Injuries continue to mount for the Buffalo Bills as their best players go down left and right it seems over the last few seasons. The latest casualty is LB Terrel Bernard who suffered a left pectoral injury midway through the first quarter against the Miami Dolphins.
After going into the blue medical tent, Bernard was deemed questionable before he was ruled out at halftime. This is just the latest in the significant injuries for high-impact defensive starters as this stresses the depth even further.
Fortunately, Bernard’s injury is not season-ending but he is expected to miss some time.
Below is a detailed analysis of Terrel Bernard’s pectoral injury including anatomy, how the injury occurred, and timeline to return.
The Anatomy
The pectoral muscle connects from the sternum and stretches over the rib cage laterally to attach to the humerus. This is a powerful muscle required for inward rotation, flexion, and adduction—all actions required for pushing. These actions are vital for blocking, tackling, and reaching—all important motions required for football.
Mechanism of Injury
The mechanism of the injury, forceful eccentric contraction, led to the partial tearing of the muscle belly. Muscles normally lengthen under tension, which is an eccentric contraction, but a sudden overload to the area causes injury. Bernard likely tore where the muscle meets the tendon in the picture below.
In the case of Bernard, his pectoral injury when he was forced to take on G Robert Jones as he blocked downfield. Bernard tried to scoot away from Jones but got his left arm caught behind as he ran away from Jones. He didn’t appear to make any noticeable indication that he was injured, but he stayed on for three more plays where he attempted to tackle with only his right arm.
Finally, at the goal line where the Liam Eichenberg false start was called, Bernard broke through the line of scrimmage and fell to his right before walking off for further assessment.
Severity of Injury
Fortunately, excellent news came on Friday when the Buffalo Bills announced that Bernard suffered a pectoral strain and would be out for a month with the potential to go on injured reserve.
Considering that he played another three snaps after suffering the injury and wasn’t immediately ruled out was very promising. Add in the fact that we saw Bernard in the locker room after the win last night without a sling which provided a further clue as to the level of severity of the injury.
While every muscle strain’s timeline to return is different based on positional demands and body parts, there are some general guidelines for muscle strains. Grade I is when several muscle fibers tear and can take 1-3 weeks to recover. Grade II is where 50% of the muscle fibers tear and loss of function is noticed, these can take 4-6 weeks. Grade III is where there is severe tearing or complete loss of function in the area.
Based on the phrasing used for Bernard, he is looking at a Grade 2 strain. This also implies that the damage is in the muscle belly itself rather than where the tendon connects to the bone which usually results in surgery.
The discussion now is whether to place him on injured reserve to free up a roster spot or hope that he can return in three games. Should he be placed on injured reserve, he has to miss a minimum of four games and cannot practice with the team. If he stays on the active roster, he can slowly ramp up and return sooner if he is healing well.
Comparable Players
Looking back at how the team has managed pectoral strains, they don’t need to look further than All-Pro LB Matt Milano.
Milano suffered a left pectoral tear in 2020 in Week 4, initially missing two games before returning to play poorly in the next two contests. He then went to injured reserve for three games when IR was only three games but had the benefit of four weeks due to the bye. He did not require surgery with the total time for the injury to heal took eight weeks including the bye.
Based on how they managed the injury this time, I would expect they are more conservative with Bernard and hold him out for at least three games. Depending on his healing over the next week, they will make their decision on injured reserve before the Week 3 matchup against the Jacksonville Jaguars.
Unfortunately, this is a common injury to see in football with most players being linebackers and as a whole, defensive players suffering this injury. For further comparables, below is a list of recent players who have suffered this injury and timelines for return.
- Philadelphia Eagles DT Javon Hargrave suffered a pectoral injury in training camp in 2023 on August 17th. He returned to play in Week 2, missing roughly four weeks.
- Steelers DE TJ Watt partially tore his left pectoral muscle in 2022 in the season opener trying to tackle Joe Burrow. He did not require surgery and missed seven games
- Las Vegas Raiders LB Nick Kwiatkoski suffered a pectoral injury in Week 1 and returned to play in Week 4 against the Bills with a shoulder harness on, missing two weeks. He also suffered a pectoral injury in 2017 with the Chicago Bears, missing five games.
- Dolphins OT Terron Armstead suffered a pectoral strain in 2022 as he worked through a variety of injuries last year. It appeared to be a rather minor pectoral strain as he only missed one game.
Timeline to Return
If Bernard doesn’t go on injured reserve, then he can reasonably return by Week 6 against the New York Jets. If he goes on injured reserve, then I would expect him to return in Week 8 against the Seattle Seahawks as he would miss the four games and then require at least two weeks of practice to ramp back up, missing one additional game. This is the same approach they took with DaQuan Jones coming off his pectoral surgery last year when they activated him.
It’s worth noting that the Bills played Milano immediately coming off injured reserve but he was slowly worked back in by limiting his snap count. Once again, I believe the Bills will be a little more cautious than they were with Milano. Even when Bernard does return, he will wear a shoulder harness as seen below. This prevents excessive abduction and external rotation, the very movements that led to the injury in the first place.
I do expect Bernard to have some difficulty wrapping up tackles and taking on blocks in the first few games he returns. However, as the tissue continues to heal and get stronger, this should improve. Barring a repeat mechanism of injury that worsens the original injury, Bernard will not require surgery.
Unfortunately, Bernard will be out for at least the next several weeks, but this is still better than the three-month absence had he fully torn the pectoral tendon.
I wish Terrel Bernard the best of luck during his rehab and to come back healthy and strong this season.
Top Photo Credit: Getty Images
