2020 Week 3 Bills Injury Preview- Rams

Make sure to scroll down to the players you’re interested in. It’s a long one.

Heading into Week 3, we got a long injury report here folks. But the Bills have been through this before. They have quality depth and the ability to call up practice squad players that have been in the system before rather than street free agents who don’t know the system. 

While there are a lot of players in today’s report, everyone is still adjusting to the regular season with hitting, conditioning, and getting back into game shape. This is where some preseason games are beneficial to prime their bodies rather than going from 0-100. Ideally we see this drop off as the season progresses. But until then, this week’s injuries are below. 

OUT

RB Zack Moss (toe)

Moss was ruled out of Sunday’s matchup due to a toe ailment suffered in Sunday’s win. This was likely the result of the catch & run midway through the 4th quarter. He eventually returned to the game later, albeit briefly before the game finished. 

Based on the designation of a toe, it sounds like it could be turf toe. There are other possibilities such as a fracture, but he was observed off to the side on the exercise bike and doing individual activities.

PTEducator.com

Turf toe is an injury where the big toe is suddenly hyperextended due to a fall or some other force such as a tackle when the foot is planted into the ground that pushes it past its normal range of motion. Like any other joint in the body, this too can be sprained. The risk for this can be increased with flexible shoes which reduce support around the area of the foot.

Any other toe injury can be conservatively managed and isn’t a problem even in day to day life. But the big toe is vital to walk a heel toe gait pattern; strike with the heel, push off on the toe. The toe is even more vital during running as sprinting is done up on the balls of the feet, placing further stress on the toe. 

The timeline for a turf toe injury can be 2-4 weeks or even more based on severity. Look back at Packers WR DaVante Adams last year for reference. Due to the demands of the big toe, especially with high end athletics, it can be easily re-injured if not managed properly. This is something that can linger for weeks and limit production. 

He is obviously missing this week and potentially next week. Once he returns after the area has had a chance to heal, he can use a stiff sole to help reduce toe extension during push off and taping/bracing to support the area. He may lose some explosiveness after coming back, but if he gives it proper time to heal, then he may be fine. It will be important not to rush back because then he will lose that first step explosiveness and top end speed if he cant push off his toe effectively.

It’s important to note that he had a toe injury back in 2016 during his freshman year at Utah. It’s not certain that it was a turf toe injury, but he missed 2 games as a result. The injuries are not directly related as we don’t know specifics or even side l along with the time span in between. But if this is another bout of turf toe, he may be able to understand his body better and rehab more effectively. I expect TJ Yeldon to get a rare crack at the game day roster. Remember, he’s a 3 down back according to Brandon Beane.

TE Dawson Knox (concussion)

Knox is out with a concussion following Sunday’s win. He has since had 3 straight DNP’s at practice and right now appears to be at about Stage 3 due to participating on the exercise bike and drills. He will now have to go through football specific drills and a full practice without symptom reproduction before he can be cleared by the neurologist. 

It’s rare that a guy is able to return from a concussion in a week’s time and hopefully he can return for Week 4. There were a lot of people who sent video of hits he sustained to the head that game. I do appreciate every one of you for doing that, but it is nearly impossible to diagnose a concussion on video alone unless the individual has been knocked unconscious. Let’s hope he’s back for Week 4.

LB Del’Shawn Phillips (quadriceps)

Phillips continues to be out with a quad injury sustained in the season opener over the Jets. He has not practiced since then and video does not exist of the injury that he sustained on special teams. 

This is appearing to be more of a quadriceps strain and literature for quadriceps strains is more limited than hamstrings, but from what I found, timelines are similar to that of hamstrings. There’s a possibility that this could be a tendonitis as well, but that is something that can be played through more than a strain.

It’s important to note that WR Andre Roberts missed the first two games of the season last year with a quadriceps injury. This may be the same course of action that the Bills take with Phillips or this could be an injury that we don’t have all the facts on yet. We continue to wait and see. 

QUESTIONABLE

LB Matt Milano (hamstring)

Milano has been able to practice in a limited fashion all week after missing Week 2 with a hamstring strain. Hamstrings can take 13-18 days on average to return to play, but his injury may have been truly minor; a term that I’ve come across is “niggle”. I believe Milano had a niggle. 

Could he benefit from another week off? Sure. But if he’s feeling good and he can play, then I can live with that. He is questionable, but a hamstring is not an automatic out for 2-3 games. Some guys can come back the next week, others take much longer. We are seeing that with the setback with CB Josh Norman & this shows that each hamstring is unique. With how practice has been this week, he is still 50/50, but I’m leaning towards him playing Sunday. 

LB Tremaine Edmunds (right shoulder)

Edmunds has been tricky for me these past 2 weeks. I initially had him as a contusion, possible AC joint sprain. Then he missed the last game which leads me to believe he may have had more of a SC joint sprain or bruised rotator cuff. I’ve studied the film, watched his practice and without a physical examination, I am stumped.

This could be Occam’s razor and I’m overthinking this. The fact that he has had a red non-contact jersey for the last two weeks is concerning, but that may be more to prevent further injury. He may have benefitted from the week off and be ready for Sunday. 

From what I’ve seen, it’s very possible he plays. Especially with the benefit of his skill set against the Rams, it’s an important game to get up for. He’s also 50/50, leaning towards seeing him playing. 

CB Taron Johnson (groin)

Not much is known about Johnson. He has a long history of injuries dating back to his rookie year with the shoulder labral tear followed by a hamstring strain last year. Now he has the groin strain which isn’t great for a defensive back with all the cutting & pivoting he has to do as part of his position. 

He did not exit the game and was a full participant on Friday which is a good sign. However, groin strains, like many other soft tissue injuries can linger and cause problems later. We do have depth at the position, he will probably play, but considering Johnson’s penchant for injury, he may be best served to sit this one out. 

ACTIVE

WR Cole Beasley (hip/right thumb)

Beasley is active despite dealing with two separate injuries. The hip is not all that concerning, it could be more of generalized hip soreness or bruising due to the fact that he had several hard falls during his catches on Sunday. 

However, the injury I am more concerned with is his right thumb injury. He had it heavily taped in practice on Thursday and was in visible pain when catching the ball. 

He may have suffered a mild/moderate thumb sprain, also known as skier’s thumb. He could have fell on the thumb during one of his catches, forcing it into extension and abduction. He could also have gotten it tangled up with a defender, it wasn’t clear on film. He’ll be able to play & still be effective, but with how hard Josh Allen throws and the injury, I hope we don’t see a drop or two due to the pain and resulting weakness in the thumb region. This will be something to monitor on Sunday. 

DT Ed Oliver (right knee)

Oliver suffered his knee injury as the result of a leg block that fortunately was not flagged on Sunday. During replay, his knee gets struck by the Dolphins offensive player and then his shin strikes the player again once the leg kicks forward.

It initially appeared that he suffered a shin contusion which would have been more pain related. But since he struck the knee, it forced the knee into hyperextension. What’s beneficial is that the leg was swinging freely and not in a fixed position. There was some stretching of the knee capsule and overall pain, but structural damage to the area appears non-existent save for maybe bruising due to the hit itself. Fortunately, the knee does have several degrees of hyperextension available in the human body, giving the knee some pliability to reduce the risk of injury. 

He was spotted by The Athletic’s Joe Buscaglia wearing a knee brace at practice. I asked Joe for clarification on the type of brace and he said that it appeared to be more hinge like. This would support that his knee was hyperextended and that he is wearing the brace for support. These braces don’t outright prevent injury, but the idea is that the side supports do lock out in full extension and if he were to get hit directly over the knee, the brace would take the forces of the hit and lessen the impact on the knee itself. In addition, the side supports limit medial/lateral movements so if they get hit from the side, the entire leg goes down rather than the valgus force that we see in ACL and MCL tears.

It will be interesting to see if he plays Sunday with the brace on or if this brace was simply used to help give him some confidence with the knee during practice. If you look closely, fellow DT Harrison Phillips wears one as well when he plays following his ACL tear last year. Overall, I don’t believe Oliver’s quality of play will be affected by the knee injury nor is he at a higher risk to suffer further injury due to Sunday’s hit.

CB Tre’Davious White (shoulder)

Virtually nothing is known about White’s shoulder ailment that had him limited at Wednesday’s practice. He is getting older, he’s a highly paid player who knows he’s valuable to the team, this may have been more of a maintenance day than anything. I could not find anything specific on film to support a shoulder injury and he was able to practice in full Thursday & Friday. I can’t even speculate what he could be dealing with because there is no mechanism of injury. Right now, this is a wait and see approach. 

He did deal with a neck injury last year that caused him to wear the red non-contact jersey for about 2 weeks last year but he did not miss any games or appear to have his play suffer as a result.

WR John Brown (foot, possible plantar fasciitis)

Brown popped back up on the injury report this week with what the team described as “foot soreness”. He was on the injury report last week briefly with the same issue. The fact that he is able to practice in full certain days and then has to be limited others indicates that this may be more of a chronic issue which I believe is plantar fasciitis.

The plantar fascia is a tough band of fascia that connects from the heel to the balls of the feet. This acts as a shock absorber and helps keep the structural integrity of the foot intact during walking and running. This effect is known as the windlass mechanism. This allows the foot to stay rigid as the foot goes into push off moving from stance to swing phase. If we did not have the plantar fascia to help keep the foot rigid, then the big toe would not have the leverage to push off as effectively and drive the entire foot forward.

ChoosePT.com

The area of the irritation of the plantar fascia is at the base of the heel, where the fascia originates. Microtears occur due to overuse or excessive running which appears to be in the case of Brown. This appears to be more of a problem this year than other years because of the change in training camp with less ramp up time. If he wears shoes that are not supportive, this could cause the foot to excessively pronate which means the foot rolls inward when walking versus maintaining support during heel toe walking. The overpronation would pull on the plantar fascia during push off using the windlass mechanism and the excessive running could cause microtears, causing inflammation.

Functionally, he will not be greatly affected by this, but it is a painful condition to deal with. He likely wakes up in the morning and has difficulty bearing weight through his foot due to the tissue tightening up throughout the night, making those first few steps during the morning painful. He can rehab to stretch the calf, Achilles, overall improve the range of motion in the ankle and big toe mobility to take stress off the area. He can also get injections to help manage the pain, but this is not something the doctors like to do often because too many injections can increase the incidence for rupture of the affected tissue. These rates are fairly low, but injecting and numbing pain is not an effective solution to manage a condition. It can be an intervention that assists with taking care of a problem, but not the only solution. 

It’s possible that Brown battles with this off and on throughout the season, using rest days and rehab to address the matter. As a treating Physical Therapist, I have found plantar fasciitis to be a stubborn diagnosis, but this does not mean that Brown will not be able to overcome this. The team does have a lot of interventions with the possibility of cupping, laser therapy, acupuncture, injections, iontophoresis with medication, stretching, using night splints, strengthening, taping, footwear modifications, among others. There are far worse injuries that can be played through, but plantar fasciitis is still a troublesome injury. This sounds all doom and gloom, but he will be alright.

Final thoughts:

The team is banged up. This is why I believe some preseason games are good to get the live reps out of the way rather than going from practice and limited contact to full blown games. Even if the starters were playing for two series a game in the preseason, it helps them acclimate slowly to game speed versus full speed right away. The Bills have been through this before with the lengthy injury report. The tweet below shows how things looked last year prior to the Titans game and how things look going into Week 3. 

You’ll also notice that the team does a fairly good job of dealing with injuries in that they don’t become a chronic issue. The training staff likes to address the injury, give it time to heal if possible, and then return to play. We are not seeing the walking wounded out there like some other teams around the league. 

I did note last year that injured players may have been active, but their snap counts significantly reduced in that particular game to prevent further injury. Two instances I can think of were WR Isaiah McKenzie during Weeks 4 & 5 last year and G Cody Ford during Week 8. This team has a plan to get guys healthy and have them available if needed, but not to rely on the walking wounded to play a full game. 

It’s also important to note that CB Josh Norman was observed on the exercise bike this week as he prepares to hopefully get activated from IR following Sunday. He may still not be 100%, but he can begin practicing with the team as they have a 21 day window where he doesn’t count against the roster. If he’s ready, they can activate him, if he’s not, he can be shut down and go back to IR. He can also just stay on there longer and activate his window later, so it’s not certain that he will begin practicing next week.

The same can be said for G Jon Feliciano. Coach McDermott even came out and said that he didn’t want to put guys out there that weren’t ready. Feliciano had said he wanted to come back by Week 4, but I have maintained that he would benefit coming back closer to Week 7 or 8 where he could be more effective. This will be something to continue to monitor.

Inactives:

QB Jake Fromm

RB Zack Moss

TE Dawson Knox

LB Del’Shawn Phillips

OL Ike Boettger

DE AJ Epenesa

The team will get through this. Years past, injuries would have decimated a promising season, see the 2011 Bills. But the team has quality depth and lots of experience to withstand some of these bumps and bruises. I would grow more concerned if we get a rash of season-ending injuries like in 2011. This is still a talented roster despite the Rams coming to town. Hopefully next week, this report will be a little shorter.

Top Photo Credit: WKBW

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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