Preseason Injury Review- Browns

Analyzing the latest injuries following the preseason win over the Browns including AJ McCarron, Kyle Williams, and Cory Carter.

The Bills got their first win of the preseason with a decisive 19-17 win over the Cleveland Browns Friday night. While we saw some good things including the continued emergence of RB Marcus Murphy and darts thrown by QB Josh Allen show that there is some talent on this team and should be a force to reckon with this coming season. However, with all the good also comes the bad. The Bills have been relatively healthy over the course of this preseason, getting some bumps and bruises along the way but avoiding serious injury. Unfortunately, the Bills luck ran out Friday night on the shores of Lake Erie. Today’s post will review injuries sustained Friday and what this means going forward.

Prior to the game, DE Trent Murphy and WR Brandon Reilly were ruled out prior to the game with groin and rib injuries respectively. Hopefully both will be able to return to full health very soon and bolster depth going forward. The biggest injuries sustained Friday night with regards to name recognition were QB AJ McCarron and DT Kyle Williams. The former Alabama QB came from Cincinnati in the off season and was expected to compete for the starting job. Regrettably, McCarron reportedly sustained a hairline fracture in his collarbone towards the end of the 1st quarter.

The play that McCarron potentially suffered his collarbone fracture seemed pretty innocuous. He was tackled hard with most of his weight coming down onto his right shoulder but was able to finish the series. He did not appear to have any initial discomfort or favoring the injured area. Reports do not state which collarbone he fractured but my guess is the right side which is his throwing arm. However, after today’s press conference, there is question regarding the severity of the injury as McCarron is getting a second opinion which may change his availability. Once we have confirmation one way or another, I will be able to elaborate more.

DT Kyle Williams suffered what appeared to be a season ending injury early in the 2nd quarter. This occurred when he was getting blocked and a Browns offensive player fell into his right leg and he went down immediately in pain. The initial fear when a knee is bent like that with an outside force on the knee is an ACL tear. Thankfully, he avoided the dreaded injury and only sustained a MCL tear. The MCL is the ligament on the inside of the knee and is a commonly injured ligament during knee sprains. It appears as though Williams suffered a Grade 2 sprain which should heal on its own and will not require surgery.

Had Williams foot been planted in the ground when he got hit, he would have most likely torn his ACL and ended his final season. This is an injury that will take 4-6 weeks to heal which means he should be able to come back for Week 4 against the Packers. If things go well, Week 2 against the Chargers. As he is older, he will most likely be on the slower side of this timeline and lets face it, Kyle Williams is a national treasure when it comes to Bills fans. Training staff will not rush him back to the field unless he is truly ready to play. Once he returns, he should have no performance issues with the exception of some pain/swelling initially after playing.

One player who was hit hard by the injury bug was P Cory Carter who suffered a torn ACL after a collision late in the 3rd quarter. His plant leg was fully extended as he came down and the Browns defender rolled into his leg, preventing him from landing safely, causing his knee to hyper extend and tear the ACL on the second small hop in the above posted video. Prior to this injury, reports were coming out that he was having a solid camp and really challenging for the starting position. I have detailed ACL tears in a previous article, please check it out. Carter will be out for the entire year. I wish him the best of luck in his recovery. To note, this is the first ACL tear for the Bills since TE Chris Gragg tore in the preseason in 2016.

Another player that has had a very strong camp and warrants a roster spot is TE Jason Croom. The WR turned TE injured what appeared to be his left ankle on a punt return play the next play after Carter was injured. On the play, Croom went downfield and changed direction quickly to tackle the punt returner and LB Tanner Vallejo attempted to do the same thing, missed, and rolled into Croom’s ankle. He was able to walk off under his own power with a noticeable limp and was done for the night. It appeared as though he may have a low ankle sprain at worst. However, he was able to practice today according to reports which is something to watch for as the week progresses.

Others injured Friday include S Siran Neal, CB Taron Johnson, and OT De’Ondre Wesley. Neal was injured after a hard tackle and appeared to have the wind knocked out of him but was able to return later in the game. Johnson suffered a crackback block at the hands of WR Jarvis Landry who infamously ended the career of former Bills S Aaron Williams, thankfully no long term issues. Finally, OT De’Ondre Wesley appeared to tweak his ankle and came off the field but was able to return. I don’t see anything that warrants further concern. Also today, S Kelcie McCray was not practicing but film did not reveal any injuries at first glance.

Finally, QB Nathan Peterman appeared to sustain an injury in the last series of the game. Upon review, he took a low tackle which appeared to hit his knee but when he came up, he was hopping on his right leg and favoring his left. He was able to walk it off and finish the series but when he kneeled down to run out the clock, he did a reverse lunge and appeared to stumble backwards. It appeared as though he injured his left ankle. He may have twisted/tweaked it but as he was practicing today, it does not appear to be serious. Further reports will be made available if this becomes a problem.

Overall, the Bills escaped Cleveland without major losses.  They also have 9 days before their next game against the Cincinnati Bengals. Unfortunately, there are two more preseason games which mean two more possibilities for players to get hurt before the regular season. While all injuries cannot be prevented, preventative measures such as exercises/practice and limiting playing time appear to be the only way for now.

Continue to check back for the latest updates and injury analysis as the season progresses. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills, online www.bangedupbills.com and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

Groin Pains for Murphy

Exploring why Trent Murphy’s groin injury isn’t healed yet & what this means for the rest of preseason.

As the local media continues to find story lines to report on, injuries are always an easy topic to report because it usually affects the quality of play on the field for that particular game and can affect the season as a whole. New Bills DE Trent Murphy is no exception. As detailed in past posts, he is coming off an ACL tear that caused him to miss the entire 2017 season. Unfortunately, Murphy has not been able to show off the talents that scored him a new contract due to a groin strain suffered a week into training camp. Today’s post will explore why Murphy is slowed with his groin and how it’ll affect him the rest of the preseason.

Previous posts have explored muscle strains including severity and general healing times. Murphy’s groin is no exception. The groin muscles are also known as adductor muscles. They attach from the pubic region of the hips and go down to the inside portion of the femur or thigh bones. These muscles allow the leg to adduct/cross midline and medially/laterally the femur rotate based on hip position. They also assist with hip flexion; all of these motions assist with running/cutting/juking motions required of football players.

We know that Murphy tore his left ACL last year and has worked steadily back into athletic shape. As for his groin injury, regrettably, I have unable to find which side of his groin he has injured as media reports do not specify. Overall, this won’t really affect recovery time but may shed light on how his body is compensating following the surgery. It’s possible that both sides are injured but we are unsure. He wasn’t able to really participate in OTA’s due to his recovery from the ACL surgery. Since then, he has been cleared for full practice but is still attempting to overcome a full year of restricted activity due to rehab. Normal population may have an ACL reconstruction and not deal with injuries with returning to sport, but as a high level athlete in the case of Murphy, small deficits can become bigger detriments as he asks the most out of his body. Despite being functionally strong enough for football, his body is still relearning the proprioceptive movements required for the position and this is most likely the reason why he is suffering other injuries because the hips/groin and ankle are having to compensate for the knee as he regains his football abilities. A quick refresher, proprioception is the ability to understand where your body is in space in relation to movement. Think of your leg like a chain in which each link is the ankle, knee, and hip. If there is a weak link in the chain, it will break. Same thing can happen in people, if one joint is injured or weak, others begin compensating and may cause further injury.

What does this mean for Murphy going forward? I believe he will eventually be able to play without restrictions by the time the regular season starts. It appears as though he initially suffered a Grade 1 strain which can take anywhere from 1-2 weeks to heal after injury, with some taking up to 3 weeks. This is supported by the fact that he first reportedly sustained the injury August 1st, which is 2 weeks ago today. As stated above, it normally takes 1-2 weeks to heal under normal circumstances. I believe Murphy felt as he was able to return to practice after a week, re-injured going full speed and will require further rest. He will probably need another 1-2 weeks max to fully recover. While teams do want their athletes to heal fully, re-injuries still occur. The big question is whether that timeline for recovery restarted or this is a minor setback. I personally believe this is a minor setback but allows other guys including DE Shaq Lawson to get more looks and earn their way onto the roster.

He will most certainly miss the Browns game, should be able to play against the Bengals game if practice goes well, and ideally have no issues and be available for the Bears game. There is a possibility this could linger all season, but considering this is the preseason, the Bills will allow for extra rest time over return to play.

I expect Murphy to start against the Ravens on opening day. I’m going to also state that this won’t be an issue that lingers all season. I also believe that Murphy may have a slow start to the season and come on later in the second half as his body re-acclimates to football. I may be totally wrong on everything as this is only speculation, but this is highly educated speculation. However, I fully believe Murphy should be ready to go soon.

Continue to check back for the latest updates on the latest injury news and updates. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills, online at www.bangedupbills.com, and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

NFL Injury Series- Hamstrings

Reviewing the hamstring strain, severity, and rehabilitation.

Today’s post will look at the all too common hamstring strain. This is an injury even the best conditioned athlete can sustain. This article will not focus on one specific player, but rather educate and inform what the hamstrings are, how they operate, why they’re injured, and prevention.

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Credit: myprotein.com

The hamstrings are made up of 3 muscles in the back of the thigh consisting of the biceps femoris on the outside and the semimembranosis and semitendonosis on the inside. Together these three muscles attach to parts of the upper femur and bottom of the hip which is called the ischial tuberosity . This is the bony part that everyone sits on when they are in a chair. At the other end, they connect to the top of the tibia and fibula, which is the lower leg bones. Due to the muscles crossing over two joints, they have different functions. Together, these muscles allow the leg to extend and drive the body forward, along with bending the knee. During running and blocking, these muscles cycle through the process of shortening and lengthening at regular intervals depending on the position of the leg.

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Credit: livestrong.com

To help you envision the hamstring functioning, picture a sprinting athlete. Typically, one foot is in contact with the ground, the other in the air. During the foot that is in contact with the ground, the hamstrings with other muscles assist in extending the thigh to assist in moving the body forward. As the body moves forward and begins to push off, the other leg begins the process towards beginning to make contact with the ground. Once the original leg finishes pushing off, the knee begins to bend to assist in clearing the foot to bring the leg forward. Even during the portion where the leg makes contact with the ground, the hamstring is loading back up and eccentrically contracting which means that it is accepting a load while lengthening, which is the most taxing type of muscle contraction. When the foot makes contact with the ground is where most hamstring injuries can occur which is why you see most players stop quickly due to the sudden nature of the injury. While the hamstring does sound confusing, it can be, but know that without them, you’re not doing much walking without them

During times of injury, the muscle can be overworked, overstretched, or fatigued, leading to part of the muscle to become injured. Depending on the severity and location can dictate the recovery time. A strain is due to the injury to the muscle or the muscle bone attachment. Grade 1 tears are the least severe in which a small portion of the muscle tears during excessive activity. This can heal up rather quickly but several days of rest, stretching, and light exercise can remedy the muscle.

Grade 2 hamstring tear is where at a moderate portion of the muscle tears with a greater force, leading the player to limp and be unable to properly use the affected leg as intended. Typically, there is greater bruising and swelling with initial difficulty placing weight, keeping the player off it for some time. Bruising, poor functional control, and tenderness may occur during this time which could cause the athlete to miss several weeks before they are back to playing shape.

Grade 3 hamstring tear is where the muscle nearly or completely tears. It can also pull a chunk of the bone away from the bony attachment, most likely at the ischial tuberosity, known as an avulsion. This is due to this area being the anchor point, meaning the harder the muscle contracts, the harder it pulls on the anchor point, leading to eventual overload. At this level of injury, the muscle is quite weak and function is no longer normal. With this injury, the athlete is in danger of missing significant time or can be potentially season ending. Recovery time with surgery can be anywhere from 3-6 months with some resources stating closer to 8 months.

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Credit: physioprescription.com

These types of injuries occur when an athlete suddenly tries to decelerate and change direction, hurdling a player, or trying to push their body faster and faster. This can also occur during blocking, trying to maintain their ground as their being pushed forward and backwards, eventually the muscle gives out and the player becomes injured as a result. There are countless ways for the hamstring to be injured, these are just several of the more common mechanisms of injury.

While the injury is not fully preventable, there are certain steps that can be taken to reduce the incidence. Some preventable measures that can be taken is ensuring proper hydration, conditioning, stretching, and strengthening. Some things that can’t be controlled is previous hamstring injury and increased age. The best method to treat an injury is to prevent. However, I would be hard pressed to find an athlete that has not sustained some sort of hamstring injury during the course of their athletic endeavors.

As Bills fan, we have already seen several players deal with hamstring injuries this season with varying degrees of severity. As a PT, I am not concerned about the long term management of the injuries. I know these players need time to rest, recover, and not to rush back. I would expect to see these injuries increase as the season wears on and the bodies begin to break down. So far, only Matt Milano has been slowed up by hamstring strains and has been brought along slow so far in training camp after re-injuring in OTA’s.

Continue to check back for the latest Bills news and injury updates. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills and on reddit at u/BangedUpBills. As always, thank you and GO BILLS!!

Preseason Injury Review- Panthers

Reviewing the injuries sustained during the loss to the Carolina Panthers.

Football is back! The Bills opened the 2018 season with a preseason tilt against the Carolina Panthers with an unfavorable outcome in a 28-23 loss. Overall, it appeared as though the Bills played pretty well despite the loss with the QB competition beginning to parse itself out. Today’s post will review the injuries sustained in the Panthers game and what these mean going forward. Thankfully, the Bills didn’t suffer any season ending injuries and move onto next week against the Browns with a healthy roster.

Prior to the game WR Zay Jones, WR Corey Coleman, WR Cam Phillips, LB Corey Thompson, and DE Trent Murphy were all ruled out prior to the game. Jones did not play as he is still recovering from off-season knee surgery and while he is medically cleared, he is not quite ready to participate in full contact football. I expect that he should be ready next week against the Browns once he gets in better shape. It was reported that he was participating in 11-on-11 drills today at practice.

Coleman was ruled out due to his recent trade and inability to learn the offense quickly enough to participate. Prior to the acquisition, it was reported that he was having a strong training camp after initially being slowed up with a hamstring injury. It was not disclosed what Thompson is dealing with and no further information has been revealed since then. Phillips is still dealing with a groin injury sustained late last week in practice and is most likely what is still affecting his availability.

Finally, Murphy has been dealing what appears to be a Grade 1 groin strain. He has been limited in practice over the past week and the team is not willing to let their new DE injure himself further after coming back from an ACL tear which wiped out his entire 2017 season. Expect Murphy to play against the Browns barring any setback.

Following the loss, several players along the defensive line were reported injured which may affect their availability next week. First up is DT Star Lotulelei who suffered a back/neck injury. While I do not have video to fully assess the specifics, I can speculate that he may have sustained a trapezius injury. The trapezius muscle is a large muscle that covers the upper back and neck which provides support to the arms and shoulders which in turn assist in raising the arms. It also assists in extending the neck and adduction of the scapula which allows a person to pinch their shoulder blades together.Trapezius.jpg

I suspect a trapezius injury due to the fact that the muscle covers such a large area, it connects from the head down to middle of the back as seen above and the nature of the injury falls in line with his positional duties. He may have sustained a neck injury which is affecting his upper back with movement. Typically, violent twisting or collisions cause trapezius injuries which could explain the back/neck designation due to the location. Either way, it was reportedly not severe which may limit his practice availability but should be able to play next week.

DT John Hughes suffered a groin injury and while there is not video, it appears to be a Grade 1 strain according to the team. He may ideally need a week off similar to what DE Trent Murphy is going through but Hughes may not have the opportunity to rest as he has not exactly stood out in practice and is in danger of being cut. DT Marquavius Lewis also suffered an ankle injury which may appear to be a mild lateral ankle sprain. This is something that Lewis should be able to play through with some rest and rehab along with taping to support the area.

Finally, WR Brandon Reilly suffered a rib injury as reported. Rib injuries are typically more painful limitations than functional issues. As it was reported not serious, it may be bruised ribs which will require rest and extra padding but could resolve over the next week with no long lasting issues.

Fortunately, the Bills did not suffer any major injuries unlike the Redskins and Colts who suffered ACL tears in their respective games last night. The Bills continue to manage their injuries effectively and have been fortuitous in maintaining their depth players. Expect to see all these players be available for next week against the Browns with continued limited participation from starters.

Continue to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, and at www.bangedupbills.com. Continue to look for new articles on common NFL injuries and the latest injury news. As always, thank you for reading and GO BILLS!!

NFL Injury Series- Contusions

Reviewing what contusions are, severities, and recovery times.

Today’s post will consist of several terms that come up often but aren’t well defined. My goal is to identify the rest of the terms and continue to further the knowledge base. There are many terms for the same problem or based on location, which define how it is described.

First up is the common contusion. A contusion is defined as a blow to an area that damages the small blood vessels and connective tissue in the area. This can be caused by getting hit hard or falling the ground which if severe enough can impact function. While everyone has dealt with a bruise at some point or another, not everyone gets hit by a 250 lb linebacker going at full speed.

When the contusion occurs, the blood vessels do burst and the discoloration is the result of the burst blood vessels releasing blood, rising up to the surface, then slowly reabsorbed by the body. This is why a bruise fades over time. The more severe the contusion, the more impact it can have. While nothing has been torn, the connective tissue of the muscles and other tissues including fat and skin are still impacted. The tissues of the body are quite pliable and if damaged, will respond to pain as any other portion of the body, except brain tissue. Contusions vary in recovery times to no time missed to several weeks based on location and severity.

Contusions, if severe enough can cause compartment syndrome in the area. This occurs when swelling becomes excessive and pushes on the connective tissues surrounding the muscles. If not managed quickly, the excessive pressure can begin to kill the muscle, leading to permanent damage.

Various types of contusions include hip pointer, nerve contusion, stingers, and bone bruises. Hip pointer injuries are to the bony portion of the hip known as the iliac crest. This is right above the waist line and are common due to the location players fall to the ground or are tackled in the area. This area is also where the abdominal wall attaches to which limits trunk motion and the hip abductors connect right below the area, which allow for a player to run and perform lateral movements. These can take 1-3 weeks to recover based on severity of the injury.

Nerve contusions, such as what Shaq Lawson dealt with last season, is when bruising occurs to a nerve. In most cases in the body, the nerve is well insulated and protected from injury. However, in certain cases, these nerves sometimes exit the body temporarily and are exposed. Cases include the ulnar nerve that exits temporarily near the elbow and the peroneal nerve which is on the outside portion of the knee near the fibula. If you’ve ever hit your funny bone, that’s your ulnar nerve screaming at you. In Lawson’s case, he hit the peroneal nerve which causes pain and weakness to the area. These injuries can resolve relatively quickly, but are quite painful and may take some time to rehab from to ensure proper movement. Once again, depending on the location and severity determines recovery time.

Stingers are another type of nerve injury that can be incredibly painful, but can quickly resolved if managed correctly. Stingers occur when a player gets tackled violently and the shoulder is pushed in one direction and the head in the opposite, leading to traction on cervical or neck nerves. Compressive forces can also cause similar symptoms, such as a direct head blow during a poor tackle or when driven into the ground. Pain is typically felt in the neck and shoulder region, with pain also produced sometimes all the way down the arm causing pain, weakness, and numbness. Due to how the nerves connect all back to the spinal cord and brain, this is why pain can travel down the arm despite the injury occurring in a different area. These injuries can resolve with rest and proper stretching, but is not something that can be rushed.

Finally, bone bruises complete this article. Bone bruises are actually a type of fracture that is less severe than a true bone fracture that we all think of. Keeping it brief, there are 3 types of bone bruises: Sub-periosteal hematoma, inter-osseous bruising, and sub-chondral lesion.

Sub-periosteal hematoma occurs when a direct high force trauma occurs and blood forms under the periosteum, which is a membrane that covers the outside of the bone. Inter-osseous bruising occurs when the bone marrow of the bone becomes damaged, specifically the blood supply. This occurs as the result of a repetitive high compressive forces on the bone, such as excessive running or jumping. These are seen more common in the knees and ankles.

Sub-chondral lesions occur when the cartilage layer of the bone becomes damaged. This area is found at the end of the bone and is the part that articulates with another bone. An extreme crushing force or rotational/shearing force may also cause this, commonly seen in injuries such as ACL tears. ACL tears typically not isolated, but MCL damage, meniscus damage, and even a sub-chondral lesion due to the forces that occur on the joint during the injury also occur.

Recovery times are difficult to manage with mild bone bruises recover in several weeks with more severe instances can be months. It really is specific to each person and how the injury was sustained. I wish I could give a more specific timeline for these recoveries but some players respond quickly and others such as Sam Bradford could take several weeks and leave uncertainty regarding their availability for future games.

These injuries happen far too often and are a part of football. While padding, playing surfaces, and proper tackling can reduce incidence of injury; these are the types of injuries that come with playing football. Most of these injuries can be managed conservatively with rest, icing, stretching, and padding. These are injuries that do not keep players out for extended time, but can be injuries that knock out players during key games.

Continue to check back for regular updates and further in depth analysis of the latest Bills injuries. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills and at http://www.bangedupbills.com. As always, thank you and GO BILLS!!

NFL Injury Series- Sprains

An overview of general sprains, severity, and recovery times

As we continue to delve into common injuries seen around the NFL, today’s post will consist of an overview of general sprains. Sprains are very similar to strains, but differ in function and location. Sprains are an injury to a ligament or multiple ligaments based on location. Ligaments are found all over the body and provide connections between bones to create a joint. When an injury occurs to the area, instability, pain, and swelling occurs based on severity.

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Grade 1 sprains are when the ligament is stretched minimally and minor swelling/pain occurs. This can cause some players to miss time based on location and position, but typically can be managed conservatively in order to return to prior level of function. These types of injuries are week-to-week and can be played through if absolutely required, though increased risk of injury occurs. X-rays may be performed to ensure no fractures have occurred but are usually diagnosed through physical examination.

Grade 2 sprains are when the ligament is partially torn and moderate swelling/pain occur. These types of sprains typically keep players out for some time and cause moderate loss of function. A conservative expectation for a Grade 2 sprain could be anywhere from 4-6 weeks, though could vary based on location. At this time, an X-ray is performed to rule out any fractures. An MRI is performed to support physical examination and determine extent of damage.

Grade 3 sprains typically involve near or complete tearing of the ligament leading to significant loss of function and possible season ending surgery based on location of area. At this point, the ligament is classified more of a tear than a sprain which is why you do not see this as a Grade 3 sprain. Typically, ACL, PCL, and severe MCL tears can be categorized as such along with AC joint sprains. Ankles, shoulders, and wrists are also common areas for complex ligament damage to occur. It is common to see other structures become damaged as the result of a severe sprain/tear. MRI’s are performed to determine severity of tear and to assess for any injuries missed by physical examination or initial swelling.

In most cases, a sprain can be due to an overload to the joint as a direct blow, violent twisting/pivoting, or excessive tension on the ligament. As with all other materials in the body and in nature, everything has a breaking point. Injuries such as these can be reduced but not totally prevented. Preventative measures include playing on forgiving surfaces such as grass which reduce the friction and prevent cleats from sticking in the surface. Proper strengthening to the area and proprioceptive exercises which include body awareness activities help keep the body from overloading the joint. Bracing and taping may also give support to an area if there is a high risk for injury or prior instability. Taped wrists, knee braces on lineman, and ankles braces assist in limiting excessive range of motion, reducing the risk.

Continue to check back regarding updates on Bills news and general injuries in the coming days. While it is impossible to review every injury, this is merely a guide to assist you in understanding the severity and expected timeline upon injury. Follow on Twitter @BangedUpBills and at http://www.bangedupbills. As always, thank you and GO BILLS!!

NFL Injury Series- Muscle Strain

An overview of general muscle strains, grade severities, and recovery times.

The Buffalo Bills training camp continues to roll right along with no major injuries to report. The only reported injuries so far is TE Nick O’Leary who suffered an ankle injury which kept him out of practice for a short time but did not appear to be anything serious as he was able to return to full practice after several days rest. TE Logan Thomas was limited in practice but no further updates have been released regarding his current injury.

As we continue with the NFL injury series, today’s post will consist of identifying several terms used to describe injuries and educate on how to differentiate on what is being reported. I have used many of these terms before and have done my best to describe them, but I believe they are worthy of their own article. Today’s overviews will consist of the common muscle strain.

A muscle strain can occur in virtually any muscle within the body if the muscle is suddenly overworked, stretched, or fatigued to the point where the muscle becomes injured. A strain is classified as a strain due to an injury to the muscle itself or the muscle bone attachment which is called the tendon. There are varying grades of muscle strains which can progress up to a muscle tear, avulsion fracture, or rupture.

Grade 1 muscle strains are relatively minor and is when a small portion of the muscle is torn; function may be limited, but is typically not serious and can heal up relatively quickly with proper management. This usually consists of stretching, icing, anti-inflammatory medications, and light strengthening exercises to restore proper movement. With effective management, this can be a day-to-day injury with some lasting up to a week or two. Most of these injuries are able to be played through with proper rehab and rest.

Grade 2 muscle strains are where a moderate portion of the muscle is torn which is typically associated with bruising, swelling, and partial loss of function which is demonstrated as difficulty performing the muscle movement and is typically limited secondary to pain. Rehab management will consist of generally the same procedures as Grade 1, but will require a longer duration to recover. I can not make a blanket statement and state that a Grade 2 muscle strain will take “X” number of weeks to heal up. It is typically more than week-to-week, but based on location and job duties of the position may dictate how long the player is out.

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If a Grade 1 or 2 muscle strain occurs close to the tendon attachment, if not healed up correctly or chronically injured/overused, the muscle or tendon may develop into a tendinitis based on healing. The suffix “-itis” is Latin for inflammation, which indicates that the tendon is irritated and may become painful over time. Most muscle/tendon fibers have consistent, linear striations, such as in a nice cut of beef or in the picture above. When the tendon does not heal correctly, the connective tissue heals in an uneven pattern as seen in the picture below. This does not allow for effective contraction of the tendon, leading to increased pain, weakness, and loss of function. This could lead to tendonosis which is the chronic form of tendinitis and becomes even more difficult to treat. Eventually, this can lead to a higher risk of rupture in the tendon later but is not a requirement for a rupture to occur.

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However, when a severe muscle strain occurs, this is classified as Grade 3. This is where most of the muscle is torn, there is typically significant damage and surgery is possibly required to repair the structural damage. There is significant swelling, bruising, and pain to the area due to the sudden and forceful nature of the injury. The muscle no longer is able to function as intended and pain limits the possibility to attempt. At this point, several other injuries may have occurred including an avulsion fracture or ruptures. If an avulsion fracture or rupture has not occurred, surgery still many be indicated to assist the muscle in healing correctly.

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Credit: physicaltherapyct.com

In the case of an avulsion fracture, the tendon that attaches the muscle to the bone and acts as the anchor pulls away from the attachment point and takes a chunk of the bone with it. While this injury is uncommon, it still does happen. Surgery is sometimes indicated to reattach the bone to the original area and requires extended time missed, requiring the body to build up toleration to the muscle pulling on the attachment point without re-injuring the area.

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Finally, a tendon rupture is when the tendon tears away from the attachment point but does not take a piece of bone with it. This is commonly seen in biceps and Achilles’ injuries, among other areas. If this injury occurs, the player may feel a pop with immediate loss of function. The muscle may act like a bungee cord and rebound violently and become balled up, leading to a deformity. These types of injuries also require surgery and cause a player to miss extended time due to the requirements of the muscle contraction and the actions of the muscle. As there are a variety of potential tendon ruptures and recovery times, it is difficult to state a general timeline without having specific information.

This is just a brief overview of the muscle strain and how to understand the various nuances of the wording and injury. Sometimes injuries such as calf and hamstring strains can appear to follow a player for their career or never fully heal without significant rest. The best thing that a player can do is hydrate well, stretch effectively, strengthen properly, and listen to their bodies. While the NFL is a tough sport, pain is expected, but trying to play through an injury may only worsen it and cause further complications down the line.

This completes another article in the NFL injury series as we prepare for pre-season games and the regular season. There is much more to come regarding the common injuries we will inevitably see over the next several weeks. Continue to check back for posts regarding other general injuries and broaden your knowledge base. Follow on Twitter @BangedUpBills and at http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!!