Dustin Perry - Vice President, Player Health & Performance

Having to spend the whole weekend at home thanx to a dental infection (and pain), I made some internet research.
Right now there are 19 players in the IR. Apart from Ayiuk, the other 18:

*Non soft-tissue injuries and/or not related to the training/medical staff:

- Alfred Collins (DL). He suffered a torn patellar tendon during practice. Out for the 2026 season.

- Andrew Farmer (OLB). On July 29, Farmer was waived by the 49ers with an injury designation and reverted to injured reserve the following day.

- Darrick Forrest (S). He was placed on injured reserve on May 28, due to an undisclosed injury.

- Isaac Guerendo (RB). Suffered a torn pectoral muscle while lifting weights in late May.

- Mikail Kamara (ED). He was waived by the 49ers with an injury designation after suffering a torn ACL during training camp. He then returned to the 49ers injured reserve after he cleared waivers.

- Sam Okuayinonu (ED). "He had a plate in his foot a while ago," Shanahan said. "And on our bonus practice, the day we came (to Australia), just stepped on it, and it broke. So, he's going to have to get surgery. It was a bad injury". Unclear if he will be able to return this season.

- Ricky Pearsall (WR). He strained his PCL in week 4. Missed 6 games and he was medically cleared by team doctors. He also received a second opinion before he returned to play week 11. He aggravated the injury in Week 15 after a dirty hip tackle and missed some other games.
When the season ended, Pearsall had several months of rest and rehabilitation. He experienced swelling in the knee after participating in the first two training-camp practices. That setback prompted the decision, made in consultation with team doctors and independent surgeons, to operate.

The lengthy rehabilitation explains why Pearsall and the 49ers decided against surgery after the 2025 season. Had Pearsall undergone the procedure in January, he still might have missed most or all of the 2026 season.
The complexity of the procedure is another reason doctors exhaust nonsurgical options before operating. The surgeon must drill near the back of the knee, close to the popliteal artery, a major blood vessel. Damage to the artery could put the patient's leg at risk. It is a very technically challenging operation with significant risks.

There's only one prominent professional athlete whose situation closely resembled Pearsall's: NBA center Steven Adams underwent surgery for an isolated PCL injury in November 2023, about 10 months after he was hurt.
"Isolated PCL injuries do not typically require surgery," said Ramkumar, who works at MemorialCare Long Beach Medical Center. "We usually operate when a patient has failed nonsurgical treatment for several months, if not years."
https://www.sfchronicle.com/sports/49ers/article/ricky-pearsall-s-rare-pcl-surgery-49ers-last-22371636.php

- Austen Pleasants. Injured his knee in preseason game against Chargers. "not an ACL tear", could return after week 4.

- De´Zhaun Stribling. Deltoid rupture,which is very unusual.

Stribling suffered the injury in the first half against the Rams. The rookie initially exited in the first quarter with an ankle injury but returned. However, Stribling had to leave again in the second quarter and did not return, prompting some criticism of the decision to keep the receiver in the game.

"We don't have X-rays and MRIs on the sidelines, and they take a while," Shanahan explained. "So, when a guy comes off—Stribling did it and played a number of plays before even saying anything. We didn't know which play it was on. It was actually on a bootleg that I think we hit [TE] Luke [Farrell] on, and somebody hit him at the end of the play that no one even knew about. And he fell on his ankle and got up and walked off. But he was hobbling a little bit, like all of us have rolled our ankle and stuff, and you play through an ankle. When you find out it's a high ankle, usually you find out you can't play.

"So, that's what we thought, and then they go through the whole protocol of it, have him run up and down the sidelines, they test everything. I get on the headsets, 'Hey, he's out for a little bit. We're testing him. His Achilles is intact. We've seen it's not a high ankle sprain. He's running. We're going to let him go back in.'
"And then he goes back in and does a turn that you don't replicate on the sideline, and then you find out it's worse than that."
https://www.49erswebzone.com/articles/203320-rookie-dezhaun-stribling-tonges-season/

- With Stribling, he went out of the game twice. Is there a sense that he exacerbated the injury after going back out onto the field?
"No, it just didn't check out as an Achilles, didn't check out as a certain ankle. The stuff that they did, they went through the normal protocols, he was passing them, but then when he ran a certain route it really showed, the one you guys saw on TV that he collapsed on and it was going to happen regardless."
https://www.49erswebzone.com/articles/203328-transcript-shanahan-shares-updates-dolphins/

- Jake Tonges. Season ending MCL tear playing against the Rams

- Brett Toth. Concussion. He went on IR at final cuts and didn't get one of the return designations so he won't be back.

- CJ West. Chip bone.

- Mykel Williams. ACL tear 2025 season. Expected to return soon, week 5-week 7

- Nick Zakejl. Elbow. No return desgnation

I extended the cases of Pearsall and Stribling because they were the most controversial but I don't think any of these 14 cases can be blamed on the training/medical staff.
S**t happens

*Soft-tissue injuries:

- Nate Hobbs (CB). He suffered a groin injury during joint practices with the Tennessee Titans. He went on IR shortly after making the initial 53-man roster so he could return but it will probably depend on the team's needs at CB position as the season advances.

- Christian Kirk (WR). Calf injury. Expected to return week 5-week 7.

- Nick Martin (LB). Hamstring. He is eligible to return after making the 49ers initial 53-man roster but that's still up in the air.

- DeMarcus Robinson. Landed today on IR with a high ankle sprain. Typically takes 3-6 weeks but this is going to be at least 4.

Apart from all these 18 on IR, there are another 2 players injred who have not entered the IR, both with soft-tissue injuries. James Tompson Jr. with a high ankle sprain and Bosa with a calf injury.

Kyle Shanahan explained that Bosa's injury occurred when he was warming up doing high knees before the official team stretch: "He does his warm-up deal, right before walkthrough. He does his own warm-up on the side. Just got his calf doing it."

I don't think Bosa's injury can be blamed on the training/medical staff since it happened during individual warming (seems like very rare). Not all the soft-tissue injuries can be blamed on them, as some people has said.
So there are 5 soft-tissue injuries occurred during TC and the firsts 2 games of the season. I don't follow other teams' injuries but I really don't think this is so unusual.
People feel more confortable finding someone (like the training/medical staff)/something (like the substation) to blame but there's probably nothing there.

The issue is just way to consistent to not have some underlying cause. If luck was the driving factor you'd see far more varience year to year.

The young guys are just as prone to getting injured as the vets so age can't be a major reason.

Doubt Shanahan runs his practices significantly different then 31 other teams.

Drafts especially in recent years don't really have any major injury red flags.

So if it's not the substation that only leaves the medical and strength and conditioning staff to point the finger at.

Originally posted by replikante:
*Soft-tissue injuries:

- Nate Hobbs (CB). He suffered a groin injury during joint practices with the Tennessee Titans. He went on IR shortly after making the initial 53-man roster so he could return but it will probably depend on the team's needs at CB position as the season advances.

- Christian Kirk (WR). Calf injury. Expected to return week 5-week 7.

- Nick Martin (LB). Hamstring. He is eligible to return after making the 49ers initial 53-man roster but that's still up in the air.

- DeMarcus Robinson. Landed today on IR with a high ankle sprain. Typically takes 3-6 weeks but this is going to be at least 4.

Apart from all these 18 on IR, there are another 2 players injred who have not entered the IR, both with soft-tissue injuries. James Tompson Jr. with a high ankle sprain and Bosa with a calf injury.

Kyle Shanahan explained that Bosa's injury occurred when he was warming up doing high knees before the official team stretch: "He does his warm-up deal, right before walkthrough. He does his own warm-up on the side. Just got his calf doing it."

I don't think Bosa's injury can be blamed on the training/medical staff since it happened during individual warming (seems like very rare). Not all the soft-tissue injuries can be blamed on them, as some people has said.
So there are 5 soft-tissue injuries occurred during TC and the firsts 2 games of the season. I don't follow other teams' injuries but I really don't think this is so unusual.
People feel more confortable finding someone (like the training/medical staff)/something (like the substation) to blame but there's probably nothing there.

Much of what you say here is true. Fans always react more to injuries on their team. I'm sure fans around the league are upset about whoever is getting injured on their team. The Giants can't be happy about thier QB getting injured again and possibly being out for the year. You can bet they're hoping Scatterbrain doesn't get injured every time he carries the ball. Same for Bengals fans and Joe Burrow who had been hurt so often.

I don't know what is causing the injuries but until there is normalcy around the players and their health I doubt we are going to win the prize. I don't knotw what's causing it but as others have said it can't be just bad luck. Training staff, substation harmonic power frequencies or style of play. Someone is going to have to figure it out. Above my pay grade so hopefully they will find a consultant to figure it out.

Just dumb luck, every f**king week, huh.

Fire him. This week is a clown show of injuries too

Originally posted by InfernoDaLuz:
Just dumb luck, every f**king week, huh.

IMO frequent, consistent "bad luck" like this year after year is not coincidence. It's systematic.

In case anyone is surprised why old Dustin is beyond reproach.

Originally posted by brodiebluebanaszak:

Originally posted by leakyfausett:
2025 #4 Most Injured < 12-5, Lost NFC Divisional
2024: #1 most injured < 6-11
2023: #29 most injured ? 12-5, lost SB
2022: #9 most injured ? 13-4, lost NFCCG
2021: #3 most injured <10-7, Lost NFCCG
2020: #1 most injured < 6-10
2019: #6 most injured ? 13-3, lost SB
2018: #4 most injured < 4-12

I will Just drop this right here. Top 6 most injured 6 of 8 years. Top 10 1year and one healthy year. Playoffs in in 4 of the big injury years says a lot about the Coaches and Players that were healthy.

What does "most injured" mean? Where is the stat definition?

When running his outside zone offense, Shanny loved to use undersized backs that can run a 4.3. They were ALWAYS injured. Mostert, Brieda, Mitchell.

Then, we draft already injured guys. We take flyers on complete throwaways like Rueben foster javon kinlaw jalen hurd.

How many days do we lose doing stupid s**t like that? Just last year, kurtis rourke drafted injured. Lost all last year. Does that count on our "most injured definition?"

Most injured means most games lost to injury by players. Pretty simple really.

This is one of those times, as a fan, just give me change for the sake of change and lets see what happens.

When you have a curse you clean house not wait around hoping s**t changes….nothing has changed

Originally posted by bassmanr:
I don't know what is causing the injuries but until there is normalcy around the players and their health I doubt we are going to win the prize. I don't knotw what's causing it but as others have said it can't be just bad luck. Training staff, substation harmonic power frequencies or style of play. Someone is going to have to figure it out. Above my pay grade so hopefully they will find a consultant to figure it out.

At this point, fire the entire training staff and start from scratch.

Originally posted by Phoenix49ers:
At this point, fire the entire training staff and start from scratch.

The medical staff too for good measure.