Will Carroll
Saturday December 11th, 2010

The problem with covering sports medicine is that things are always changing, faster than anyone can really keep up. By the time I learn one thing, doctors are on to another. Ligament repair is now both routine and advancing, showing returns in as little as six months. Some orthopedists are talking about stem cells and re-growing structures the way that some surgeons once talked about the arthroscope.

It's simply astounding and all the better since much of this will trickle down to the rest of us. If you or I went in for knee surgery today, we'd have the same type of procedure an NFL player would have, using techniques that were perfected by them. The difference would be the level of care, the constancy of care, and likely the doctor. I know for me, I'm not in the same physical condition as an NFL player - well, maybe some of the linemen. So I shouldn't be surprised that when I spoke to doctors this week about Matt Cassel, they were much more optimistic about his return than I had been initially.

Asked just after learning he'd had his appendix removed Wednesday, I gave an answer -- two weeks -- that would have made sense a couple years back. Now I know that answer is from a world where someone had to be famous before they got into Us Weekly, where Lost was still a show on an island, and having an organ removed would cost you a couple games. We don't live in that world any more. I asked Dr. Matthew Lublin of St. John's Health Center in Santa Monica, Calif., about this type of procedure and he explained that it was all about pain tolerance. "If he feels healthy enough, he can play. He cannot cause any damage to himself by playing. It comes down to his pain threshold following the surgery," he said.

Honestly, I was stunned. Like many, I've had my appendix out and still have the three inch scar to prove it. I wouldn't have thought about standing up for a couple hours, let alone playing football, in the weeks immediately following that procedure. It's a different world and Cassel, like all NFL players, are not like me and you. The fact the Chiefs have decided to give Cassel this week off and let him get ready for Week 15 and beyond shouldn't disguise the fact that it was even an option. Just a few years ago, it would have been a lot different. Let's look at the rest of the games around the league and don't forget to join me for tomorrow's chat at 11 a.m. Eastern.

UPGRADE: none DOWNGRADE: Mario Manningham, Ahmad Bradshaw, Brett Favre NOTEWORTHY: The Metrodome roof has caved in; Monday night is now unlikely. UPDATES: NYG: Word out from Giants sources is that the brace that Steve Smith will wear "won't make noticeable difference in extension". The brace is designed to prevent only the most extreme part of his range. He'll play and should play close to normal. MIN: Brett Favre gets extra days to rest and extend his streak. The Vikings QB was ready to take an injection to free up his shoulder in hopes of convincing Leslie Frazier to give him more than just a cameo start.

Is the streak over? Brett Favre wasn't able to throw Thursday, but few observers think an interim coach is going to have the pull to say it's over before game time. Most think the worst case scenario would be letting Favre get the start, then bringing in Tarvaris Jackson on the second series, much the way some teams will do in the last game of the season with the playoffs clinched. Since Peyton Manning has done this several times and is second on that consecutive games list, it would be hard for him or anyone to cry foul with Favre doing that. That said, this isn't a typical situation. This isn't a post-clinch game and the off-field drama surrounding Favre does play a part here. Favre understands the NFL is going to be very reluctant to end his streak with a suspension. Does that make Favre more or less likely to go Monday? We just don't know, but neither do the Vikings. He's going to be more than a GTD -- he's going to be a last-minute GTD. Beyond Favre, there's also the continuing saga of Percy Harvin. He's been out of practice with what's being described as an "illness related to his migraines." I'm not sure what that means exactly and doctors I spoke with offered no clarity. Harvin has a long-standing issue with migraines that has resisted treatment, so the timing of things is key. The fact that this lingered, leaving him off the field, doesn't bode well. There should be no worries with Adrian Peterson after his performance last week, despite being on the Official Injury Report (OIR). Over on the Giants side, it looks as if they'll get Hakeem Nicks and Steve Smith back, but the issues on the offensive line are still a major problem. Expect Ahmad Bradshaw to get a bit less touches, since the Giants staff feels that Brandon Jacobs' size allows him to "open his own holes" more than the speedy Bradshaw.

UPGRADE: Rashard Mendenhall DOWNGRADE: none

Ben Roethlisberger isn't even listed on the OIR, which brings up the issue of what the OIR is and isn't. It's not -- as many think -- a listing of all the injuries in the league. Total up the OIR references and you're going to learn next to nothing. (In fact, Football Outsiders' AGL is the only stat I've seen that's even a decent proxy.) The OIR is only to say who will, might, or won't play and to get that information out on a consistent level. It's strictly to keep gamblers from trying to get inside info, not that it does that, but it's reasonably good at making sure things don't get too out of whack. Heath Miller is out this week due to his concussion. It seems the team is not only being smart about a head injury, but realize it's much more important to have him available for Week 15 and beyond. There are some big GTDs, with Ike Redman and Troy Polamalu. Both should play, but might not have their normal time on the field. For the Bengals, there are lots of small injuries, on top of their defensive issues. Add Rey Maualuga to that mix, as he's been limited with a shoulder injury. This one is making some wonder if he plays so hard that he won't be able to stay healthy, much in the same way as Polamalu, Bob Sanders, and his fellow USC alums Brian Cushing and Clay Matthews have been. Terrell Owens and Jermaine Gresham missed some practice, but are expected to play.

UPGRADE: Mike Williams DOWNGRADE: none

Mike Williams was back at practice Friday, which makes him very likely to play his normal role. That's the only real question for the Bucs, but there are a lot more for the 'Skins. In addition to their normal listing of several players like Donovan McNabb as "questionable", they do have some real issues at WR and all over their defense. LaRon Landry, Carlos Rogers, and Brian Orakpo are all dinged up and GTDs, while Santana Moss and Ryan Torain are expected to play. With Torain especially, we have to keep in mind that it's Mike Shanahan making the calls. Be ready with Plan B with all of them or hope you're playing a "set and forget" player this week.

UPGRADE: Peyton Hillis DOWNGRADE: none UPDATES: TB: Mike Williams is active as expected, and should get his normal targets. WAS: Ryan Torain is active after missing a month, but it's unclear how much he'll mix into the Redskins running game.

The Browns' concerns are the same as last week, with Colt McCoy (ankle) and Josh Cribbs (foot) the only major concerns. Cribbs was active last week, but not used as a WR or in the Wildcat at all. Signs are more positive that he'll be a contributor, though it's unclear just how much, making him a risky fantasy play at this point in the season, unless you're in a return yard league. McCoy is looking less likely to return this week. His high ankle sprain is continuing to limit him. Sources tell me the problem is less one of mobility, as you'd expect, and more one of quickness. "His biggest issue is getting out from under center," I was told by a team source. McCoy's footwork was one issue raised during the draft process, so it makes sense at some level. Jake Delhomme will get the start, which bodes well for Peyton Hillis. For Buffalo, most of their problems are on defense. The injuries, I mean, though the defense has been a big part of why Buffalo is thinking they'll get Luck-y in next year's draft. Donte Whitner will be a GTD and is the most key play/not play decision for the Bills.

UPGRADE: none DOWNGRADE: none UPDATE: ATL: Jason Snelling is inactive, which bumps Michael Turner up slightly. Very slightly.

The Falcons look for their seventh straight win, despite a lot of little injuries. The two key ones, Roddy White (knee) and Tony Gonzalez (ankle), don't look to be enough to keep them off the field, though Gonzalez is more affected. I don't think it's quite to the GTD situation point with the big TE, but it's not that far off, either. The Panthers are a bit more healthy, but they have a lot of people already on IR, so that's a bit of a false read there. None of their injuries should affect anyone's fantasy context.


The Lions will be without Matthew Stafford at least one more week, but hope that Jahvid Best and Calvin Johnson can produce without him. Those two should be fine to play normally, with Nate Burleson looking like to play as well. It's still not a great matchup and Drew Stanton will be at the controls, so adjust accordingly. The problem is the Packers defense is really banged up, with seemingly the entire set of DBs on the OIR. It's hard to tell just who's in and who's out, so the inactive list will go a long way in telling you if any of the Lions offense is going to be an upgrade. Offensively, the only significant situation is with Donald Driver, who should play.

UPGRADE: none DOWNGRADE: Zach Miller (OAK) UPDATES: JAX: Mike Sims-Walker is active and should be a WR1 in the Jags game, with Mike Thomas as a real 1A option. This also helps Maurice Jones-Drew and of course David Garrard.

Most of Oakland's issues are on defense, with a lot of injuries stacking up. Zach Miller will be a GTD, but after seeing what he was able to do last week, it's more of a question whether Tom Cable will want to have him out there versus resting him for a week. I'd stay away, either way it goes. For the Jags, they should be getting Mike Sims-Walker back this week. He's missed two of the last three games and wasn't very effective in the game he did play. He's more a WR2 at this stage, especially with the offense focused on Maurice Jones-Drew.


It's a safe assumption that Pierre Thomas will return. It's not safe to assume he'll slot right back in as RB1. As I discussed Thursday, Thomas is really the RB2 with Chris Ivory keeping the "between tackles" runs and likely the goal-line looks. Reggie Bush hangs on to the speed back and passing downs looks. That leaves, well ... not much for Thomas. He'll get some looks, sure, but unless he happens to break one off for a long TD, he shouldn't get enough touches to make him anything but a desperation play. The Rams don't have any significant injuries on offense, but the continued absence of Michael Hoomanawanui keeps Brent Bajema as a TE possibility. Injuries in the Rams defensive backfield however, could open things up for Drew Brees and his WR. Watch to see if Oshiomogho Atogwe is active. If not, everyone in the Saints passing game goes up a notch.

UPGRADE: Seahawks DST DOWNGRADE: Mike Williams UPDATE: SF: Brian Westbrook is getting the veteran's treatment, not having to practice much in order to keep him as healthy as possible. Reports from this week are mixed, but Westbrook looks to be at least part of the Niners running attack.

Each of these teams has an injury stack at a key position, leaving their offenses pushing the other way to fill the gap. The Seahawks look to be without both Mike Williams (ankle) and Ben Obamanu (hand), forcing them to run more. That likely means Marshawn Lynch and Justin Forsett will split more touches, though figuring out that split is tough from week-to-week. The Niners don't have a solid, healthy RB with Brian Westbrook the best available. They'll have Alex Smith back under center and look to be asking him to throw more despite the lack of running game. That would usually mean a shift to a more "West Coast" style passing game, but ironically, that's what the 49ers lack. Instead, it means Vernon Davis will be even more important.

UPGRADE: Tim Hightower DOWNGRADE: Larry Fitzgerald

Derek Anderson hasn't been cleared after his concussion, so it looks like John Skelton will get the start. If you don't know much about Skelton, join the club. The Fordham product is big and strong, consistently getting physical comps to Ben Roethlisberger, but is very raw. That puts downgrades on the passing game, including Larry Fitzgerald, despite the Denver defense and the coaching uncertainty. Expect the Cards to run a bit more, with Tim Hightower getting more touches last week than Chris Wells. Steve Breaston's knee is in the same condition it has been for a couple weeks, but he'll play. Denver's only significant injuries are on defense, with a DB injury stack making Skelton's first start a bit easier.


It's not an injury, but the loss of Brandon Spikes to suspension isn't going to help much and could open things up a bit for Greg Olsen. Neither team has any significant injuries.

UPGRADE: none DOWNGRADE: Brandon Marshall

If Brandon Marshall plays -- and he's a GTD again this week -- everything's working against him. He's got a QB with a bum leg, a weather report that looks cold and wet, plus Darrelle Revis lined up across from him. It's not good either way from a fantasy perspective, though right now, the Dolphins seem to be leaning to playing him. They'll be without Brian Hartline, who is out this week, and Jake Long is once again iffy up front. There's some issues on defense, especially at LB. The Jets aren't very healthy, either, losing both Jim Leonhard and James Ihedigbo in the space of a week. LaDanian Tomlinson is ready to play normally despite a hand injury, so don't be wary of using him.

UPGRADE: Thomas Jones DOWNGRADE: Dwayne Bowe

Matt Cassel didn't travel with the team to San Diego -- he's out for Sunday. Aside from that, the Chiefs are healthy. With Cassel out, look for Thomas Jones and Jamaal Charles to get more work. The Chargers have their continuing WR/TE issues, with Patrick Crayton, Antonio Gates, Legedu Naanee, and Vincent Jackson all on the OIR, plus Darren Sproles out with a concussion. Gates is likely to play, as is Jackson, but the rest are GTDs at best.

Philly should have Michael Vick at near full strength, while the Cowboys continue to miss Marion Barber and have an injury stack at LB. In Monday's game, there's no solid read yet on Andre Johnson, though he's played through most of the season with this ankle issue. Owen Daniels is looking like he could return this week, but the Texans will continue to start Joel Dreessen. The Ravens will be without Todd Heap, who's out for this week. My guys at numberFire like Ed Dickson as the Ravens TE this week.

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