The NFL Combine is upon us and with that comes more Buffalo Bills updates from the front office and coaching staff. Much has been said regarding the new coaches on staff and their relationships during the season. In the midst of all of that discussion, a new piece of information was discussed regarding star CB Tre’Davious White as he continues to work back from his ACL tear suffered on Thanksgiving. Below are quotes regarding his rehab progress from GM Brandon Beane.
Outside of some passing thoughts at the season-ending press conference, there haven’t been many updates on his rehab. Tuesday’s quotes don’t offer a lot more, but it provides some insight and benchmarks White is approaching as he prepares for the 2022 season.
Days prior, Tre’Davious White took a picture with former Cincinnati Bengals great WR Chad “OchoCinco” Johnson in the Buffalo-Niagara Airport. The picture alone doesn’t tell us everything, but it does tell us a few things.
First off, we don’t see any type of assistive devices such as crutches or a cane which wouldn’t be expected to see anyway at this point. This does reinforce that he likely hasn’t any significant setbacks such as infection or persistent issues where there may be irritation in the knee during exercise.
He did tear the ACL in his left knee and we don’t see any hard bracing on the area. He could be wearing a neoprene sleeve underneath, but not likely. There also doesn’t appear to be any swelling in the area, though the loose-fitting pants can easily hide all of that.
To sit on an airplane with a flexed knee for a long duration tells us that his range of motion is normalizing. His ROM should be full by this point, but if he was having difficulty with swelling or full knee movement, then airplane rides would not be fun as he would be uncomfortable for the majority of the trip.
Referencing the initial tweets above, Tre’Davious White is on track and that picture gives some confirmation to those statements. According to teammate S Jordan Poyer, White had surgery back on December 15th, just under three weeks following his injury. This is common to prevent arthrofibrosis of the knee, otherwise known as scar tissue buildup. This also helps reduce swelling in the knee and prepare the knee for surgery.
As of publication, this puts him at 11 weeks post-op, just shy of the 3-month mark. There are a variety of ACL rehab protocols available, but it’s entirely possible that White is on an accelerated rehab protocol. This is due to the availability of the resources to White rehabbing with the team or personal PT, his participation in high-level athletics, and his self-motivation.
According to this accelerated ACL rehab protocol, he could be nearing the end of Phase III which would mean he has met certain benchmarks. This includes a normal range of motion, walking pattern, and minimal swelling, all supported by the airport picture above.
The rehab protocol above is a generalization as it isn’t known who did the surgery or what specific protocol the training staff uses.
He is likely performing a lot of the activities we normally see the players participate in within warmups. These include skipping, butt kickers, walking lunges, sidestepping, etc. seen below.
Tre’Davious White has also likely begun a jogging program and has probably started out on an Alter-G treadmill. This uses air pressure to allow a reduction in body weight through the leg. This encourages proper running mechanics to avoid compensation patterns or irritation. He may also be doing normal jogging on a track as well. However, the Bills have equipment most therapy clinics do not have.
A hinged brace commonly used post knee injury is fitted at this time. This will allow him to begin participating in sporting activities in the future.
By this point, strengthening-wise we would see lunges, squats, deadlifts, monster walks, and sled pushing. Balance-wise would see White working with a Bosu ball, single leg balance activities, plyometric ball toss, and other dynamic balance work to work on proprioception within the joint.
Proprioception is the feedback the knee gives to the body to understand where they are in space. Without this, fluid movements and the ability to change direction quickly becomes more difficult, activities essential for a cornerback.
Eventually, White should be progressing to ladder drills, carioca, and figure 8 drills at increasing speeds as he ramps up towards sporting activities. Increasing running speed/duration along with swimming are added for endurance training.
Brandon Beane noted that the training staff has to hold him back from himself as White wants to get back ASAP. This is the mark of good training staff, knowing when to push and when to hold an athlete back from returning too soon.
Return to play
As fans, we have heard countless times how it takes even longer to feel normal following an ACL surgery. We saw this with former Bills DE Trent Murphy and current DT Harrison Phillips. Despite coming back in a year, they stated that it took even longer to work out all the kinks.
As Tre’Davious White is on track, this still puts him just shy of eight months following surgery when training camp starts in late July. It will be a decision between White, the training staff, and the team, but he may start on the Physically Unable to Perform list (PUP) until he can clear a physical.
Starting on PUP means that he will count against the roster during the preseason, but can’t participate in training camp. They could keep him on PUP to start the regular season. This means that he would have to spend the first six weeks inactive before opening his practice window.
He would not be able to practice with the team but can participate in meetings and use the facilities. Once the six weeks are up, he would have five weeks to decide if they want to open his 21-day practice window.
This could save a roster spot altogether during the regular season, but another option is that he is activated off PUP during training camp. He could participate off to the side in team drills but not full practices make the initial roster and is then immediately placed on IR, not counting against a roster spot.
This would result in a minimum three-week stay with a 21-day practice window afterward but could return sooner than if on PUP. A Week 1 return is about nine months removed from surgery. A minimum stay on IR would put him about 10 months which could be a safer timeline to play.
I personally believe that they will go PUP until he hits 9 months post-op. They can activate after that, then get placed on IR to begin the season and buy more time.
Effectiveness upon return
This is all an educated guess as I am not the one in the building working with the athletes. Considering his position and the contract, there isn’t any incentive to return quickly for the beginning of the season.
A less than 100 percent Tre’Davious White may still be as good as other cornerbacks on the roster. But the team is playing an elite corner to be elite. Rushing back too soon may cause further injuries such as hamstring, quadricep, or groin strains. Potential re-tear of the same ACL or opposite side is also a consideration. Athletes returning before nine months following an ACL tear are at a 7 times greater risk to suffer another ACL injury.
As OTA’s begin in the spring, we will get further updates on his movement and rehab progress. I am not hopeful right now that White beats the expected timeline to return in Week 1. He doesn’t need to return quickly in order for the team to win. We saw how well the team played in his absence down the stretch. I will be glad if I am wrong and I have full faith in the training staff.
It’s excellent to see White in public and positive news out of the front office. However, keep the expectations tempered as the offseason progresses. September wins don’t make a Super Bowl championship a foregone conclusion.