Patrick Mahomes’s Injury and Nine Other Pivot Points Facing NFL Teams

How will the Chiefs handle their star QB’s recovery? Plus, what can the Lions do about their mounting injuries, and what’s next for the Texans’ middling offense?

Mahomes injured his lower leg in Kansas City's 21–7 win over the Browns. / Ken Blaze-Imagn Images

Most rational people hope the Kansas City Chiefs get a positive prognosis on Patrick Mahomes’s high ankle sprain. You can count me among them (not that I’m always rational).

But, even if they do, Andy Reid and his staff will have a lot to think about.

Mahomes is tough as nails. Given the choice, he’ll always play through an injury. And I think the Chiefs will have to consider not giving him the option for Saturday’s game against the Houston Texans, regardless of the prognosis.

The way Mahomes went down Sunday—with Cleveland Browns DT Dalvin Tomlinson wrapping his legs from behind, and another 300-pounder, Mike Hall, coming high to bend him back over his legs—reminded me of a slew of conversations I had 22 months ago in a cigar smoke-filled Chiefs locker room in Arizona. The quarterback had won his second Super Bowl, and did it battling, yes, a high ankle sprain. The Chiefs’ head athletic trainer, Rick Burkholder, was explaining how.

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“Those high ankle sprains,” he told me, “even when you’re coming back in practice, and he had a couple episodes in practice over the last couple weeks, you tweak, and it’s like 10 minutes till it calms down. And then it’s seven minutes, and then it’s five minutes.”

It was Burkholder’s way of explaining how the injury wouldn’t get better if Mahomes kept playing on it, which he had resolved to do, so the staff simply had to manage it. “That ligament won’t heal any faster than God wants it to,” Burkholder continued. So in the past few practices before the game, the excellent Kansas City training staff, with Julie Frymyer running point, pushed Mahomes to try to give him confidence moving around on it.

Everyone, of course, knew that win or lose, they had an entire offseason to deal with it.

That’s not the case now.

In fact, the predicament Kansas City now faces—thanks to the NFL’s insistence on playing on Christmas Day, even when the holiday falls on a Wednesday—is pretty much the opposite of that. The Chiefs have a short week ahead, and a shorter week after that, with the Texans coming to Arrowhead on Saturday and a trip to Pittsburgh on tap for the holiday.

They also have bigger fish to fry in January and, they hope, February, and a little bit of cushion to work with at 13–1 with the Buffalo Bills at 11–3. I’d suggest they use it.

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Welcome to The MMQB for Week 15. We’re going to do things a little differently this week, which I’ll explain in a second. First, here’s what you’ll find in the Takeaways, as we recap a week that brought a fantastic set of late-window games …

• A look at how the Philadelphia Eagles handled the drama that gripped Philly last week.

• The difference in this year’s Bills, in the aftermath of an impressive effort in Detroit.

• An appreciation for Tampa Bay Buccaneers receiver Mike Evans and his ridiculous consistency.

And a whole lot more.

But we’re starting with 10 pivot points across the league heading into the final stretch, beginning with how Kansas City handles its star quarterback’s injury.

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The Chiefs face a tough decision in handling Mahomes's injury and recovery. / Jim Dedmon-Imagn Images

Again, I’m not a doctor. Nor am I one of Mahomes’s coaches.

But, I have a pretty good idea of how the quarterback is about to handle those doctors and coaches, and it’s a credit to who he is—so if they leave the door open a crack for him to play, then Mahomes will play.

That said, there’s a lot to consider here. As the above story illustrates, and I’m sure many of you who follow football know, a high ankle sprain is a nasty injury that doesn’t simply resolve itself as an athlete is playing through it. It takes treatment and rest. And, oftentimes, even if a player can get the injury to calm down, to minimize its impact on his play, it won’t truly go away until the offseason.

Then, there’s the cumulative effect of all this on Mahomes. Quietly, there has been some concern about the raw number of lower-leg injuries that the three-time champion quarterback has suffered throughout his eight-year career. He doesn’t run as much as Josh Allen or Lamar Jackson, but he does take a lot of punishment scrambling to create opportunities to throw, and those hits, particularly to his legs, can add up over time.

Finally, the Chiefs have played well enough to have a two-game lead over the Bills in the race for the AFC’s top seed into Week 16. They have a three-game edge on the rest of the field, meaning it’s nearly impossible for them to fall below the No. 2 seed. This means the only way they’d play a road game in the playoffs would be if it’s against Buffalo in the AFC title game, and that’s only if they lose twice and Buffalo wins out.

If I’m Reid, Burkholder & Co., I use that leeway.

Even with the best-case result, and again, that’s what we’re all hoping for, I’d sit Mahomes on Saturday and give him the full 10-day run-up to Christmas. That way, if you have to play him in Week 18 with home-field advantage on the line, he has 11 days to prepare. 

The Chiefs fought, clawed and scratched their way into this spot where they have that two-game lead on the rest of the conference. To me, no question that getting your legendary quarterback physically ready for January is the best way to use it.

Even if the tough, resilient, gutsy Mahomes won’t like it.

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And with that, here are nine other story lines I’m keeping a close eye on with three weeks left …

How the Pittsburgh Steelers use Justin Fields going forward. When the Pittsburgh coaches talked to Fields after he lost the starting job six weeks into the season—with Russell Wilson coming back—they made a couple of points to him. One was that they still believed he had a bright future, and hoped it’d be in Pittsburgh. The second was that there was a pretty good chance that they’d need him again. Sans George Pickens, the Steelers’ offense crashed to earth against Philly, with the run game stymied, and the team held to 163 yards from scrimmage.

I’ll be interested to see if the Steelers start to use Fields more now. Pittsburgh gets the Baltimore Ravens and Chiefs next, which means the division, and a home playoff game, are on the line over the next nine days. So, I think this is the point where Mike Tomlin and OC Arthur Smith pull out all the stops.

Where the Detroit Lions are from an injury standpoint. No one has exhibited a higher ceiling than Detroit this season. But the injury situation on defense reached critical mass Sunday, with Alim McNeill, a massively important defensive tackle, now out for the season. The Lions lost Carlton Davis, too, and they already had 13 guys on that side of the ball on injured reserve. They have vets such as David Long, Kwon Alexander and Jamal Adams, who weren’t on the team on Veteran’s Day, playing vital snaps.

Does it mean the Lions’ season is dead? Of course not. But it does make it important that they get some of the cavalry back, and guys such as Brian Branch, D.J. Reader, Levi Onwuzurike, Jack Campbell and Terrion Arnold stay healthy. The margins on that side are now razor-thin.

C.J. Stroud and the Texans’ offense. It’s not that the Texans are suddenly bad on that side of the ball. It’s that they aren’t what we thought they’d be—they’ve only topped 30 points twice this year and, at 9–5, seem to be more comfortable winning slugfests than they are engaging in shootouts. Where is OC Bobby Slowik taking the offense next? Is a Stroud breakthrough coming? Is a well-paid offensive line good enough?

We should get answers soon, with DeMeco Ryans’s crew facing the Chiefs and Ravens next.

The growth of Buffalo’s skill group. You can make the excuse for Houston that the Texans lost Stefon Diggs—but Buffalo did, too. And as great as Diggs was, the Bills now have answers all over the field, from Dawson Knox to Khalil Shakir to Keon Coleman, Dalton Kincaid, Curtis Samuel and Mack Hollins, plus a trio of backs capable of catching the ball.

The arrow is pointing up on these guys. And if the Bills can win at Arrowhead in January, presuming that’s how things play out, they’ll be a big reason why.

Shakir helped the Bills to a 48–42 win over the Lions. / Kimberly P. Mitchell / USA TODAY NETWORK via Imagn Images

How the NFC’s reclamation QBs play in January. The Minnesota Vikings, Seattle Seahawks and Buccaneers are all closing in on playoff spots, and they’re doing it with highly drafted quarterbacks who were unceremoniously dumped by their original teams—none of whom are doing nearly as well now without them. I love the stories of Sam Darnold, Geno Smith and Baker Mayfield, and each has a chance to affirm who they are as players in the coming weeks.

To me, this is a pivot point beyond 2024. If these guys show up in the playoffs, I think it leads to bigger questions on just how young quarterbacks are developed in the pros.

The Los Angeles Rams’ post–Aaron Donald look. I was talking to a San Francisco 49ers coach last week ahead of their game against Los Angeles, and he wouldn’t stop talking about what new DC Chris Shula is able to do with the tough, nasty group he has along the line of scrimmage. Jared Verse is probably the Defensive Rookie of the Year, and Braden Fiske is right there with him. Fiske is a clone of second-year man Kobie Turner in a lot of ways, and Byron Young is a solid bookend to Verse. And then you have Bobby Brown III and Michael Hoecht.

Add that to having Sean McVay and Matthew Stafford on the other side, and the Rams look like a team that could cause some havoc in the NFC bracket. Which is remarkable to think about, given that their defensive front just lost one of the greatest players of all time.

How do the rookie quarterbacks finish out? One advantage Washington Commanders QB Jayden Daniels and Denver Broncos QB Bo Nix had coming into the year was an incredible amount of experience they brought to the NFL—between the two of them, there were 116 college starts and multi-year starting stints at four different power-conference programs. It’s shown this year, with both looking thoroughly prepared for the rigors of pro football.

Of late, though, there have been bumps. Nix wasn’t great in Sunday’s win over the Indianapolis Colts. Daniels has played better in his past two games after a midseason lull. So where those guys go from here—and how they play in the playoffs, if they get there—will be interesting, given that they should, on paper, be more prepared for these ups and downs than your average rookie.

Will there be a one-and-done coach? The Las Vegas Raiders are playing hard, but there are fair questions about the team’s direction under Antonio Pierce. Ditto for the New England Patriots and Jerod Mayo. Owners in both spots gambled with these hires, knowing there would be growing pains. Will they have the stomach to keep going with them, with Mike Vrabel looming as a possibility in both spots?

(Tom Brady’s presence in Vegas is particularly interesting, if there is a change there. He’s been all-in on his broadcasting job, and with assignments to call the NFC title game and Super Bowl, it’d be hard for him to engage in a search at this point anyway. But if he has a recommendation for Mark Davis, I believe Davis would be all ears.)

How do the Cincinnati Bengals finish out? Cincinnati has the Browns on Sunday, then can affect the playoff picture in Weeks 17 and 18 with the Broncos and Steelers. There’s an outside chance they could climb back into it themselves. But with that unlikely, if Joe Burrow, Ja’Marr Chase and Tee Higgins stay on this heater until the final whistle, it sure could impact how the offseason goes in Cincinnati.

And make no mistake, it’s a pivotal offseason coming for that franchise.

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