Week 14 Bills Injury Preview- Ravens

Breaking down why Nsekhe is out so long.

9-3. What a sight to behold!

The Bills are 9-3 heading into the month of December. That’s pretty incredible after all the years of cold meaningless football. While the Bills still have more work to do this month, this has turned into quite a special season, making the national media take notice on the team from Western NY. As the Bills embark on vital December games, the team continues to stay healthy following a rash of injuries around a well-timed Week 6 bye. But the Bills, they’re incredibly healthy now & in prime position to capitalize on teams limping into the playoffs. With the Ravens coming to town on an 8-game winning streak, this is a true test for the Bills to create an opportunity to capture an elusive AFC East crown.

OUT

OT Ty Nsekhe (right ankle)

Nsekhe continues to rehab back from his severe ankle sprain suffered against the Dolphins back on November 17th. On Wednesday, it was reported that Nsekhe would be out on the practice field in some role, however, he was a DNP all week. This is not surprising considering the severity of the ankle sprain he suffered, assessed out at least as a Grade 2 inversion ankle sprain. 

The reason this ankle continues to require more time is due to how ligaments heal. Like all tissues, they are made up of various building blocks. In the case of ligaments, water, collagen, & amino acids create the makeup of the tissue. During normal use, the ligaments crimp & uncrimp based on the tensile loads placed through the joint as they connect bone to bone for structural support. As the joint is progressed through the range of motion, the ligaments elongate until they are maximally stretched. Prior to the injury, the striations of the ligaments are linear and allow for support during the full range during joint motion. Think of the striations in a nice steak, all linear and uniform as seen below.

blood cell types
Credit: Sportsinjuryclinic.net

When an injury occurs, the ligaments are either overstretched or outright tear. When a joint is taken to its end range, the proprioceptive nerves in the ligament start signaling for the muscles around the area to contract to prevent the joint from injury. While this attempts to reduce injury, the muscles are not always able to overcome the forces from the injury. Based on the severity, anywhere from several fibers to the entirety of the ligament can tear. 

During healing, the body attempts to heal quickly by putting scar tissue down in a haphazard fashion to heal the tissue. Because the tissue is not linear, the elasticity decreases & the tissue is not as strong as what was originally torn. What happens then is if the tissue is reinjured, it takes less force for the tissue to tear or it stretches out & does not regain its normal shape as easily. You can see below how the makeup of the tissue changes with injury.

scar-tissue-image-300x175
Credit: oregonmassageandwellnessclinic.com

All this tissue healing takes time, anywhere from 6 weeks to a few years for the tissue to fully mature. Fortunately, progressive loading movements help remodel the tissue as it heals in order to return to activity sooner. This is why we are able to gauge return to play timelines based on the severity of the injury. At the end of the day, Nsekhe needs proper rest with increasing loading of the surrounding tissue and ankle joint to ensure that he regains full function in the ankle without causing further damage to the healing tissue.

According to ESPN’s Marcel Louis-Jacques, Nsekhe is out of the walking boot this week, hopefully walking without pain. Ideally, he begins to practice in a limited capacity next week with an outside chance to play against the Steelers but more realistic chances to return against the Patriots. 

CLEARED

OG Quinton Spain & RB TJ Yeldon (illness)

Both Spain & Yeldon missed Thursday’s practice with what was described as an illness. Considering its flu season, that’s likely the cause. Neither were ruled out and while Spain won’t be 100%, enough fluids & Vitamin C should get him through the game. Just another reason to get the flu shot so you don’t get the flu. If you can’t get the shot, you know you can’t. But if you’re able, it helps keep you & others around you healthy. 

Possible Inactives:

TE Tommy Sweeney

OG Ike Boettger

OT Ty Nsekhe

WR Duke Williams

RB TJ Yeldon

S Dean Marlowe

DT Vincent Taylor

The Ravens are on an 8 game winning streak coming into New Era Field. Winning streaks in the NFL like this are rare & need to end at some point. I believe the Bills with their elite defense are primed to stop Lamar Jackson & Greg Roman’s offense. The Ravens are dealing with injury, but the Bills are healthier which with that and the ability to contain Lamar Jackson, could propel the Bills to victory. Here’s to a competitive game with the home crowd advantage, leading to a defining Bills win.
Top Photo Credit:

Baltimore Sun

Author: Dr. Trimble

My name is Dr. Kyle Trimble and I am, first and foremost, a Buffalo Bills fan!! When I am not cheering on the Buffalo Bills, I am a Physical Therapist. To give a background on myself; I was born and raised in Erie, PA, moved to Buffalo in 2006 to begin my studies at D'Youville College towards becoming a Physical Therapist at which time I became a devoted Buffalo Bills fan.  I graduated in 2013 with my Doctorate in Physical Therapy and moved home for several years. Moving back to the Buffalo area in 2016, I have gained extensive experience in outpatient orthopedics, skilled nursing, acute care hospital, and home care. Having obtained a significant wealth of knowledge that continues to grow, along with a undying fandom of the Bills, puts me in the unique position to educate my fellow fans about our great team. 
I am currently an injury spotter working with Dr. David Chao, Orthopedic Surgeon @ProFootballDoc based out of San Diego. In this role, I provide real time updates regarding injuries during the game. I hope you enjoy what I publish and I welcome any comments or questions you may have.
Disclaimer: My opinions are my own.  Any thoughts I have on the injuries is based on media reports, my knowledge of the injury, and speculation based on the information currently available.


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