Injury Analysis: Roethlisberger & Bryant Return

Roethlisberger and Bryant Return To Play Scenarios

This week marks the return of two of 2015s most highly touted players at their respective position. For Roethlisberger his return should help out the other two superstar first round draft picks of 2015 Antonio Brown and Le’Veon Bell whose performances have left “meat on the bone” due to the absence of their gun slinging quarterback. The return of Bryant could not be at a better time for those patient owners who drafted him as their first round pick only for him to go down in the first game of the season. 

But what can we expect upon their return? If you have been holding these players for so long, is now an opportune time to offload them before their floor caves in as they risk reinjury, or should you be holding on to them knowing that your path to the playoffs just got significantly clearer with the return of your stud?

Ben Roethlisberger

Roethlisberger suffered a high grade MCL Sprain in week 3. The original timetable he was given was 4-6 weeks and a return to play this Sunday puts him smack in the middle of that timeline. According to most reports he was really close to playing last week, but held off to get an extra week of reconditioning in and has been declared probable for this week. Barring any unforeseen setbacks we will see the return of Big Ben.

Description of an MCL Sprain

The MCL connects the femur, or thigh bone, with the lower leg (tibia). The MCL’s main function is as a stabilizer of the inside of the knee. Unlike the anterior cruciate ligament (ACL), which can often be torn in non-contact situations, the MCL is usually injured by direct contact through a force directed to the outside of the knee, called a valgus stress.

A good example of this type of blow is the clip block in football. The impact to the outside of the knee results in a stretch, sprain or tear of the MCL on the inside of the knee. There is a good reason this type of hit is illegal and penalized. MCL sprains also occur in sports where there are a lot of quick stops and turns, such as soccer and basketball.

Treatment: The more minor sprains, like Grade I injuries, may only keep an athlete out of action for a few days to a week or two. Grade II sprains may take from two to four weeks to heal fully. In Grade III injuries, the athlete should expect to be sidelined from four to eight weeks. Usually, once these injuries heal fully, they do very well with a minimum of long-term effects.

Return to play scenarios

1)      Re-injury of the MCL

Using our injury database here is what same season MCL reinjury rates look like:

Total players: 77

Total players with MCL injuries that reoccurred: 14

Total players reinjured in the same season: 2

Total QBs reinjured in the same season: 0

Looking at our numbers there is a very small probability of getting reinjured this season

2)      Playing limited/full

This is a very common injury in football players as a population but a very rare injury for Quarterbacks. Of the 77 players who suffered from MCL injuries only 11 of them (14%) belong to QBs (RBs 46%, WRs 26%, TEs 14%). This gives us a very small sample to work with in determining how likely a return to full ability is. Making it an even smaller sample size is the fact that the majority of those injured QBs do not fit the scenario of a multi game absence. Either they missed one game (low grade MCL sprain) or they missed the rest of their season (high grade MCL sprain). We have two examples that make good comps and give us a range for a QB’s projected stats following a mid-grade MCL sprain.

Matt Hasselbeck: At the age of 30 while playing for Seattle Hasselbeck sprained his MCL in 2006 and missed 4 games. He returned and posted the following splits:

Matt Cassel

Cassel injured his MCL in the preseason and while he missed a good portion of the preseason games he only missed one regular season game. His numbers that year were very Cassel-ian like but were pretty much exactly the same as what he generated the previous year.

There is a huge caveat here in that the re-injury year was with the Patriots while the post-injury year was with the Chiefs.

Let’s assume there are three ranges of outcomes for Roethlisberger: full recovery, Hasselbeck (let’s round up to 5%), Cassel (15%)

The standings for QBs according to the two percentages above are as follows:

If we use this as our benchmark we see that Roethlisberger’s range of outcomes lies between QB5 and QB13. This obviously is a very wide range but we have some anecdotal signals that give us the direction that Big Ben should be on the higher end of this range.

The main signal is Roethlisberger’s ability to play through pain. He has only played a full complement of 16 games 3 times in his career that started in 2004. However, when you take into account the injuries he has suffered and the amount of games he has missed you get an idea of just how tough he is:

• 2012 he suffered an ankle sprain, a shoulder dislocation and rib that dislocated from his spine. He missed 3 games…
• 2011 Roethlisberger fractured his hand – he missed one game
• 2010 he missed four games with a foot fracture, shoulder dislocation and ankle sprain

Most of these injuries would have sidelined players for the rest of the season. Big Ben always is no stranger to injury and always bounces back strong.

The other signal is that he had no setbacks in his reconditioning and that the local beat writers reported that he was ready to go last week but held out to get in one more week of rehab.

With these three pieces of anecdotal information (legendary durability, no setbacks and an extra week as a precaution) we can assume that he is coming out ready to ball with arguably the best weapon-set of any team in the NFL. Our estimate is that at worst he sees a 5% drop-off that will place him in the top 5 QB conversation for the rest of the season.

Dez Bryant

Bryant fractured his foot in the fourth quarter of the week 1 game against the Giants. He was diagnosed with a Jones Fracture, underwent surgery and was given an aggressive 4 – 6 week recovery timetable. All signs point to him being ready to go on Sunday against the Seahawks which would put him at one week removed from the original timetable. During last week’s pregame workout he looked “fresh” and was seen moving and cutting without any limitations.

What is a Jones Fracture?

A Jones fracture is a broken bone in the midsection of the fifth metatarsal of the foot, at the base near the little toe. It can cause pain and swelling if not treated.

It’s challenging to fix as a result of “poor blood supply to that area, a problem that can result in increased healing time and a greater likelihood for refracture.” The injury is primarily caused by stress rather than a single acute instance of contact.

Treatment

There are several ways to treat a Jones fracture, but in the NFL, pretty much every team opts to have players undergo surgery. Odds of reinjury are higher with the Jones fracture than other foot breaks to that area, so surgical procedures are more common than with similar foot injuries. The most common surgery to repair a Jones fracture involves placing a screw into the foot to stabilize the area around the injury and minimize the amount of time required for immobilization.

Typical recovery period is usually around six to eight weeks.

In a paper titled: “Return to Play in National Football League Players After Operative Jones Fracture Treatment” by Lareau, Hsu and Anderson (09/2015) that studied 25 NFL players who underwent surgery for a Jones fracture they found that all players returned to play with 12% requiring revision surgery.

Return to play scenarios

The list of some of the elite and near elite players who have suffered Jones Fractures more recently are: Julio Jones (2011 and 2013), Marvin Jones (2014), Allen Robinson (2014), Hakeem Nicks (2012), Ahmad Bradshaw (both feet 2011), DeVante Parker (2014 and 2015), Michael Crabtree (2009 and 2011).

Any foot injury is a huge concern for an NFL player. Running, cutting, pushing, bursting, jumping all place immense stress on the feet. Add to that the contact that comes with owning the lion’s share of the team’s targets and it’s easy to see how problematic an area this is for an athlete of Bryant’s caliber.

There are three Return To Play scenarios for Bryant:

1)      Reinjures his foot and is shut down for the rest of the year

There are several medical journals that claim a very low rate of reinjury for Jones Fracture (12% in the article mentioned above). There are cases of elite players whose careers were derailed by repeat injuries (Nicks and Bradshaw) but the likelihood that Bryant gets reinjured this season, while present, is not a highly probable outcome.

2)      Suffers a conditioning related injury (hamstring, groin etc)

A huge challenge for any player who has had a long term of absence from team activities is the conditioning aspect. Earlier in the season we did an analysis of the increased chance of injury an elite player has if he misses significant portions of the preseason. If we assume this trend to be constant for players missing significant time in the regular season the likelihood is actually really high that Bryant suffers an injury related to his lack of conditioning or “game readiness”.

Also keep in mind that Bryant already missed the bulk of preseason with a hamstring injury – it’s fair to say that he has not trained properly since summer camp back in June.

Our injury prediction model has Bryant with an extremely high chance of injury going forward for this season.

3)      No further injury but plays limited

There are those players who don’t play well hurt. Bryant is not one of those players. He played with fractured fingers for over a month in 2012 at a super-elite level. This is obviously pure opinion based on observation but I don’t think we will see Dez going out there to act purely as a Roddy White-esque decoy anytime soon.

4)      No further injury and plays full

Bryant has shown himself to be one of the fastest healers in the NFL and has come back from several injuries to play at an elite level the following season. There is a chance that he does come back injury free and produces consistent, elite numbers on a weekly basis going forward.

Cramping his return to form is the “Cassel effect” that has rendered many an elite player useless to fantasy owners. Bryant’s full homecoming party might only kick off once Romo returns from his collar bone injury in the next few weeks.

Final Analysis and Recommendation

Ben Roethlisberger: All signs seemingly point to Big Ben picking up where he left off at his elite level. That’s obviously not only great news for Roethlisberger owners but Antonio Brown, Le’Veon Bell and even Martavis Bryant owners will be salivating at the thought of their players hitting stride down the stretch.

Dez Bryant: It’s complicated. There is a very good chance he suffers a conditioning related injury which could keep him out for a few more games down the stretch. The upside is there though and should he be able to return to form you will be rewarded for holding on to him through the first part of the season. However, you could make the argument to grab on to the buzz surrounding his return and offset any risk of further injury by shopping him to other owners in need of a boost and seeing who you can get for someone banking on his upside.

Foot injury aside, Bryant’s upside is also firmly anchored by Cassel. Even if he is able to play the full slate of games he will most likely only be able to realize his full potential when Romo returns in a few weeks-time.

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