Before I get started, it would be beneficial to read my broader overview of running back injury rates and how it might affect your fantasy team first. So at some point, you should check that out. Now that’s out of the way, I need to say that this Dalvin Cook Injury Outlook is personal to me. Not that I don’t already pour every ounce of brainpower into each injury outlook (I do), but it’s just that this specific player holds a special place in my fantasy football heart. I’ve been going back and forth in my head about which two guys to keep between Leonard Fournette, Dalvin Cook, and Miles Sanders in one of my keeper leagues. So, what kind of mental gymnastics does a medically-inclined fantasy football player go through?

TLDR

Dalvin Cook is statistically one of the best fantasy running backs in the league with unmatched upside (other than Christian McCaffrey). His median fantasy points per game in ten games is 20 compared to 16 for Zeke, D. Henry, and Aaron Jones. He’s is also statistically one of the biggest injury risks among top-five fantasy running backs in the league. Theoretically, his chances of another ACL tear are approximately 20%. His chance of dislocation for one shoulder is 13%-26% and 40%-50% for the other. There might be a much more insidious reason for his specific connective tissue injuries, but even if he’s not the history places him at high risk on its own. This isn’t a “splitting hairs” type of decision. There’s plenty of objective information that would reasonably lead you to avoid Dalvin Cook depending on the opportunity cost.

The Upside

How can you ignore it? Cook is one of those players who has the ability to carry you to a fantasy ‘ship. When doubts creep in about his injury history (I’ll get there in a moment) all I think about is him catching that classic Stefanski screen pass and bursting forward for a 20 yard gain. Then I remember how the Vikings’ game plan every week is to establish the run so hard that a portal to 1969 opens up at the 50 yard line (shout out to C.D. Carter for that joke).

So, in an effort to prove myself wrong, I plotted Cook’s fantasy points per game of Week 1 through 10 of the 2019 season. I compared those average scores against the numbers put up by Ezekiel Elliot, Derrick Henry, and Aaron Jones in their first ten games of the season. The result is below in the box and whisker plot.

The median is the midpoint of a data set. So 50% of scores lie above the median and the other 50% lie below.

The orange shaded box is Cook’s average fantasy points per game. Statistically, it essentially represents his expected ceiling/floor for that stretch of games. The lines that extend outside of the boxes are statistical outliers. The X in each box is the median score for both data sets. The blue shaded box represents the same for Zeke/D. Henry/A. Jones combined.

Cook’s median fantasy points in his first ten games of the season is 20. The other three players’ median is 16. Although this is only a sample of ten games, there’s no reason to believe in that offense with Cook’s talent that it’s a statistical fluke. However, I’ve been told that every rose has its thorn.

The Injury History

March 2018 – Right shoulder dislocation/subluxation March 2016 – Right shoulder dislocation/subluxation October 2017 – ACL tear with two hamstring strains to follow December 2019 – Sternoclavicular (SC) subluxation/sprain December 2019 – Left shoulder dislocation

Can't really spot the mechanism but around :23 it appears that Cook throws his arm up to potentially reduce ("put back in place") his shoulder. Not 100% confident in that but Cook has dislocated/torn his labrum twice before in '14. Not looking good at all.https://t.co/BeKTcN6zAH — Dr. Edwin Porras (@FBInjuryDoc) December 15, 2019

Dislocations damage the glenoid labrum, which provides stability for the head of the humerus (upper arm bone) to remain in the glenoid (shoulder socket). To help visualize the shoulder joint, imagine that the humerus is a golf ball and the shoulder socket is the tea. The labrum is cartilage that surrounds the outer edges of the golf tea. When the cartilage is damaged, the joint becomes less stable. This is a major issue long term due to the chance of developing osteoarthritis. Reportedly, Cook’s first shoulder dislocation was actually in high school.

Don’t let the fact that he came back for the playoffs to dominate fool you- Cook’s shoulders are an absolute injury liability. In fact, there’s a 40%-55% chance that he re-dislocates the left shoulder in 2020. What’s worse, there’s still a 13%-26% chance he re-dislocates the right shoulder. I won’t even get started on the fact that roughly 20% of NFL players who tear their ACL have a second tear at some point in their careers.

Are you starting to see why this Dalvin Cook Injury Outlook is so polarizing? Furthermore, what really worries me about Cook could be a bit more insidious.

The ACL is a ligament and the SC/labrum is cartilage, but fantasy analysts love sneaking in the term “soft tissue” into their analyses of players. Why no love for the connective tissue? Anyway, isn’t it curious to you that Cook’s major injuries primarily involve connective tissue (ligaments/tendons/cartilage)?

Conditions such as hypermobility syndrome and Ehlers-Danlos, although relatively uncommon, are not unheard of and many individuals can go about their daily life without ever knowing they have it due to its enormous variability in presentation.

As usual, I feel the need to clarify what I’m not saying before moving forward:

I have not examined Dalvin Cook.

I do not know Dalvin Cook’s official medical history.

I am not reporting that Dalvin Cook has one of the above conditions.

What I am saying is that Dalvin Cook has a well-established history of instability injuries and “dysfunctional” connective tissue. Even if this pattern did not seem suspicious and Cook isn’t hypermobile, at this point his chance of re-injury is objectively high.

The Decision

So, to summarize this Dalvin Cook Injury Outlook:

Dalvin Cook is statistically one of the best fantasy running backs in the league with unmatched upside (other than Christian McCaffrey). His median fantasy points per game in ten games is 20 compared to 16 for Zeke, D. Henry, and Aaron Jones. He’s is also statistically one of the biggest injury risks among top-five fantasy running backs in the league. Theoretically, his chances of another ACL tear are approximately 20%. His chance of dislocation for one shoulder is 13%-26% and 40%-50% for the other. There might be a much more insidious reason for his specific connective tissue injuries, but even if he’s not the history places him at high risk on its own. This isn’t a “splitting hairs” type of decision. There’s plenty of objective information that would reasonably lead you to avoid Dalvin Cook depending on the opportunity cost

Cook carries a legitimate re-injury risk overall, so holding Sanders along with Kirk or Fournette is very realistic for my level of comfort at this point. The flip side is that I wouldn’t blame you for drafting/holding Dalvin Cook either. No risk-it, no-biscuit, baby amirite?!

So, what will you do?