2020 Week 12 Bills Injury Review- Chargers

How did Josh Allen avoid serious injury?

Another week, another stressful win. Consistently winning is something this generation of Bills fans has to get used to. It’s a great feeling, but it would be nice to just absolutely dominate a team from time to time. At the end of the day, I’ll take the win because that shows up in the box score and string together enough wins and that qualifies for the postseason. I am aware the Bills are still not a finished product with glaring mistakes and continued issues, but if they can play like this and be 8-3 with the ability to fine-tune things and peak at the right time, then that’s all that matters. But this isn’t a blog that looks at the play of the Bills, it looks at the injuries of the Bills. Fortunately, there were not many in-game injuries and below are the ones noted in the game.

QB Josh Allen (right knee/ankle)

Josh Allen may very well be Gumby. The way his right leg twisted down under Joey Bosa, affecting his right ankle and knee wasn’t pretty. He walked off the field, misses one play, and then returns to finish out the half before returning is impressive.

Looking at everything after the game and his body of work, it actually looks as though he injured his knee versus his ankle based on the picture below. 

I’m going to walk through the thought process with this injury so you can understand why it’s a knee and not ankle, though it’s quite possible he suffered an ankle injury in addition to the knee injury. During the moment of play, I had originally thought a high ankle sprain based on how the ankle twisted but was not convinced that it was with how quickly he returned and played afterward.

Looking at the play initially, Bosa wraps up Allen and attempts to twist him down. Allen’s ankle gets caught up under Bosa and is pushed into eversion or twisting outward. Allen continues to be dragged down to the turf with his knee taking the brunt of the force as his knee continues to bend into flexion and into a valgus position. By this point, the ankle is pinned under Bosa as he pulls Allen up towards his head to ensure that he is down. The play finishes and Allen is in obvious pain. 

The mechanism for a high ankle sprain was clearly there with the foot in eversion and dorsiflexion as seen below. The mechanism for an MCL sprain was there with the knee bent and in valgus position. Two things really played into Allen’s favor. The fact that Bosa pulled him up over him, relieving pressure on the pinned ankle and the fact that Allen has fairly decent hip internal rotation, allowing the leg to turn out. Had Allen’s hip not continued to turn out to reduce pressure on the knee/ankle, or Bosa didn’t pull him backwards, things could have been much worse. 

Forces showing a high ankle injury
Forces showing an MCL injury
Credit: physioadvisor.com.au

It also helped that Allen was pulled down relatively slowly when it comes to tackling, things weren’t abruptly forced. Another benefit was that Chargers defensive tackle Jerry Tillery bailed out of hitting Allen at the last second, which could have potentially added more force to the stressed knee/ankle and causing further damage. 

Allen played the second half with a hinged brace on the right knee under his pants and socks and was surprisingly effective. Had he suffered a high ankle, he could have still performed and run alright with a tape job, but the swelling would have been set in as the game progressed. I’m not certain he would have been able to run as well as he did if the ankle took the brunt of the injury.

The MCL injury makes more sense because the knee was bent into flexion and stressed into a valgus position which allowed the tissues to stretch and partially tear, resulting in a sprain, but not with the force necessary to really sustain a significant injury.

It would not surprise me and it should not surprise you if Josh Allen shows up on the injury report Wednesday with a knee and ankle designation or one or the other. I personally believe that it will be more of a knee designation based on the bracing observed after the game.

It appears to be a mild MCL sprain which can take 1-3 weeks to fully heal. I’d expect him to deal with some swelling and pain in the area, but since the knee is a hinge joint, he can continue to run but may have difficulty in running to his left due to needing to push off the right side.

I’d also expect him to wear the brace for a little while to protect the knee in order to ensure that it heals properly. This might be the milder side of an MCL sprain which heals well to begin with. He should play through this and hopefully avoid further injury in order to wrap up the division and get him much needed rest. 

CB Levi Wallace (right leg)

I’m not sure what to make of this injury. This occurred during the roughing the passer call on Justin Herbert with 11:58 left in the 4th quarter covering Mike Williams. He kept with Williams going out of bounds and he jumped as they both went out of bounds in the end zone. He got up and moments later was down on his left knee.

He required attention from the training staff briefly before missing one play and returning. As he was walking off, he appeared to be shaking out his right leg. There is a thought that he injured the ankle but I’m not certain of that. This will be a wait and see approach if he ends up on the injury report. 

Other injury thoughts:

G Cody Ford (meniscus) & WR John Brown (right high ankle sprain)

Ford ended up on injured reserve with a torn meniscus following a knee injury Wednesday at practice. His recovery timeline is 3-4 months which fits in line with a meniscal repair. This will allow him to have the best outcomes possible with his knee injury and maximize his career to prevent possible problems and chronic issues such as arthritis.

Brown also earned a stay on IR due to a now confirmed right high ankle sprain sustained in the Week 10 Cardinals game. I had originally thought he suffered more of a medial eversion sprain, but according to Adam Schefter, it is a high ankle sprain. 

By the time he is eligible to return in Week 15, he will have had nearly a month to recover. By that time, it will only be a guess if he’s needed or if they wish to keep him on IR until the playoffs. 

LB Matt Milano (left pectoral)

LB Tyrel Dodson (hamstring)

CB Cam Lewis (left wrist)  

WR Isaiah Hodgins (left shoulder)

All are eligible to return from IR and have been activated for their 21-day practice window except Milano as of today. There is a strong chance that Milano gets activated for Wednesday’s practice. There are currently 3 roster spots available for which I believe Milano, Dodson, and Lewis will return. 

Milano will be 8 weeks out from his pectoral injury against the Raiders with 4 weeks since playing football, Dodson is 6 weeks out from the hamstring injury against the Chiefs, and Lewis is also 6 weeks out from his possible wrist fracture against the Chiefs. For their respective injuries, that is adequate time for those injuries to heal, but it is not certain that each are 100%.

There is a chance that Hodgins gets activated but he was put on IR with a shoulder injury sustained in training camp and has been on there ever since. It’s possible that they want to see him in-game action or at least get him on the practice field to see what they have in him. In the coming days, we should see several roster changes. I will also not be surprised to see a few names added to the injury report for various ailments and/or chronic issues.

Overall, the Bills are 8-3 as they head into a Monday Night Football against the 49ers as they set up shop in Arizona as a temporary home due to COVID. The big storylines will be the Bills warding off the demons of the Hail Murray in Arizona, the return of a variety of players from IR on both teams, and whether Jimmy Garoppolo and George Kittle will be activated for Sunday. Right now, it doesn’t appear to be the case based on their respective injuries, but with the 49ers sitting at 5-6, they still have a shot at the playoffs and the return of those two along with other players could allow them to make a push. We’ll see what happens in the coming days. Regardless of what the 49ers look like, the Bills are still relatively healthy and ready to move on to the next week.

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.


One thought on “2020 Week 12 Bills Injury Review- Chargers”

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s