2012 injury outlook: Running backs

A preseason injury outlook for fantasy-noteworthy running backs. This column has been updated throughout the summer. A final addendum for each relevant player was posted on Sept. 1.

Adrian Peterson, Minnesota Vikings: The injury was devastating when it happened -- a torn left ACL and MCL that left Peterson shaking on the ground -- but his recovery has been nothing short of amazing. Starting with his ability to get to surgery quickly, Peterson has met or exceeded every target along the way. Given that his injury was so late in the 2011 season (Week 16), no one anticipated Peterson would realistically be in the mix for Week 1 in 2012. His progress to date allows for that possibility.

Still, despite the fact that Peterson has incorporated agility drills and has beaten his teammates in wind sprints, he has multiple hurdles to cross before he can be declared ready to start the season on time. Every time he increases his activity or incorporates something new, he and the medical staff must evaluate how his knee responds. One of the final things an athlete regains after an injury such as this is the proprioception in his knee, essentially the innate sense of understanding where the limb is in space and the confidence to rely on it without hesitation. The key for the athlete is getting to the point of playing football with the focus being more on the game than on how the knee will respond.

If anyone possesses the combined athleticism and work ethic to pull this off, it would be Peterson, but the definitive answer about his status might not come until just before the season begins.

Addendum (Aug. 16): Much to his delight, Peterson was recently removed from the active/PUP list and was cleared for a return to practice. On Sunday, he participated in the team walkthrough. On Tuesday, he was running through various drills, notably with no brace on his surgically-repaired left knee. While he has been kept from contact thus far, ESPN 1500 Twin Cities reports that could possibly change next week. All of this certainly points toward the possibility that Peterson could (emphasis on "could") return for Week 1. There is still the issue of testing how he responds to traffic, getting legs tangled with teammates and, if he sees preseason action, testing his reaction responses and timing along with the contact of an opponent. Even if he does get clearance to play in Week 1, expect the Vikings to ease him into a return in terms of both ball touches and total playing time. They have been pragmatic with his recovery every step of the way; that is not going to change just because the season officially launches.

Addendum (Aug. 21): The Minneapolis Star-Tribune reports Peterson will not play in this week's preseason game, or the one after that. Perhaps the Vikings have been watching preseason games from around the league and have decided they do not want to take a chance with their star running back. Peterson remains just shy of eight months removed from major ligament reconstruction on his left knee, so the hesitation to return him to game play is understandable. After all, he still needs to experience more progressive exposure to contact in practice. While the indications are that Peterson is on schedule to potentially return for Week 1, it still seems most likely that he will be returned to action on a gradual basis.

Addendum (Sept. 1): Coach Leslie Frazier says AP is likely to be a gametime decision for Week 1. According to ESPN1500 Twin Cities, the Vikings will wait to see how Peterson tolerates another week of practice. "I doubt that we would know without getting him through an entire week if we thought he were ready to play in a football game," Frazier said. It would not be surprising if Peterson suits up and is active for the game but even if he does play, it still appears the Vikings will ease him into a normal workload over the early part of the season.

Jamaal Charles, Kansas City Chiefs: "When they let that cape off me, I'm ready to go." That's what Charles told the Kansas City Star during June minicamp, signaling there are no doubts on his part about his readiness for the season.

Charles suffered a season-ending ACL injury in Week 2 and has been champing at the bit to get back. Last fall, Charles often tweeted updates about his progress and suggested he was ahead of schedule in his rehab.

But the news that he could be cleared to participate fully in training camp could be the best indicator yet that he will start the 2012 season on time. If an NFL player is going to tear his ACL, at least sustaining the injury early in the season provides more cushion for ensuring a timely start the subsequent year. While there are players returning at an even quicker pace with the advancements of rehabilitation and a dedicated work ethic (such as Peterson), there is more comfort with the timetable of a player such as Charles, who will have been rehabbing for approximately 10 months by the time camp gets under way.

That said, expectations for a running back in his first year back from ACL surgery should be tempered, as history has shown it often takes until the second year to return to pre-injury form. Charles does not plan on waiting that long, however. As he told the Star, "I'm ready to put my cleats back on and punish everybody in my way."

Addendum (Sept. 1): Charles has held up well in the preseason, reacquainted himself with playing in games and even taking contact to his surgically-repaired knee. It doesn't appear he will have any limitations heading into the season.

Rashard Mendenhall, Pittsburgh Steelers: Mendenhall is one of many players who suffered a torn ACL last season, but the injury happened so late (Week 17) that it was literally this calendar year (on Jan. 1). There have been various reports on Mendenhall's status, ranging from suggestions that he might miss 2012 entirely to his potential availability for Week 1.

At the time of this writing, it appears most likely that he will fall somewhere in between. The Steelers likely will see the return of Mendenhall, but it would not be surprising if that return is delayed, perhaps leading to six weeks on the physically unable to perform list. Mendenhall has been working out individually during organized team activities and insists he will be playing at some point this season, but as to when that will be, nothing is certain.

Addendum (Aug. 22):
In a somewhat surprising move, Mendenhall was activated from the PUP list last week. Had he begun the season on the PUP list, he would not have been available for six weeks. His activation should not suggest, however, that he will be ready much sooner. The move appears to have been performed in an effort to increase his workload by integrating him into more aggressive football activity. Steelers general manager Kevin Colbert told the Pittsburgh Post-Gazette, "The trainers felt that he had progressed as far as he could in doing what they were doing and the kid felt confident that he was ready to take the next step." Mendenhall is still recovering at an impressive pace given how late in the season his injury occurred. Still, given the difference in activity level between individual workouts and team drills, including initial contact on his surgically repaired knee and having to react in real time, there is a ways to go before Mendenhall will be game-ready.

In the meantime, teammate Isaac Redman has been dealing with what has been termed both a groin and a hip problem (they are often inter-related). After undergoing an MRI late last week, the most significant news was that he would not need surgery. Redman told the Pittsburgh Tribune-Review Tuesday that the issue was, in fact, his hip and although he has returned to practice he is still exercising caution. "I'm trying to do what I can do without triggering it, without making it worse," Redman said. "Hopefully, I can just keep getting better and better and not have a setback." Neither Redman nor the Steelers have offered any specifics as to which structure(s) is/are involved, but the avoidance of surgery suggests no major damage to the hip labrum. Still, his guardedness in practice warrants some concern, especially given Mendenhall's status. It's not yet clear whether Redman will play again in the preseason.

Addendum (Sept. 1): Despite being activated from the PUP list two weeks ago, Mendenhall's work in practice has been limited. It still appears that it will be several weeks into the season before he is activated. In the meantime, teammate Isaac Redman says his hip has been feeling better but he missed practice early this week because of an ankle injury. All of this perhaps has opened the door a little wider for Jonathan Dwyer who saw significant action in the team's preseason finale. After the game, coach Mike Tomlin told reporters, "He was the primary ball carrier, and that's kind of what we wanted to see," adding that Dwyer came to camp in "good physical condition." (Translation: healthy and ready to play). On the Steelers' official website, Bob Labriola stated the preseason finale "served as a sign the team found itself a starting running back." At the very least the injury situation in Pittsburgh has set up the possibility of a mix at running back.

Darren McFadden, Oakland Raiders: Lisfranc injuries can vary in severity, and not all require surgical stabilization. But the affected region of the foot must heal adequately in order to allow proper load transfer from the rear foot to the front foot. If that does not happen, the area can remain painful, making it difficult to push off and pivot. Improper healing can cause the joint to become arthritic down the road.

McFadden acknowledged it has been a long road to recovery, but he has declared himself fully healthy. The proof seems to be in the work he is doing on the field. New coach Dennis Allen told the San Francisco Chronicle during OTAs in May that McFadden looked to be running at full speed without limitation.

This was not McFadden's first lower extremity injury. In fact, he has never played more than 13 games in a season, having missed time because of hamstring, knee and toe injuries, along with this latest foot injury. McFadden remains upbeat heading into 2012 despite the evidence documenting his struggles to stay on the field. His talent is unquestionable, but neither is his risk.

Addendum (Sept. 1): After an outstanding training camp and preseason, there is not much new to add about McFadden. The talent has been confirmed and he will start the season as perhaps the running back with the highest potential but until sixteen games have passed the question remains: Can he finish?

Fred Jackson, Buffalo Bills: Jackson's season came to an end sooner than he would have liked after he suffered a broken right fibula, the skinny lower leg bone that forms the outer part of the ankle, in Week 11. Jackson has fully healed from his injury but told reporters in May that he still had a ways to go to get into football shape. The good news is he can participate in all the activities necessary to get him there.

Beanie Wells and Ryan Williams, Arizona Cardinals: Wells has been a nemesis for fantasy owners since he came into the league, as he has held the dreaded "game-time decision" status perhaps more than any of his peers. In 2011, a nagging right knee made him an on-again, off-again option who could not be counted on to play a full game yet could explode for huge yardage at any time. He underwent an arthroscopic surgery in the offseason. While no specific surgical procedure was announced by the Cardinals, Wells, when asked if the surgery was to address a meniscus, cryptically told the Arizona Republic his surgery was "a little more complicated." It is worth noting that a variety of surgical conditions can be addressed through a scope, which describes merely the tool used during surgery (an arthroscope) rather than the surgery itself (such as meniscus repair, cartilage debridement, etc.). We are left to wonder exactly what Wells meant by those remarks.

Regardless of what procedure Wells had, coach Ken Whisenhunt is not leaving any room for doubt as to what he needs to do before camp. According to the Arizona Republic, Whisenhunt indicated Wells has his work cut out for him.

"He's got to bust his tail over the next few weeks to be ready for training camp, because we've had some guys look good there," Whisenhunt said.

Whisenhunt needs Wells to get ready, because Williams may not be able to start the season on time. Williams never saw the field last year after he tore his patellar tendon during the preseason. He has worked diligently in rehab across the entire year but has still been relegated to the sideline for the bulk of OTAs. This issue is him regaining the strength in his injured quadriceps muscle to function at a competitive level and protect his knee going forward, a very slow process following this type of injury. Williams believes he could be ready by Game 1, but it's no guarantee.

Addendum (Aug. 22): Wells came off the PUP list and began practicing with the team two weeks ago. He has gradually been increasing his activity in practice and the Cardinals now expect him to see some game action Thursday. Various reports have indicated that he has still appeared limited by that knee in practice, including ESPN NFC West blogger Mike Sando, who noted Wells still seemed to be favoring his knee as recently as this week. Wells will likely see limited action, but it's important for him to get back out on the field.

Williams saw his first NFL action in the Cardinals' second preseason game. He carried the ball five times for 25 yards and got himself a touchdown. Nice way to be welcomed into the league, especially coming off a devastating injury. While he is still in the final phases of recovery from the torn patellar tendon, his progress bodes well for him to be ready to go at the start of the season. He may not be ready to take on a huge workload out of the gate, but he could certainly nudge Wells for time as the season develops.

Addendum (Sept. 1): Wells was able to see action in two preseason games, a good sign that he is ready to begin the season. Given the Cardinals' overall challenges on offense, it's hard to read too much into what can be expected from Wells. His ability to stay healthy during the season will be the question.

Jahvid Best and Mikel Leshoure, Detroit Lions: Best missed the final 10 games of the 2011 season as a result of a concussion, and to put it simply, that was not his first head injury. While playing football at Cal, Best suffered a scary-looking injury when he launched into the end zone and landed awkwardly on his head and neck. He recovered and returned to play, but when this latest event took place, many flashed back to the college injury.

Best says he is symptom-free and fully recovered. He has been cleared for football-related activities but not for contact. Reports out of Detroit OTAs and minicamps indicate the Lions are pleased with what Best has been able to do so far. He hopes to be cleared for contact in advance of training camp. With Best's history of concussion and dual turf toe injuries, which affected his performance in 2010, Best must show he is healthy enough to stay on the field. Until he has resumed full activity -- including contact and game play -- without incident, it is too soon to say the injuries are completely behind him.

Leshoure missed his entire NFL rookie season after tearing his Achilles tendon during the preseason. Although he has participated, to some degree, in OTAs, he is still working toward full recovery. He has taken part in team drills during minicamp and recently began pressing his speed and making cuts on his surgically repaired leg.

One of the keys for an athlete returning from injury is forgetting about the involved body part and simply playing the game. Leshoure's comments to the media after mid-June minicamp practice hint that he is getting there.

"I wasn't thinking about anything out there, just going out there playing and reacting," Leshoure said.

Given the timetable for recovery from this type of procedure, it's certainly feasible that Leshoure could be ready by the start of the 2012 season, or at least after he serves an NFL-mandated suspension in Weeks 1 and 2.

The critical factor will be whether Leshoure can regain the speed and explosiveness that made him so attractive to the Lions in the first place. Broncos wide receiver Demaryius Thomas returned from a similar injury last season and showed it was indeed possible, so Leshoure should feel encouraged.

Given the challenges the Lions have had fielding a squad of healthy running backs, the sight of both Best and Leshoure in camp, even if their activity is controlled, is encouraging. Whether they will be in top form when the season gets under way remains to be seen.

Addendum (Aug. 16): ESPN's Adam Schefter reports that Best is likely to start the season on the PUP list, meaning he would be unavailable for at least the first six games. This does not come as much of a surprise since Best has not been cleared for contact since the start of training camp. Although Best has maintained that he is symptom-free, there is some information the medical staff has which is causing them to continue to restrict his activity. There is no predictability here in terms of if or when Best will be able to progress.

In the meantime, Leshoure has been bothered by a right hamstring strain since virtually the start of camp. Any opportunity to see how he was recovering from his left Achilles repair was lost for the bulk of training camp, although Leshoure returned for a portion of practice Wednesday. It's unclear when he will be able to return to full practice and game play.
For now, Kevin Smith remains the leader on the team's running back depth chart.

Addendum (Sept. 1): Best has officially been placed on the PUP list to start the season. It's important to note that this means he will miss at least the first six weeks and there are no guarantees that he will return at the end of that time period. LeShoure has been able to get a bit of preseason action under his belt, most notably in the finale where he ran for 43 yards and a score. The Detroit Free Press described him as "evasive, electric and effective." His performance went a long way in proving he has recovered nicely from his injuries but now he must sit for his two week suspension and he cannot practice with the team during that time. That leaves the starting job to Kevin Smith for Week 1, the same Smith who has had several notable injuries in the past and already suffered an ankle sprain during the preseason. The sprain, according to Smith, was just a "minor tweak," but it's still enough to raise concerns about how he'll hold up to a full workload, at least for the first two weeks.

DeMarco Murray and Felix Jones, Dallas Cowboys: Murray fractured his right ankle and suffered a high ankle sprain in December, ending his impressive rookie season early. After undergoing surgery to stabilize the ankle, Murray embarked on a rehab program and was running by February. As early as May, Murray was telling reporters the ankle felt great and that he was 100 percent.

The Cowboys seem to agree with his assessment. Running backs coach Skip Peete observed Murray during OTAs and told the Dallas Morning News, "I don't see any ill effects of his ankle injury from this past season."

Jones, meanwhile, has been challenged by a variety of injuries in his young career, and 2011 was no different. He injured his right shoulder early in the season and later suffered a left high ankle sprain and a hamstring strain. In the offseason, Jones underwent surgery on his shoulder, and he has not participated in OTAs or minicamp activities. It is not yet clear whether he will have recovered to the point of being able to participate fully in training camp.

From the look of things, the Cowboys' primary RB job is shaping up to be Murray's. The University of Oklahoma product impressed when Jones went down last season and seems to be recovering more swiftly. The Cowboys still will find touches for the explosive Jones, but staying healthy has clearly presented an obstacle for him.

Addendum (Sept. 1): Murray has had a strong camp and preseason. His touches have been limited primarily due to the fact that the Cowboys have already racked up so many injury concerns, they are protecting him for the regular season. Meanwhile Jones has been present but underwhelming this preseason. Coming off shoulder surgery appears to have had him a bit behind as far as football conditioning but the good news is he seems to be off to a healthy start for the season.

Knowshon Moreno, Denver Broncos: Add Moreno to the list of running backs recovering from ACL reconstruction surgery. Moreno tore his right ACL in November and has been participating in OTAs this spring. Moreno wants to prove not only that he can come back healthy from this, but also that he can stay healthy, something he has not been able to do so far in his career. Moreno has battled repeated hamstring and groin strains, and even when not missing complete games, he has at times struggled to complete games, which is every fantasy owner's nightmare.

Addendum (Aug. 16): Moreno returned to full practice with the Broncos and even took part in the team's first preseason game (5 carries, 20 yards; 1 reception, 6 yards). While he acknowledges he does not yet feel 100 percent recovered, his clearance for full activity and game action is a huge step forward.

Addendum (Sept. 1): Moreno did enough in the preseason to earn himself a final roster spot with the Broncos, something that was not guaranteed when training camp opened. He is still working his way back from his ACL surgery and Willis McGahee is the unquestioned starter, but Moreno is making gains and could see more work as the season progresses.

Ryan Mathews, Chargers: In the Chargers' first preseason game, Mathews left the game after being tackled on his first run and did not return. The grim news that Mathews suffered a broken clavicle, or collarbone, came soon afterward. He underwent surgery to repair the fracture Friday, and the team has issued a projected return of four to six weeks.

Broken clavicles are not uncommon in football as they typically occur when the shoulder is driven into the ground on a tackle or after a hard landing on the shoulder (the result is either a shoulder separation or a clavicle fracture, depending upon where the force is). They are common in offensive players, such as quarterbacks (Tony Romo, Matt Leinart), wide receivers (Marques Colston and Riley Cooper, who incidentally fractured his on July 28 of this year in camp, had surgery and is projected by the Eagles to miss six weeks) and running backs. (Adrian Peterson suffered this injury in his junior year of college, and it raised some concern about his durability before the draft. Of note, he did not have surgery, missed seven games, returned to play in the Fiesta Bowl and suffered another fracture. Ultimately that injury healed on its own.) Although Colston missed only three weeks after his injury, Romo's was season-ending -- he was injured in late October and missed eleven games -- and it was his non-throwing side. Colston had surgery; Romo did not.

Despite the relatively common occurrence of these injuries, the timetable to full health can vary greatly. Given that the clavicle does not always heal well, athletes in contact sports often undergo surgery nowadays to help stabilize the injury and promote quicker recovery. Factors that can influence the severity of the injury include the location of the fracture within the bone (the midshaft of the clavicle is more commonly broken and often less problematic than the end near the shoulder, for instance), whether the fracture was displaced (whether the bony ends remained in alignment or not), and whether there were multiple fragments (more often seen in high-speed accidents). None of this information has been made available regarding Mathews' injury.

Fracture healing typically is about six weeks, and, before a player is cleared to resume contact, there must be sufficient evidence of bony repair to alleviate concerns of reinjury. Every fall onto the shoulder, direct hit to the shoulder (especially if the player is hit from both sides simultaneously), even a stiff-arm move, will translate force through the collarbone area. For an athlete such as Mathews, who will incur contact through his clavicle (directly or indirectly) on virtually every play in which he carries the ball, the confidence that the bone will remain intact must be high before allowing him to compete.

Mathews should be able to maintain his cardiovascular conditioning but will be limited with respect to upper-extremity weights initially. This is not like a knee or ankle injury, in which his ability to perform well enough could be in jeopardy; once he is cleared to return, he should be able to pick up where he left off. Unfortunately for Mathews, this latest injury does nothing to increase confidence that he'll stay up once he picks back up.

Addendum (Sept. 1): Despite his best intentions and proclamations that he expects to play in Week 1, Mathews is still subject to the same healing parameters as other humans. If his collarbone has not progressed to the stage where the team is confident he can avoid re-injury, he will not play. All signs are pointing to him having a delayed start and the San Diego Union-Tribune reports he is expected to miss Week 1. Normal bone healing takes approximately six weeks which, given Mathews' injury date, would suggest he could be ready by Week 3. The situation remains fluid however and Mathews is certainly keeping up his conditioning in the meantime. Once he is cleared by the medical staff he should hit the ground running.

Roy Helu and Tim Hightower, Redskins: Not long after Helu rushed four times in the Redskins' preseason opener, we learned that he was dealing with Achilles tendinitis. Initial reports identified it as a problem in his left Achilles tendon, and according to the Washington Post, this was not Helu's first episode of symptoms. "I've had it in the past, but not to where it is now," he said.

Given that Helu missed some offseason workouts with soft-tissue injuries, there was some cause for concern about his health heading into the season. That concern went up a notch with the news this week that Helu has been experiencing soreness in both Achilles tendons. Helu has been limited in his workouts, and coach Mike Shanahan told the Washington Examiner that Helu would not be able to play in a game right now. His status for the opener is uncertain, but the bigger concern is that if this is a problem now after just a few weeks of practice, it's unlikely to completely resolve as the season progresses. At best, it appears the Achilles tendinitis will be something Helu must manage this year.

Meanwhile, Hightower continues his recovery from ACL reconstruction. He suffered his injury about halfway through the 2011 season. As of late July, the Washington Post had reported Hightower was still moving with a slight limp. He has since made enough progress to join in on team drills, and he progressed to full pads just this week. Still, just as all backs returning from ACL surgery, Hightower will need to gradually increase his activity to return to game action.

That game action will be initiated Saturday, Aug. 25, as Hightower makes his debut in the Redskins' third preseason contest. Hightower hopes to be ready by Week 1 -- how he responds to Saturday's action will be telling - but that is not a lock. Even if he's able to suit up, it does not appear he will be taking a full complement of snaps.

Thus far in the preseason, Evan Royster appeared to be the frontrunner for the starting job in Washington. Then he also suffered an injury. On Thursday, the Washington Examiner reported that coach Mike Shanahan plans for Royster to sit out this week because of a knee injury sustained a few days ago. Apparently Royster awoke mid-week with a sore knee, but an MRI was negative. It doesn't sound as if he will miss much time, and by the season opener, Royster could still be the lead candidate to start. Still, the Redskins have to be at least a bit concerned about the injury issues manifesting themselves so early in the season. It may be yet another sign that there will continue to be a rotation of running backs in DC.

Addendum (Sept. 1): The Redskins cleared up their murky backfield situation a little bit when they released Tim Hightower during final roster cuts. Helu seems to be faring much better as far as his bilateral Achilles are concerned. He was able to run for 90 yards and two touchdowns in the team's preseason finale and there have been no reports (yet) of any postgame setback. It certainly appears he is ready to start the season but it doesn't mean this won't become an issue again at some point during the year.

Jonathan Stewart, Panthers: It seems like Stewart has battled various foot and ankle injuries during his college and professional career, most notably an ongoing Achilles issue that required surgery two years ago, but he has played all 16 games in three of his four seasons in the league. In Sunday night's game (Aug. 26), he added a right ankle sprain to the mix.

Reports Monday indicate that X-rays of the ankle were negative. According to the Charlotte Observer, coach Ron Rivera does not believe Stewart suffered a high ankle sprain. Rivera points out they will be "careful with it," and Stewart will not play in the Panthers' final preseason game Thursday night. Without knowing the degree of injury and a few more details, it's difficult to project whether or not Stewart will be ready for Week 1, but at this point, nothing beyond Thursday has been ruled out.

Addendum (Sept. 1): Stewart was held out of the Panthers' final preseason game, as expected, but otherwise there have been no major updates as to the status of his ankle. According to the Charlotte News and Observer, coach Ron Rivera said Stewart's sprain is not severe but his practice status will bear watching heading into Week 1.