cheaply in dynasty.

It is well-documented in the literature that athletes who tear an ACL are at a higher risk of re-injury to the repaired ACL and opposite knee. Various publications note a risk of re-injury 2-6%, whereas others are much higher (20% ACL opposite knee, 9% to the repaired ACL). Specific to Charles, his risk of re-injury is higher but we still should use proper perspective, it’s still a low risk.

Charles has been a durable player. Excluding the 2011 and 2015 seasons, he has only missed three games in six seasons since 2008.

Eddie Lacy, RB GB

Lacy entered the NFL under a cloud of uncertainty from a turf-toe injury that required surgery. I wrote an article on Lacy’s value back in 2013 and advised spending a mid-to-late rookie 1st on him.

Lacy missed one game in three years at Alabama, and only two games since his rookie season. For all the flack Lacy got for poor conditioning and toe injury, he’s been a durable player. He’s had a variety of nagging injuries (ankle, groin) in the past. The most concerning injuries are two concussions he sustained in 2013 and 2014. Studies support and the American Academy of Neurology note an increased risk of concussion for players with prior head injuries. If there is a concern about Lacy, it would be concussions and how that might impact his NFL future. He did manage to play the entire 2015 season without a documented concussion.

The biggest red flag concerns poor conditioning. NFL teams are typically loath to reveal injury information, but the Green Bay Packers weren’t shy about their displeasure with Lacy’s poor condition. Photos all over Twitter painted Lacy in an unflattering manner, so it’s not like the Packers could deny it.

Lacy was a constant headache for fantasy owners in 2015, yet his season wasn’t  that bad. Lacy had three 100 yard games and 4.1 YPC. Matt Forte had only one 100 yard game in 2015, and even Devonta Freeman had four 100 yard games (4.0 YPC). I think hate on Lacy is overstated.

The biggest problem for fantasy owners was the Packers usage of him. He had four games with five or fewer rushing attempts, and 11 games with 13 or fewer rushing attempts. The Packers coaching staff created a fantasy football nightmare in limiting touches for Lacy. When Lacy had 17 or more rushing attempts, he was effective (three 100 yard games, two touchdowns, and 5 YPC).   All three 100 yard games came in weeks 11 to 14, and that seems to suggest Lacy didn’t wear down.

Reports indicate Lacy is taking his conditioning seriously. If Lacy can get himself into the best shape of his career, he could be in-line for a productive season. He should be motivated, as he will be a free agent in 2017. It’s not unprecedented that players have conditioning issues, and I don’t think it is a death-sentence to his NFL or dynasty value. Lacy hasn’t shown a propensity for character-related issues, and several NFL players valued greatly in dynasty have done far worse.

DeMarco Murray, RB TEN

Murray didn’t have specific injury issues last season, but got dinged for a big workload in 2014 and he fell out of favor with Philadelphia Eagles head coach Chip Kelly. Murray’s ADP is RB31, a staggering fall for him (RB5 June 2015). I’m no scout or NFL coach, but I watched coaches film on NFL Game Pass, and if Murray has slowed down, it doesn’t seem like much. Murray may have been less explosive and decisive at times, but the Eagles offensive line was underwhelming. Murray lined up next to Sam Bradford in the shotgun, running lateral to the line of scrimmage, and he often didn’t get a chance to feature his speed/explosiveness. Execution of the rushing attack seemed to suffer at all levels.

The situation for Murray isn’t ideal. Tennessee Titans head coach Mike Mularkey has shown mostly average or poor results in past years. Table 1 shows how his teams have ranked in rushing as either offensive coordinator or head coach:

Table 1

Team	Year	Rushing Rank
Buffalo Bills	2004	13
Buffalo Bills	2005	20
Miami Dolphins	2006	22
Miami Dolphins	2007	23
Atlanta Falcons	2008	2
Atlanta Falcons	2009	15
Atlanta Falcons	2010	12
Jacksonville Jaguars	2012	30
Tennessee Titans	2015	25

 

The Titans also finished as the worst offensive line in 2015 (NFL statistics).

Who will have the best bounce-back season?

I want to say Murray, but his situation is not optimal. Murray’s workload in 2014 was significant (393 rushes, 57 receptions), but he didn’t have a substantial workload other years (734 rushes, 157 receptions 2011-2013, 2015). He certainly has room to bounce-back, based on ADP and his 2015 statistics (193 rushes, 702 yards, 6 TD). If Bell can stay healthy, he should be the most productive player on this list. Charles has shown no signs of slowing down, but he has to contend with Spencer Ware and Charcandrick West taking away touches.

My choice is Lacy. Here are Lacy’s statistics since 2013:

Year	Rush attempts	Rush Yards	YPC	Receptions	Receiving Yards	TD
2013	284	1178	4.1	35	257	11
2014	246	1139	4.6	42	427	13
2015	187	758	4.1	20	188	5

 

Unlike the other three candidates, Lacy doesn’t have injury concerns (Charles, Bell) or concerns about breaking down (Murray). The Packers brought back James Starks but didn’t make a specific effort to acquire other running backs that could challenge Lacy. Starks is a concern, but if Lacy enters training camp in prime condition, he should get starters touches. Whereas Bell and Charles must overcome serious injuries, Lacy only needs to improve his conditioning, regain his coaches confidence and all signs are positive thus far. Lacy isn’t a character concern, and he stands a good chance of a bounce-back in 2015.

Who is your choice? I’d like to get your thoughts on it.

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