Owners should tread lightly with Dion Lewis and other agile RBs returning from ACL repair

Just so it doesn’t look like I am a Monday morning quarterback, here is a Tweet from about 10 days ago in response to a question I received about the injury outlook for Dion Lewis. I did not write a full piece on Lewis at the time as I simply did not think the interest was there. I assumed everyone was like me and disregarded New England Patriots players not named Tom Brady or Rob Gronkowski. Now that I know that some of you are interested, here it is.

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The reason I said that Lewis was off-limits until 18-to-24 months after his surgery is because that is how I feel about nearly all running backs returning from ACL repair. Lewis suffered his ACL injury last November, and not even a year later he seemed to be pushing to get back on the field. I feel that this approach will often be unsuccessful and I generally avoid players who return from injuries too quickly. The only reason to accelerate the rehab process is if that player is preparing for a conference championship or a Super Bowl, but players who rush back to take part in regular season games are simply playing the risk to reward game poorly.

Now that Lewis appears to have had a “clean up” in his knee, I think it is safe to say that “risk” defeated “reward” once again. A clean up likely means that his knee was suffering from excess inflammation, scar tissue, fluid or any combination of the three. In this case, the surgeon can go in with an arthroscopic approach and clean up whatever should not be in there. This is a fairly minor procedure in most cases, and Lewis should feel better after surgery.

The reports have him out for another 8-to-10 weeks after this procedure, but I would say that this should have been the length of time he would have been out regardless of this procedure. I don’t think I have to give my opinion any further on Lewis, as I can’t imagine anyone would invest in him beyond a daily fantasy play late in the season or possibly a late season pickup in a deep league.

I am happy to keep answering these questions about running backs coming off ACL repair, but I think that I will start sounding like a broken record. I am on record in a number of articles about my feeling on waiting until the second season following ACL repair, but I would contend that running backs are the absolute worst pickups in fantasy football after an ACL injury.

If you have ever experienced or monitored an ACL recovery, you can attest to the long period during which you simply don’t use the injured leg like you normally would. I won’t bore you with an ACL protocol, but you can search for it and see the specific time points in which these athletes are typically allowed to resume certain activity. The bottom line is that any living thing that takes almost a year off from what it usually does will have an adjustment period to resume functioning properly. The ACL is no different!

As for the specific reason that running backs are the worst after this injury; the running back is maybe the only offensive position that is more reactive than proactive. A running back must react to blocks and defenders in a similar way to defenders reacting to the offense. The wide receiver has the luxury of knowing where they are going and planning their moves; the quarterback more often than not knows exactly how many steps they will take before releasing the ball on a well executed play; and offensive lineman almost always know their first step and the direction they will go on the snap. The running back has to cut, juke, jump, and accelerate based a number of factors that happen after the ball is snapped. For those who have played football, you know that the running back rarely ends up exactly where the play designs him to be.

The frequency and severity of the reactive movements that a running back needs to make depends on supreme biomechanics and reaction time, and having the Anterior Cruciate Ligament take a year off does not bode well for this to exist within the first 18 months after repair. Cruciate actually describes the shape of the ligament, but I like to think of the word “crucial” when considering the role of the ACL. Without the ACL, the mechanics of the knee-joint changes significantly and once it is repaired and healed, that significant change must be overcome. Many of us walk around and do not realize the precision that is needed in order for the human body to work. For an NFL running back this precision is at a higher level than the average person and is developed over years; when an injury as significant as an ACL tear occurs this precision must rebound. Particularly, running backs that depend on agility will suffer with slower cuts and acceleration which will surely decrease their productivity. Bigger backs who are more straight-line runners are more likely to retain a larger percentage of their skills and their productivity. I think Lewis definitely falls under the agility back designation and will see his skills suffer when he takes the field sometime in November.

I know there are some fantasy football commandments out there, but to my knowledge there are none that specifically address this from an injury perspective. So here is your first fantasy football commandment (Injury Science edition):

Thou shall not draft running backs coming off ACL repair prior until their 18-month recovery mark!

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Dr. Eric Petty is a Physical Therapist who is taking his talents from the treatment room to help fantasy owners. You can find more of his work at his site, The Injury Report Doctor, and you can follow him @DrPettyIRD.