HOUSTON, TEXAS - OCTOBER 01: Pittsburgh Steelers medical staff looks at Kenny Pickett #8 of the Pittsburgh Steelers during the third quarter against the Houston Texans at NRG Stadium on October 01, 2023 in Houston, Texas.
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Injuries to Watch in NFL Week 5

You don't need me to tell you how much injuries have affected the first four weeks of the NFL season, but here in Week 5, we're going to see even more of the same. With players starting to see the effects of fatigue added in to the workload and recovery from the workload, we're likely to see more muscular injuries starting to add to the collision and traumatic injuries like concussion and joint problems. NFL medical staffs will double down, almost literally, on the work they need to do.

One of the worries is that more time spent on injuries and rehab limit the amount of time they can work on prevention. There's only so many man-hours in the medical staff and even with associated health professionals like physical therapists, massage therapists, and outside staffers, there's still a limitation. The solution should be easy - hire more medical staffers! - but most teams continue to have AT staffs that are three or four deep, often augmented at times by interns. The advantage could be huge if managed well and I hope one day to see a team really dive in on sports medicine and sports science as an advantage. For now, let's get to the injuries:

KENNY PICKETT, QB PIT (sprained knee)
MICAH PARSONS, DE DAL (sprained knee/ankle)
GENO SMITH, QB SEA (sprained knee)

Those names don't seem to have much to do with each other, but they are going to be out on the field due to an innovation that's been coming for a while. "ACL Prevention" programs have been around for about a decade, built on research largely done in soccer. The results have been astounding, seeing as much as 70 percent reductions. The problem is the term "Prevention." It's never going to be zero ACL injuries, but less - we've had 25 so far this NFL season - would be nice.

While I can't pinpoint a specific ACL Prevention program used here, there's no question that NFL teams have become more sports science savvy lately. There's a lot of English and Australian accents in NFL buildings these days, proof of how far ahead those types were from the NFL and American sport in general. Luckily, the result of that is that in many cases, what would have been a devastating injury is avoided or mitigated. With Kenny Pickett, Micah Parsons, and Geno Smith, big problems were avoided, and seasons continue for three key players to their teams.

For Pickett and Smith, the hits to the knee were clear. Pickett was caught in the pocket and looked to be the very typical mechanism for an ACL injury. Instead, he doesn't have an injury designation heading into this week and a source tells me that while there's likely minor sprains to the knee, Pickett has no real deficits or limitations heading into the game.

I won't debate the hit on Smith, but in his case, it's clear that both his strength and movement skills allowed him to withstand the force that would likely tear the ligaments of a lesser person. Watching the play back, Smith makes a save with balance and body movements, but on some angles, you can see Smith's quad tighten as the hit is happening. It's unclear whether it happens before or during, but either way, those secondary stabilizers limited the damage.

Parsons' knee injury is a bit more complex. His knee gave way on a hit to the outside of his leg, but the hit was just below the knee. If you do this at home, stand up with your feet about shoulder width and try (gently please!) to touch your knees together. Notice that it's not only the knees that move, but there's subtle movement and tension in the ankles and often the hips. It's that give that helped Parsons, along with his strong legs and stabilizers. It's also why his ankle was a problem; that same motion is the mechanism for a high ankle sprain. Instead of one taking the brunt, Parsons spread the force and has only mild issues in two joints rather than a big problem in one. He's expected to play fully this week.

DEREK CARR, QB NO (sprained shoulder)
DESHAUN WATSON, QB CLE (sprained shoulder)

Both Derek Carr and DeShaun Watson have the same injury, a sprained AC (acromioclavicular) joint. The degree and likely their pain tolerance is why one played and one didn't. Even though Carr's injury was more dramatic, with him forced to the turf and left lying there in pain before walking to the locker room, Watson's injury was a bit more damaging. A source tells me that Watson's joint was more compromised, with the joint significantly more swollen and painful in the 48 hours post injury.

The Browns get lucky with the bye week, as Watson still  isn't ready to play. Were there a game, he would have been a GTD at best, but the team backed off some of the work, knowing they had two weeks instead of one. The Saints aren't so lucky and while Carr didn't get worse last week, it's still problematic. The medical staff spent a lot of time with Carr and his throwing was extremely limited during the week. It's reasonable to expect that Carr will be able to do about what he did last week, but that's not a high bar and resulted in a loss. If Carr has to throw 35 times a game, the Saints are in trouble and putting more pressure on Carr's shoulder. Take the under.

AMON-RA ST. BROWN, WR DET (strained abdomen)

How much depth do the Lions have in their wide receiver room? We may find out this week, with their top three of Amon-Ra St. Brown, Jameson Williams, and Josh Reynolds all listed as questionable. (St. Brown was a late downgrade to doubtful.) Kalif Raymond probably isn't rostered in your fantasy league (3 percent!) and most probably just said "who?" That's what's facing the Lions and Jared Goff if those three don't go. The most questionable of the questionable, and arguably the most valuable is St. Brown. His abdominal strain makes him, at best, a game time decision, with the downgrade making him unlikely to play and certainly unexpected to put up his big numbers.

The Lions haven't let out any specifics on the injury itself, aside from the general. There's nothing in the game tape or stats from the last game that indicate when it happened, but the assumption is it happened late. Even with the extra time, St. Brown hasn't made any apparent progress and missed all the sessions aside from working with the medical staff. The Lions are keeping an unusually tight lid on this, which makes me think it's more than a simple muscle strain. With St. Brown's skill set, any sort of strain that stops his stretches and acrobatic sideline antics will limit his value and that of Goff. The worst case scenario here is that this is a "core muscle injury", which often requires surgery.

JONATHAN TAYLOR, RB IND (strained ankle)

After all the drama about his contract, Jonathan Taylor just walked back in and is expected to start after just a handful of practices. It's an unusual situation all around, but ahead of Week 5, it leaves us with a couple questions - is Taylor healthy and can Taylor come back with so little practice? The answers to both seems to be yes. Whether he'll be effective is entirely another thing, and doesn't entirely rest on Taylor, but a banged up Colts line.

Ignored in all the posturing is that Taylor was ostensibly out with an ankle issue. Taylor had surgery to clean the ankle out back in the spring, a procedure that normally takes about six weeks to heal. Six months later, after the holdout and after the IR, Taylor passed a physical. We may never know whether the ankle really was an issue, but sources tell me that Taylor didn't pass a physical until this week.

Multiple reports said that Taylor looked solid at practice. There were never questions about his conditioning and there's no expectation that he doesn't know the offense. There's some newness to everything, but even while Taylor asked for a new deal, he was with the team and in meetings for much of it. The ankle is enough that Taylor was listed as questionable on Friday and hasn't been activated officially. If he does play, he's expected to be splitting carries with Zack Moss, though no one I spoke with could speak to a plan for a specific count or even a role share. Add in that Anthony Richardson is functionally another running back and it's almost a complete unknown, a tough variable to a division game.

Fortunately for the Colts, Taylor appears to be full go after being activated from the PUP list while simultaneously signing a three-year contract extension.

COOPER KUPP, WR LAR (strained hamstring)

The Rams have gotten by quite well without Cooper Kupp, but now, they could have both Kupp and Puca Nakua, the NFL's breakout star not named Taylor Swift. I imagine someone inside the Rams HQ has wondered if they could clone Kupp at some point and now, they basically have. The question now is how they'll use two, but I have no doubt that Sean McVey has been scheming this up for a while. The Air Raid offense has long had two slots and excelled with this kind of receiver, so it's not rocket science.

First, Kupp has to be ready to play and his hamstring isn't quite back to 100 percent. Kupp has been doing a lot of work on this, both inside and outside the organization. The team's very well respected medical staff has been augmented by several experts, which has required Kupp to travel some. A source tells me Kupp has been diligent in keeping the team updated and with the work he's supposed to do, even away from the team. Knowing the offense and working with Matthew Stafford should be no issue, and hasn't been since returning to practice.

Kupp is likely to be a true GTD on Sunday, which does raise the question of whether two game plans are necessary. The answer is mostly no. If you think of Kupp/Nakua as a package, there's a series of plays designed to exploit the advantages the staff think they have. Those wouldn't be able to be called, so it just shrinks the opportunities. In a week with such a tough opponent, that would be a problem, but the Rams are clearly playing the long game with Kupp and his hamstring issues.

Bumps and Bruises

Jimmy Garoppolo was cleared and is expected to play in full on Monday night ... With his QB back, Davante Adams should have more chances, even with his mild shoulder sprain ... Saquon Barkley will test things out before game time. He's a true GTD, but the trend on his high ankle sprain is going the right way for the Giants ... While Miles Sanders doesn't have an injury designation as of Friday, he's likely to lose some carries to Chuba Hubbard as he continues to deal with a groin strain that's affecting his ability to make hard cuts ... Jahmyr Gibbs was a late add to Friday's injury report, with a hamstring strain. That's bad news for a speed player that's already struggling to get more touches ...  Javonte Williams made progress during the week with his quad strain, but if his push is limited, there's questions about how effective he can be. The Broncos got the win last week, but this is hardly a reliable offense even with Williams at full go (and he's not) ... Odell Beckham returned to practice this week and while officially GTD, he's very likely to play. His effectiveness remains a question ... Both Matthew Stafford and Kyren Williams were hobbled by the time the Colts took them to overtime. Both had hip bruises and there were backchannel complaints, again, about the Colts turf. Stafford and Williams will play and the bruises should be effectively healed by Sunday ... Tee Higgins has a fractured rib (singular) but the Bengals will check to see if he can go in warmups. Even with a better flak jacket, Higgins is unlikely to play ... Joe Burrow continues to deal with a calf strain and playing through it isn't helping. The hope is he can avoid a major issue before the Week 7 bye and keep the Bengals from being completely buried in the standings ... Kenny Pickett is healthy, but Pat Friermuth won't be catching his passes this week. A hamstring strain will have him out this week and possibly more ... Tua Tagavailoa's backside protection was an issue against the Bills. Now he and the Dolphins will be without Terron Armstead for an extended period. Armstead hits the IR with what's believed to be a sprained MCL ... Treylon Burks is out again for the Titans, pushing Nick Westbrook-Ikhine up as the target king for the Titans in a division game.

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