It happened. A unanimously beloved player, LA Rams receiver Cooper Kupp has suffered an injury to his right ankle that will keep him out for several weeks. As the defending Super Bowl Champion Rams season spirals out of control, Let’s talk about Cooper Kupp’s injury status and rest-of-season outlook. Can you rely on him in fantasy?
Cooper Kupp’s Injury Mechanism
We had a clear video of Cooper Kupp’s injury. We can see that Kupp’s right lower leg gets hit from the outside as his foot is planting, causing his lower leg to twist on a planted foot. This is a classic mechanism for a high ankle sprain.
A direct blow to the lower leg can also cause a tibia or fibula fracture. Kupp was seen struggling to bear weight after the injury, which often is a sign of fracture. In the medical world, when a person suffers a foot or ankle injury and cannot bear weight for four steps, it’s an automatic referral for an X-ray. Luckily, Kupp did not suffer any fractures.
Cooper Kupp’s Injury Anatomy
To understand a high ankle sprain, we must know the anatomy. The tibia and the fibula are the two bones of the shin. The tibia is the larger and takes on most of the weight-bearing role. The talus is a bone in the foot. The tibia and fibula sit on the talus to create the ankle joint. These bones are held snuggly together by several ligaments. The main ligaments involved in a high ankle sprain are the Anterior Inferior Talofibular Ligament (AITFL), the Posterior Inferior Talofibular Ligament (PITFL), the Interosseous Membrane (which connects the tibia and fibula), and the Deltoid ligament.
In a normal situation, the ligaments mentioned help hold the tibia, fibula, and talus together. The relationship between these bones and ligaments creates a stable ankle. An athlete can quickly push off to run and cut when the ankle is stable. A high ankle sprain is when one or several of these ligaments get injured. The injury to these ligaments causes the tibia and fibula to separate to some degree, creating pain and instability in the ankle.
Pain impacts athletic function, as an athlete cannot create as much power when pushing off the ground to run or cut. Instability also affects function, athlete’s cannot push off as hard when running or cutting. Think of it like this, if you are in a kayak and attempting to push away from the dock, is it easier to use a rigid paddle or a pool noodle? In this example, a healthy ankle is a paddle, whereas a pool noodle is an unstable ankle.
High Ankle Sprain Healing Time
When considering Cooper Kupp’s injury status and the impact on his rest-of-season outlook, we must consider healing times. Like all soft tissue injuries, there are different grades of severity. An NFL team will seldom give us this information, but we can do our best to determine the most likely grade based on reports. Kupp is expected to miss. Reports so far have been all over the place, but for the most part, they are not optimistic.
If Kupp’s injury were a grade I high ankle sprain, which involves injury to the AITFL and minimal loss of stability (different sources use different grading scales), reports would be much more optimistic. Historically, some receivers have missed 0-2 games due to a high ankle sprain (TY Hilton 2018, Terry McLaurin 2020). These guys likely had a grade I injury.
Kupp is expected to miss more time than two games, meaning he has either a grade II or grade III injury. With a grade II-III injury, the ligaments no longer appropriately hold the tibia and fibula snuggly on the talus. With grade II-III high ankle sprains, players experience instability in the ankle joint. This was discussed recently with Mac Jones as he attempted to return quickly from his injury.
Scientific research on athletes shows that grade II high ankle sprains average 45 days to return to competition, and grade III injuries average 10-14 weeks. These numbers would put Kupp’s rest-of-season outlook in doubt. NFL players, however, can often return sooner than the average timelines suggest as receivers average missing 4.4 games.
High Ankle Sprain Rehab
The grade of the sprain influences the rehab tremendously. Grade II-III sprains often need some external stabilization. This can be casting, wrapping, bracing, or in severe cases, surgery. As mentioned, the more significant sprain leads to a gap in the tibia and fibula. This must be corrected. Correction of the gap is most efficiently performed via the above-mentioned methods to hold the tibia and fibula together, allowing proper healing.
Kupp will likely use a boot and crutches for a few weeks to protect the injury. This protection phase is often 7-10 days but can be longer. Regaining range of motion is paramount. With severe foot and ankle injuries, we often see persisting stiffness that may last for years. Ankle mobility is our main shock absorber; without proper ankle mobility, forces into the knee, hip, and back are increased. The Rams medical staff must help Kupp regain motion into dorsiflexion (foot pointing up) as soon as he can tolerate it.
As pain subsides and range improves, Kupp will have to regain strength and balance. Balance is key. Proprioception is a term indicating a person’s awareness of their body in space. This is huge for athletes. Proprioception allows a receiver to look at the ball to make a catch and properly place their foot on the ground to land safely. Proprioception also allows players to look downfield while accurately planting their foot to cut. Ligaments are a major source of proprioception, and injury to ligaments impacts an athlete’s ability to know where their foot is without looking at it. This becomes a major part of rehab, utilizing unstable surfaces such as Bosu balls, wobble boards, and other unstable surfaces to re-train his balance and proprioception. The twitter video below shows Alvin Kamara performing several proprioception driven exercises.
For Kupp to play, he must demonstrate adequate stability on one leg. This is determined via various tests such as (but not limited to) the Y-balance test and several single-leg hop tests. Kupp will also have to show he has regained his speed and ability to change direction.
Cooper Kupp Rest-of-Season Outlook
The rehab process listed above varies in the timeline. High ankle sprains are unique, and each player progresses at a different rate. Kupp is different than most. He returned from ACL surgery in just 43 weeks and played tremendously. This injury, however, may be different. The Rams season is unwinding quickly, and by the time Kupp returns, they may have nothing to play for.
| Wide Receivers Returning From High Ankle Sprains | Games Missed | PPG 1st Game After Injury Compared to Pre-Injury | PPG Games 2-3 After Injury Compared to Pre-Injury | PPG Games 4-6 After Injury Compared to Pre-Injury |
|---|---|---|---|---|
| Average | 4.4 | -2.4 | -1 | -2.9 |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 4/11 (36%) | 7/11 (64%) | 6/10 (60%) |
At best, Kupp will return in week 14, but this is a stretch, with week 16 being more realistic based on the current reporting. Week 16 is fantasy playoffs. Additionally, data suggests a notable decline in receiver fantasy output in their first game returned from a high ankle sprain. The combination of missing several weeks and being unlikely to be dominant Cooper Kupp when he returns puts a grim outlook on the remainder of Kupp’s 2022 season. Fantasy players should try to trade him if they can.
New information from multiple sources now says that Kupp will be having “tightrope surgery” on his high ankle sprain. Does this push his potential recovery time past the end of the regular season?
Not necessarily. The typical timeline is 6 weeks, but Tua returned in 4 in college. The difference is Tua was 10 years younger than Kupp is now, and Tua had a national championship to go win. The Rams may not be playing for anything and may just shut him down.
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