Week 14 Bills Injury Review- Jets II

Breaking down the latest Bills injuries following Sunday’s loss to the Jets.

Back to back tough losses really take the wind out of the Bills sails and drops them to 4-9. This was the 3rd loss this season where the Bills had the game in hand but were unable to secure the win. I’ve said this before and I’ll say it again, we knew that they were going to take a step back this year. However, the mark of a good team is the ability to finish games and beat the teams you should beat. This wasn’t one of those times. Hopefully the Bills can learn from this season and transition into more consistent wins next season. Sunday’s loss also marked one of the most injury riddled days in recent memory and the most since I began this site. Today’s post will review the injuries sustained and what significance they have moving forward.

Starting off with the most serious injury, LB Matt Milano (fibula) suffered an ankle dislocation and fracture late in the 4th quarter at the goal line. This was the result of QB Sam Darnold attempting to dive into the end zone, landing on the back of Milano’s heel, firmly planting the foot in the turf. As the foot is planted, Milano is hit from behind by S Jordan Poyer and Darnold’s body being in the way prevents Milano from falling naturally, instead twisting to the left and snapping his fibula which is the outer portion of the ankle. I had retweeted a rather graphic picture of Milano’s ankle twisted 180 degrees with his heel facing where his toes should be. Thankfully, the tibia, which is the shin bone, was spared due to twisting to the left instead of the right. The ankle broke on what I can only assume based on video is the lower portion of the fibula which is the outside portion of the ankle. There is fairly significant ligament damage based on the twisting but can and will heal up due to the ankle being reduced or put back into place on the field and the ankle will be immobilized for some time due to surgery. Below is a picture of a fractured fibula, though not exactly represented as how Milano’s may look on x-ray.

Ankle Fx Pre-op.jpg
Credit: ankleandfootnorthwest.com

A lot of chatter on Twitter has been discussed over the Bodine injury compared to the Milano injury. Both injured the same bone but the severity is starkly different. Bodine will be back before Milano in regards to healing and normalcy due to Bodine’s fracture was fairly simple; he suffered a break, there was no dislocation or what appeared to be associated damage to the area. He just required surgery to set the bone and stabilize it in order to heal. Milano’s injury was more severe due to the corresponding ligament damage in the area. He will be immobilized and non-weightbearing post surgery, but as a result of the immobilization with the ligament damage, the ankle will become very tight due to the scarring down of the healing ligaments. This limited range of motion this will require further stretching and rehab interventions to address the tightness coming out of the surgery to regain the mobility required for his position. However, the timelines are still similar with rehab and recovery with the difference being weeks vs months in regards to return in comparison to Bodine vs Milano. I still expect Milano to take between 6-9 months to fully recover, but I’ll take the low side of that recovery which makes him possibly ready to participate in OTA’s.

The most comparable Bills injury is that of RB Travaris Cadet who suffered a similar injury late last year but was able to return in time for training camp. The only difference between the two players is that Cadet was a fringe roster player buried on the RB depth chart and couldn’t make the team. However, he was able to return to full health as evidence in his participation in training camp.

The other significant injury is RB LeSean McCoy (hamstring). Shady suffered a hamstring strain during the first offensive series against the Jets and was initially questionable to return, later downgraded to out. He appeared to pull his hamstring on a 6 yard gain right before the first Bills TD by QB Josh Allen. There was not anything specific regarding the injury; he did cut hard to his right before taking a step forward and going down. He was observed at one point running on the sidelines and cutting to test it out, but it appeared that he was not ready to return Sunday.

Hamstrings are tricky because they range in severity and affect each position differently. With McCoy’s skill set, as poor as it’s been this year, that hamstring is still more vital to his abilities than let’s say an offensive lineman. The veteran running back has since been listed as day-to-day by the team and has had an MRI to determine severity. This tells me that this is most likely a moderate Grade 1 strain. Yes I am splitting hairs here but they performed an MRI which in my observation is only reserved if the physical assessment is not matching up with typical physical examination. Day-to-day indicates that he will be limited with the possibility of playing next Sunday. However, we have seen this wording used in the past and interpreted to eventually missing some time. Typically we are not seeing players who suffer a strain come back this quickly.  But since there is a muscle tear as all strains are classified, once he rests, the muscle does tighten up and the inflammation process begins which limits his abilities. I’m going to be conservative and say he misses next week against the Lions because it’s a game that doesn’t mean anything and Shady has been absolutely been beat up this year, so a week off will only help.

Other players sustaining injuries include RB Chris Ivory (shoulder), WR Robert Foster (right thigh) WR Isaiah McKenzie (left ankle) OL Jordan Mills (left knee), CB Levi Wallace (left ankle), CB Ryan Lewis (concussion), and K Stephen Hauschka (hip/back). Ivory suffered a left shoulder injury running through the linebackers and secondary, landing hard on his left shoulder after being taken down for an 8 yard gain, appearing to favor his left shoulder coming off. If you recall, he suffered what I believed to be a left AC joint sprain back in Week 9 during a failed goal line plunge. He may have aggravated this injury again as he was slowed down and then fell hard to the turf onto the left shoulder and potentially re-spraining the area. He may also be another guy who misses a week, but he would be more likely to play Sunday than McCoy. Overall, AC joint sprains heal on their own with rehab and rest and only require surgery in the event that there is significant trauma to the area.

Foster and McKenzie got banged up on back to back plays at the end of the first half. Upon video review, McKenzie landed awkwardly on his left foot, appearing to tweak his ankle trying to haul in a pass from QB Josh Allen; this occurred with 1:26 left in the 2nd quarter. He was able to return and finish out the game. I would suspect this is nothing more than at most a mild ankle sprain that will may end up on the injury report but should not slow him for next Sunday as he was able to return very quickly after the injury. He did come into the game questionable with a toe injury but this does not appear to be related to the injury he suffered Sunday.

As for Foster, he got hurt on the very next play after hauling in a 17 yard pass from Allen before taking a very hard shot into his right thigh area that drove him out of bounds. This injury appears to be a contusion at worst as he was able to return quickly. He may be dealing with some soreness and may be limited in practice Wednesday, but this also appears to be an injury that should not keep him out Sunday as he has become a vital piece to the limited WR corps.

OL Jordan Mills suffered a left knee injury performing what appeared to be a chop block though he was withering in pain immediately after the play which required training staff to assess his knee. He was able to return the next offensive series and finish out the game. My best assessment is that he came down on his knee hard and he suffered a mild contusion. Mills has had several injuries similar to this this past season in where he goes down, needs to come off, and then quickly returns. I can’t even classify this as an injury per se, sometimes things hurt when you hit a certain way. No concerns for next Sunday.

CB Ryan Lewis suffered a blow to the head which was later diagnosed as a concussion late in the 2nd quarter. We have seen most of the younger players return from concussions quicker than older players such as QB Derek Anderson, but each concussion continues to be unique and only time will tell how Lewis responds while in the concussion protocol. Far too early to tell whether he will be available Sunday.

CB Levi Wallace suffered an odd looking left ankle injury early in the 3rd quarter. He began to suddenly stop and planted hard on his left leg, the ankle buckled as he attempted to pivot and assisted in taking down the ball carrier. I do not believe that he suffered any major injury to the area, coming off may have been more precaution to further assess the injury after the play. He was able to return after several plays and finish out the game. With his stellar play this year, we can not afford to lose anymore players in the secondary in order to finish this season. He should be available for Sunday.

Finally, K Stephen Hauschka (low back/hip) suffered a cheapest of cheap shots by Jets DE Henry Anderson after the blocked FG on the last play in the 2nd quarter. Hauschka was blindsided when he got hit, unfortunately he was unable to react properly and came down hard on his right hip and potentially jarring his back. It was reported that he had x-rays to assess for any damage but based on the hit, it appears as though he suffered a hip pointer injury. An injury such as this is basically a bruise to the bony portion of the hip that is about where most of our pants sit at on our waist. The reason this is so painful is because there are so many muscles that attach to this area which in turn affect how the core muscles perform along with the hip musculature especially with him being a right footed kicker.

The blindside hit clearly affected his ability to kick as he missed a FG try later on in the game and appeared to be limping at times afterward. This is an injury that does not appear to be long term nor should affect him next week due to the limited need of his position. We have also not had any reports that kickers were being brought in which indicates that this is not a severe issue which should make him available for Sunday.

Overall, a very rough day from an injury standpoint. The only silver lining is that we are out of the playoff race which makes these injuries hurt less. The benefit to these injuries now is that all these won’t be long term and allow all to be ready by training camp barring any setbacks or new injuries over the next several weeks.

As a result of all these injuries, the team will have some new faces in the starting lineup. LB Julian Stanford will be starting in place of Milano, RB Marcus Murphy may get the start if Ivory can’t go and RB Keith Ford may be brought up from the practice squad to backup Murphy. This is the time of year that is great for the front office to find out who else they want to keep for next year by seeing how they do in game action now. We know this roster will have more turnover next year; might as well get familiar with some new faces with the idea that they are here next training camp.

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

Week 14 Bills Injury Preview- Jets II

Assessing the latest Bills injuries including Taron Johnson’s shoulder surgery and Jason Croom’s groin prior to the Jets game.

This has been one of the more busier weeks of the Bills season as the front office is demonstrating “The Process” with moves preparing the team for 2019. If you’ve been under a rock, the team released WR Kelvin Benjamin & WR Andre Holmes, signing CB Denzel Rice & DE Mike Love from the practice squad, and placing C Russell Bodine on injured reserve as the result of a fibula fracture during last week’s game. With all this upheaval along with several injuries, this leaves many questions going into the Week 14 match up against the Jets. As one may fondly recall, the Bills absolutely destroyed the Jets 41-10 in their Week 11 match up behind an effective performance by QB Matt Barkley. This time around, it will be QB Josh Allen vs QB Sam Darnold with both teams jockeying to avoid the AFC East cellar. Today’s post will identify the injuries going into the game and how things may shake out.

Those already ruled out are QB Derek Anderson (concussion) and CB Taron Johnson (shoulder). Anderson continues to be limited indicating he is in stage 3-4 of the concussion protocol. I’m waiting for the other foot to drop and he gets placed on IR. At this point, he is taking a roster spot for someone else but his tutelage of Allen appears to be the reason he is still active despite not playing.

Johnson suffered a dislocated shoulder resulting in a torn labrum in his right shoulder during Week 1. He has since then re-injured the shoulder several times, missing only one game right after the initial injury along with wearing a shoulder harness to limit recurrence. He had been reportedly been in a non-contact jersey the past several weeks, giving his shoulder the rest and protection it required to get through the season until the Bills were officially eliminated from the playoffs. As a result, Johnson had successful shoulder surgery on Tuesday to repair his labrum and has since announced his season is done. I am not sure why the Bills are hesitating to place him on injured reserve; this may be due to a contract issue which we as fans are not privy to. The shoulder labrum recovery is a ~6-9 month recovery which will allow Johnson to ready for OTA’s in May-June at least in a limited fashion and fully healthy by training camp. To read more about the surgery that Johnson had, make sure to check out my article on WR Zay Jones who had the same procedure last year with great success.

Listed as doubtful is TE Jason Croom (groin). Upon video review, Croom doesn’t appear to have one play in where he injured his groin. He did not have any targets during the game but was involved in 35% of the offensive snaps and was playing until the final offensive series. Based on the knowledge we have, this appears to be a mild strain and the team is being proactive, allowing him to heal completely before rushing him back onto the field. We have seen most of the muscle strains this season result in minimum 1 game missed and this is no exception. I believe that this is a Grade 1 strain with Croom having the ability to return next week fully healthy. As he is listed as doubtful, most players listed as doubtful do not even play. In the event that he is active, he will likely be limited in offensive packages and used more likely as a decoy. Regardless of status, he should not play.

Listed as questionable is WR Isiah McKenzie (toe). Reports indicated that McKenzie injured his toe late in practice Thursday and was limited Friday, making him officially questionable for the game Sunday. Fortunately, publications state that he feels as though he will be able to go on Sunday which is a good thing as the Bills are expected to only have 5 WR’s available. My suspicion is that he sprained his great toe running a route pushing off too hard or pivoting. It is possible to injure the other toes on the foot, but when it comes to running, the great toe is essential for effective push off required for sprinting. He is truly a questionable decision, but considering the personnel available and his thoughts in the article, I expect that he plays.

G John Miller (oblique) is coming off a strained oblique suffered in the win over the Jaguars. He missed last week but is able to return which fits the timeline regarding muscle strains; I had suspected that he would miss 1-2 games based on the location. There is possibility to re-injure the area, but I would not consider the risk to be significantly greater than when he originally sustained the injury.

Those injured earlier during the Miami game that did not appear on the injury report were LB Tremaine Edmunds (knee/ankle) and S Jordan Poyer (finger). While they may be dealing with some soreness, this was not enough to warrant an injury report slot. Expect both to be key players to slow the Jets offense.

While the Bills are slowly losing players to injured reserve as the season winds down, most starters continue to stay healthy or at least available in order to help the team finish strong over these last 4 games. I believe the Bills will be able to finish this season with a 6-10 or 7-9 record. The big question marks I have are this upcoming Jets game and maybe the second Dolphins game. A 7-9 record would be a great finish after such a terrible start to the season. There’s a lot of promise on this team going into next year, we just have to see how the draft and free agency play to our favor. I believe the Bills will complete the season sweep of the Jets to move to 5-8.

Continue to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at www.bangedupbills.com for the latest injury news and updates coming out of One Bills Drive. As always, thank you for reading and GO BILLS!!

Week 13 Bills Injury Review- Dolphins

Analyzing C Russell Bodine’s fibula fracture and other injuries sustained in the Bills loss to the Dolphins.

That loss hurt. We lose to the Patriots all the time, but we lose to the Jets and Dolphins more than we should. The NFL is “Any Given Sunday” but to lose in that fashion to the Dolphins stings. While there was an opportunity to win on the Bills final offensive play with that pass to TE Charles Clay, there were still many glaring mistakes that cost the Bills that game. Whether you thought QB Josh Allen could have thrown it better or Clay should have caught that, it doesn’t matter. There were other opportunities to win the game and that’s where the Bills have to improve on. While there were minimal injuries again this game, the injuries sustained were more significant than usual. Today’s post will review injuries in Sunday’s loss.

Overview-of-the-Fibula.png
Credit: teachmeanatomy.info

C Russell Bodine (fibula fx) is done for the season after breaking his fibula (seen above in red) midway through the 1st quarter on Sunday. Video is limited but Bodine is observed going down with DT Davon Godchaux falling on his leg while his knee is on the ground. The direct blow to the area from a 315 lb human will do some damage, in Bodine’s case, resulting in a fracture. Bodine was able to walk off the field without assistance because these guys are tough and won’t let pain stop them unless it’s truly unbearable. Add in the fact that the fibula is a non-weight-bearing bone which allowed him to still walk despite being part of the lower leg. The fibula makes up the outside portion of the ankle and goes up to the lower outside portion of the knee. This bone provides many attachments for the lower leg bone but does not have any actual weight bearing function in regards to walking.

Weber+C+fracture.jpg
Credit: http://www.raynersmale.com

Bodine will miss the rest of the 2018 season, going to IR to have surgery with what is expected a full recovery for 2019. The surgeon performing the operation will be performing an ORIF which is short for open reduction, internal fixation on a fracture similar to the picture above. This means they will surgically open his leg, re-align the broken bone, and reinforce the fracture with screws and a plate to ensure proper healing to the area. Once the surgery is complete, Bodine will be non-weightbearing for at least 6 weeks. Despite the above statement that the fibula is not involved in walking or weight bearing, the leg still must avoid weight through the area due to the possibility of disrupting the healing process. If weight bearing were to occur, excess stress from the attached muscles performing their actions during walking could lead to weakness/instability to the healing bone. Other concerns would be a potential fall directly on the area or sudden jarring movements could lead the hardware to loosen or shift leading to the bone not healing properly. If he does indeed have the syndesmotic injury as Dr. Chao theorizes, then he could be non-weightbearing for 8-12 weeks according to this protocol which would require removal of the hardware. We will not know which type of surgery he will have and it may come down to surgeon preference or the amount of damage. Regardless, this will not affect recovery time which is about 12+ weeks. Seen below is a picture of what his ankle may look like on x-ray once surgery is completed.

pt1014syndesmotic2_0.png
Credit: podiatrytoday.com

12 weeks will not allow him to be ready for football related activities, but will at least allow him to work towards getting back in shape. The timeline to return to football specific activities and return to full form is longer, but not exactly known. My best guess is ~6 months to fully regain what he has lost and resume activities as though he never suffered the injury. Everyone responds differently and Bodine is no exception. The Bills have begun working out centers but have not appeared to sign anyone at this point. It is likely that C/G Ryan Groy will step up and take over the starting role for the rest of the season.

Other injuries sustained were LB Tremaine Edmunds (knee/ankle) and CB Jordan Poyer (finger). Edmunds suffered an injury to his right leg midway through the 3rd quarter in which his foot got caught in the turf and he got hit from a falling body. The knee looked structurally fine as it was going into a varus position. This is when the knee is buckling out as the foot moves inward. This is opposite of the dreaded ACL/MCL mechanism of injury but Edmunds mechanism of injury could still cause damage to the knee under the right circumstances. Thankfully, the rookie LB was checked out by the medical staff, missed a few plays and was able to return rather quickly. He may be dealing with at most, a sprained ankle with the foot having been caught in the turf and rolled inward. He may show up on the injury report but it does not appear to be anything that will limit him next week.

Poyer suffered a right finger injury shortly after Edmunds sustained his injury in the 3rd quarter. He was attempting to secure an interception by QB Ryan Tannehill but was unable to come up with the ball. He appeared to be shaking his hand out as though he jammed his finger. He was able to return playing immediately and may or may not show up on the injury report. Even if he does, it is unlikely to affect his ability to play next Sunday.

Overall, the Bills did not lose much injury wise and should continue chugging along to next Sunday where they have their 2nd game against the Jets in what should be a winnable game. I am encouraged by how this offense is starting to click with the progression of QB Josh Allen & WR Zay Jones and optimistic how the team can upgrade with the cap money they have for 2019. Only time will tell how things play out.

Continue to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at http://www.bangedupbills.com for the latest news and updates coming out of One Bills Drive. As always, thank you for reading and GO BILLS!!

 

Week 13 Bills Injury Preview- Dolphins

The latest Bills injuries going into Week 13 agains the Miami Dolphins.

The Bills are on a two game winning streak and getting healthy! As they travel down to balmy Miami for Sunday’s matchup, they do so with nearly their entire roster available and an offense starting to find its groove. Today’s post will review the injuries going into Sunday’s game.

Already ruled out is G John Miller (oblique). The veteran guard suffered an oblique injury late in the 1st half of the win over the Jaguars and did not return. Since Sunday, he has been unable to participate in practice which due to the location of the injury, is not surprising. As obliques are vital to the duties of his position in relation to bending forward, twisting, and pushing, it is already known that he he will not suit up Sunday. Even if the Bills were in the thick of a playoff race, this injury would sideline the big man for at least a week. Expect Miller to miss 1-2 games due to this injury. Starting in his place may be G Jeremiah Sirles who has shown effective play in limited time this year.

QB Derek Anderson (concussion) has also been ruled out due to continued symptoms of a concussion sustained during the Monday Night Football game against the Patriots. The more we know about concussions, the greater understanding we have of its effects. This is why Anderson’s symptoms are not concerning overall because we know that the brain heals at different rates and each concussion is unique. However, I do believe that if Anderson wasn’t mentoring QB Josh Allen, he would have been placed on IR long ago. As he is limited, there is hope that he will be able to practice in full next week and at least be available game day in Week 14.

TE Charles Clay (hamstring) has been ruled questionable, which in the case of Bills players ruled questionable, whether they play is ~50% based on this season statistics. I believe Clay will play as he’s missed several games, he has given his injury ample time to heal, and if this video is any indication of his abilities, then I am fairly confident that he will play against his old team. Add in the fact that he will be playing in 85 degree weather will help the muscles warm up easier and stay warm, reducing the incidence of re-injury during the game. I also believe that he will want to hang some stats on his old team to let them know what they lost.

Others dealing with injury coming off the report this week are CB Lafayette Pitts (concussion) & CB Taron Johnson (shoulder). Pitts suffered a hard hit to his head on a punt return early in last weeks win and was unable to finish playing. He has since been cleared to play in full and will continue to be a key piece in secondary depth and on special teams.

Johnson continues to deal with his injured right shoulder which he will eventually require surgery on the torn labrum. He has been quite effective despite being limited but has a much higher risk to be re-injured during hard hits. Hopefully he can get through these remaining 5 games and then work hard on recovering fully for training camp.

Fortunately, the Bills are in much better shape health wise than the Miami Dolphins who have been hit hard by injuries which may limit their ability to effectively play both sides of the ball despite having home field advantage. The relative lack of injuries for the Bills has been a key reason why the Bills have been able to stay in more games and build for the future effectively as they are not relying on 2nd and 3rd string players starting for significant chunks of the season. I hope this trend continues in a positive direction with next year allowing the Bills to bring in some top end talent they are sorely missing this year.

As an eternal optimist, I believe the Bills will win this one against the Dolphins. However, coming off two straight wins may set the Bills up for a trap game and they could lose a very winnable game. Even though each win represents a worsening draft position, these young Bills must know how to win now to win bigger games later.

Continue to follow for the latest updates and news coming out of One Bills Drive. Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit u/BangedUpBills, and online at www.bangedupbills.com. As always, thank you for reading and GO BILLS!!

Week 12 Bills Injury Review- Jaguars

Read up on the latest Bills injury news following Sunday’s win over the Jaguars.

The Bills are still in the hunt! With a 4-7 record, they still manage to stave off playoff elimination for another week with a thrilling 24-21 win over the reeling Jacksonville Jaguars. While 4-7 doesn’t sound like things are going well, there are positives to take away from this game and so far, the season. I do not believe that the Bills will make the playoffs even with the possibility that they win out. Having a strong finish to the season along with the development of QB Josh Allen, LB Tremaine Edmunds, and the improving offensive play calling allows the Bills to head into 2019 with lots of tools at their disposal and allows them to take that next step forward. However, as with every post, we will review the injuries sustained during Sunday’s win.

First up is CB Lafayette Pitts (concussion). The veteran corner suffered a concussion early in the 1st quarter on a punt return. He collided with WR Dede Westbrook and began stumbling off the field, initially ruled questionable, eventually downgraded to out before being placed in the concussion protocol. Like QB Derek Anderson, LB’s Matt Milano & Tremaine Edmunds, Pitts must pass through the protocol in order to be cleared for Sunday. The only information we have is that he is in protocol but not how severe this injury is. As always, we are unable to assess severity by video alone. This week’s practice will identify whether he will be available come Sunday.

Next up is G John Miller (oblique). The veteran O-lineman suffered what has since been described as an oblique strain. Quick reminder, a strain is an injury to the muscle itself which in turn affects movement. He was injured late in the 2nd quarter and was unable to return. There was not one particular play which identifies the strain which makes it difficult to diagnose severity.

As this is his oblique, this is a part of his abdominal muscles positioned on the outside portion next to the “six pack” we are all know. They are positioned on both sides connecting to the xiphoid process which is the pointed bottom portion of the sternum and connect down to the upper portions of the hip including the iliac crest, the bony portion of where our waists are located and about where most people’s pants sit. There are internal and external obliques but we would not really be able to identify which obliques he injured nor is it important to this discussion. Due to not identifying which play he suffered this injury on also limits knowing which side is ailing.

All these abdominal muscles make up what is known as the core. These muscles provide protection to the inner organs and function to flex and rotate the trunk. As he is on the offensive line, bending forward, twisting his upper body, and pushing against large humans while staying upright takes an immense amount of strength. Having an injury to this area would make his position very difficult to perform. It is also too soon to tell how severe this injury is and whether he will be available Sunday until he goes through this week of practice.

Finally, WR Robert Foster (head/neck). The rookie receiver suffered a brutal hit to his head/neck region catching a key pass to move the chains. He was forced to leave the game briefly but was able to return later. While he was able to return, this does not mean he’s totally clear from injury. He did get a hard hit up on the head/left shoulder area hauling in the catch. He could have lingering neck pain from this hit but according to media reports, he is not limited nor appearing on the injury report at this time.

Others coming off injury included: QB Josh Allen (elbow), DE Shaq Lawson (elbow), DE Trent Murphy (knee), and C Russell Bodine (shoulder). All appeared to play effective despite their recent injuries. Allen did not appear to be limited in any fashion, though still wearing a protective brace on his right elbow. We all saw how Lawson fought off RB Leonard Fournette indicating his elbow injury did not appear to hamper his abilities to fight or play. Finally, Bodine was observed to wear some type of neoprene compression sleeve up on his right shoulder which may indicate the side of his injury but without further information, we can only speculate that this appears to be minor such as a mild AC joint sprain or rotator cuff contusion. To note, this is not an item that he appears to have been wearing in previous games which further supports which shoulder is injured and the type of injury.

Those still working back from injury include TE Charles Clay (hamstring), QB Derek Anderson (concussion), and CB Taron Johnson (shoulder). All of these injuries have been well documented in past articles if you would like to read further.

Regrettably, as the season begins winding down, we will see injuries that are not that severe but could cause players to miss several weeks go straight to IR rather than try to return so that the front office can get guys who they like on a longer tryout in preparation for next season. Expect that after each game, injured players begin moving to IR rather than clogging up the injury report and roster spots.

Continue to follow Banged Up Bills for the latest updates and news coming out of One Bills Drive. Follow on Facebook at Banged Up Bills, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at www.bangedupbills.com. As always, thank you for reading and GO BILLS!!

Week 12 Bills Injury Preview- Jaguars

Read on the latest injuries coming off the bye as the Bills get ready to face the Jaguars.

I hope you all enjoyed your week free of Bills football along with Thanksgiving! As a devoted Bills fan, make sure you are recharged and ready to hunker down to take on the last 6 games of this season. This season has been a dramatic step back from last season’s successes and while it is tough to see that the Bills lose more than they win, they are still building towards something greater than the 2018 season. Regardless of outcomes, I do I enjoy watching the Bills every Sunday and today’s post will review the injuries going into the Jaguars game.

Those coming off injury from the Jets game include LB Matt Milano (concussion) & CB Taron Johnson (shoulder). Milano has cleared the concussion protocol and practiced in full which is an excellent sign and should continue his stellar 2nd season as an integral part of the defense. As for Johnson, unfortunately suffered another injury to his right shoulder in where he continues to sublux/dislocate his shoulder during direct blows to the area. He was observed to not wearing his shoulder harness during the Jets game which reduces the shoulder movement in order to limit dislocation which may have resulted in the most recent re-injury. The direct hits to the shoulder continue to dislodge the humerus from the socket, causing pain, weakness, and limited strength. This in turn has caused him to miss short stretches of the season. This is something that he will continue to play through until he feels he cannot anymore or until the end of the season, whichever comes first. He was limited in practice this week and will continue to play at less than 100% until he gets surgery to correct the problem. To note, we have full confirmation of his shoulder injury based on GM Brandon Beane’s appearance on One Bills Live this afternoon, outlined in this tweet here. I expect that Johnson will still suit up come Sunday.

Others practicing in full include RB Chris Ivory (shoulder) and QB Josh Allen (elbow). Ivory was dealing with a left AC joint sprain that caused him to miss the Jets game after suffering the injury during the loss to the Bears. He should have no limitations on Sunday and relieves RB LeSean McCoy as a change of pace back. Allen has been a big talking point when it comes to injury this season, missing 4 games due to the sprained right UCL suffered in the loss to the Texans. He has progressed as expected; Allen himself has reported that his elbow continues to feel better and news reports are showing him making all his passes without obvious compensation. Interestingly, he is still wearing a brace on his right elbow which does concern me, but he may play with the bracing on the elbow as he may be comfortable with the throwing motion with it on. I would prefer to see him play without it, but the medical staff knows best and will ensure that he will minimize re-injury. The only benefit to the brace would be to provide protection in case of a direct blow to the area. While he could re-injure it throwing, the chances are significantly reduced as he has given himself an appropriate time to heal to where he is able to play at a high level. He may not be 100% healed but enough that the medical staff feels he can perform without causing further injury. 

Others limited in practice include: C Russell Bodine (shoulder), QB Derek Anderson (concussion), and DE Trent Murphy (knee). I am not sure what Bodine did to his shoulder as he did not appear to require medical attention during the Jets game but this could be an injury sustained in a previous game with re-aggravation or could be a new injury. Until we have more information, I cannot even speculate what he is dealing with.

Anderson continues to battle back from the concussion sustained late in the 4th quarter of the Patriots loss on MNF. He has been slowly working his way back into shape with his limited designation, but is clearly not ready yet. Based on being limited, he appears to be in Stage 3-4 of the concussion protocol, allowing him to go through sport specific activities and perform aerobic activities. Unfortunately, he has since been ruled out for Sunday’s game, dealing with concussion symptoms for nearly a month now. While this is atypical from what we usually see during a concussion recovery, this would be considered normal for concussion management outside of the NFL as not all concussions are mild with a quick turnaround time. Hopefully he continues to improve and help Josh Allen develop.

Murphy continues to battle back from injury after injury. The latest injury is a right MCL sprain suffered halfway through the 4th quarter in the loss to the Colts. He has since missed 3 games and is slow to return but the vibe is that he will be ready come Sunday to help contain the rushing attack. The veteran DE has had 4 weeks to fully recover which is within the expected recovery times for an MCL injury. With his recent injury history, the Bills training staff were not in a position to rush him back and cause further complaints.

Those not practicing are TE Charles Clay (hamstring) and DE Shaq Lawson   (elbow). Clay pulled his hamstring running a route early in the Bears game and was unable to return. He since missed the Jets game and right now could potentially miss the Jaguars game. Lawson suffered an elbow injury during practice early in the week which makes it nearly impossible to diagnose. Reports indicate that he tweaked his elbow and is considered day-to-day. Until we get further information, I will not speculate as to what he is dealing with at the moment. 

Overall, while the list does look long, with QB Derek Anderson ruled out, TE Charles Clay is doubtful, and those questionable include: C Russell Bodine, CB Taron Johnson, DE Shaq Lawson, and DE Trent Murphy. Clay will not play and even if he somehow suits up, he will not be effective. Those questionable that I expect to play are Murphy and Johnson. We do not know whether Bodine or Lawson are ready to play based on the fact that we do not know the extent of their injuries. If they do indeed sit out, this fits with the roughly 50% of questionable’s not playing this year. I do have a feeling Lawson will be available.

With injuries beginning to take their toll, this is also the time of year where we begin to see players go on IR quickly if they have an injury that will take longer to heal than the remainder of the season so that the team can roster healthy players or guys they want to take a longer look at in game action. Do not be surprised if we see players such as QB Derek Anderson and CB Taron Johnson go on IR in the near future so they can fully address their medical complaints in order to be healthy next season.

Continue to follow for the latest updates and news coming out of One Bills Drive. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills, on reddit u/BangedUpBills, and online at http://www.bangedupbills.com. As always, thank you for reading, and GO BILLS!! 

NFL Injury Series- High Ankle Sprain

Read the latest article in the NFL Injury Series on High Ankle Sprains.

Thankfully, we are in the midst of a bye week. This is a long deserved break from the rigors of the NFL season. While the players physically rest, as fans, we can mentally rest. This is a trying season and while there are some positives to take away from this season, we all still need a repose. We have seen flashes of potential from QB Josh Allen, the stellar play of a top 10 ranked Bills defense built for long term production, and the emergence of top draft picks growing into their positions. Along with growth, we have seen several moves made to improve and reshape the roster including the cuts of QB Nathan Peterman, WR Terrell Pryor, and LB Ramon Humber. The Bills have also brought back a familiar face in WR Deonte Thompson to give Allen another veteran weapon to stretch the field. As there is no game this week, today’s article will add to the NFL Injury Series with a review of the dreaded high ankle sprain.

The ankle is comprised of the distal end of the tibia which is the medial malleolus and the distal fibula which is the lateral malleolus. These structures articulate with the talus bone which connect the lower leg to the foot. Ligaments connect these bones together to create the ankle as seen below which allow the joint to move in a multitude of directions required for running, jumping, and cutting.

Credit: loptonline.com

Additional tissues connecting the fibula to the tibia include but not limited to are the syndesmotic ligaments and interosseous membrane. The syndesmotic ligaments comprise of the anterior inferior tibiofibular ligament (ATFL), posterior inferior tibial ligament (PTL), anterior talofibular ligaments, (ATL), posterior talofibular ligament (PTL), and calcaneofibular ligament (CFL) as seen below. These structures connect the tibia and fibula to provide near immovable stability between the two bones so that the muscles that attach to the respective bones can allow the ankle joint to function as intended, prevent excessive movement, and tolerate weight bearing.

Credit: http://www.premierortho.com

In the event of a high ankle sprain, the ligaments that attach the tibia and fibula above the talus become injured as the result of a fixed foot with sudden and forceful rotation to the leg inward, forcing the foot outward. Excessive dorsiflexion or pointing up of the foot can also injure the ankle significantly. These injurious motions do not have to be high speed but strong enough to cause damage. These are both commonly seen in football when bodies are falling on each other and feet are getting caught in the turf or getting hit falling forward, though not limited to those specific activities. To note, this motion does mimic the mechanism for an MCL/ACL injury though positioning of the knee/ankle during the activity affects which structure is injured. 

Credit: physioworks.au

The reason these injuries are much more severe is due to the demands of the joint. In a low ankle sprain, the outside ligaments are typically injured below the lateral malleolus and make cutting difficult but preserve the plantarflexion/dorsiflexion required for running. Taping/bracing can usually provide the necessary support to complete the activity. In the event of the high ankle sprain to the syndesmotic ligaments, immense demand with the plantarflexion/dorsiflexion motion along with compression during weight bearing is put through the tibia/fibula and talus complex. This creates an instability when attempting to perform walking/running after initial injury. To give a real world example, imagine a wedge being placed into wood to split it, once external pressure is placed on that wedge, the log eventually splits. Turn that upside down in the ankle complex, but that is how motion and compression would affect the connection between the tibia/fibula connection, separating the two bones, leading to greater instability and loss of function in the ankle than a lateral ankle sprain. 

Once this injury occurs, there are a variety of special tests that can help determine the severity of the sprain. These include but are not limited to: anterior drawer test, external rotation test, and squeeze test. These all mimic the mechanism of injury and place stress through the suspected area injured with reproduction of pain noted. Also used is the Ottawa ankle rules in determining injury. The Ottawa ankle rules are a series of tests that involve assessing tenderness in specific parts of the ankle along with the ability to weight bear initially after the injury. This would assist with determining whether there was a suspected fracture or whether further imaging is warranted. As with any other strain or sprain, there are various grades of injury. Grade 1-2 are common and can be treated non-operatively, Grade 3-4 are more severe and surgery is considered in Grade 3 if conservative management fails or surgery is performed with significant damage to the surrounding ligaments along with a fracture in Grade 4. Imaging such as X-Ray and MRI are commonly used to assess the damage of the surrounding ligaments in addition to a physical exam.

Once the extent of the damage has been known, the athlete is typically put in a walking boot with non-weightbearing restrictions put in place to reduce stress on the injured structures and prevent further separation between the tibia and fibula region. With nonoperative conservative management, most recoveries are between 4-8 weeks based on severity of the injury according to research here and here.  Recovery consists of eventual weight bearing progression along with rehab focused on strength, range of motion, proprioception, and pain reduction. Once the athlete can perform activities such as walking/running without pain/limp, single leg hop/calf raise, and all position specific related activities, then the athlete can be cleared to return to sport. As with other sprains, there is always a higher chance to re-injure the ankle, but with proper rehab the first time, this can reduce the likelihood.

The most recent Bills player to suffer a high ankle sprain is DE Shaq Lawson in Week 13 of the 2017 season against the New England Patriots, placing him on IR for the remainder of the season. The Bills have been lucky to avoid these injuries more frequently as a player missing 4-8 weeks could be a huge blow to any team. To note, Buffalo Sabres C Jack Eichel also suffered the same injury back in February of 2018, missing 15 games. Overall, this is also an injury that cannot be truly prevented, but having good situational awareness during play may help a player avoid an unintended collision, leading to this result.

This wraps up another injury seen in the NFL and its implications on a player’s availability. Continue to follow for the latest updates and news coming out of One Bills Drive. Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit u/BangedUpBills, and online at http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!