Joe Burrow’s calf strain: Fears, realities and how the Bengals are plotting a path forward

CINCINNATI — The top storylines surrounding Joe Burrow just two days ago involved his pending contract extension, decision to pass on the “Quarterback” documentary and why he thought playing a few series in the preseason would prove “beneficial.”

With one rollout to the right on Thursday, the previous reality disappeared into the steamy Cincinnati summer.

Head coach Zac Taylor on Friday termed Burrow’s expected absence with a right calf strain as “several weeks.”

See you in September, Mr. Burrow. A new reality exists for the Bengals now — one all too familiar for Burrow, the NFL’s reigning king of August adversity. One all too nerve-wracking for those who know this injury well.

Everyone here held their collective breath from the moment he hobbled and fell to the ground. Did the diagnosis of a calf strain for Burrow bring a sigh of relief?

“Sure,” Taylor said, almost dismissing the emotion. “There’s a lot of bad scenarios out there.”

This wasn’t a rupture. This didn’t require surgery. This wasn’t the Achilles tendon. This doesn’t carry with it the deep-rooted depression induced by the phrase “season-ending.”


Joe Burrow’s calf strain: Bengals’ locker room reactions and timeline examples

For the fourth consecutive offseason and camp, Burrow will not get a full preparation for the season. From pandemic to ACL rehab to appendectomy to calf strain. An almost impossible run of bad luck.

“It sucks, I feel for him,” offensive coordinator Brian Callahan said. “But this is not a huge deal in the grand scheme of things. Every situation is unique, and this is unique in its own right. We just won’t have him for a period of time here in practice. I was more concerned about him coming off the appendix last year than I would be off of this just because of the physical nature.”

So, is this a relief? Sure.

Is this simple? Not in the least.

First, nothing is simple when it comes to the health of the team’s MVP candidate and source of championship hope.

Second, these specific injuries can be problematic.

Just ask the NFL. Just ask Aaron Rodgers. Just ask Los Angeles Angels star Mike Trout.

“It’s one of the hardest things I’ve been through in my career,” Trout said in August 2021, a season that ended after just 40 games and a Grade 2 calf strain. “I’ve been through some injuries, but this thing is tough. I never realized how much I use my calf.”

Different sport, different player. No two injuries are the same, but the range of outcomes on calf strains varies wildly.

Almost always for one tricky reason.

“These injuries, most athletes do fine,” said Dr. Jessica Flynn, sports injury analyst and sports medicine doctor for two decades at Lahey Hospital and Medical Center in Boston. “Two-thirds, they have the injury, they heal, they do fine. One out of three is going to have a recurrence sometime during the season.”

Those numbers come from studies utilized by the NFL, which turned a health focal point and $4 million in research toward training camp and early season lower extremity injuries.

“We’re so focused on strains,” said Dr. Christina Mack, chief scientific officer, IQVIA and advisor to the NFL during a February presentation, pointing out the emphasis on avoiding this early because of how often they recur and hamper entire seasons. “Muscle strains are the highest-burden injury to our players, year over year.”

Specifically, what happened to Burrow is exactly the type of injury the NFL is working tirelessly to avoid because the league knows how unpredictable recovery can be. It has implemented new rules for ramp-up periods and documented closely every player movement from each team activity.

Most hear the word “strain” and think to take a load off and see you in a few weeks. Fair enough. The danger comes from the player returning too early.

Dr. Timothy Gibson, sports medicine specialist at MemorialCare Orange Coast Medical Center in California, says that once the injury is 100-percent healed, the chance it continues to be a part of the athlete’s life is minuscule. The danger lies in the final stanza of recovery.

“Part of the recovery you feel really good, you feel 90 percent, and then you feel a little tweak, you break up some of the scar tissue,” he said. “You can have a little setback. That’s the question to me whenever there is a calf muscle injury. Is it going to be quick two-to-six weeks minor, or you are set back? That’s hard to predict.”

Looking at examples of quarterbacks and other athletes in recent years illustrates the unpredictability. Some were season footnotes, some were playable but altered effectiveness, others proved devastating.

Here are the recent outcomes for the most notable quarterbacks:

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Dak Prescott missed one game — at the Vikings in Week 8 — in 2021 while recovering from a calf injury. (Matt Blewett / USA Today)

Aaron Rodgers (2015): Rodgers sustained a calf strain in January and played through the pain but was nearly immobile in the pocket during the playoffs. Hindered, he still managed to reach the NFC Championship Game.

“It’s a significant injury,” Rodgers said at the time. “I was able to get through it.”

Tom Brady (2014 and 2019): Brady missed a practice before the opener in 2014 with a calf injury but didn’t miss a game. He was limited on the injury report for two weeks in September 2019 but also didn’t miss a game. In 2014, the Patriots went 12-4 and won the Super Bowl.

Andrew Luck (2019): Technically, Luck suffered a posterior impingement in the ankle/calf at the end of the season, but it falls into the lower extremity category of proceeding with caution. He aggravated the injury playing in the Pro Bowl, then again in the spring. It lingered all summer as the team kept saying he’d be fine. He never was. He stunned the football world retiring that August, more for a compilation of many concerns, but the ankle/calf issue undeniably followed him.

Jimmy Garoppolo (2021): With the 49ers, he suffered what was called a calf contusion instead of a strain during a Week 4 game against Arizona. He couldn’t finish that game and missed the following week but returned in Week 6. He had no issues the rest of the season, even beating Cincinnati 26-23 in Week 14 on the way to the NFC Championship Game.

Dak Prescott (2021): The Cowboys quarterback was enjoying a 5-1 start to the season when he hurt his calf. He missed two weeks (one bye, one game at Minnesota) before returning. The Cowboys struggled the rest of the year, going 6-5. He consistently downplayed any role the calf had in the performances.

“I wouldn’t say it lingered as long as people gave me the excuse of it,” Prescott said on “The Rich Eisen Show” after the season. “I went through a period of time during the season where I just didn’t play my best ball.”


Bengals defensive end Sam Hubbard (2022): One of Burrow’s best friends on the team strained his calf last December. He missed two games then returned to play the season finale against Baltimore and the entirety of the playoffs, including his infamous Fumble in the Jungle 98-yard return to beat Baltimore.

“They are really painful,” he said. “They are not the end of the world. They do linger a bit. Took me a while.”

Kevin Durant (2019): He injured his calf in playoffs and returned during the NBA Finals as frustration seemed to set in with his extended absence. He ended up tearing his Achilles in the game in which he returned.

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Mike Trout was limited to just 36 games in 2021. (Robert Hanashiro / USA Today)

Mike Trout (2021): Then there’s Trout, who suffered a Grade 2 strain early in the 2021 season and never could have imagined what came next. He didn’t play another game that year, partially because of a setback trying to return too early in mid-July. He started working out with the team and aggravated the injury. He hoped to come back, but as the Angels faded, he was shut down to let it heal completely. The frustration made him open up about the mental struggles he had in dealing with his physical limitations.

“Mental health is serious stuff, man,” he said then.

Bengals director of rehab Nick Cosgray will be leading the charge on Burrow’s situation, with the obvious collection of every mind in the building closely monitoring. Cosgray has a spotless history in Cincinnati of success with returning players, including helping Burrow back from his ACL tear coming out of his rookie year. Burrow being cleared to participate in training camp that season was a remarkable feat.

Cosgray and Burrow might have as much time logged together as nearly every coach in the building. Burrow’s list of injuries through three seasons now includes ACL/MCL, pinkie, throat, another knee, appendix and calf. Those are just the reported instances.

The strain being in his plant foot will make for a specific set of metrics to monitor as he returns. With the back leg bearing more weight and utilizing more torque, the Bengals will monitor velocity and accuracy closely in part of assessing his readiness.

If this rehab goes as well as the previous efforts, Burrow will return after “several” weeks, and all expectations are he’ll be fully healed in time for the opener. Even in the lightest instances of a calf strain, any sooner wouldn’t make sense because of the time of year.

“Talking about preseason or training camp, you’re going to be ultra-conservative,” Flynn said. “I think you have to add a couple weeks.”

Callahan doesn’t see a major adjustment in the August plan with Burrow out. The team will allow Jake Browning and Trevor Siemian to serve as “point guards” for the high-powered offense in practice. The advantage they will lean into is a roster not short on continuity.

“That’s the benefit of where we are,” Callahan said. “To be together as a staff for five years and Tee (Higgins) has been here for four and Joe has been here for four and Ja’Marr (Chase) has been here for three, (Joe) Mixon has been here for seven. (Tyler) Boyd. The guys up front have accumulated a year under their belts. There is not a lot of stress on my end about whether or not we are going to get what we need out of camp. We are going to get what we need. We will be ready to play football when it’s time to play football.”

In a weird way, the Bengals will arrive in Cleveland on Sept. 10 ahead of where they were the last few years.

“Joe got more days this July than he’s ever had in the NFL,” Taylor said. “I feel really good about the progress we made in those July practices with Joe. When he’s able to get back we’ll be able to get the work in we need.”

Call it relief. Call it a dodged bullet. Call it whatever.

Just don’t call it over, yet.

Managing the calf strain and avoiding a recurrence will be how we truly learn how this injury will be viewed historically. Once it ends up in the rearview mirror, the Bengals plan on returning to focus on one of the deepest rosters in recent team history and one of the betting favorites to reach Super Bowl 58.

“We are not in a position where if you lose one guy, you are like, how are we going to overcome it,” Callahan said. “We are built now to withstand any and all of it.”

Well …

“Except for one,” he said, admitting losing the franchise QB for a chunk of a season is far different than the entirety. “And that’s every team in the league. The ultimate one you cannot survive.”

(Top photo of Joe Burrow: Kareem Elgazzar / USA Today)

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