2020 Injury Outlook – Running backs

I began this article just after the conclusion of the Super Bowl in early February. A belated congrats to the Chiefs, and former Eagles’ head coach Andy Reid! Hard to believe just about two months ago, we were living our lives as normal, waiting for Spring to arrive, and checking dates off the list in the countdown to the return of football. Now? Well now, now, I’m not sure what we have. We have uncertainty. How will the rest of the offseason pan out? Will the NFL season start as planned? Will there be fans? What will be the first sport to return? Are we combating this crisis correctly? Will I be working next week? Will my family be ok? Will we ever return to the lives we once knew? Uncertainty is all we have in these trying times, living day by day trying to comprehend and deal with this new life. What we do know, is that this will not be forever. By taking the right steps, and being a good husband, wife, sister, mother, brother, father, friend, neighbor, etc, etc, we will once again have our lives back. Will they be exactly the same as they once were? I’m not sure. Should they be? Again, I’m not sure. But for now, let’s continue to take this day by day, and just LIVE. That is one thing I know we do have. LIFE. And now, let’s get to what you came for, the 2020 injury outlook on running backs!

Saquon Barkley – High Ankle Sprain

While Saquon Barkley is technically not hurt at this point, his injury during the prior season begs discussion going forward. Saquon came out of the gates HOT, starting his season with back to back 100+ yard rushing games against Dallas and Buffalo. Week 3, unfortunately, shut down that momentum as Barkley suffered a high ankle sprain against the Buccaneers. In typical superhero Saquon fashion, the star Giant running back returned from the injury after missing only 3 games. Which, on its face, is quite impressive, but is also WAYYY too soon to return from that type of injury (I’ll get into that more later). From weeks 7-14 Barkley put up some decent to good games, but never topped 83 rushing yards over that six-game stretch, and only accounted for two total touchdowns…not what you’re looking for from the consensus #1 overall pick in drafts. But then, just when you needed him (if you made it to the playoffs), he likely won you a title after 2TDs and 143 total yards in week 15, and 279 (!) total yards and 2TDs in championship week. Both weeks, Barkley went up over 100 yards rushing for the first time since week 2. So then why did it take so long for “Saquads” to return to top form? I mean, he was able to return in week 7, WHAT THE HECK?!

Well, looking at the injury specifically, high ankle sprains are caused by a foot that gets planted and turned outward while the body continues moving forward. This outward turning of the foot causes strain and separation of the tibia and fibula which disrupts ligaments and (obviously) results in significant pain. Saquon’s mechanism of injury was also quite forceful and high impact leading to a likely more severe sprain, as his injury was caused after leaping and landing on the foot followed by a Tampa defender latching onto his ankle. Typical return to play after high ankle sprains is anywhere from 3-6 weeks in NFL players. That being said, the mentioned return to play timeline is certainly NOT the time it takes for full healing. A complete recovery on average takes 2-3 months (or more). Looking at this timeline, it makes sense as to why Saquon took EXACTLY 3 months (12 weeks) to return to his elite form. High ankle sprains have a significant effect on a player’s elusiveness, most notably with lateral mobility, a staple in every running back’s game. Without his elite lateral quickness, Saquon is simply not Saquon, as we saw during a seven-week stretch after returning from injury. Once he hit that 12-week mark, Saquon was BACK. High ankle sprains do not have a particularly high reoccurrence rate, therefore there should be NO HESITATION inserting Saquon back near the top of draft boards. Year two for Daniel Jones, and, say what you want about him, but Jason Garrett, new OC for the Giants, was at the helm for Ezekiel Elliott’s career fantasy finishes of  #2, #9, #5, #5, and I don’t think it’s a stretch to say Saquon is more talented than Zeke. I’ll have Saquon at #2 on my board going into next season.

Best Case Scenario: Saquon gets his 2nd full season, Jason Garrett continues to feature the running back on offense, Daniel Jones takes a leap forward, the offensive line improves, and the defense stays bad. Surrounded by the solid talent around him on offense, and needing to score a lot to win games, Saquon is once again the centerpiece and finishes the season as THE #1 RB in fantasy with 2000+ yds, and 15+ TDs.

Worst Case Scenario: Injury would NOT be the main concern as to why Saquon has his worst-case scenario in 2020, which, barring an unpredictable season-ending injury, would be a back-end RB1. For this scenario to happen, the Giants would have to neglect the O-line (they’ve done it before), Daniel Jones would have to flop in year two, and the team as a whole, led by first-year HC Joe Judge, would have to once again be a bottom feeder in the league.

Alvin Kamara – High Ankle Sprain

After an RB #4 finish in 2018 on the back of 18 total TDs, Alvin Kamara finished 2019 as the RB#16, with only 6 total TDs. While the variance in touchdowns (-72 fantasy points from ’18 to ’19) would be an easy way to explain away Kamara’s (relatively) down year in 2019, there’s more to the story than just touchdowns. Since Kamara’s stellar rookie year when he averaged, an impossible to maintain, 7.7 yards per touch, the Saints’ young star has steadily declined in the last two years dropping to 5.8 and 5.3 yards respectively in the last two years. Touches were relatively close between ’18 and ’19, 275 to 252. Also, random stat, Kamara has had exactly 81 catches each of his 3 years in the league! So what could have been a cause for Kamara’s decreased efficiency in 2019, as based on the eye test, he didn’t seem to have that same explosion and elusiveness as he did in prior years? Kamara is still a young back (only 24), and talent is NOT an issue. What was an issue was the fact that Kamara missed his first-ever NFL games due to injury as he, like Saquon Barkley, was dealing with a high ankle sprain (and to a lesser degree and MCL sprain).

So, I will not belabor my previous points about high ankle sprain discussed in the Saquon breakdown. But just to emphasize my point on the impact high ankle sprains can have on even the most elite players in the league, Alvin Kamara prior to his ankle injury averaged 116.6 ypg. Pretty nice right? Very worthy of his top 3 ADP billing coming into the year. After the injury? Kamara averaged just 67.5 ypg. Not great. Considering the 8-12 week timeline for a full recovery I discussed previously, Kamara may have not been healthy the entire final 2/3 of the season! Looking at Kamara going into 2020, I have no reservations injury-wise heading into the season. From a talent perspective, he’s arguably the #3 in the league behind CMC and Saquon. A player who can do it all, does not have a significant injury history, and is due for POSITIVE touchdown regression? I think Kamara is easily a top 5 back in 2020. Coming off a down season in 2019, his ADP will likely take a bit of a dip (late 1st/early 2nd). If it does, I’ll have A LOT of shares of Kamara in leagues this year.

Best Case Scenario: Kamara has another season of around 250-275 touches (probably with 81 catches), stays healthy (missed first 2 games of career last year), and experiences an uptick in touchdowns, leading to another top 5 season as Kamara has 1500+ scrimmage yds and 12-15 TDs.

Worse Case Scenario: After another heartbreaking season not finishing in a championship, the Saints take a step back in 2020 as Drew Brees has a notable decrease in performance. With teams not respecting Brees’ mid-deep ball, defenders creep toward the line of scrimmage. Kamara will have less room to run, and not as much open space on dump-off balls. Due to his pass-catching prowess, Kamara finishes as an RB2, but his efficiency statistics continue to fall.

Dalvin Cook – Shoulder

After a hot start to the season, Dalvin Cook finished the season, well, not so hot. Over the first 7 games of the season, Cook had five 100+ yd rushing games. In his final 7 games, Cook had ZERO games over 100 yards rushing and had more than 71 rushing yards in just 2 of those games. Thankfully for Cook’s fantasy owners, he stayed active in the passing game, offsetting the lack of big-time rushing games. A portion of Cook’s lackluster close to the season coincided with a shoulder injury in week 13, followed by another shoulder injury to the opposite side in week 15, which is, obviously, not optimal for a running back. Diving a little deeper into Cook’s prior injury history, makes this situation a little more concerning, despite his ability to return in the NFL playoffs and run all over the Saints.

Since high school, Dalvin has had problems in both shoulders (just as we saw in 2019). Two labral repairs on his left shoulder, and one labral repair on the right. The labrum is what gives the shoulder extra stability as it sits in a small cup on the side of the scapula like a golf ball on a tee. The repeated stress on the shoulders of running backs, in general, is not great for future well-being, but on shoulders with a prior significant injury history, this repeated trauma could increase the risk for further injury as well as chronic shoulder pain and instability. To highlight this point, a 2016 study by Chambers et. al, investigated the effect of labral tears on contact athletes. A key finding, that is worrisome for Cook going forward, is that players without a history of labral tears (on average) play 15 more games in their careers. All this to say that there is an increased injury risk for Dalvin Cook compared to other running backs. Don’t forget, coming out of college Cook was graded as an elite talent, but due to injury concerns (in addition to some off the field issues), he dropped to the 2nd round in the draft. While we typically hear “too much tread on the tires” referring to legs on a running back, I think this phrase can be utilized for Dalvin Cook’s shoulders in the future. Will we see a future load reduction for Cook? Alexander Mattison is pretty…pretty…pretty….good.  The injury concerns will not stop me from picking Dalvin Cook in redraft or dynasty leagues, but I will absolutely utilize this information in tiebreaker situations. Considering the injury history and likely top-5 ADP this year, chances are that I won’t have many Cook shares on my teams.

Best Case Scenario: Cook is able to stay healthy, and with the addition of Gary Kubiak (run-first style), Cook’s game takes another leap forward sending him to superstardom as racks up over 2000+ scrimmage yards and 15+ total touchdowns. Remember Arian Foster? Under Kubiak in 2010, Foster had himself over 2,200 yards. Dalvin Cook talent > Arian Foster talent.

Worst Case Scenario: Cook is banged up early, and the Vikings decide he is unable to carry a bell-cow role. Alexander Mattison works his way into the lineup, forming a split backfield (60%/40% split favoring Cook), severely limiting the upside of Dalvin Cook as he underperforms his top-5 ADP by a wide margin.

James Conner – Shoulder, Ankle, Knee

Despite a breakout campaign in 2018 filling the shoes of Leveon Bell as a true workhorse back finishing the season as the #6 overall running back, there were some troubling signs towards the end of the season as Conner seemed to get banged up on a weekly basis. Coming into 2019, expectations were high for Conner, but he got off to a very slow start before injuries began to pile up and wreck his season both in reality and fantasy. In week 2 against the Seahawks, Conner tweaked his knee, and although this was not a serious injury, it was only the start as Conner then proceeded to sprain his ankle in week 4 against the Bengals. Both of these injuries seemed to be more of the nagging variety, as Conner did not end up missing any time, but likely did affect his efficiency. Finally, just when it seemed Conner had turned a corner, rushing for 145 yards against Miami in week 8, he landed on his shoulder causing an AC joint sprain. This was the injury that would derail the rest of the season for the young Steelers’ back. Conner would be hampered by this injury for the remainder of the season, missing multiple games, and leaving early for others giving fantasy owners zero confidence from week 8 on. So what is it about James Conner that he is seemingly ALWAYS banged up? Well, I think some of it is being unlucky, but I think another portion of it could be what we always inevitably hear about when commentators discuss Conner, his fight with cancer.

While it’s easy to look at James Conner and chalk him up to being “injury prone”, it is at least worth looking into a potential reason WHY Conner is always injured. Now, this hypothesis may not be correct, but the fact that Conner’s injuries have no correlation with each other is a reason to look a little deeper. During cancer treatment, patients will undergo treatments such as chemotherapy, immunotherapy, and steroid medications (among many others). These three medications can lead to long term side-effects relating to bones, joints, and muscles. These effects have been studied in the general population, but HAVE NOT been studied in elite athletes after cancer treatment which is a potential limitation to my hypothesis. Despite this limitation, considering Conner’s injury history, it makes sense. Knowing this, regardless of if the Steelers believe this or not, they can’t possibly think they can rely on Conner as a workhorse going forward, as he’s shown an inability to stay healthy in back to back years. In addition to injury concerns, I am not a big believer in Conner’s overall talent, as even when healthy last season, he didn’t show much as a runner. 

Best Case Scenario: With Big Ben and his beard back at the helm, the Steelers’ offense returns as a top 5 unit. Conner is able to stave off injury, as well as a host of other RB’s vying for snaps in the Steeler backfield, returning him to bell-cow back status. Conner finishes the season as a top 5 running back.

Worst Case Scenario: The Steelers recognize that Conner can not be trusted as a lead back and with a dearth of talented options currently on the roster, the team spends high draft capital on a running back that, at best, will split time with Conner and, at worst, take over for Conner as he is once again in and out of the lineup. Conner is relegated to a backup role by year’s end and finishes the fantasy season on waiver wires.

Josh Jacobs – Shoulder

Another running back with shoulder issues that altered their season. Jacobs originally injured the shoulder in week 7 against the Packers, before being limited in practice much of the rest of the season. Jacobs missed three of the final four contests as we learned the rookie actually had a fracture in his shoulder that likely had been building up and worsening with the continued contact since the original injury in week 7. The stats show a strong showing in his rookie season, finishing with over 1,300 scrimmage yards and 7 TDs (all rushing). But with the shoulder fracture to conclude the season, should fantasy owners be concerned about his future prospects?

The answer is no. Honestly, I’d be more worried about coach Gruden and why he isn’t utilizing Jacobs more as a pass-catching back than I would be about the shoulder. From all reports, of which there isn’t much reporting (for obvious reasons), Jacobs did not and will not require surgery on the shoulder. These types of non-displaced fractures typically do not require surgery (~80% of the time) and will fully heal with rest in 6-8 weeks. For this reason, I have no worry going into the 2020 season from an injury perspective regarding Josh Jacobs. Coach Gruden just needs to LET THE MAN EAT! Realistically, if Gruden features Jacobs more in space as a pass-catcher, he decreases the between the tackles pounding Jacobs absorbed through most of the 2019 season as he only had 20 (!!!) receptions on the year.

Best Case Scenario: Jacobs maintains his 4.8 yards per tote and has his true fantasy potential unlocked as Gruden’s eyes are opened to Jacobs’ skillset (gotta think he knows this right?). According to GM Mike Mayock, the plan is for Jacobs’ to be more heavily involved in the passing game during “Phase 2” (???) of his development. Jacobs in “Phase 2” the young star becomes the face of Vegas and finishes with over 1,700 scrimmage yards and 10+ TDs making him a high-end RB1.

Worst Case Scenario: Jacobs has a high floor generally, so his worst-case scenario to me is basically his 2019 season. I have no injury concerns coming into the season, so my only true concern is Jacobs’ utilization in this offense. At worst (assuming no major injury), I’d expect 1,300-1,400 scrimmage yards and close to 10 total TDs making Jacobs a low-end RB1/high end RB2.

Chris Carson / Rashaad Penny – Hip Fracture / ACL Tear

Double trouble here as the top two running backs on the Seahawks went down for the year late in the 2019 season with some serious injuries.

We’ll start with the lead back from 2019, Chris Carson. After a relatively slow start to the 2019 season that saw him lose a fumble in each of the first three games (NOT IDEAL), the former 7th round pick, rewarded fantasy owners over his final 11 full games, averaging 14.7 fantasy points per game, which would have been good enough for RB7 overall on the season. Additionally, after those three fumbles in the first three games, Carson lost only one fumble the rest of the season. Thank GOODNESS Pete Carroll loves the guy. Unfortunately, after coming off his best game of the season, Carson fractured his hip in Week 16, ending his season. We’ll dive into that shortly.

Next is Rashaad Penny. The 2018 1st round pick missed a significant amount of the 2019 season due to a nagging hamstring injury that lasted much of the season. Finally, though, in week 12 against a formidable Philly front four, Penny emerged, breaking out with 129 yards and a touchdown on the ground. He then followed up his Week 12 performance with 107 yards from scrimmage and a touchdown in week 13! Now, THIS is why the Seahawks saw Penny as a value in the 1st round, over 100 yards in back to back weeks against two top rush defenses?! NICE. Welp, that excitement quickly ended in week 14 as Penny tore his ACL, putting an immediate halt on the momentum he had been gaining. So where do these two injuries put these two young backs in terms of the 2020 season?

Beginning again with Carson, from what has been released, and what I can gather, he did not require surgery which tells me this is another non-displaced fracture, similar to Josh Jacobs’ shoulder fracture. No surgery is required, and following typical bone healing of the lower extremity, full healing can be seen in 8-12 weeks (slightly longer healing time for leg fractures versus arm fractures due to weight-bearing). Due to Carson’s running style, and past history, he does seem to demonstrate a greater propensity to be nicked up throughout the season, but there is no significant risk in re-fracturing his hip going into 2020.

As for Rashaad Penny, things are much murkier going into 2020. Considering how late the injury happened (December), Penny will struggle to be back for week 1. In the sports rehab community the magic number for return to sport after ACL tears is nine months where data suggests the athlete is no longer at high risk for re-injury, BUT, this data essentially shows the MINIMUM time needed to return to sport. At nine months, athletes are still not at 100%, with recent research suggesting two full years before an athlete is at 100%, showing inadequate hamstring and quadriceps strength, as well as a dampened neuromuscular connection helping the body know the position of the knee in space. There are other factors that come along with ACL rehab that further complicate things (ie. HIGH risk for hamstring strains), but without getting too deep in the weeds, generally, I do not see Penny making much of an impact in 2020, as he almost certainly will not be 100% to start the season, and with his prior history of injuries, I don’t see the organization risking further missed time.

To quickly summarize both players, Carson, likely to be at 100% for training camp, Penny, not likely to be ready for the start of the season. Without any other challengers in the backfield, Chris Carson looks to have the backfield to himself in 2020 (pending the draft)

Best Case Scenario Carson: Seahawks do not spend draft capital on a running back, essentially putting their full confidence behind Carson. He is able to solve his fumbling issues, and with continued work in the passing game, and no real competition for touches, he is able to have a MONSTER season finishing with close to 2000 scrimmage yards and 15+ TDs

Best Case Scenario Penny: Rehab goes SMOOTH. Penny works his butt off and is ready for week one, a la Adrian Peterson 2012 (realistic?). Defying the odds, Penny stays healthy, and with a banged-up, fumble prone Chris Carson, he takes firm hold of the starting spot in Seattle. Penny takes the leading side of a 60/40 split with Carson and finishes the season with 1,300 scrimmage yards, and double-digit touchdowns.

Worst Case Scenario Carson: Continued fumbling issues and nagging injuries allow someone on the roster (Penny, rookie, etc) to take over as the lead back. Carson does not quite get shutout of touches, but only averages 10-12 per game, severely limiting his upside, making him no more than a weekly flex option.

Worst Case Scenario Penny: Rehab DOES NOT go smooth. Early reports already suggest that Penny will not be ready for the start of the season, with HC Pete Carroll expecting Penny to start the season on the PUP, which requires a six-game absence to start the season. After testing the knee over the first few weeks of the season, Penny has a setback, which lands him on IR for the rest of the season, a la Jerick McKinnon

Derrius Guice – Knee

Two years, three knee injuries, one being major (ACL), all of which impact his longevity. Derrius Guice’s injury story began with a torn ACL in the first preseason game of 2018. After missing the entire season, Guice was ready for action week one against the Eagles in 2019. Unfortunately, after the game it was found that Guice tore his meniscus, putting another pause on his career. After returning in week 11 and having some pedestrian stat lines in both weeks 11 and week 12, Guice finally had a breakout game in week 13 against a BAD Panthers rush defense, rushing for 129 yards and two touchdowns. The success would not last though, as Guice then sprained his MCL, which landed him on IR for the last few games of the season. So where does this leave us with Derrius Guice? In a very small sample, in games where Guice received double-digit carries, he averaged 1.8 ypc, 3.2 ypc, and 12.9 ypc. It doesn’t tell us much. As a player, whether he is good or not, we still do not know, but, as far as injuries go, there is a little more that can be gathered.

ACL tears, in general, are many times seen as precursors to knee osteoarthritis down the line. And considering the wear and tear put on running backs during a season, this can accelerate the process (see Todd Gurley, Sony Michel, Jay Ajay) and lead to backs quickly falling off a cliff. Thankfully for Guice, he gets to see an example of a positive story after an ACL tear every day in his own position room. ‘All Day’ Adrian Peterson, is likely the most successful return from an ACL injury ever in the NFL. That being said, he is more of an exception than he is the rule. Not every NFL player is built physically, or mentally, like Adrian Peterson, one of the greatest running backs in the history of the NFL. Additionally, the cushion that helps keep the knee moving smooth, the meniscus, has also been damaged, which may have an even greater impact on Guice’s longterm prospects. Personally, I am out on Guice due to his injury concerns. There is no guarantee Guice ever returns to the talent we saw on his college tape. His only real productive game came against a very bad defense in Carolina in 2019, and other than that, he was unable to get much done. The running back room in Washington is also PACKED, with Adrian Peterson back for another season, Guice, and Bryce Love who is himself returning from an ACL injury, and was no slouch in college at Stanford. This is not to pile on Guice and to say there is no shot at him having a successful career and bringing fantasy success to your teams, but what it is saying is the odds are stacked against him.

Best Case Scenario: Guice returns to camp HEALTHY and shines. Clearly asserts himself as the best back on the team, forcing Adrian Peterson to step back and take more of a mentor role. Guice becomes a versatile three-down back racking up over 1,500 scrimmage yards and becomes the face of the franchise as Washington continues to rebuild.

Worst Case Scenario: Camp is a muddled mess with none of the three top backs asserting themselves. By default, Adrian Peterson begins the season as the starter with all three (Peterson, Guice, Love) mixing in as the Redskins ride the “hot hand” on a weekly basis. Guice has some great games but you never know when they’ll be coming, making him a headache on your fantasy roster.

BONUS! (depending on if you care about these two guys)

Lamar Miller – ACL Tear

For anyone who wants him, Miller should be ready to go for week 1 as the former Texan suffered the injury early in the preseason of 2019. That being said, not all players recover in a perfectly linear manner, AND players demonstrate a reduction in performance in their first year back post-ACL reconstruction. I don’t see any teams picking up Miller until around preseason if (when) injuries begin cropping up. If a big name were to go down, Miller has been serviceable as a starter in the NFL averaging around 1,100 scrimmage yards and 6-10 TDs as a starting running back in Miami and Houston. Sure, it wouldn’t be a flashy signing (in real life or fantasy), but your squad could do worse.

Jerick McKinnon – ACL Tear (2018)

As I said with Lamar Miller, ACL injury recovery is not always a linear process. Jerick McKinnon is a perfect example. After a career year in Minnesota and subsequent payday, McKinnon’s 49er career has yet to begin after suffering an ACL injury prior to the start of the 2018 season, yes, 2 seasons ago. McKinnon has had multiple setbacks during his rehab, which culminated in the last offseason when he was once again shelved on the IR after one final setback. Now in his 6th season, McKinnon is BURIED on a 49er depth chart with the likes of Tevin Coleman, Raheem Mostert, Matt Breida, and even Jeff Wilson all likely ahead of him currently. I can’t imagine the 9ers keep ALL of those backs, but who knows with Kyle Shanahan. Depth chart aside, it is not known if McKinnon will ever even return to football at this point as ~30% of those who undergo ACL reconstruction never play another snap. His best chance at relevance is being released with an injury settlement and finding a new home with fewer backs.

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