2020 Week 9 Bills Injury Review- Seahawks

Looks like the Bills may finally be getting healthier.

The Bills are 7-2 for the first time since 1993 and in control of the AFC East following a convincing win over the Seattle Seahawks on Sunday. To put it into context, I was 5 when this last happened. A lot has changed since then, but the Bills are finally contenders again and it’s a great feeling! On top of the excellent start, there were minimal injuries that have been termed day-to-day from Sunday.

In-game injuries:

G Cody Ford (right ankle)

Ford suffered a right ankle injury on the first TD of the day to TE Tyler Kroft. This was the result of Ford getting knocked backward from his block before tripping over RB Zack Moss as he tumbled backward. It wasn’t clear initially what he had injured, but based on how he fell outward, it appeared that he rolled his ankle. It’s also possible he could have stepped on Moss as he came through, leading to the injury. Here’s the play below.

He made it to the sidelines before getting carted to the locker room for further evaluation. He eventually returned to the sidelines later in the game. He was even observed holding his helmet and jogging, ultimately not returning to the game. Considering he was coming off the right MCL injury and now dealing with a right ankle, it appears the team did not want to risk further injury and kept him out as a precaution.

Unless the practice reports show otherwise, he may be limited with an ankle sprain this week and tape it up for Sunday. Small possibility they have him sit to maximize his healing time with the bye coming up.

G Brian Winters (left knee)

Shortly after Ford went down, Winters suffered a left knee injury with 14:23 left in the 2nd quarter. He fell down in a pile of bodies as the pocket collapsed, leading to him having some difficulty getting off the field.

On broadcast, he was observed rubbing the inner portion of the knee indicating a possible mild MCL sprain or patellar contusion. It’s also not clear if this is the same knee that he has been limited with the past 2 weeks. He eventually returned roughly a half-hour later to finish out the game. He may continue to show up on the injury report this week with a knee ailment, but it doesn’t appear that this is a concerning issue.

T Daryl Williams (leg)

Williams may be the most difficult injury to observe on film similar to Winters, also falling in a pile of bodies with 6:40 left in the 2nd quarter. He landed on his left side and appeared to be favoring the left side slightly walking off.

The injury did not appear to be an issue as he returned several plays later and finished out the game. Based on the pile of bodies and short time missed, it was likely that he suffered a general contusion that required brief attention before returning. Normally, injuries to Williams and Winters are inconsequential, but at one point the Bills were without 3 offensive linemen available to protect QB Josh Allen.

CB Tre’Davious White (left ankle)

White sustained an ankle injury late in the 4th quarter with 3:16 left, quickly getting tended to by trainers before hopping off to get taped. Upon further review, it appears he suffered a medial eversion ankle sprain. There was a possibility that he suffered a mild high ankle sprain, but his foot appeared to be pointed down more towards neutral than upward into dorsiflexion, avoiding the more severe injury observed in the top picture below.

White quickly got taped up and was walking around on the sidelines, possibly waiting to return. He was designated as questionable to return but ultimately was not needed as the team iced the game with the recovery of the onside kick.

It appears that White avoided major injury and he should play next week. It’s possible that if the ankle is worse than originally thought, he could miss the next game considering the bye coming up, but the video and sideline impressions following the injury don’t imply that it was.

Other thoughts:

G/C Jon Feliciano (pectoral)

Feliciano continues to play in 100% of the snaps in the absence of C Mitch Morse following his concussion. For someone 3 months removed from tearing his pectoral muscle, he looks pretty good out there. I had hoped that he would be worked in to not stress the surgically repaired area, but at this point, it doesn’t appear to be an option. The band-aid has been ripped off; there is no point in trying to restrict him now. Hopefully, he continues to work back into shape and round into form for the late-season stretch.

LB Matt Milano (pectoral)

Milano was placed on IR on Saturday to better manage his pectoral injury. He missed the Titans and Chiefs game but returned for the Jets and Patriots game, but was on a pitch count and obviously limited. Based on what he was doing out there, he was able to play and did make a difference in pass coverage, but when asked to tackle or stop the run, he simply could not wrap up his tackles. This was a concern of mine returning from the injury and it appears to be true.

I question whether he had a setback with regards to the timeline the team has taken with this injury. He could have re-injured some of the healing tissue in the pectoral region, leading to putting him on the shelf. It’s more likely that they weren’t satisfied with his play and limited availability, leading to the shutdown.

The team saw an opportunity to put him on IR to maximize his healing time while minimizing games lost. He does have to miss 3 games which means he was out for the Seahawks game and will be out for the Cardinals and Chargers game.

In addition, he will use the bye to get an entire month off to recover. A whole month of no football activities to allow the pectoral muscle to heal in addition to the past month of rehab he’s already performed should work out in his favor. With this timeline, he could potentially come back close to 100% when he returns.

I saw some comments on social media questioning the handling of Milano’s injury. I can say with a moderate level of confidence that they handled it the best they could with the information they had at the moment. That’s all you can do in situations like this. They had the physical testing, the imaging, and they made an informed decision. The research supported his ability to return when he did. Injuries like this, a likely Grade 2 strain, do take upwards of 6 weeks to heal, but in the NFL, these players don’t typically get that time to fully recover, leading to him returning after 2 games.

In rehab, I have had countless patients “fail PT” or not progress as expected. This is due to other circumstances that play into the decision-making process or are considered in the plan of care but overtake the issue at hand, preventing the patient from reaching their goals.

Sometimes, those other issues need to be addressed before therapy can be successful. For example, people with arthritic knees that can’t tolerate progressing exercises secondary to pain, sometimes they need a cortisone injection to help calm things down before they can complete PT.

In other cases, a surgically repaired area needs further healing before therapy can be initiated or progressed. Sometimes a chronic health condition can become problematic and must be addressed to maximize rehab. I have had many cases where this needed to be completed in order for the patient to ultimately be successful at rehab.

In Milano’s case, they let the research and imaging dictate when he returned. They probably realized he wasn’t as effective as he could have been and ran the risk to suffer further injury and shut him down. Medicine is a lot of trial and error at the end of the day based on the research and experience of the providers treating those issues. The providers are allowed to change their minds if something isn’t working or adverse effects occur. The poor decision would have been to be stubborn and continue to play through the injury, potentially leading to a worse outcome.

Fortunately, the team has the short term IR to allow him to rest and not waste a roster spot. In other years, he probably would have continued to try and gut it out like we saw LB Tremaine Edmunds do earlier this season, though it’s important to note that the injuries were different.

As the theme has been this year, there will likely be an injury here or there that shows up on Wednesday that we did not expect. My hope is that some of these injuries do fall off the list because if the list grows anymore, we may need a magnifying glass to look at some of these names. However, the bye is coming up and while it feels much later than usual, it is perfectly timed. I would rather have a late bye with all these injuries to get right for the final push rather than limp into the postseason. The Bills are 7-2, life is good.

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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