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Original article by Jeff Nowak for Nola.com.

If you watched the NFL last season, you may have noticed All-Pro running back Alvin Kamara wasn’t 100%. Nevertheless, that didn’t stop the Saints from signing a major extension with him for the 2020 season. Is this injury something he can bounce back from? Let’s dive in.

“I tried to put my best product out on the field,” Kamara said, speaking to reporters Aug. 10 about the injury, adding that he “tore” his knee during a Week 6 win against the Jaguars.

“Sometimes it was enough, sometimes it wasn’t.”

Though details of the knee situation weren’t disclosed by the Saints or Kamara, a report from Master Tesfatsion of Bleacher Report shared that it was a notable injury to his MCL. The injury happened during the middle of the first quarter, where Kamara bulls through the middle of the line. Met with resistance, Jaguars defenders Josh Allen and Marcell Dareus tackle Kamara awkwardly. Right away you can tell Kamara is in pain, as he reaches for his left knee and holds it as he’s helped to his feet.

Though he did not personally treat Kamara’s injury, Dr. Rand McClain, chief medical officer for Los Angeles-based LCR Health shares that the reflex to stiffen that joint is indicative of a possible ligament injury.

“That’s what the body tries to do whenever you hurt a joint, it tries to immobilize it. … The body’s answer to a joint injury is to stop it from moving,” McClain said after reviewing the play. “So he’s consciously saying ‘this does not feel good’ and tries to keep it as immobile as possible.”

Though Kamara had suffered a new injury along with the ankle injury from the previous week, he finished the game. For the next two games, he sat out.

computer-desk-laptop-stethoscope-

What’s an MCL?

In each knee, there are four major ligaments, including the MCL. Besides that, there are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), and the lateral collateral ligament (LCL).

Any issues to an athlete’s MCL would inhibit their ability to perform movements that require the knee to bend inward with force, such as a running back attempting to cut to the left off the left leg, explained McClain, who specializes in regenerative medicine and works regularly with professional athletes.

“I don’t care how tough you are,” McClain said, “pain will stop you from moving the way you want to. Period.”

Often times, the physical injury is not all an athlete suffers. The mental challenge of changing their normal style affects the athlete as well.

“There was a lot of times where I’d get into situations last season where normally I wouldn’t think twice about being able to break a tackle, or bounce it outside and turn a 2-yard gain into 10,” Kamara said. “But last year was a lot of ‘get what I can get and go down. Don’t do too much,’ because I could possibly hurt my knee more. ”

Kamara’s struggle can be seen in the Saints’ playoff loss to the Vikings. After a play where he stumbles, he claps his hands together in the huddle, seemingly frustrated by the play.

“He’s catching, stepping and using that left leg to then twist to his right,” McClain said after reviewing the play. “And so what has to happen with that knee is it’s got to dip in, and that definitely puts strain on the (MCL). … So this would be a classic example, if you want to read into what he’s feeling, where he’s probably going ‘ouch,’ and just better brace for a hit.”

By The Numbers

As the season continued on, Kamara performance seemed to decrease. In his final eight games, he had 11 broken tackles, which alone matches his amount from the Saints’ Week 4 win over the Cowboys. Below is a list of Kamara’s broken tackles per game each week on either a catch or a run in two-week splits, demonstrating the steep dropoff after the injuries in Week 5 (ankle) and Week 6 (knee).

  • 1&2: 6
  • 3&4: 19
  • 5&6: 3 (ankle/knee injuries)
  • 7&8: DNP
  • Bye week
  • 10&11: 1
  • 12&13: 4
  • 14&15: 2
  • 16&17: 4

(SOURCE)

Other key metrics lessened as well, such as a decrease in explosive plays of 10-plus yards and a higher percentage of plays limited to 1 yard, no-gain or a tackle for loss.

PRE-INJURY (Weeks 1-5)

CATCHES: 26 for 342 yards

  • *For ≤1 yards: 3 (0.6 per game)For 10-plus yards: 8 (1.6 per game)

CARRIES: 75 for 342 yards (15 per game; 4.56 YPC; 68.4 YPG)

  • For 10-plus yards: 8 (1.6 per game)
  • *For ≤1: 21 (28% of total carries)

POST-INJURY (Weeks 10-17)

CATCHES: 26 for 257 yards (32.1 YPG)

  • For 10-plus yards: 8
  • For ≤1 yards: 9

CARRIES: 85 for 424 yards (10.6 per game; 4.9 YPC; 53 YPG)

  • For 10-plus yards: 11 (1.3 per game)
  • *For ≤1: 27 (31.7% of total carries)

* = excluding touchdowns

Asked if anything else might’ve contributed to a downturn in chunk plays, Kamara needed just three words.

“I was hurt,” he said, falling silent as he waited for the next question.

Though, it wasn’t only Kamara’s injury that was limiting. Starting guard Andrus Peat broke his forearm and was out for six weeks, leaving Nick Easton picking up snaps during his leave.

From Weeks 1-6, 21.7% of Kamara’s carries (20 of 92) were runs off the left guard (Peat) or right guard (Larry Warford), according to Pro Football Focus. From Week 10 through the Saints’ wild-card loss to the Vikings, that split accounted for just 7.6% of his carries (7 of 92).

Kamara’s yards gained after first contact also dropped dramatically overall from his average of 49 per game (294 total) in Weeks 1-6, to an average of 26.6 per game (240 total) over the final nine games, including the playoff the loss.

Possibly due to these numbers, the Saints decided to pick up Cesar Ruiz, the Michigan center, in the first round of April’s draft.

Surprisingly though, Kamara became a more efficient runner statistically post-injury, with his yards per carry increasing from 4.56 to 4.9 since Week 10. Though as the Saints worked the runs to the edges, less and less success came from them as the season continued.

The Weak Toss

To clearly see the impact of Kamara’s injury, look to the “crack toss”. Typically, his abilities are showcased in this play, along with other types of weakside toss plays the Saints use. To identify the strong side of a formation, use the tight end as an indicator. Where they are lined up is the side defenses will be on high alert for potential run plays.

The crack toss plays on this positioning. Instead of initiating a run to the strong side, like what’s indicated with the formation, the ball is tossed to the running back in the opposite direction. In turn, the wide receivers block back toward the line of scrimmage, sealing a lane to the outside. This type of block is referred to as a “crackback block”.

In recent years, the NFL rules have limited this type of block due to player safety. To avoid being called for a penalty the receiver must be set at the start of the play and aligned close to the formation. Contact during the block must occur above the defender’s waist and below the head or neck area, otherwise it is likely to earn a yellow flag and a 15-yard penalty.

Though there is a variety of how blocks can be executed on a play like this, the most usual includes at least one player responsible for getting ahead of the runner to block defenders to the play side. The Saints are no stranger to this type of toss play, often featuring a player, usually Josh Hill, who executes a “kickout block” toward the sideline. On these toss plays, it’s not unusual for the Saints to load up extra blockers and an extra lineman on the strong side. This draws more defenders into the box but pins them to the edge of the formation opposite the play.

Chargers StadiumThe Play in Action

Earlier in the season, the Saints saw success with these plays in the form of broken tackles and big gains. The same can’t be said about later in the season.

From Weeks 1-6 Kamara averaged 4.8 yards gained on 30 carries to the right or left ends. Even more telling, he logged 114 yards after the first contact on those plays, according to Pro Football Focus.

From Week 10 through the playoff loss, Kamara logged 35 such plays for 149 yards, down to a still-effective 4.2 yards per carry but with just 75 yards after contact, a drop of 2.7 per rush from the beginning of the season.

What does this mean? For one, it shows the Saints have confidence in their young running back in high-pressure situations. Though, it also shows that Kamara’s post-injury game didn’t stress defenses the same as pre-injury. Keep in mind, plays by a back rely on the blocking doing its job, which makes judging these plays complicated.

In one failed crack toss against the 49ers (shown below) it was star rookie Nick Bosa’s incredible speed off the snap that blew up the concept before it started.

It’s unclear whether Bosa read the play, but by getting upfield before receivers could throw their blocks he was able to hinder left tackle Terron Armstead from pulling around to lead-block. Bosa didn’t get credit for a tackle, but his rush blew up the design and Kamara was unable to make the unblocked defender miss.

Fair Examples

Despite those obvious caveats, this play concept generally serves as a fair example for these purposes.

The Saints rely heavily on Kamara’s ability to stress defenses on all levels to open up options across the field. For an example, look no further than the counter to this toss play.

After forcing defenses to account for the toss, the Saints often come back to a similar formation later in the game but dummy the action. Drew Brees gives a quick toss fake, Kamara takes a hard step to the weak side, and the tackle sells the block with the goal of influencing the box defenders out of position.

Kamara then takes the handoff and angles his run toward the opposite guard/tackle gap where the blocking should have an advantage. Suddenly a run play that should be easy for a defense to predict by the offensive alignment catches them offguard as they adjust to what beat them earlier in the game.

The Saints executed this combination for big gains against the Texans and in their first game against the Panthers. But without an effective punch, a counter typically won’t work well. In one play, two toss fakes worked for big gains, but the third from that same Panthers matchup shows Luke Kuechly ID the toss fake and effectively plug the run gap to stop the play dead.

That’s one of many examples of how an injury limiting any part of a running back’s game can have a cascading effect as trends develop.

What’s Next?

With the exception of a complete tear, it’s typical for MCL injuries to heal without surgery, according to McClain. He adds that if there is any scar tissue buildup that interferes, the patient could undergo a knee scope to clean up the joint.

Kamara confirmed he didn’t undergo surgery, “just a lot of rehab.”

This is a good sign, as McClain relays that the most important element of bouncing back is strengthening the muscles that support the injured ligament, especially the ones to the inside of the leg. Another key element is correcting any imbalances that might have started.

“Fortunately he’s had a lot of time to get back to his best self,” McClain said.

Often featured in viral videos showing his extreme balance drills, Kamara echoed that sentiment in recounting his offseason training. He said there have been no limitations for him in team practices this offseason, which coaches confirmed to be the case.

“It’s clear that he’s back to 100%,” Saints running backs coach Joel Thomas said early on in training camp, later adding: “We just need to make sure we continue to keep him healthy.”

But at least one thing is now clear in assessing Kamara’s 2019 season, regardless of what happens in 2020 and beyond.

“If (Kamara) indeed had an MCL injury,” McClain said, “he did pretty damn good.”

Dr. Rand

Author Dr. Rand

Dr. McClain has dedicated over 35 years of his personal and professional life studying nutrition, exercise, herbs and supplements and is also a Master of Acupuncture and Traditional Chinese Medicine.

More posts by Dr. Rand

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