As NFL fans around the world get ready to enjoy what will be the first of many football-filled weekends, we can’t forget about three star running backs that unfortunately didn’t make it to this point.

It happens every year. The injury bug strikes and rules out a handful of stud playmakers for the season before the first official game even kicks off. This year, it was especially merciless and claimed the seasons of Baltimore Ravens running back J.K. Dobbins, Jacksonville Jaguars running back Travis Etienne, and Los Angeles Rams running back Cam Akers.

In hopes of better understanding the uphill battle that Akers, Etienne, and Dobbins now face with their specific injuries, I spoke with Dr. Derek Ochiai, an M.D. doctor of sports medicine. Dr. Ochiai is an arthroscopic hip surgeon that serves on Virginia’s leading board-certified program.

I hope you learn as much as I did from this conversation.

JM: I want to start with Cam Akers. He suffered the most damning injury of the three we will be discussing today. An Achilles injury is such a tough injury, especially for a running back. What are your thoughts on his chances of returning to form in 2022?

DO: High-level athletes can come back from an Achilles tendon rupture. Just last night, we watched Dak Prescott make his return to the field from a similar injury in admirable fashion. Don’t get me wrong, it’s a tough injury. It’s a difficult one to come back from, and Akers may never be the same.

With a good surgery and a lot of rehab, we’ve seen several athletes come back from that. It’s very possible.

JM: With Akers specifically, does your take on it change at all because he plays the running back position?

DO: I sort of compare it to playing basketball. Basketball players do a ton of cutting. If a basketball player can come back from Achilles tendon rupture, and they have, there’s no reason a running back can’t achieve the same. Basketball players aren’t getting tackled. That’s an obvious fact I can’t ignore in this equation, but there are some similarities between the two sports and positions there. When I speak on the Akers injury, I’m factoring in that he’s a running back in my thought process. He can come back from it. I expect that he will.

JM: We love hearing that. Moving onto Ravens running back J.K. Dobbins, it was tough to see him go down with an ACL injury before the season even began. It’s a terrible blow for Dobbins and the Ravens. I’m really curious to get your take on this one. From my perspective, ACL injuries don’t appear to be as serious as they used to be say 10, 15 years ago. We’ve typically seen a lot of players come back from that, and the timelines have actually gotten shorter. Guys used to miss 12-plus months with a torn ACL. In the NFL, it seems like guys are coming back in 7-9 months nowadays. What’s your opinion on Dobbins and his ACL injury?

DO: The first thing here, I’m glad you brought up the point about guys coming back in a quicker fashion than they used to. I don’t necessarily think that’s a good thing. The rehab process for an ACL should never be accelerated in my opinion, but that is what we’ve seen as of late.

There’s a lot of research that shows that the chance of re-injuring that ACL is higher when you come back that quickly. I know Adrian Peterson came back and almost broke a bunch of NFL records the year he returned from his ACL, but that’s NOT the norm. That’s not how everyone should approach it.

It’s not a matter of dedication. It doesn’t matter how dedicated you are to the rehab process. Everybody rehabs at a different pace. You need to have your strength back. It should take a year or even a little longer for that strength to come back from that.

These athletes are returning to the field because they feel fine and ready to go, but that doesn’t mean that they are totally healed from that. In most cases, they aren’t.

With Dobbins, obviously he can and will come back from that. We’ve seen a ton of high-level athletes come back from an ACL injury, but you never hear about the ones that don’t come back (laughs). Nobody wants to talk about those guys. Plenty of players tear their ACLs and can’t perform at an NFL level anymore. Most of the time, a guy will return just fine from it, but the approach should be more cautious than we’ve seen in recent years.

JM: That’s extremely interesting to me. Knowing what you know about the rehab process sometimes being accelerated, do you think he *should* be on the field for Week 1 of the 2022 season?

DO: Yeah, absolutely. That’s enough time in my opinion. The injury occured in August 2021 and we're talking about September 2022. That’s enough time right there. We're talking about 13 months. That’s a full year of recovery. That’s right around the ballpark of how long it should be. It’s the 7-8 month timelines that I think are a bad idea.

JM: Moving onto Travis Etienne and his lisfranc injury, I’ll be honest with you. I’m not a doctor so I don’t know a ton about any of these, but this is the one I feel I know the least about. It’s a lisfranc injury for Etienne, which is a foot injury. It’s one I feel we don’t hear a ton about, certainly not as much as the ACL we just discussed. How do you feel about Etienne and his lisfranc injury?

DO: That’s a bad injury to have. That one is typically treated by a foot and ankle orthopedic surgeon. You don’t typically see a sports doctor or surgeon deal with a lisfranc. When a lisfranc occurs, it basically disrupts a bunch of joints in the foot. It can sometimes occur closer to your toes and have all kinds of implications on the foot.

It can sometimes be misdiagnosed. It’s a good thing that for him, it was appropriately flagged and treated as a lisfranc injury. I would say it typically carries a 4-6 month recovery timetable. It’s not a very common injury in the world of sports, and it’s not a quick recovery either. Try to think of multiple fractures when you think of a lisfranc. There isn’t just one angle to it. There are multiple issues there.

JM: Knowing that he’s a running back, knowing that he’s going to be tackled and how much his position relies on their ability to make timely cuts, does that create any additional concern for you? Would you be less concerned about it if he played a different position? Running backs obviously put a ton of stress on their feet.

DO: The injury itself, any sport that requires cutting, it really concerns me. Whether it’s a safety, cornerback, or a running back, that’s a tough injury to recover from. It would be a little bit easier if he was an offensive lineman for example. It’s the cutting that concerns me. The recovery from a lisfranc is more unpredictable than an ACL. It’s harder to come back from. Etienne can come back from it with a lot of rehabs, but it is a bit more unpredictable than your typical football injury. We’ll have to wait and see how he performs once he’s back on the field.

All three of these players should be back on the field in 2022, but they’ll all go through very different processes in the coming months.