The Dallas Cowboys and Jaylon Smith continue to exude confidence about his knee and nerve injuries.

We can admire the optimism and the hard work Smith has done to even get to this point. But in fairness to Smith and the tough situation he is in, there are some medical realities that should be addressed.

Smith has proclaimed he is “going to be 100 percent again.”

Unfortunately, it does not appear likely the nerve will ever fully recover.


Any nerve injury is unpredictable; however, the typical pattern is for the majority of recovery to be early in the first few days/weeks and sometimes months. The longer it takes, the less likely it is to fully recover. Unfortunately, Smith’s injury timeline is approaching a year-and-a-half, and his continued use of an ankle foot orthosis (AFO) brace indicates that may be a permanent need.

Last year, there were numerous videos and declarations Smith would play in 2016, and that never happened. Now, the Cowboys insist he will play in 2017. That is likely true, but it is virtually impossible to envision him being the generational linebacker he was pegged to be. The game of football is not that easy. A tenth of a second faster pass rush than average, you are Von Miller. A tenth of a second slower than average, you could be out of the league.

Although I have not examined Smith and hope to be wrong, a full nerve recovery at this point goes against medical science.

Certainly, it is great news that Smith is progressing well in the offseason program and will see the field on a limited basis for the first time at Cowboys rookie minicamp (even though it is technically his second year in the NFL).


The team maintains excitement.

Stephen Jones on Jaylon Smith: "He's doing great. He's making great improvements. We're more fired up than ever we picked him last year." — Jon Machota (@jonmachota) April 21, 2017

Now, some reality.

Video shows the severity of the injury:


@ProFootballDoc Jaylon Smith went down hard non contact what do you think pic.twitter.com/uH5GW2WjJK — Evan Callahan (@e_callahan1) January 1, 2016

Viewing this at the time caused concern Smith had suffered a multi-ligament knee injury worse than an ACL tear with concern for the peroneal nerve and that he would no longer be a top pick.

Hope I am wrong, but by video of significant knee injury, JAYLON SMITH will no longer be top 10 pick. Too bad. https://t.co/Js6WyvMotu — David J. Chao, MD (@ProFootballDoc) January 1, 2016


That, unfortunately, proved true.

Smith had major reconstructive knee surgery in January 2016 that was declared an immediate success, but that is like calling a draft pick a success before a player takes the field. Only time will tell.

An early report the nerve looked fine was suspect:

Hope nerve is ok but typically don't do surgery to find out. Also could have nerve look good but not work well. https://t.co/6OrqGMmu9U — David J. Chao, MD (@ProFootballDoc) January 11, 2016


Surgeon’s don’t expose or look at a nerve during surgery unless there is a functional problem. Your contractor doesn’t dig up the gas line just to look unless something is wrong.

You can’t fault a player for being optimistic or an agent for doing his job to produce positive spin. But we must be realistic. Smith’s video celebrating coming out of a knee brace after surgery created quite a stir as that tweet also confirmed his nerve injury, since he was wearing an AFO brace for a drop foot.

#JaylonSmith

Good news: no more knee brace & walking.

Bad news: wearing an AFO, indicates nerve issue.

Too bad. https://t.co/PyYYTDh4wG — David J. Chao, MD (@ProFootballDoc) February 26, 2016

Although his pre-Combine tweet did reveal to the world his peroneal nerve palsy, it did not cost him millions of dollars as there was no hiding the injury from team doctors who would examine him days later.


Here are the realities:

Despite all the positive reports, my pre-2016 draft thoughts on Smith have not changed.

Recovery from nerve injury is usually early or not at all.

At this point medically, it appears there is no way for the nerve to ever be 100 percent.


Smith has blown through the reported recovery estimate already, as his doctor initially indicated a three-month timeline from April of 2016. No question he had a top surgeon, who happens to be the Cowboys team doctor, but there is not much one can do about a nerve. It either does or doesn’t recover.

Peroneal nerve palsy causes a foot drop weakness or inability to lift up the foot and evert, both important qualities for a linebacker. The Cowboys continue to be hopeful of full regeneration.

Much potential misinformation continues.

It is good to hear about some nerve recovery, but reports of feeling in his toes returning seem inconsistent, as sensation in the toes are not even related to the peroneal nerve that was injured. Nerves to the skin in the toes should not have been affected in the first place. Peroneal nerve sensation is to back, side and top of foot, not the toes.


It appears Smith will play with an AFO brace. That is rare – if not unprecedented – among NFL linebackers, though some offensive linemen and at least one quarterback has done so. He is likely to have an active assist spring (flexible ankle brace) to help him be more dynamic.

After initial declarations by the Cowboys that Smith would participate fully in rookie minicamp this weekend, head coach Jason Garrett now says that participation will be limited.

It is not impossible Smith could be the linebacker the Cowboys hoped, but it is highly improbable.