2020 Week 4 Bills Injury Review- Raiders

Is Josh Allen going to be ok? What happened to Levi Wallace? How long will Matt Milano be out for?

The Bills are 4-0 for the first time since 2008 and the fanbase is buzzing! That was about the time I began to sink my teeth into what is now my full-fledged Bills fandom & totally embraced it. While the beginning of the season was fun, the later half clearly wasn’t. However, this 2020 team is something else! 4-0 including two wins over division opponents in the Dolphins & Jets and two more wins over playoff contenders in the Rams & Raiders. 

While it’s unrealistic to run the table to a Super Bowl, the Bills are showing they know how to win games that they are expected to win. There are still several games on the schedule that aren’t automatic & realistically, they will suffer some losses. But for now, the Bills are getting stacking wins as they continue to march forward in the season.

In light of the win, there were several injuries to note of varying concern. Below you will find my thoughts and expectations for each injury moving forward.

CB Levi Wallace (left ankle)

Wallace injured his ankle with 8:22 left in the first quarter with what appeared to be a calf/ankle injury. Upon review & just prior to falling to the turf, Wallace changed directions suddenly, going backwards in order to get the tipped ball. As he was going backwards, he rolled his ankle inward. That sudden weight through the rolled ankle likely worsened the severity of the ankle sprain observed on film. He was down on the ground in obvious pain and required assistance to get back up and off the field. Regrettably, he was unable to return.

Noted above, following the game, he was on crutches as Coach McDermott was giving his post game speech. From the video, it isn’t determined whether he had a boot on, but considering the possible severity of the sprain along with the crutches, it’s very likely he did. 

McDermott has since stated that he is week-to-week which translates out to several weeks missed. Grade 1 ankle sprains can usually be played through. Grade 2, which I believe is what Wallace has, is anywhere from 3-6 weeks. Considering they have not put him on IR yet, I believe he can come back after missing 2-3 games, barring setbacks.

They do have Josh Norman available and may be the only option until Wallace is ready to return. 

WR Cole Beasley (left foot)

Beasley suffered what he termed a foot sprain on his TD catch when he got flipped into the air before coming down hard for the score. As he came down, his left foot smashed into the turf.

This appears to be a generalized foot sprain, more specifically to the midfoot. He had it taped up and returned later in the game, at times labored. He’s a guy who could benefit from some time off but he’s a baller and he’s going to play. I expect him to be limited in practice or have a day off this week. Unless the foot gets much worse Tuesday & Wednesday, I expect that he’ll have it taped up for next Sunday.

QB Josh Allen (left shoulder)

Allen scared the entire NFL when he got tackled scrambling out of the pocket before getting taken down from behind, falling with his arm outstretched, hitting at the elbow then rolling onto his left side, grabbing at his non-throwing shoulder. 

There’s a lot to unpack with the injury so stick with me here. It initially appeared that he injured his hand due to shaking it out with noticeable discomfort. Due to the elbow striking the ground, he likely hit the ulnar nerve that runs on the medial portion of the elbow, aka, the funny bone. 

That would explain the hand component. When the elbow struck the ground, he immediately grabbed at the shoulder. There are several things that he could have injured with that fall including an AC joint sprain, rotator cuff, or labrum tear due to subluxation/dislocation.

I would take the above order of injury based on severity. Best case he could have injured his AC joint with the fall. He can wear a brace for a few weeks and have no lasting effects, especially considering this is his non-throwing shoulder. 

The rotator cuff could have been strained due to the elbow hitting the turf, jamming the humerus up into the acromion, causing injury. This injury would also take several weeks to recover from. Think QB Drew Lock of the Broncos from Week 2 below.

However, the worst and I feel is most likely is the labral tear due to a subluxation/dislocation. The elbow hitting the turf and forcing the arm up and into the shoulder socket could have forced the head of the humerus away from the labrum which helps deepen the socket for the shoulder to articulate.

Credit: https://link.springer.com/article/10.1007/s00167-015-3979-8

If this is the case, I see a scenario where he wears the brace the rest of the season as he rehabs in order to keep the shoulder strong and as stable as possible. My hope is that he subluxed the shoulder, it caused a small tear in the labrum that he plays through and then the team can evaluate if he needs to undergo surgery in the offseason. There is concern that he injures the shoulder further if he falls on it.

Check out Bears QB Mitch Trubisky’s shoulder injury from two years ago for similarities.

My biggest worry if he continues to sublux or dislocate the shoulder, leading to missed time. This could cause further damage to the labrum or a significant dislocation could lead to a brachial plexus injury which is the bundle of nerves that supply the arm for sensation and movement. This is less common, but still possible. A non-throwing shoulder injury isn’t as big of a deal, but if he takes further shots, this could take him out of games even temporarily.

As it’s not his throwing shoulder, the team will unlikely give any further information and we will have to read the tea leaves. 

RG Brian Winters (right knee)

Winters suffered what appears to be a right knee contusion on the same play that Josh Allen got injured on. He was engaging his block before getting shoved down way behind the line of scrimmage, falling directly onto his right knee. He was able to get back up & finish the play, but was laboring to get back towards the action. 

He was later ruled questionable with a right knee injury & did not return. This isn’t something that should linger outside of dealing with pain. He could have played through, but considering that the team has depth & still wants to get reps for all their guys, it was a smart move to avoid having him continue to play. This might show up on the injury report but it doesn’t appear to have lasting concerns.

LB Matt Milano (left pectoral)

Milano injured his left shoulder/pectoral area attempting to tackle RB Josh Jacobs near the line of scrimmage. As he went to wrap him up, Milano’s momentum kept him moving upfield as Jacobs began to run downfield. In the process, his left arm was pulled away by Jacobs running. Milano got up, having his left shoulder/pectoral muscle checked out by the team doctor on the sidelines.

This is the exact mechanism of injury for a pectoral tear, maximal eccentric contraction of the muscle, leading to overload and tearing. However, it does not appear that a full tear is the case. This appears to be more of a strain by how Milano responded and how quickly he fell to the ground, allowing the ground to stop some of his momentum. This could be an injury that he does miss some time for, but isn’t something that I expect to hinder him all season. 

He has since been termed as week-to-week, which isn’t promising. Most of the literature I found spoke more of the pectoral tendon rupture, exactly what G Jon Feliciano is recovering from. There are some resources that note that this strain could be a 2-6 week recovery.

Considering they’re not placing him on IR at the moment, this leads me to believe that he’ll be out 2-4 weeks. Not quite enough to be placed on IR but not a quick return. I will say he’ll miss probably 2 games which will put him on track to return for the Jets game. Unfortunately, that second game missed would line up with the Chiefs game which would be vital for him to be available. More information will have to be available in order to change my mind on the timeline.

Already this season we have seen Eagles DT Javon Hargrave miss almost 4 weeks with the injury before returning to play in Week 2. Raiders LB Nick Kwiatkoski missed 2 games with a pectoral injury and returned to play with bracing. So to put him on track to return after 2-3 games should be reasonable. Had he outright ruptured, this wouldn’t even be a discussion. This is highly unfortunate considering he already missed one game with a hamstring strain. This will be another injury he simply has to battle back from. 

S Jaquan Johnson (right lower leg)

Johnson continues to show why he is active every Sunday as a special teams contributor. He successfully recovered the onside kick that the Raiders attempted to try and recover to get one more shot at the end zone. During the recovery, he was kicked hard in the lateral lower leg area during the scramble for the recovery. That kick, along with at least a dozen grown men landing on him would make even the toughest of men hurt.

Like Winters, there will be pain, but outside of that, he should be alright for next week.

Other observations:

G Cody Ford (left shoulder)

Ford was noted wearing a brace on his left shoulder signifying some type of instability. This was first noticed by Erik Turner over at Cover 1.

Looking back at the Miami game, there wasn’t any apparent instance of an AC joint sprain or even a labral tear. You could make the case for some pectoral strain possibilities, but nothing was definitive and I would have expected he would miss some time.

I then also grew concerned for a labral tear. These are highly common in NFL lineman & something that can be played through. Finding that on film would be difficult due to repeated blocking with the arms extended & I’m not certain that he even suffered this during a game. He could have injured the shoulder at practice In between the Rams and Raiders game.

Like all the others, something to monitor. To note, he had surgery on the opposite shoulder last year but details were never made public on whether it was a labrum or rotator cuff. We are once again left to speculate. 

All these injuries, most of them aren’t things that could have been prevented with preseason. These are just unfortunate and the reality of the Bills returning to the mean in regards to injuries. None of these injuries are season ending and most can return to full health. Football is a physical sport, there are injuries, I am glad that we are not seeing season ending ones yet. Looking forward, the Bills move on to play the Titans in Week 5 as they continue to maintain control of the AFC East. 

Top Photo Credit: larrybrownsports.com

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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