Dak Prescott’s Injury Outlook

Dak Prescott

Recent reports suggest that Cowboys quarterback Dak Prescott could return as early as Week 6. NFL Network’s Ian Rapoport reported earlier this week that “there was a lot of optimism after the surgery” regarding the quarterback’s fractured thumb. That optimism influenced the Cowboy’s decision to forgo his placement on injured reserve.

Cowboys’ Owner and General Manager Jerry Jones explained his rationale by stating, “If we thought he wasn’t going to be ready to go until after four games, we would put him on IR. We’re not doing that. We think he can come in and play, so we don’t want to not have him out there practicing.”

NFL teams are notorious for being overly optimistic after an injury but are they realistic about the expectations? Initial reports suggested a 6-to-8-week recovery timeline, which aligns closely with the typical healing rates of fractures. How does the initial timeline shift to a 3-to-4-week range? Is that a reasonable projection?

Before we can address those questions, we should review the reported details of the injury that Prescott sustained. Per reports, Dak Prescott suffered an extra-articular fracture at the base of his right thumb. This is considered the most stable of the three types of fractures to that area since it does not involve the joint. These stable fractures have the best prognosis and give credence to the Cowboys’ optimism.

Although the fracture is considered stable at the joint, Prescott underwent surgery that required a plate and screws for reduction and fixation this past Monday. This type of injury can be treated conservatively with a splint and immobilization for 4-to-6-weeks if the degree of angulation is < 30. The fact that Prescott underwent this procedure suggests that increased angulation was present.

After a successful surgery, head coach Mike McCarthy said that Dak Prescott will need at least 7-to-10-days of healing before he’s cleared to resume football activities, per Jon Machota of The Athletic. That does seem fast, but keep in mind that the joint was not involved, and the fracture has been fixated with the hardware.

The only caveat to this is that you cannot speed up the time it takes for a bone to completely heal.  The typical duration for bone healing is congruent with the initial estimate reported. That is the time it takes for a bone to complete the remodeling process. As Wolff’s Law suggests, bones are incredible at repairing themselves but until that process is complete, the bone will be susceptible to re-injury.

Controlled stress can and should be part of Prescott’s rehabilitation as it will assist in the healing process as well as maintain and increase his grip strength during his recovery. The Cowboys’ medical staff will be cognizant of what the “football activities” entail. The risk of re-injury during this phase will be low and other factors will be considered for his eventual return to play.

Those factors will include aspects that affect the functionality of his right hand, including pain, swelling, range of motion, and grip strength. As a Physical Therapist, I presume that each of these components will be deemed satisfactory by the 3-to-4-week timeline the Cowboys have suggested.

If Dak Prescott can grip, throw, and demonstrate he is an effective quarterback during practice, the Cowboys could have him back on the field by Week 6 against the Eagles. 

The fact of the matter remains that his function may return by that time, but his tissue integrity may be vulnerable to re-injury. A re-injury can be caused by excessive stress to that area. Stress like that has a higher probability of occurrence during an actual game than what he would be exposed to during practice. In essence, the optimism is factual, but the safety may be questionable if he returns too soon.

James Rodriguez PT, DPT contributed to this report

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