The Dreaded ACL

By: Eric Schuettenberg

Year after year, NFL players are decimated with injuries. An injury that seems to continuously grow each year is the torn ACL (Anterior Cruciate Ligament). The ACL provides stability in the knee by resisting anterior translation or forward movement and medial rotation or rotation towards the inside of the knee. 

The structures of the right knee are shown above. Photo from Wikimedia Commons. 

The structures of the right knee are shown above. Photo from Wikimedia Commons. 

This is injury may occur with or without contact. Once an athlete suffers a full ACL tear, the ability to plant or turn while running becomes impossible as the athlete will lose stability in the knee. The video below displays an example of the instability in the knee once the ACL is torn. 

Following this ACL tear, an athlete requires surgery to repair the tear and return stability to the knee. This can be completed with the use of a few different tissues. The gold standard is to utilize the middle one-third of the athletes own patellar tendon but the athletes hamstring tendon or a cadaver tendon can be used as well. This is often dependent on the surgeon, how strong the potential graft sites might be and if the athlete has had previous ACL surgeries.

Once surgery is complete the athlete will return home in a brace for a few days to begin Physical Therapy. During the first two post-operative weeks, the athlete will focus on restoring range of motion without in knee for bending and straightening as well as begin to reeducate the quadricep muscle. The athlete will begin to return to walking without a limp and progress exercises to include hip and knee strengthening utilizing body weight and machines in the gym. The athlete will continue to normalize range of motion in the knee, utilize challenging balance activities and improve strength in their core, hips and knees while also working on functional activities such as lunges.

At around the three month mark following surgery, the athlete will begin jogging activities. This means the athlete has gained back approximately 80% of his pre-injury strength. Athletes using the patellar tendon graft can typically return to jogging and agility a few weeks before athletes who used hamstring tendon or cadaver grafts which can be important depending on the timing of the injury with regard to the athletes return to football. During the next few months, the athlete will continue to work on strength and return to activities with the use of sport specific drills such as agility ladder, cutting, jumping, conditioning and plyometrics.

The final timeframe for an NFL player to return to full participation in typically 6-9 months. We all know the Adrian Peterson story, torn ACL and MCL during the last week of December in 2011 and return to not only start week 1, but to take his first carry 78 yards to the house only 8 months after his surgery. He went on to finish the season just nine yards short of breaking the single season record for the most rushing yards. This was an incredible feat and is not the norm with regard to timeframe. For a more realistic reference, Todd Gurley suffered his torn ACL in early November of 2014 while at Georgia and made his NFL debut on September 27, 2015 with limited touches which means it was approximately 10 months before he was back. Gurley finished last year with over 1,200 scrimmage yards and 10 TDs and most are expecting that to improve this coming season.

For full-disclosure, there can often be additional injuries coupled with a torn ACL. Depending on the mechanism of injury sustained the athlete may also injury the meniscus, MCL, PCL, LCL, or suffer a micro fracture. There are specific guidelines that would alter rehab with each of these additional injuries.

This Changes Everything: The First Round

Reactions to the 2015 season and it's effects on 2016

Eric Schuettenberg

The Fantasy Football PT

The 2015 NFL season has now come and gone, and while a small portion of the fantasy football world is left rejoicing, the remaining team owners are left counting the numerous injuries that plagued their teams all season. This football season was particularly riddled with injuries leaving behind a trail of concussions, torn ligaments, broken bones and more. Couple the amount of devastating injuries that occurred this year with the wacky fantasy year that was, and people are left with an incredible number of questions heading into the fantasy offseason. Through this article series we will take a look as reactions through the fantasy football community and what effects it will have on the 2016 season.

As we look back on the first round picks of 2015 and begin to make preparations for the 2016 draft, we review evidence to make strategic changes to these first round picks. 7 out of the first 12 picks in 2015 were RBs, AP finished as the second best running back, Matt Forte finished as number 9, two of these RBs were hurt by season ending injuries and 3 finished outside the top 10. 3 out of the first 12 first round picks were WRs, each of these 3 WRs finished within the top 10 with Antonio Brown and Julio Jones finishing in the top 2 respectively and Calvin Johnson finishing as the 9th best receiver. Rounding off the first round, the final two picks included Aaron Rodgers and Rob Gronkowski. We will discuss Aaron Rodgers and drafting quarterbacks in a future article. Gronk, is simply by far and away the best at his position and finished as such.

What does this mean for 2016? Historically RBs have dominated the first round. Is this due for a change? The NFL is changing, with injuries mounting and running back by committee becoming more of a trend, is WR the safer first round pick. At this moment, I believe that we will see a drastic change toward a WR heavy first round. The top 12 WRs averaged 9.75 targets per game compared to 17.67 touches/targets per game for the top 12 RBs. If we take a look at average fantasy points per game we will see that the top 12 RBs in 2015 scored 11.64 fpts/game and the top 12 averaged 12.73 fpts/game. There are many variables that play into these statistics but if we look as this initially, we can see that WRs seem to be more efficient with their usage, with almost 8 less targets, WRs are scoring over a point more per game than RBs. To apply this to the possibility of injury, RBs will be hit and tackled on average, nearly 8 more times per game, which one could argue would increase their risk for injury. Based simply on the above statistics it does seem to present the idea that WR would be the safer first round pick in 2016.

Another factor in the RB vs WR debate is position scarcity. This argument has been made year after year as to the rationale for taking a "stud" RB in the first round since there are naturally more fantasy producing WRs than fantasy producing RBs due to NFL formations, snap percentages and RBBCs. We will take a very focused look at the Arizona Cardinals for an example. This is a very balanced team with the second best scoring offense during the 2015 regular season. The top three runnings backs are David Johnson with 37.4% snap percentage, Chris Johnson at 33.2% and Andre Ellington at 19.3%. The top three wide receivers are Larry Fitzgerald with 89.2% snap percentage, John Brown with 74.9% and Michael Floyd with 59.1%. These statistics are only one simple example but lets break this down. Chris Johnson began the year as the lead back in Arizona and prior to his injury, was one of the top fantasy backs in the league. Following his injury, David Johnson assumed that role to also become one of the best fantasy backs in the league. This displays a simple fact; there was only one running back to own and start from the Arizona Cardinals each week. If we look at WRs we will see a very different tale, we see that these three were very viable options in fantasy, week to week, when healthy. This is taking a very small sample and applying it to the entire NFL community but as a whole there are significantly more fantasy significant WRs than RBs leading to the position scarcity at RB.

At the end of the day, you want your first round pick to stay healthy, be consistent and be a true cornerstone of your fantasy team. So what will be your number one pick? Will you take the Wide Receiver or the Running back?