It’s officially that time of the year, fantasy football draft prep! With just over two weeks before the Bills and Rams kick off the season on September 8th, fantasy players worldwide are joining together to prepare for the upcoming season. Aside from scouting average draft position (ADP) and participating in endless mock drafts, fantasy players must pay attention to the health of their favorite players. In 2022, fantasy football injuries are prevalent, and there is much confusion about what to make of some of our favorite players.
At the Fantasy Injury Team, we utilize a combination of understanding injuries inside out and providing our fans with the stats on how players perform after injury to help make the best decisions. Our knowledge of anatomy, cause of injury, and rehab process, combined with our clinical experience treating athletes with these injuries, guides our analysis of each player.
Today we will start with arguably the most prized position in fantasy football, the running back. We will discuss the major running backs coming off a season-ending injury in 2021 or who have already dealt with injuries early in camp.
The Elite
Christian McCaffrey: ADP RB2
No player can stuff a stat sheet like CMC. Over the past three seasons, he has averaged an astounding 24.8 ppg in half-point PPR formats. The issue, of course, is durability. In the past two seasons, he has only finished 8/33 games (24%). That’s not good! Let’s dive into the impact of his injuries on his long-term outlook.
- High ankle sprain (2020) – Missed 6 games
- AC joint sprain (2020) – Missed 4 games
- Thigh strain (2020) – Missed 4 games
- Hamstring strain (2021) – Missed 5 games
- Ankle sprain (2021) – Missed 5 games
First, an AC joint injury is caused by falling or being hit in a specific way that would typically injure anyone’s AC joint. I am not concerned about this one at all going forward.
The ankle sprains are the concerning injuries here, especially because he missed so much time, indicating they were fairly severe. Clinically, after severe ankle sprains, we often see a decline in the ankle joint’s range of motion (ROM). This stiffening of the ankle can impact the function of the entire lower body.
Specifically, a stiff ankle decreases shock absorption (increasing forces elsewhere in the body) and can lead to weakness of the same-sided glute muscle. When the glute muscle becomes weak, muscles like the hamstring, groin, and low back must work harder to compensate. This can often be a factor in injuries to these muscles (McCaffrey has a history of two thigh muscle injuries).
There is no denying injury risk with CMC. Fantasy football players must decide if his almost unlimited upside outweighs this risk. At only 26 years old, when on the field, nobody has a higher floor and a higher ceiling.
Derrick Henry: ADP RB 4
The king was on a dominant pace last season until fracturing his foot in week 8, ending his fantasy season. He was able to return for the divisional round of the playoffs and found the end zone once again. There appears to be a concern in the fantasy community about Henry, who does have 1,495 career touches. That being said, his injury history is a short list.
- Calf strain (2016) – Missed 1 game
- Hamstring strain (2019) – Missed 1 game
- Foot fracture (2021) – Missed 9 games
The first two injuries on this list were minor, as he only missed one game each and several years ago. I am not concerned at all about these. The foot fracture is intimidating on the surface, but this is the same injury we saw Deebo Samuel suffer in the 2020 offseason, and we can all agree he looks just fine now!
This type of fracture heals just fine, and Henry has had a whole offseason to rehab and train at full speed. If you avoid Henry in drafts, it should not be because of this injury.
D’Andre Swift: ADP RB8
Swift was electric last season, at RB7 through the first 11 weeks of the season. With all eyes on Detroit this training camp with HBO’s Hard Knocks, the fantasy community is eager to know if we can trust the elusive three-down back after he burned many fantasy players with a late injury rendering him unavailable for much of the fantasy playoffs.
- Concussion (2020) – Missed 2 games
- Groin strain (2021) – Did not miss time
- AC joint sprain (2021) – Missed 4 games
The injury history is short and, overall, not very concerning. While the medical research suggests groin injuries have recurrence rates as high as 18%, this typically occurs within a few months of injury. He is now a full year clear of this injury and is not a concern at this time. Interestingly, even with groin injuries, we see almost no decline in fantasy performance when running backs return. As mentioned above with CMC, we are not overly concerned about recurring AC joint sprains either, as this type of injury occurs from an awkward fall or a perfect hit.
Saquon Barkley: ADP RB10
One of the most polarizing players on fantasy football Twitter right now. Fantasy players don’t know what to make of the ultra-talented running back. Like CMC, Saquon possesses the rare, elite talent and is in a position to see many carries and targets. The concern is that he has missed a large part of the last two seasons due to injury.
- High ankle sprain (2019) – Missed 3 games
- ACL/MCL tear (2020) – Missed 14 games
- Low ankle sprain (2021) – Missed 4 games
The ACL/MCL is well documented to impact players’ performance, especially running backs showing a significant decline in fantasy points in their first year back from injury. This is because players are cleared to play when the injured leg tests at 90% of the un-injured leg in several different strength, balance, and functional tests. We know that at the NFL level, the difference with 90% and 100% can be the difference between the elite and not elite. The last 10% takes a long time and effort to re-gain, which is why we often see year two post-ACL when players return to their pre-injury levels.
Knowing this, the ACL/MCL history is not likely to impact Saquon’s performance anymore. However, similar to CMC, we discussed how a history of severe ankle sprains can impact mechanics, rendering a player prone to injury. We can’t predict injury, but fantasy players must at least acknowledge that Saquon is at a higher risk for a future injury than some other players.
That being said, also similar to CMC, the upside is tremendous. Fantasy players will have to weigh the risk vs. reward on who could very well be a league winner if he can stay on the field.
The unproven
Cam Akers: ADP RB 15
We all know the story here. Akers tore his Achilles in July of 2021, we all assumed he would miss the entire season, but he miraculously returned for the Rams Superbowl Run. A fantastic story, and certainly hope that the medical advances in surgery and rehab can change the historical course of this injury. Akers enters 2022 as the starting back for the high-powered Rams offense.
- Rib injury (2020) – Missed 2 games
- High ankle sprain (2020) – Missed 1 game
- Achilles tear (2021) – Missed 16 games
As impressive as his speedy return was, he did not perform well. This is, unfortunately, how it tends to go with this injury. Running backs have never returned to their prior level of performance after an Achilles tear.
The Achilles tendon is the strongest tendon in the human body and must take on up to 10x body weight in force! For a 200lbs running back, that is 2,000lbs of force! Medical research shows that the strength of the calves on the surgical side averages 10-30% weaker compared to the non-surgical side, and the muscle endurance is only 52-88% that of the non-surgical side. This deficit lasts even several years after surgery! Running backs must be able to generate tremendous force through their Achilles. This unfortunate inability to regain the muscle strength and endurance is a significant factor in why it is so hard to return.
That being said, medical advances in surgery and rehab are constantly occurring. Some day we will see a running back who successfully returns from this injury. Fantasy players must decide if they want to risk betting correctly on Akers being the first to do so.
Travis Etienne Jr.: ADP RB 19
Etienne is another tricky one to assess heading into the 2022 season. A prolific runner and pass catcher in Clemson and a first-round draft pick in 2021, Etienne’s rookie season ended before it ever started due to a Lisfranc injury in the preseason. Now he enters as the presumed started alongside James Robinson, who is recovering from a late Achilles tear.
- Lisfranc injury (2021) – Missed entire season
The good news for Etienne is he had an entire year to rehab from his injury. Historical data on the Lisfranc injury in running backs is somewhat scarce, but the trend shows that young players have no trouble returning from this injury (Le’Veon Bell, Julio Jones). Old players appear to be significantly impacted (Alshon Jeffery, Ronnie Brown). Fantasy players should not fear this injury when considering drafting Etienne this year.
J.K. Dobbins: ADP RB 25
Dobbins is a promising 3rd year RB coming off an injury that ended his Sophomore year before it started. There was a lot of concern a few weeks ago when Dobbins started camp on the PUP list, despite having nearly a full year to rehab. Dobbins now appears ready to be the week one starter for Baltimore’s run-heavy offense
- High ankle sprain (2019) – College
- ACL tear (2021) – Missed entire season
Unlike Barkley, Dobbins is in year one after his ACL injury. Running backs historically do not perform well in year one after this injury, especially early in the season. However, what works in Dobbins favor is that he will have had more time to rehab than almost every other back in the sample size. We discussed with Barkley how the last 10% of the surgical leg’s strength, balance, and function takes quite a bit of time. While it is unlikely he will be at 100%, he should be closer to 100% than most backs coming off this injury.
If fantasy players choose to use valuable draft capital on Dobbins this season, it is wise to make sure you have replacements at the position for the first few weeks of the season as he continues to recover from his injury.
Rashaad Penny: ADP RB 30
Penny, a former 1st-round pick finally showed what he could do during a miraculous run to end the 2021 season, finishing as the RB 1 from weeks 14-18. Before this, Penny’s career had been largely impacted by injury. To the surprise of some, Seattle elected to take talented running back Kenneth Walker in the second round of the 2021 draft, creating competition for Penny in the backfield.
- Finger fracture (2018) – Did not miss time
- Knee strain (2018) – Missed 2 games
- Hamstring strain (2019) – Missed 2 games
- ACL tear (2019) – Missed rest of season
- Knee strain (2020) – Missed 1 game
- Calf strain (2021) – Missed 5 games
- Hamstring strain (2021) – Missed 1 game
- Groin strain (2022)
Penny’s laundry list of injuries is quite concerning. We know from the medical literature that a previous history of a hamstring injury increases the likelihood of another by 2.7x, that groin injury recurrence is as high as 18%, and calf muscle recurrence is as high as 16%. All that being said, this does not guarantee he will get re-injured. Fantasy players should understand that while we can outline risk factors for injury (previous injury and age are the two most predictive), nothing can guarantee injury.
Up Next
Make sure you check back in later this week for the second half of the running back injury breakdown! As always check out our podcast, currently on Spotify, soon to be on Apple as well!
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