Ahh yes, the headache that is the Andrew Luck saga just won’t end. It seems like every other month, we get an optimistic update from the Colts front office and coaching staff saying that Luck is close to throwing or feeling confident he’ll be ready for Week 1. With OTAs coming to a close and training camp on the horizon, it’s officially crunch time for Luck to make a significant progression in his return to the field. Otherwise, Luck’s 2018 season may be jeopardy. I’ll do my best to break down this situation from both a medical and a fantasy football perspective.

As a sports and orthopedic physical therapist, I normally have a pretty good handle on the injuries these players experience, what their rehab is going to look like, and when to expect them back on the field. But Andrew Luck’s situation is just…different. Why isn’t he throwing? Is his career in jeopardy? And what should we expect in 2018? All of these questions answered below.

Editor’s Note: For more injury updates from Matthew Betz on several other players returning from injury, be sure to check out the Ultimate Draft Kit, and click the ‘Injury Report’ section.

The Injury

To get an idea of what’s exactly going on with Luck, we need to start with the original injury. It all started back in 2015, nearly three years ago. The last time Luck played completely healthy, Adrian Peterson finished as the RB2, Brandon Marshall finished as the WR3, and Blake Bortles finished as the QB4. Yikes! That’s how long it’s been since we’ve seen the real Andrew Luck.

Luck was banged up all year in 2015. He only played in seven games due to a variety of injuries, including a lacerated kidney, a torn abdominal muscle, and yes, a right shoulder injury. This right shoulder injury was originally diagnosed as a “sprain” and caused the former No. 1 overall draft pick to miss the first two games of his NFL career. Details regarding the exact injury sustained during Week 3 of the 2015 season are unclear. It is likely that Luck experienced a micro-tear or a fraying of his labrum.

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The labrum is a tiny cartilaginous ring that helps to provide structural support to the shoulder joint. It is attached to the shoulder blade and acts like a vacuum suction to help hold the arm bone (humerus) in the ball and socket joint, creating stability. When injured, athletes can experience pain, weakness, and feelings of instability, depending on the size and location of the tear. At times, the tendons of the rotator cuff (muscles in your shoulder) and the biceps can be affected because of their anatomic relationship to the labrum.

Surgery isn’t always required for this injury. It depends on severity, location, and the demands of the athlete. For example, a running back will almost always have surgery to repair the injury because they’re often taking hard hits and landing on the shoulder, which can lead to instability, and in extreme cases, a dislocation, if the injury isn’t structurally repaired.

It was ultimately determined by the Colts’ medical staff that Luck didn’t require surgery. However, upon returning to the field, Luck was clearly limited by the shoulder. From Weeks 6-9 in 2015, he averaged a completion percentage of just 54.8% while averaging 282 yards and 2.5 TDs per game while throwing 3 INTs and 2 INTs in separate games. Over the course of those four weeks, the Colts went 1-3.

Take a look at an interesting quote I found from Colts’ owner, Jim Irsay, in 2015. “There isn’t some kind of chronic shoulder injury or anything like that, I promise you. There are no surgeries planned. He is fine, and the shoulder is something that just disappears into the woodwork when he wins his next MVP or when he wins a Super Bowl.

He played 15 games in 2016, but was listed on the injury report all year after aggravating his injured shoulder in Week 2 against the Broncos. Luck threw an interception to Acquib Talib and attempted to tackle the corner back. This was later confirmed by Colts’ owner, Jim Irsay. There’s another reason Luck was listed on the injury report all year: as a team, the Colts gave up 44 sacks, fifth-worst in football, and 128 hits, more than any team except for the Cleveland Browns. Without a doubt, this beating in 2016 contributed to worsening shoulder pain and dysfunction, leading to the eventual shoulder surgery that has now kept Luck from throwing a football for nearly two years.

The Surgery and Rehab

It’s now officially been 17 months since Andrew Luck’s surgery to repair a torn labrum in his throwing shoulder. His surgery was in mid January of 2017. During the surgery, the doctor will go through a scope and generally will re-attach the torn labrum back onto the bone. I can’t speak to exactly what was done during the surgery because, as I mentioned previously, many other structures and tendons can be involved and we don’t know the exact details of Luck’s injury.

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Rehab after this type of surgery typically takes anywhere from 6-9 months, with a longer recovery typically required for an overhead athlete, such as an NFL quarterback. If we assume the nine month timeline, Luck should have been ready to go by Week 1 of the 2017 season. As we all know now, this was not the case.

All along, fantasy owners were optimistic in Luck’s availability for Week 1. Reports from the Colts’ organization were positive throughout the summer of 2017, which isn’t new from the front office (see the overly optimistic quote above). He was added to the physically unable to perform (PUP) list during training camp and was not activated before the start of Week 1. We know how the rest of the story goes. Luck doesn’t play at all during 2017.

What Went Wrong?

Simply put, I’m not quite sure, but here’s a list of possibilities. These NFL stars have access to some of the best doctors in the world, so there’s a very slim chance that the medical team missed another structural injury. However, I believe the real fault in this whole scenario is the Colts’ decision not to have an exploratory arthroscopic surgery when this rehab wasn’t going smoothly. MRIs are very accurate, but physically going back into the shoulder through the scope is the only way to confirm if there was subsequent injury with 100% accuracy. Even with this second exploratory surgery, Luck only would have been setback 2-3 weeks. In the grand scheme of things, this could have provided the answers to the mystery that is Andrew Luck’s shoulder.

In October of 2017, Luck was experiencing continued pain and soreness in his shoulder. He got an injection into his shoulder to attempt to temporarily reduce soreness, but this was ineffective. The fact that the medical staff decided to utilize a cortisone shot tells me that they believed the source of Luck’s pain was from inside the shoulder joint (where Luck had his surgery). Again, an exploratory surgery would have been able to confirm this likely suspicion.

After this was unsuccessful, Luck traveled to Europe in November for alternative treatments, and was there for two months, returning in December of 2017. I won’t speak to exactly the type of treatments were used, but here are a few possibilities: platelet-rich plasma injection, stem-cell therapy, and more rehab.

Upon returning to the U.S., reports again showed Luck should be on track for initiating a throwing program prior to the start of OTAs. Stop me if this sounds familiar… It’s certainly possible that Luck suffered a setback during his rehab. What that setback was, I’m not sure. The throwing motion is very complex, involving extremes of range of motion in the shoulder and high quality muscle performance of all the muscles in your back and core as well as your rotator cuff. If anything goes wrong in the throwing motion, it can cause poor performance and pain. It’s actually pretty rare for rehab to go perfectly after a surgery. Small setbacks, soreness, and weeks built in for extra recovery are often needed. That’s why we get broad ranges for recovery timelines (i.e. 6-9 months for a labral repair, 9-12 months for an ACL, etc.) Every individual is different and there’s a lot of room for error.

How Do We Move Forward?

Luck has been seen at OTAs participating in drills, but these drills don’t involve throwing a football. This should NOT make you optimistic as a fantasy owner, as the drills I’ve seen him perform involve hand offs and drop backs with an emphasis on footwork. These put very little stress on the shoulder. I’ve also seen people on Twitter and heard other podcasts state that they’ve seen pictures of Andrew Luck looking really strong and that because he’s put on all this muscle, he should be fine for 2018. This could not be further from the truth! Muscle size and bulk does not translate to an efficient and healthy throwing motion (ever see a shirtless picture of Peyton Manning?). Until I physically see Andrew Luck throw a football consistently for multiple weeks, he’s off my draft board for 2018. The ‘multiple weeks’ is in italics for a reason. Keep reading to find out why.

When a throwing athlete attempts to resume throwing after a surgery, we as rehab specialists, generally take them through a progressive throwing protocol before they are cleared to return to the field. Think about it. You wouldn’t take a professional baseball pitcher and have them just start to throw 100 pitches at 95 mph the day they’re cleared to throw, right? Well, this is no different for a quarterback. The speed of the throw, the arm angle, and the distance the ball is thrown all need to be progressed slowly, generally over the course of about a month to two months, assuming no setbacks or soreness.

As I write this article on June 10, and I look at the calendar ahead, I am beginning to become more and more concerned about Luck’s availability for 2018. Let’s assume the shorter end of that 1-2 month throwing progression. Andrew Luck needs to start throwing a football by mid July in order to be available to participate in the pre-season and training camp. The reason I use training camp and pre-season as my timeline rather than Week 1 is because if I’m the Colts, I want my franchise quarterback to have a few weeks of leeway for any setbacks or soreness that could occur again. In addition, building team chemistry with new offensive players is crucial for the success of the offense.

I’ll wrap up this lengthy article (sorry, I’m kind of a nerd when it comes to this kind of stuff!) by letting you know how I’m approaching Andrew Luck and the Colts offense in 2018 for fantasy purposes. Luck’s current ADP in 12-team leagues according to Fantasy Football Calculator is 11.03 as the 15th quarterback off the board. If you’re drafting right now, there’s no way I’d take Luck before the 13th round as a flier. When most fantasy drafts occur in August, I’d expect Luck’s ADP to rise as we hear more (potentially false) positive reports come out of Indianapolis. When it comes down to it, he’s the riskiest player in 2018 from an injury perspective. Period. Even if his return to throwing goes well over the next month, there is certainly a risk for a setback. Personally, I am not drafting Andrew Luck in 2018 if he doesn’t start to throw a football before the end of July. This should tell you how concerned I am about Luck this year and beyond.

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