Multi-sport injury mailbag: Patrick Mahomes, Stephen Curry, Mike Trout and more
This week, Inside Injuries’ Virginia Zakas takes a look at the health question marks in the NFL, NBA and MLB that plague fantasy executives and sports fans alike. But before we get into that, here is a brief description of the terms from their violation algorithm:
- IRC = Injury Risk Category (Low, Elevated, High) – the overall probability that a player will be injured
- HPF = Health Performance Factor (Top, Above Average, Below Average, Poor) – our metric used to predict player performance
- ORT = Optimal Recovery Time – the time it takes for a player to fully recover from an injury (not the same time he actually misses).
NFL Postseason
Patrick Mahomes, KC, QB
The biggest question in the Super Bowl is Patrick Mahomes’ health. The Chiefs’ QB suffered a bad ankle sprain in the divisional playoff round and somehow came back to lead Kansas City to victory. Then a week later he folded and looked OK against the Bengals, but he was clearly still limping. In each of the last two games, Mahomes has rushed for eight yards three times, a much lower number than his season average of 21 rushing yards per game. Now Mahomes is in the middle of a two week hiatus to get healthier and I expect a significant improvement.
The Inside Injuries algorithm has a promising future for Mahomes in the Super Bowl. While his injury risk remains elevated at 16%, his HPF (Projected Power) is back in the top category at 87%. A high ankle sprain means that the ligaments that hold the two lower leg bones together are damaged. These are especially important for a quarterback when planting on the back leg to make a deep pass and when cutting and making side-to-side moves. Don’t be surprised if we see Mahomes limping around at some point, but I expect a great game from him despite the injury.
KC receiver
The Chiefs lost three wide receivers – Mecole Hardman (pelvis), Juju Smith-Schuster (knee) and Kadarius Toney (ankle) – in the championship playoff round. Hardman suffered an abdominal injury in Week 9 followed by a pelvic injury while out and only returned last weekend. He’s injured his pelvis again and is back on IR now, so he won’t be available. Smith-Schuster was a full participant earlier in the week and will play through his injury. He comes with a high risk of injury and a below-average HPF. I don’t expect him to be able to route and change direction as effectively on that knee. Kadarius Toney started the week with limited training and is expected to pull through the ankle sprain. His stats look worse than Juju (high risk of injury, poor HPF). I don’t expect him to play a big part in the game. Mahomes likes to disperse the ball, and with all their offensive injuries, he’ll need to use his creativity to lead the Chiefs to victory.
Brock Purdy, SF, QB
Early in the 49ers’ playoff loss to Philly, Purdy was hit in the arm mid-shot, resulting in UCL (ulnar collateral ligament) damage. This is the same ligament that’s often a problem for MLB pitchers, but it’s a far rarer injury in the NFL. After obtaining multiple opinions, doctors determined that Purdy would not need Tommy John surgery. Instead, he will undergo an internal brace procedure later this month. During this surgery, the native ligament is reinforced (rather than reconstructed with a graft). It comes with a faster recovery but I don’t expect Purdy to be fully recovered by the start of training camp.
Early reports suggest Purdy will be 100% recovered by the start of the season. Medically this is not likely. When the season starts in September, Purdy will be about six and a half months away from surgery. While he should resume throwing well before that point, the arm will not be back to normal just yet. Purdy might be available in week 1 but I would be surprised to see him as a full participant throughout training camp. He’s unlikely to be fully healed until mid-season.
NBA second half expectations
Karl-Anthony Towns, MIN, C
KAT has been sidelined since late November with a significant calf strain and there is no timetable for a return. Calf injuries are incredibly difficult due to the muscle involved in pushing off (jumping, running, cutting). An MRI revealed a grade 3 injury, suggesting a muscle tear. When he will be back is not yet foreseeable. Cities’ re-injury risk remains high for the remainder of the season. Not only is the calf at risk, surrounding structures such as the Achilles tendon are also vulnerable, along with a similar injury to the opposite leg.
Kevin Durant, PHO, F
In a shocking move, Kevin Durant and his sprained MCL make their way to the Suns. KD was sidelined last month with a grade 2 (moderate) sprain. The MCL (medial collateral ligament) runs on the inside of the knee. It tends to heal well on its own without surgery, but it can be a slow process. According to our algorithm, he is close to reaching his optimal recovery time. When Durant returns to court, it shouldn’t be long before he looks like his old self again. That’s supposed to happen soon after the All-Star break.
Stephen Curry, GS, G
Curry is likely to be sidelined for over a month after being hit just below his knee on the outside of his left lower leg. Scans showed “partial tears on his superior tibiofibular ligaments and interosseous membrane, and a contusion on his lower leg.” I love how detailed some of these NBA injury reports are, so let’s break down exactly what that means.
The superior tibiofibular ligaments sit just below the knee and connect the two bones of the lower leg at the head of the fibula. These ligaments were partially torn but do not need surgery to heal, just time. Curry also damaged the interosseous membrane, a layer of thick connective tissue that runs through the lower leg and connects the tibia and fibula. Then there’s a bruise that could be a deep bruise to the bone.
This is an incredibly rare injury and we really don’t have any other NBA player to compare him to. Curry’s injury mechanism of being hit from the outside of the leg and forcing the knee inward typically causes an MCL injury or high ankle sprain, but these were spared damage. While early reports indicated an absence of several weeks, no clear timeline was given. At this point it is realistic to expect at least 4-6 weeks. Curry’s injuries should heal well without surgery, but they will take a long time.
MLB Expectations for 2023
Mike Trout, LAA, OF
After first reporting back cramps and then rib pain last season, Trout underwent further testing that revealed a rare condition called costovertebral dysfunction. This affects the point in the back where the end of the ribs meets the transverse process (a small bony prominence on the sides of each vertebra). His problem is with the T5 vertebra, which is located in the upper middle of the back. Trout was sidelined for six weeks between July and August and performed well upon his return to the lineup, but it’s a chronic issue he’ll have to manage for the rest of his career.
Treatment for costovertebral dysfunction includes rest, physical therapy, and anti-inflammatory drugs whenever it flares up. Surgery is not really beneficial to treat or improve this condition. While it has to be taken seriously, I don’t see Trout’s career being cut short. It’s just something he has to deal with from time to time. That could mean spending more rest days or time as DH. It also shouldn’t stop Trout from playing at the MVP level when he’s feeling healthy.
Jacob de GromTEX, SP
Heading into the 2022 season, deGrom had a disappointing year in which he only made 15 starts due to an elbow/forearm injury. Unfortunately, last season was even worse. In early April, deGrom was diagnosed with a stress reaction affecting his shoulder blade (aka the scapula). This is the triangular bone that connects the collarbone to the humerus at the back of the shoulder. Stress fractures of the scapula are very rare. It’s usually an overuse injury that occurs over time, in deGrom’s case because something about his throwing motion is putting extra pressure on that spot.
While his specific elbow and shoulder blade injuries don’t have a very high risk of recurrence, I’m concerned that there was something about deGrom’s birth that was putting stress on different parts of the body. Rangers took a huge risk by signing him on a five-year, $185 million contract. Given his age (34) and injury history, it doesn’t seem like a wise choice. deGrom is now climbing draft boards, but I don’t want the headache of putting him on a roster. DeGrom is highly unlikely to make more than 30 starts this season and shouldn’t be considered a top-10 pitching option until he proves he can stay sane. There are mechanical issues that hopefully have been fixed – he needs to prove it before I can trust him again.
Fernando Tatis, SD, SS
Tatis missed the entire 2022 season after wrist surgery and a PED suspension. His health remains a big question mark ahead of the season. It started with an off-season motorcycle accident in which he injured his wrist and was not treated properly. Tatis finally underwent surgery in March. The recovery was much slower than expected as this is a very difficult injury for a baseball player. Before he was cleared to return, he was hit by the suspension. It was at this point that Tatis finally decided to have shoulder surgery to repair a torn labrum that had been a problem for a number of years. Tatis was supposed to have surgery as his shoulder was dislocated several times, but he declined. Then Tatis underwent follow-up surgery on his wrist in October, which is very worrying.
Tatis’ suspension ends on April 20. I am not confident he will have fully recovered from his wrist surgery when he reports to training camp and even if he is eligible to return to the lineup. During Tatis’ second operation, the original screws in his wrist were removed and replaced with a central screw. This is an unusual sequence of events following a fractured scaphoid. This wrist spot doesn’t heal well due to poor blood flow and clearly the healing didn’t go very well after the first procedure. I’m not overly concerned about the shoulder, but it can take up to a year for me to regain full strength and range of motion. The bottom line is that Tatis is not a trustworthy player in 2023.
(Photo above: Cary Edmondson – USA TODAY Sports)