The hits just keep coming for Ed Oliver this season. After having a monster game in Week 1 against the Baltimore Ravens, he proceeded to miss the next four weeks with a left ankle injury. He was able to return in Week 6 and continued his menacing ways through the first half of the win over the Carolina Panthers.
Regrettably, injury struck again for the veteran defensive tackle when he was quickly ruled out of Sunday’s contest with a biceps injury.
Once the Bills returned home, the worst news came out that Oliver suffered a distal biceps tendon tear and would be out indefinitely.
Read below for a full injury analysis including how this injury occurs, return timeline, and what to expect out of Oliver when he does return.
The Injury
Oliver battled through the line with 1:59 left in the second quarter and looked to get his arm caught behind him and the elbow potentially hyperextended. He fell down and immediately grabbed at the inside portion of the elbow before he walked off with his arm dangling.
In the second video, he can once again be seen motioning to the elbow where the biceps attach to the ulna before he walks into the locker room. His biceps also looks enlarged suggesting a Popeye deformity. While it doesn’t look out of the ordinary, there may still be some fibers attached that prevent the muscle from retracting further. This presentation strongly suggests a left distal biceps tear.
This is very similar to how former Patriots LB Matthew Judon suffered his distal biceps tear in 2023.
Finally, he was ruled out almost immediately with a biceps designation.
He was spotted during the game and after with a sling on underneath his hoodie indicating he needed support.
He appeared to get bad news because on his Instagram on Sunday night, he posted the following story below implying the news is not good.
We know there is an injury, further testing will tell us how long he will be out.
The Anatomy
The bicep connects distally to the radial tuberosity near the elbow and proximally at the shoulder at both the coracoid process and labrum of the shoulder. The biceps primary movements are to flex the elbow and supinate the wrist.
Mechanism Of Injury
There are various ways for the biceps to tear both proximally and distally, but in the case of Oliver, this is distal, closer to the elbow. The distal bicep tendon is torn when the elbow is partially flexed and a sudden load is placed onto the hand or arm, causing the tendon to tear under tension. This is commonly seen in weightlifting.
Another way includes the elbow being hyperextended or falling onto an outstretched hand. In football, this could happen when the arm is suddenly forced back during a block or a diving tackle with the elbow partially flexed. This appears to be the case with Ed Oliver when his elbow was fully extended coming through the line.
Bicep tendon tears make up between 3-10 percent of all bicep injuries and normally affect the dominant extremity.
Diagnosis & Surgery
The physical testing for a distal biceps rupture is pretty straight forward. There are two tests that can help assess rupture including the Hook test and Bicep squeeze test. Both are how they sound in assessing the tendon. The Hook test is where the evaluator attempts to hook their finger around the lateral edge of the tendon while the person flexes and supinates the biceps. A false positive can occur if there is a partial tear to the area. A video of the test can be found here.
The bicep squeeze test is when the elbow is flexed between 60 and 80 degrees, the hand is placed in pronation, and the bicep is squeezed. The lack of supination or the hand turning palm up is a positive sign.
We also see the Popeye’s deformity in where the muscle retracts into the muscle belly. Oliver appeared to have this on the sidelines but it wasn’t full, meaning there may be a partial tear. An MRI will also be completed to confirm the physical testing.
However, this is pretty much an all or nothing approach. Either it’s partially or fully torn and he requires surgery. A conservative approach wouldn’t be appropriate due to persistent strength deficits and range of motion restrictions.
Oliver will undergo surgery to repair the tendon in the coming day. Surgeons attach the tendon to a surgical button which is then taken through the radius and attached on the other side, allowing the tendon to heal back to the bone.
He will be in a sling for at least two weeks followed by a hinged brace restricting the amount of elbow extension available so as to not stress the healing tendon. He will progress through rehab in order to return to the field, hitting key benchmarks along the way.
Return to Play
The literature varies on how quickly players can return from a distal biceps tear, but we don’t have to look far to have a reliable example. In 2024, LB Matt Milano returned in 15 weeks and 5 days to play in Week 13 after tearing his biceps in the middle of training camp.
Other articles are more aggressive stating that players could return in as little as two and a half months, though the average is just under five months.
However, upwards of 94 percent of players do return to play and there is not a drop off in performance once returning. Career lengths are shortened somewhat, playing up to three years after the injury, but Oliver still appears to have lots of football left in him.
Fellow Bills defensive player DaQuan Jones also suffered a biceps tear in 2017 with the Tennessee Titans and came back to play at an incredibly high level. His experience may help Oliver avoid some of the pitfalls that he experienced during his rehab.
Taking everything into consideration, Oliver could hypothetically return this season. While Milano returned to a game after 15 weeks and 5 days, he had the benefit of the preseason when it happened. He was able to return to open his practice window on November 11 at just over three months before practicing for two weeks and playing in Week 13.
If Oliver follows that exact timeline, that takes him past the Super Bowl on February 8.
Knowing Milano returned to practice sooner at three months takes Oliver to the AFC Championship game on January 25-26. The Bills have a realistic idea where they could cut corners to get him back faster, but there’s not many corners he can cut. He needs to heal from the surgery and there’s only so much someone can do to speed up healing. Week 18 will be January 3 or 4 as it is currently a flexed game on the schedule. Knowing playoff teams get two additional injured reserve designated to return spots in the playoffs, I would wait until then to open his practice window.
With the expectation that the Bills make the playoffs, the earliest I expect he gets activated to practice would be ahead of Wild Card weekend.
Wild Card Weekend would be January 10-11, having him just 10 weeks removed from surgery. If the Bills can get the number one seed, this gives him another week to get ready for the divisional round. The benefit with some respects is that if he pushes to return in the playoffs and tears the tendon again, they repair it again. Either his season ends early or the Bills season does. There is a risk with this but the benefits could outweigh the risk.
The closest comparable I can find for a playoff return is Philadelphia Eagles DE Brandon Graham who tore his triceps in Week 12 last year but returned to play in the Super Bowl. By my math, he was 11 weeks removed from the surgery.
Regrettably, he did tear the triceps again and underwent surgery to repair it and initially retired. He did come out of retirement recently to help the Eagles who are having depth issues at this position.
The literature shows athletes can return that quickly though it’s relatively rare as they are weightlifters and boxers in the studies. If he can return this quickly, his strength will not be as strong as he was prior to the surgery and will have some increased difficulty with hand fighting as he rotates his hand back and forth from pronation and supination along with grip strength trying to look for angles and leverage with his arms. He will have to wear both a shoulder harness and hinged elbow brace to protect the still healing area. Even if he is at 75 percent, this may be better than most guys at that stage in the season. Unfortunately, he will have a high risk to re-tear if he can come back, similar to Graham.
Final Thoughts
Can Ed Oliver return this season? Technically yes.
But this will be an aggressive rehab with minimal room for error in order to have him back within three months just to practice, much less play. We saw how aggressive they were willing to be with Micah Hyde and his neck several years ago, this surgery is less risky.
I’m generally a glass half full person when it comes to rehab with my patients, but I also have to prepare for the possibility that he may not play again this year. There is an element of wait and see as he progresses through his rehab. The Bills medical staff is talented and has the knowledge and expertise to push towards him playing again this year, but it’s not an absolute guarantee.
The odds are certainly stacked against him right now and there is a greater likelihood that we don’t see Oliver this season. But it’s not impossible.
The deeper the playoff run, the more likely Oliver returns.
I’m excited to see how this timeline progresses for Ed Oliver. He has the work ethic and rehab staff to make this happen, but he still needs to heal just like any other person.
I would like to wish Ed Oliver the best of luck in his rehab and look forward to his potential return for the playoffs.
Top Photo Credit: CBS Sports
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