2014 injury outlook: Quarterbacks
A preseason injury outlook on fantasy-noteworthy quarterbacks. This column will be updated throughout the summer, and the latest information will appear toward the top:
Cam Newton, Carolina Panthers: A surprise left ankle surgery in March created a stir about whether Newton would be ready for the fall. Two major concerns have been whether he will still be able to make the type of plays on his feet that earned him runner-up status for this year's "Madden NFL" cover and whether his injury will significantly compromise his work with his receiving corps.
Neither should be a worry. Newton underwent a procedure to stabilize the lateral ankle, something that proved necessary after his ankle didn't respond to conservative treatment. In fact, Newton's ankle had been increasingly problematic for some time; surgery and rehab may ultimately enhance his mobility. Newton has shown positive signs of recovery since coming out of his walking boot, including doing some side throwing during organized team activities with Panthers first-round draft pick Kelvin Benjamin. By training camp, Newton's activity should increase substantially, and there should be no physical limitations as the season rolls around.
Addendum -- Aug. 1: Newton was cleared to return to full activity when training camp opened in July. Although he is gradually increasing the workload on his surgically repaired left ankle, he has no formal restrictions and is participating in all drills. When I visited training camp on July 29, Newton was making his drop backs, stepping fully into his throws and displays the same power everyone has come to expect.
Newton says he can still feel the ankle if he steps on a rock; this is not surprising, as the quick, reactionary movements will be one of the final things to improve. He still has to regain full strength of the lower leg muscles that control ankle stability and regain full confidence on the ankle when changing direction on the fly. He'll likely experience intermittent stiffness and soreness for a period of time as he continues to work his way back to full strength. The most encouraging aspect at this stage is that he is doing as well as should be expected just four months removed from surgery.
Addendum -- Aug. 27: In the Panthers' third preseason game, Newton suffered what was originally described as a contusion when he took a cleat to the back. Coach Ron Rivera later informed reporters Newton actually sustained a hairline rib fracture. Rivera indicated Newton would not play in the team's final preseason game, but expressed hope about Newton's availability for the season opener. The primary issue for Newton with the rib fracture will be discomfort. Between the time of the injury and the season opener, the goal will be to establish early healing and hope the pain subsides substantially. Rib fractures make every movement painful, including breathing, limiting even base cardiovascular training initially. But where Newton may be most challenged in Week 1 is making the hard throws. Throwing requires rotational movement through the rib cage and no amount of external padding or localized taping can completely eliminate that motion. If certain throws are pain-provoking (some are more likely to be than others, such as sharper, cross-body throws) it could affect his performance. Other quarterbacks have played through rib injuries (Michael Vick, Ben Roethlisberger, Tony Romo), with varying degrees of success on the field. Presuming no setbacks, it should not present an issue for Newton beyond the first week or two as the rib heals. The first game of the season, however, could present some difficulties for him.
Tony Romo, Dallas Cowboys: Most years, Romo has actually begun the season healthy; the bigger concern has been how much longer he could hold up physically after taking abuse at the hands of opposing defenses. During the course of various seasons, he has suffered a punctured lung, a fractured clavicle (on his nonthrowing side) and other injuries associated with him being sandwiched between defenders and the hard ground.
Last year, however, Romo entered the season with a health question mark. He began training camp following a "minor procedure" to remove a cyst from his back. Despite initial concerns about how prepared he would be to start the season physically, Romo soon proved he was ready and went on to start every game until, well, his latest injury.
This year, Romo begins camp following yet another surgical procedure, this one a bit more specific and sounding a bit more intimidating, a microdiscectomy to address a herniated disk in his lower back, which affected the nerve to his leg. (When Romo was first injured late last year, he was initially thought to have a hamstring ailment; it was later revealed that the hamstring pain was the result of a pinched nerve related to his lumbar disk injury.) The protocol following such a procedure is fairly straightforward, and the timetable for return to activity sees the majority of athletes coming back within six months. Romo appears to have made steady progress in his recovery, enough to allow him to participate in light offseason workouts and organized team activities. Both he and the Cowboys anticipate his full participation in training camp.
At this point, there is no reason to think Romo won't be ready to start the season. The biggest concern for the quarterback will be what it has always been: Will he have enough protection against opposing defenses that, given his accumulation of various injuries throughout his career, see an even bigger bull's-eye on his back?
Addendum -- Aug. 1: Romo was cleared to return to practice when training camp opened, but his participation has been inconsistent thus far. On the first day of camp, Romo was on the field, participating in some drills but moving slower than his quarterback counterparts. During handoff drills, Romo turned soft corners at a trotting pace. Passing drills appeared to be more a matter of going through motions to re-familiarize his body with the work of football movements. Romo then took the next day off and has since participated intermittently.
As ESPN.com's Todd Archer reported, Romo may not play in the first preseason game. Thus far, this is not alarming from a medical perspective when one considers he is coming off surgery to address a herniated disc. The small abdominal and spinal muscles that are the focus of rehabilitation need to transition from basic spinal stabilization in a controlled (rehab or gym) environment to the dynamics of football, all of which takes time and happens gradually. Romo's assessment is perfectly reasonable and sensible.
"It's just a little unknown so you'd rather play it safe than be silly and just go out and do everything over and over again and all of a sudden have to sit out for a week or so," Romo said. "I think more than anything we're playing the long game and I think that's smart."
Addendum -- Aug. 27: Romo didn't play in the first preseason game, as expected, but he did play in the second and the third. His appearance should have put most concerns to rest. He did not appear apprehensive, he made some long-range throws, he even took a few sacks (and got back up). And he has emerged no worse for the wear. Romo will be ready to start Week 1 and while the Cowboys have their share of concerns, his readiness to start the season is not one of them.
Sam Bradford, St. Louis Rams: Bradford's season ended early when he tore the ACL in his left knee in October. For a player who has absorbed so much punishing contact in his short career, this latest injury and the questions that come with it regarding his durability have to be extremely frustrating.
Frustration aside, Bradford has been diligently rehabbing his knee since undergoing reconstructive surgery. He did some light throwing during OTAs, is expected to be a participant in training camp and should be ready to start the season. Quarterbacks coming off ACL surgery are typically a bit tentative in the early going when facing opposing defenses, a little nervous in the pocket as they get a crowd around their legs and perhaps a little quicker to run out of bounds when no play is available. It's tough to argue with the protective mindset, especially for someone like Bradford, whose early NFL years were shaped by excessive contact. Bradford should see some preseason game action that will offer some early insight into just how comfortable and effective he looks under center.
Addendum -- Aug. 27: Bradford suffered an injury to his ACL-reconstructed (left) knee in the team's third preseason game. He is expected to undergo revision surgery and will not play in the 2014 regular season. The Rams have placed him on injured reserve. Shaun Hill will take the reins at quarterback instead.
Eli Manning, New York Giants: Manning's inconsistent performance may try the patience of fantasy owners, but there's one area where he's been remarkably consistent: his health. Anyone familiar with the NFL can appreciate that staying-on-the-field skills are about as difficult to master as any other, perhaps requiring a bit of luck to be thrown into the mix. Still, this Manning has done it as well as -- make that better than -- anyone, missing zero games since becoming the starter in his 2004 rookie season. None. Zero. Zip. He has played in every game, which is as remarkable a stat as there is in the NFL.
It doesn't mean he hasn't sustained some injuries along the way, even if minor. The ankle injury he managed to play through last year did not let up entirely after the 2013 season. When he was continuing to experience discomfort in his left ankle, the medical determination was that surgery was in order. He made a visit to Dr. Robert Anderson for what was termed a "cleanup" procedure and, to Manning's credit, has already shown signs of this being in the rearview mirror. He has resumed running and participated in portions of the team's OTAs. He is expected to be a full participant in training camp and should have no limitations when the season begins. Manning is now 33 years old, however, and one has to wonder just how long his body will sustain his amazing consecutive games streak.
Addendum -- Aug. 1: Manning was cleared for full participation at the start of camp, and has had no limitations with his ankle. As ESPN.com's Dan Graziano reported, Manning has shown "no ill effects" from his offseason surgery. He may even play when the Giants open preseason competition against the Bills in the Hall of Fame game on Aug. 3.
Robert Griffin III, Washington Redskins: What a difference a year makes. At least that's what Griffin and his teammates, coaches, fans and fantasy owners are hoping for as he heads into the 2014 season. Last year, Griffin was recovering from a revision (second) ACL reconstruction surgery and an LCL repair on his right knee. Even throughout training camp, as he continued to steadily increase his activity, his readiness for Week 1 remained in question. Although Griffin was on the field to start the season, he appeared tentative at times, as if he was not quite ready for competition and not yet confident in his reconstructed knee. Despite this being his second experience with ACL surgery, the level of competition and speed of the game were different. When the Redskins were out of contention, then-coach Mike Shanahan put an early and protective end to Griffin's season.
Now, another year removed from both the injury and the subsequent rehabilitation process, Griffin is better poised to enter the season focusing on football as opposed to his knee. Offseason workouts with teammates and the opportunity to participate in a full training camp should better prepare him to hit the ground running in Week 1. He should not have any limitations in his mobility, and his agility should be improved this year over last. Running has always been a component of Griffin's game and should continue to be, although perhaps not to the same degree of frequency. That should be a consequence of football decision-making, however, not health.
Peyton Manning, Denver Broncos: If there were any real questions about Manning's health and his ability to perform in the aftermath of cervical fusion surgery, those should have been put to rest after last year's performance. The only reason he's even included here is because his contract agreement required him to undergo a postseason evaluation to confirm that his neck was still healthy enough to allow him to play. Following a cervical fusion, there is always the possibility of associated degenerative changes at adjacent vertebral levels, although they may not present themselves until a number of years later. Manning was given the all clear after undergoing his evaluation this spring, and other than simply being another year older, there is little to suggest he will show substantial evidence of physical decline.
Jay Cutler, Chicago Bears: Cutler missed five games last year due to injury (high-ankle sprain, groin), and suddenly it appeared he might also lose his job. Ultimately he returned to finish out the year, overcoming his predicament on both counts. But Cutler now has enough seasons under his belt to be able to fairly state that his missed games within the past three years are cause for some concern. He has not played a full slate of games since 2009 and has missed substantial time two of the past three seasons. The question at this point for Cutler is not whether he will enter the 2014 season healthy but how long he will last.
EJ Manuel, Buffalo Bills: Manuel injured both knees last season, and the question for fantasy owners is whether this was a fluke occurrence or a sign of injury issues to come. Manuel underwent a surgical procedure in January on his left knee, a cleanup procedure on the knee (LCL) he sprained late last season, the same knee in which he tore the meniscus in August that caused him to miss some preseason action. In Week 5, he sprained the LCL in his right knee and missed the following month. Heading into this year's training camp, Manuel does appear healthy and was even participating in team offseason workouts in April. According to ESPN's Mike Rodak, Manuel plans to wear a brace on at least his left knee, the more vulnerable of the two to contact when he's in the pocket. Still, for a quarterback who has demonstrated increased value with his mobility outside the pocket, he has also shown increased vulnerability with exposure to contact. There is a certain element of physical risk combined with performance-related uncertainty when it comes to Manuel's outlook for 2014.
Jake Locker, Tennessee Titans: Locker's season ended early due to a Lisfranc injury suffered in November that required surgery. In March, he had a follow-up procedure to have the stabilizing hardware removed and has slowly but gradually been increasing his activity. Although he was limited during OTAs, Locker did participate in some drills and appears to be on track to start the season, presuming no setbacks. The bigger concern might be Locker's global health history. Beyond last year, when the Lisfranc injury and a prior hip injury limited him to just seven games, Locker played in just 11 games in 2012 due to repeated injury to his nonthrowing shoulder (for which he had surgery prior to the 2013 season).
Brian Hoyer, Cleveland Browns: Hoyer is coming off October ACL surgery on his right knee, and the concerns are essentially the same as they would be for any quarterback, mobility and confidence in the knee.
Throughout OTAs, the coaching staff suggested Hoyer's progress has been excellent, and coach Mike Pettine indicated Hoyer was clearly in the lead as the starter -- for the time being. With an eager Johnny Manziel in the wings, the competition can only encourage Hoyer's progression, barring any setbacks. It will be worth watching how he performs in camp and any preseason action to gauge both his confidence in the pocket and his mobility outside of it.
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