NFL Injury Notes: German Treatment Means Christian McCaffrey Done Until November; 5 Chargers 1st-Rounders Out

Oktoberfest In Germany began on Sept. 21 this year, so one supposes San Francisco 49ers running back Christian McCaffrey might have taken a moment to sip on a beer last weekend when he was in country, but he was actually there trying to heal his Achilles tendonitis.

"He went to Germany not for Oktoberfest, he's going there for a modified PRP (Platelet-rich plasma) type injection," said OutKick medical contributor Dr. David Chao. 

"He's not going there to see an Achilles tendon specialist. He's going there to get a procedure that's basically injecting growth factors (Platelet-Derived Growth Factor or PDGF) that are modified or activated."

That treatment is not FDA approved in the United States. 

"In Germany," Dr. Chao said, "they think it makes it more effective."

McCaffrey Out Beyond IR Period

And while the 49ers are managing lesser injuries to receiver Deebo Samuel and tight end George Kittle, the McCaffrey injury is more serious. That's because there is a definite cost for the medical approach the running back took in Germany.

"This insures he won't be back right after the four-week mark [that being on the injured reserve list allows]," Dr. Chao said. "This insures he won't be back in October. The hope now is November sometime."

Why?

"After this injection, you're shut down for several weeks," Dr. Chao said. "And then gradually he's allowed time to ramp up. So it's about four-to-six weeks. He's already two weeks into his IR stint. So four-to-six weeks since last weekend puts you into November."

It's obvious McCaffrey is going in this direction so he can play late this season and help the 49ers when they are expected to be making a push for the postseason.

"Hopefully it will help," 49ers coach Kyle Shanahan said.

 Chargers Without 5 Former First-Rounders

The Chargers are very likely going to roll out much of the Junior Varsity this weekend with up to five of their former first-round selections either not playing or playing with a significant injury.

The Chargers have starting quarterback Justin Herbert (ankle), right tackle Joe Alt (MCL), left tackle Rashawn Slater (pectoral) and defensive end Joey Bosa (hip) on the injured list.

Safety Derwin James has been suspended for one game because of "repeated violations of the playing rules" and so he is out.

That's a rough situation as the team prepares for Sunday's game against the Kansas City Chiefs.

"Most teams don't even have five first-rounders that they drafted playing on the team," Dr. Chao noted.

The Chargers played Herbert against the Pittsburgh Steelers last week despite his high ankle sprain. He left the game limping. 

Was it a mistake playing him?

"No," Dr. Chao said. "I was saying he would play and he did play. The reason I say no, is I don't believe he got hurt any worse and chances of that were low."

Having said that, Dr. Chao doesn't believe Herbert plays this week despite the fact the quarterback wants to play. Does Herbert convince Jim Harbaugh to let him play without his left tackle, or right tackle and next week being a bye?

"I don't think he will," Dr. Chao said.

Thompson Could Play With Injection

The Dolphins have a decision to make with quarterback Skylar Thompson: Play him with injured ribs or sit him in favor of the team's third-string quarterback – Tyler Huntley or Tim Boyle.

Well, it really is Miami's choice because even if Thompson's rib(s) were fractured, he could play. One shot before the game would allow him to play.

"I've done it a dozen times with Philip Rivers," Dr. Chao said. "Totally fine."

But the Dolphins are managing other decisions in order to make their call on the starter. Much of that has to do with what level of play Thompson has shown even when healthy and his experience.

"If this were Justin Herbert, he could not practice all week, take an injection and play with the ribs injury," Dr. Chao said. "He's done that before.

"But if you're a Dolphins coach or executive, you're not putting Skylar Thompson out there without practicing [full]. He knows the system, but you're not going to do that with Skylar Thompson."

The Dolphins showed Thompson limited in practice on Thursday and have two more days of preparation before Monday night's game against the Titans.