Jon Feliciano’s Rotator Cuff Repair

How did Feliciano manage to play all season with a torn rotator cuff?

The injuries continue to pile up! The latest injury comes Wednesday afternoon when a tweet dropped from OG Jon Feliciano. The tweet shows him in a recovery room with a brace on his left arm with bulky padding on the shoulder. Considering it was at a lower angle, it was initially hard to determine if there were other telltale signs that could be observed signifying the specific procedure. 

This surgery is another in a line with DT Ed Oliver Tuesday with his core muscle surgery & Wednesday morning’s tweet of OT Cody Ford with a right shoulder surgeryShortly after the Feliciano tweet, Matt Parrino from NY Upstate reported that Feliciano had a rotator cuff repair Wednesday & that the original injury occurred during the Blue & Red scrimmage on August 2nd.

I noted back in August that he suffered an injury during the scrimmage after I attended, but the actual injury was unable to be observed due to the vantage point of the stadium & the multitude of activity going on at the time. What wasn’t known at the time was that Feliciano suffered a rotator cuff tear to his left shoulder that he managed to play for  5 months. 

To understand why he was able to play that length of time, the anatomy & function of the rotator cuff must be understood. The rotator cuff is made up of 4 muscles that include the supraspinatus, infraspinatus, teres minor, & subscapularis. These muscles assist in shoulder abduction, internal & external rotation. These motions are vital for a variety of activities that we perform daily from washing hair, putting a shirt on, throwing objects, reaching behind the back, & general overhead activities. The rotator cuff also helps keep the humeral head depressed and against the labrum so that it can create enough space within the joint for the humerus to move & not ram into the acromion during elevation. There are other muscles that assist with all these functions, but these are primary movers for the above-mentioned functions. 

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Credit: Physio-pedia.com

We tend to hear more about rotator cuff injuries in baseball but they can & do occur in football at a variety of positions. The mechanism for injury to the rotator cuff can happen in a number of ways. It can occur as a result of landing on your arm outstretched, jamming the head of the humerus into the scapula. It can occur with a fall directly onto the shoulder area, throwing an object either with increased frequency or if the object is too heavy. It can also occur from an overload of the area such as a sudden pull on the area. Finally, it can occur over a period of time with impingement due to weakness in the area with altered biomechanics leading to a wearing down on the tendon insertion.  

There are two types of rotator cuff tears that can affect any of the muscles in the cuff area: Partial-thickness and full-thickness. Based on the names, the partial-thickness is a partial tear to the tendon that can be small & can even heal on its own at times. Full-thickness is when the tendon tears completely through & there is a significant loss of function noted in the area. Any of the muscles in the rotator cuff can tear but the supraspinatus is the most commonly torn muscle. It is anchored at the top of the humerus head & is more likely to bear the brunt of an injury or become worn down. 

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Credit: physioworkshsv.com

There are also varying grades of partial vs full-thickness tears which further indicate the severity as seen above. The tear is measured in both size & depth. So it’s possible that there could be a big superficial tear that could be managed conservatively or there could be a tear that is deep that requires surgery as seen below. Most surgeries are indicated for tears medium & above.

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Credit: Google Images

Feliciano likely suffered a partial thickness tear to at least the supraspinatus & possibly others as the rotator cuff covers the humeral head like a blanket. The injury could have started out as a partial thickness tear, potentially progressing towards closer to a full-thickness tear as the season wore on. The other possibility is that the partial-thickness tear just never got better, requiring surgery.

I don’t believe that he initially had a full-thickness tear as he would have missed some time due to profound weakness in the area and positive signs of several special tests. In the clinical setting, a full-thickness tear is quite apparent & even the toughest of people have difficulty moving the shoulder. If his shoulder were to be assessed during the season, there would have likely been a painful arc noted in the picture below. This is due to the activation of the rotator cuff muscles assisting in elevation of the humerus during the range of motion from 60-120 degrees

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Credit: pivotalphysio.com

There was likely pain during every movement that Feliciano encountered throughout the season due to this tear. Between rehab, strengthening of the surrounding muscles & medications, he was still able to suit up for every game & at times play center. Thankfully, he didn’t have any issues with snapping the ball due to being right-handed. 

Feliciano’s glaring weakness would have been forcing to move his arm in abduction and external rotation, both of which would have been more difficult as a tackle, trying to keep the defensive end from bending around the edge. Thankfully, he was able to play inside & keep his arms closer to his body, taking stress off the cuff. Despite the rotator cuff not directly assisting with shoulder flexion, he still would have likely had pain with a general elevation of the arm due to the imbalance of the rotator cuff due to the injury. This could cause impingement where the rotator cuff gets pinched between the acromion & greater trochanter due to decreased space during shoulder elevation.

It will be curious to see if he did get beat more often on the left side when the pocket broke down & he was forced to use that shoulder more. It would also be interesting to note if Feliciano’s punching ability when engaging with his block was decreased due to not being able to put as much power through the left.

Either way, to play through this injury isn’t unprecedented in the NFL, but it is difficult. Cam Newton, Drew Brees, Kawaan Short, Alshon Jeffery & Johnathan Abram are just some of the examples that have torn their rotator cuffs & either tried to play through it or had their seasons end as a result. However, most of the names on this list continued to have incredibly productive careers, indicating that the injury alone isn’t a game-changer. 

To add insult to injury, the rehab for a torn rotator cuff isn’t fun either. It’s roughly a 4-6 month recovery & in some cases, take up to a year with severe tears. This is a tough surgery due to the variety of movements of the shoulder. In addition, the area where the rotator cuff attaches to the humerus contains a poor blood supply which means that it does not receive the needed nutrients to heal as quickly as other parts of the body. Reports indicate that Feliciano will take between 4-6 months which further supports the partial thickness tear that I had mentioned earlier.

The surgery is typically done arthroscopically unless there is a massive tear & they need to open up the shoulder to fully address the issue. Once inside, the tear can be further assessed, cleaned out & repaired. The repair is done by placing anchors that reconnect the tendon back to the bone to allow for proper healing of the area. Based on the severity of the tear will determine how many suture anchors are required.

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Credit: Physio-pedia.com

Rehab protocols dictating the specifics of the timeline for rehab can be accessed here & here, but to simplify it, it is tedious having worked on a number of these during my career. The first 4-6 weeks are spent in a sling with PROM initiated to work on the motion but avoiding any strengthening directly to the shoulder area. Motion is slowly progressed to stretch the tissue but not place stress on the healing area with range of motion limitations set by the doctor.

Once the patient has been cleared to begin strengthening, isometrics are initiated which is when the muscle tensed up but is not actively moving, like pushing with all your might against a wall. As strengthening progresses, higher-level activities are incorporated to increase stability in the joint. The rotator cuff has to improve with strength, but the surrounding muscles also have to strengthen in order to help move the scapula up and out of the way in order to allow the humerus to elevate. 

Eventually, the muscles are all moving properly with scapulohumeral rhythm, there is full ROM/strength and no pain, this allows the ability to return to sport-specific strengthening & activity. Rotator cuff repairs do have overall good outcomes, up to 95%, but they need a lot of patience to get there. Fortunately, delaying surgery does not appear to have negative outcomes, hence why Feliciano likely chose to play the season with the injury.

Risks for re-tear are as high as 26% in the literature, but is relatively lower in younger patients as the quality of the tissue is improved compared to older patients with more chronic tears. Furthermore, there is a correlation that for every 1 cm the initial tear increases in size, the risk to re-tear increases two-fold.

As a PT, these repairs are rewarding to observe the improvement, but there is a distinct process to them. There may be areas where a patient progresses faster & can shave some time off the overall recovery time, but you can’t speed up the biology & healing portion of the surgery. These can be successful surgeries, but they just require a lot of time & patience in order to maximize the results. 

Feliciano will be around during OTA’s but expected to be limited. He should be able to perform cardio activities & perform non-contact drills as long as he’s cleared by the MD, which is very possible. There is a chance he would be able to perform at mandatory minicamp in June during Phase 3 of the OTA’s but may be held out as a precaution as he is a veteran. Barring any setbacks, he should have no concerns going into training camp for 2020.

This sort of injury is just the reality of the game of football & is a look into how tough these guys really are when it comes to suiting up every week. The only benefit to having an early exit to the playoffs is that these injuries can get addressed sooner. However, I believe most, if not all of the players in that Bills locker room would go through hell if it meant hoisting that Lombardi trophy in February. With how this team is built, the chances for that increase daily. 

Top Photo Credit:

Kiss985.radio.com

Ed Oliver’s Core Muscle Surgery

Will Oliver be ready in time for OTA’s?

A surprise tweet from DT Ed Oliver hit Twitter Tuesday afternoon showing two pictures that he had successful surgery following his rookie year. This created several questions as Oliver did not appear on the injury report all season & only appeared to suffer one known injury following the Titans game in which he sustained a left foot/ankle injury when he tackled RB Derrick Henry. He was able to return following the bye & did not miss any games during this season.

However, Tuesday’s tweet changed things with Oliver in a hospital gown. The Bills had recently performed their end of season exit physicals & issues are found once a full assessment has been performed. We have already observed this with the tweets last week from DE Jerry Hughes & his torn wrist ligaments. Oliver likely had his exit physical & found this issue which required corrective surgery.

Originally, I had thought that he had a routine joint cleanout from general debris such as bone chips, articular cartilage, or frayed tissue due to not appearing on the injury report. But news came out later that he had successful core muscle surgery, commonly known as a sports hernia, announced by Buffalo News reporter Vic Carucci. 

Looking back at the Oliver tweet, there were two clues that indicated that he had core muscle surgery. First, the location was in Philadelphia, PA. Oliver could have had arthroscopic surgery in Buffalo or back in his hometown Houston, or wherever he wanted, indicating that Philadelphia was a specific location. Second, the 2nd picture shows the phrase “Vincera Institute” above his head. This was not readily observed unless you were able to zoom in on the picture but this was a dead giveaway in retrospect to what he had done. Frankly, I missed it the first time around.

The Vincera Institute in Philadelphia is run by Dr. William Meyers, a nationally renowned orthopedic doctor specializing in core muscle repair. From what I’ve read, he is THE guy when it comes to core muscle repair. Meyers is also big against identifying the injury as a sports hernia, hence my use of the term core muscle. We don’t know when Oliver suffered his injury, how long he was dealing with it, & how severe it was.

With regard to the injury itself, there is a multitude of variations according to the Vincera Institute website that frankly, even as a licensed Physical Therapist, were new to me. As there are no specifics to which injury he sustained, below is a general description of a core muscle injury.

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Credit: https://physioworks.com.au/Injuries-Conditions/Regions/groin_pain
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Credit: plankpose.com

The adductor muscles in the groin are most commonly injured pictured above, but can also affect the abdominal muscles in the 2nd picture. These injuries can occur with planting the feet & twisting maximally, causing the lower-body injury. They can also occur with violent twisting, kicking, and turning along with blows to the back, anything that overstretches or strains the muscle at its attachment.

These injuries can present as groin strains, oblique strains, or other general injuries around the hip or core region that don’t resolve with proper rest & rehab. A core muscle injury is when the tissue tears & does not heal like a normal strain, commonly with the muscle pulling away from the pubic bone attachment observed in the first picture.

This can present as sharp or stabbing pains with specific movements such as sprinting, kicking, cutting, etc. This can also be tender to touch, little to no pain during rest, and typically isolated to one side. These injuries aren’t always apparent at the time; often minor injuries are able to be played through. The severity of the injury is found later such as during a physical or if the pain becomes too intense to perform an activity.

Fortunately, surgical outcomes are great with at least 90% of repairs in the NFL have shown to resume their normal activities prior to the injury with the control group playing slightly more games and slightly longer careers than those having the surgery. However, the control group in that study were players who had similar careers in relation to experience, statistics, & position played, not indicating that the groin injury itself led to a shorter career. Another study showed 89% of repairs were able to return to the pre-injury level of play with minimal to no pain during a 4-year follow up study. 

Rehab for this surgery can be between 6-12 weeks based on the specific type of core muscle surgery & location. Rehab protocols can be found here & here with most protocols skewing towards a lengthened recovery timeline for a conservative approach.

If Oliver has any concerns regarding his recovery, he can ask fellow Bills players C Mitch Morse & WR Cole Beasley who both suffered similar injuries at the end of the 2018 season which required surgery, causing them to miss some of OTA’s last spring. As of writing, both have not had any known issues regarding re-injury to the area & should continue to stay productive. According to the 2020 NFL offseason schedule, the Bills will start OTA’s April 20th. By then, Oliver will be fully healthy without any limitations.

It’s unfortunate that Oliver suffered this injury, but injuries are a part of football. It is great that he got this addressed now so that he may be fully healthy to attack this first offseason as a professional in order to grow into the next great Bills defensive tackle. I have no concerns regarding this injury & his recovery as he was treated by one of the best in the United States & has an excellent facility to rehab at in Buffalo if he so chooses.

I expect there to be more surprise injuries & surgeries as the offseason progresses, but this is just another one that is being addressed properly & maximizing Oliver’s growth as a professional football player.

Top Photo Credit:

HoustonChronicle.com

Jerry Hughes’s Wrist Is A Big Problem

Did Hughes’s tweet write a check the Bills can’t cash?

The sting of the overtime playoff loss to the Texans was still very fresh in everyone’s mind when a seemingly innocuous tweet from DE Jerry Hughes was released. Below is the tweet which shows his passion & love for his team. All well and fine, we love you too Jerry! But 5 words within that statement got the Bills put on notice by the league & raised questions about the Bills injury reporting this season.

“Torn ligaments in my wrist”

Normally that statement wouldn’t be an issue because NFL players get injured. It’s a fact. But Hughes never appeared on the injury report this season with a wrist injury. This is where the league doesn’t like that news. Below is the first few paragraphs of the NFL injury report policy.

The Personnel (Injury) Report Policy has been a cornerstone of public confidence in the NFL for many decades. The credibility of the NFL, teams, owners and team personnel requires full compliance with and uniform enforcement of the policy.

The intent is to provide full and complete information on player availability. It is NFL policy that information for dissemination to the public on all injured players be reported in a satisfactory manner by clubs to the league office, the opposing team, local and national media, and broadcast partners each game week of the regular season and postseason (including for the two Super Bowl teams between the Championship Games and Super Bowl).

The information must be credible, accurate, timely, and specific within the guidelines of the policy, which is of paramount importance in maintaining the integrity of the game.

A violation of the policy may result in Commissioner discipline, which may include a fine on the involved club, fines or suspensions of involved individuals, as well as the possible forfeiture of draft choices by the involved club.

This weekly injury report is the cornerstone of what I do, commenting on Bills’ injuries. Fortunately, this injury was something I was aware of, but unaware of the severity of the injury as most teams won’t come out and give details.

I had first noted that Jerry injured his right wrist sometime in the preseason, likely occurring during the Bills vs Panthers preseason game. Hughes played 14 snaps in that game and was his usual self during the first few series he was in. Having reviewed that film several times, there didn’t appear to be any smoking gun with regards to injury either indicating that the injury was not realized until later or that it did not occur during the game.

Hughes was able to play in all 16 games & the postseason, only suffering an ankle injury at the beginning of camp & a groin injury during Week 12 which limited him that week in practice in addition to the wrist. He also had several veteran rest days, which isn’t uncommon for a player his age. Looking back at pictures from this season, it’s observed that he has a brace or tape for support every time he plays.

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Credit: Twitter.com/Iam_JerryHughes
Bills Football
Credit: billswire.usatoday.com
Buffalo Bills v Tennessee Titans
Credit: TheAthletic.com
NFL: Washington Redskins at Buffalo Bills
Credit: billswire.usatoday.com
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Credit: ESPN.com

As you can see in all those pictures throughout the 2019 season, he has a wrist brace on during each game, indicating that this was a lingering injury.

The next question is, what ligaments did he tear? Based on the lack of obvious injury & previously unknown severity, it’s hard to identify what he exactly did. We obviously know he didn’t suffer any fractures or dislocations as those would have either been season altering or season-ending.

I can also say confidently he did not injure any ligaments in his thumb as supported by the picture above, specifically the one with him during practice. You can see that he has tape supporting the area but the thumb moves freely, indicating that the interphalangeal joint, metacarpal joint, and carpometacarpal joint are intact. Otherwise, a thumb spica splint would have been noticeable & higher up the thumb.

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Credit: musculoskeletalkey.com/

Evaluating the anatomy of the wrist, the carpals and distal ends of the radius & ulna make up the wrist as you can see in the picture below. There are multiple ligaments in the wrist that you can view on your own if you wish. Clinically significant ones include the scapholunate ligament, the lunotriquetral ligament, & the triangular fibrocartilage complex (TFCC), among others.

Carpal-bones

The ligaments listed above are the most common wrist ligament tears from what I could find in literature, but there are certainly others. To generalize the mechanism of injury for these injuries, it typically happens when there is a fall or sudden force that places the wrist into extension and then into radial or ulnar deviation along with possible forearm pronation or supination. The presentation includes swelling, pain, weakness with range of motion, possible clicking/grinding, point tenderness, and difficulty with specific wrist movements. According to literature, if these injuries are suspected, the patient is to be placed in some type of bracing since there is instability noted.

As mentioned above, without a specific mechanism of injury or further details, hard to say what he did. Most of the time when these injuries occur, surgery is indicated to restore stability in the area. There are always reasons for non-operative treatment, but either outcomes are poor or ineffective. The only one that can be treated after the initial injury is the scapholunate injury in where surgery can be performed within 18 months of injury & splinting may be effective with incomplete tears.

It’s possible he injured the scapholunate ligament either falling on the hand or getting his hand caught up in a blocker, getting it twisted around to the ulnar side. But this is merely a guess.

After uncorking your mind from all that anatomy jargon, we go back to why Hughes & the Bills may be in trouble. The injury never appeared on the injury report during the season. Below are the indications of why an injury would automatically be reported.

Some injuries are automatically reportable because they result in the player’s unavailability or limited availability to the club. These include any injury that:
(a) causes the player to miss a game;
(b) prevents the player from finishing a game;
(c) causes the player to miss a practice (Did Not Participate);
(d) limits the player’s participation in practice (Limited Participation); or
(e) prevents the player from finishing a practice (Limited Participation).
Other injuries may be reportable because of their effect upon the player’s performance despite his continuing availability to the club.

The club must continue to list the player on its weekly Practice Reports
until the player’s injury no longer affects the player’s performance.

Below is what makes up the practice report & define full, limited, and DNP.

The Practice Report’s player participation categories are defined as follows:
Did Not Participate: means zero percent of a player’s normal repetitions.
Limited Participation: means less than 100 percent of a player’s normal repetitions.
Full Participation: means 100 percent of a player’s normal repetitions. In general,
this category should be used for players who missed or could not complete the prior
game due to injury, but have returned to participate fully in practice the following week.
It should also be used for a player who (i) sustained an injury in the prior game that
affects his performance, but was able to finish the game, and (ii) participates fully in
practice the following week, as in the example on page 2 (injured quarterback).

I think he suffered the injury in the preseason, had it addressed with the brace & likely rehab. He probably had it evaluated and determined that he could practice/play through it & get surgery later. He did not play in the Lions or Vikings preseason games but was able to play Week 1, giving him just over 3 weeks to give the wrist some time to recover.

Furthermore, this happened in the preseason where injury reporting is not as strict & by the time it got to the regular season, he was healthy enough to play. Did the injury impact his performance? Hard to say. His stats over the years show a bell curve, indicating that his best years are behind him & that he wasn’t far off from last season, though a slight drop was noted. Why were his stats down?

Possible reasons include: he may have been double-teamed more, Hughes is no longer as effective as a defensive end, scheme fit; overall, not my place to say.

Finally, what qualifies as a torn ligament? By definition, a sprain is a ligament tear with the grades varying in severity. Hughes may have suffered partially torn ligaments; never fully healing due to the rough nature of the NFL, & they require surgery. He may have fully torn some ligaments & there’s instability noted. Hughes may have also exaggerated or been misinformed about what he was saying in his post.

We always find out later that guys were playing with injuries the team did not divulge or have to publically report on. We also find out that what appeared to be a minor injury, turned out to be more significant. I think this is one of those cases. We knew that there was some type of injury, we didn’t know what exactly happened & the severity.

Do I think the Bills get fined? It’s possible, considering the Raiders had injury reporting violations last year & the Lions had issues this year with Matt Stafford resulting in a fine. The Steelers also got hit with a fine this year following Ben Roethlisberger & the management of his elbow injury. So this isn’t a rule that doesn’t get enforced.

I think the only difference from the above-mentioned fines & what the Bills did was how far removed from the injury the players were. All the other fines were responses to acute injuries. Hughes didn’t appear on the injury report for a rest day until late September.

The only way the Bills are in violation of this rule is due to the statements below.

The supplemental entry “Not Injury Related” applies to situations in which a player is withheld from his normal repetitions for reasons other than injury. Examples include: resting veteran players, team discipline, jury duty, illness in family, personal matter, etc. In these cases, the club must explain specifically – on its own participation release issued to the media – why the player missed or was limited in practice. Use of this category is prohibited if the player in question has an injury that is otherwise reportable under the policy. An injured player cannot be listed as a “resting veteran.”

The Practice Report is expected to provide clubs and the public an accurate description of a player’s injury status and his level of participation during the practice week. All players who have reportable injuries must be listed on the Practice Report, even if the player takes all the reps in practice, and even if the team is certain that he will play in the upcoming game. This is especially true of key players and those players whose injuries have been the subject of local or national media coverage.

Looking at this as a whole & how I interpret the rules, I don’t think the Bills were in violation. Hughes is a key player, but when the injury was & how it was managed I believe make this different. Full disclosure, I am a Bills fan, but looking at it from when I put my medical hat on confirms my thought process. The Bills & the NFL know far more than I will & ever should know and the decision will be handed down. I hope I am right, but we shall wait & see.

Top Photo Credit:

Twitter.com/Iam_JerryHughes

Wild Card Bills Injury Review- Texans

It was still a fun season despite the loss.

This wasn’t an article I wanted to write. I wasn’t in a rush to write this either. It’s not that I didn’t want to write about the injuries, but I didn’t want to write about the end of the season, at least not with that ending. That game was full of emotions, the excitement of that first drive ending in a touchdown, the Houston comeback, the game-tying field goal & inevitable loss. It just sucked to see such a great season the Bills have an end like this. But it ended and that’s the reality of the situation. 

However, there were still injuries that occurred & I have a duty to explain what exactly happened. 

CB Taron Johnson (lower-body injury) 

Johnson exited the game midway through the 2nd quarter with 7:30 left with what appeared at the time no apparent reason. He was observed down on his right knee after the play with trainers assessing him before walking off under his own power. 

Reviewing the game film, it was not apparent that he suffered an injury until the All-22 film came out. Upon reviewing the film, Johnson stuck with his man, TE Darren Fells until he got to the sideline. Fells cut back, as did Johnson rather vigorously and he appeared to take an awkward step on his right, which forced him to slow up as the play ended. Nothing appeared wrong until Johnson was down in the middle of the field before he went off.

My best guess due to having only one camera angle and a birds-eye view is that he suffered some type of strain. Possibly a groin, hamstring, or calf. To note, he wasn’t limping off at all from what I could tell, but something wasn’t right. If you recall, Johnson did suffer a hamstring strain back in the 1st game which ultimately cost him 4 games. Temperatures were in the 70’s at kickoff & the dome was closed, leading to a warm environment, raising the possibility for a strain due to dehydration. I do not believe the hamstring he suffered back in September caused the issues on Saturday.

Regardless of what it was, we probably won’t know until OTA’s start or if an article comes out later detailing the specifics. This isn’t anything that should be a problem heading into next year either.

WR Duke Williams (left low ankle sprain)

Shortly after Johnson suffered his injury, Williams had one of his own catching a diving pass from QB Josh Allen before going out of bounds with about 2:30 left in the 2nd quarter. It was a bang-bang play & required several replays to determine the injury. At first, it appeared that Williams hyperextended his left knee as his foot got caught in the turf, diving out. 

However, on further review, it clearly shows that his left ankle twists in quickly, causing the all too common inversion low ankle sprain. Williams took several plays off to get his ankle evaluated and taped before returning, at times favoring the ankle with a decreased ability to push off. 

Williams avoided a worse knee injury due to the ankle taking the brunt of the forces going out, snapping underneath instead of applying further pressure on the knee into extension. He will likely be feeling this ankle for a few weeks & possibly the knee but like most sprains, this won’t be an issue moving forward & had the Bills won, probably wouldn’t have kept him out next week.

Other Observations 

CB Levi Wallace & WR Robert Foster

There were several surprise inactives prior to the game, namely CB Levi Wallace & WR Robert Foster. Wallace was a surprise to me only because he was practicing, although on a limited basis with a heavily taped ankle, during the week. I had thought that even an injured Wallace would be able to play in some packages, but my guess is that the team felt he would be better suited to play next week had they made it. 

Foster was a surprise only because of how valuable he has become as a gunner on special teams & was continually a deep threat, despite not connecting on anything all season. Considering the lack of production from Foster, it made sense to make Williams active, but thankfully the special team’s play wasn’t harmed by the loss of Foster. 

DE JJ Watt

Houston’s DE JJ Watt made some noise as I had expected him too, appearing in 61% of the defensive plays along with 2 tackles, 1 sack, 1 tackle for loss, & 2 QB hits. I believe he played far more than the original plan dictated, but this is why he suited up, to make a difference & he did. Far from his best performance, but those skills he has, even with one arm, still made him incredibly dangerous on Saturday & the Bills paid for it. 

QB Josh Allen

During the Bills locker cleaning out Sunday, there was a video that came out of Allen walking across the fieldhouse in flip flops & an ankle brace on his right ankle. It was not known when he injured his ankle during the game as he appeared in every offensive play Saturday. This likely was one of those small injuries that would be impossible to find on film & won’t be anything that should linger.

I had briefly thought that this was the result of the injury he suffered in the loss to the Ravens last month. However, this occurred to the left ankle in that game & he was able to play through it. Merely an observation & just another one of the battle scars that Allen accumulated throughout the season in the march towards the playoffs.

Final Thoughts

Like I said above, this wasn’t an article that I wanted to write. But it had to be done. This ends the 2019 Buffalo Bills season & I’m pretty happy with the overall results. 10 wins, a playoff berth not given by sheer luck, tons of growth by the entire team & a bright future. I’m looking forward to 2020 with the idea that this Bills team can make a run. I’m a Bills fan, an eternal optimist, is there any other way to be?

Looking at the offseason, there will be some changes. I plan on taking some time off from weekly Banged Up Bills articles, only focusing on updates such as the inevitable surgeries, free agent signings, & any other news I deem worthy to report. Things will gear up again once the draft hits & the 90 man roster begins to take shape prior to training camp. I’m going to continue to work hard to update the appearance of the site, video reviews, injury breakdowns, & find new ways to deliver the content that is clearly wanted. 

However, you can still follow on Twitter for the latest news, podcasts & work I will be doing with the draft. Find my work over at Cover 1 detailing injuries regarding the 2020 draft prospects. Make sure to go check that out & all the other amazing content that’s available. Thanks, Bills Mafia, it was a fun season!

Top Photo Credit:

RochesterFirst.com

Wild Card Weekend Bills Injury Preview- Texans

What is the status of Nsekhe, Roberts, Lawson, & Wallace?

Well, we’re finally here, the playoffs are upon us! We are moments away from the Bills playing in Houston on Wild Card Weekend for the first NFL game of 2020! The Bills are beat up but still in a better spot than the Texans. While I could detail out every injury for Houston & compare it to how the Bills could take advantage, I may be better off writing the sequel to War & Peace. But if you want to get some detailed analysis of the Texans injuries, check out my latest appearance on Locked On Bills with Joe Marino. I have nuggets on JJ Watt, Johnathan Joseph, Bradley Roby, & Will Fuller V. Make sure to check out the pod below!

Locked On Bills 

If you want to know why Houston DE JJ Watt is able to come back so quickly from his pectoral tendon tear, check out my latest article at Buffalo Rumblings!

JJ Watt’s Unexpected Return

As this blog is a Bills based site, the Bills injuries are below & my impressions of them.

QUESTIONABLE

DE Shaq Lawson (left hamstring strain)

Lawson continues to recover from his hamstring strain suffered late in the Patriots loss but appears on the right track. He has been limited the past week, but with controlled activities, he has looked great on film.

I’ve stated all season that the hamstrings are vital for running & blocking, important responsibilities for a defensive end. It’s not a muscle group that can be babied or managed with certain bracing or necessarily protected. Even with the best rehab & rest, injuries can still occur and Lawson may be a casualty of that. 

He missed the Jets game & would probably benefit from another week off, but considering each game now is single elimination, Lawson should not miss. I have a strong suspicion that he plays.

WR Andre Roberts (foot)

Little is still known about Roberts’s foot other than it cost him another game against the Jets. Matt Parrino of NYUp.com noted that he was taking punt & kick returns in practice, accelerating up the field without issue. Any foot injury would limit sudden acceleration as the toes & foot act as a lever to push off the ground to move forward. 

If he had something such as turf toe, a foot sprain, fracture; there would be difficulty getting up to speed & slowing down. As long as Roberts is able to play Saturday, then it won’t really matter what’s wrong as long as he can add another dimension to the team.

OT Ty Nsekhe (right ankle contusion)

Nsekhe continues to work back from his right ankle that cost him 5 games this season. He was rolled up on again Sunday & but appears to be working through the injury just fine. This appears to be more of a contusion which was supported by the fact that he’s practicing all week & only has a brace on, the same one that he appeared to be wearing on Sunday.

I feel strongly that Nsekhe will suit up Sunday & will be in a rotation with OT Cody Ford with Ford taking a bulk of the snaps. 

CB Levi Wallace (right medial ankle sprain)

Wallace is the big iffy for Saturday. At the end of the day, he is still dealing with an ankle sprain that requires rest. The part of the ankle he injured was the medial side which is the inside portion of the ankle. The deltoid ligament is the strong inside portion of the ankle that provides stability between the tibia, talus, calcaneus, & navicular. This is the reason why it is so difficult for the inside portion of the ankle to suffer a sprain. If the outside portion of the ankle had the same type of structure, I would imagine we would all run very differently. You can see the makeup of the deltoid ligament below.

Deltoid-Ligament-Structure-location
Credit: medicpassion.com

The next picture below is a great example of how the injury occurred with Wallace with regards to the motion & the area injured. To note, the ligament does not likely tear that severely for Wallace or a fracture sustained as dictated in the picture.

medial-ankle-sprain419
Credit: http://www.sportsinjuryclinic.net/

If this was a regular-season game, Wallace would surely miss Saturday. Considering it’s the playoffs, I imagine that he will try to suit up with a heavy tape job similar to the one seen below. His major limitations will be pivoting, attempting to stay with his assignments. He will be able to run straight & cut off the left ankle, but forcing Wallace to jump, cut to the right, and backpedal will limit his effectiveness. I expect that CB Kevin Johnson gets the start & majority of snaps with Wallace as a backup or used in certain packages. 

Probable Inactives:

TE Tommy Sweeney

DT Vincent Taylor

S Kurt Coleman

S Dean Marlowe

OG Ike Boettger

RB TJ Yeldon

OG Ryan Bates

The Bills are in a great position to win their first playoff game since 1995 & move to the divisional round against a likely rematch with the Ravens. I could see this Bills team make a run like the Jaguars did a few years ago; anything can happen in the playoffs. 

On top of that, the injuries listed today won’t be real factors outside of Wallace heading into next week. There is always the possibility of new injuries, but thankfully the injuries we do have are at positions of depth at OT & CB. 

Regardless of the outcome, you will be hearing from me next week. However, I highly anticipate that I will be coming to you with an injury review & preview heading into the divisional round. GO BILLS!

Top Photo Credit:

USAToday.com

Week 17 Bills Injury Review- Jets

How bad are Wallace & Nsekhe’s ankle injuries?

Good thing that the game didn’t count for anything as the Bills finished 10-6. That 13-6 loss to the Jets was a rough one to watch, bringing shades of the past decade back with backups & fresh players off the street merely competing because there was no one else healthy. On Sunday, that wasn’t the case as Sean McDermott did his best to rest as many starters as he could in order to prepare for the playoffs. Unfortunately, there were a number of injuries varying in severity that will put some player’s availability in question for Saturday. 

CB Levi Wallace (right ankle)

Wallace scared a lot of people when he went down while catching an interception early in the 1st quarter without being touched. He was able to secure the ball before requiring assistance from training staff to get off the field. As with any non-contact injury, the knee is quickly assessed for any ligamentous instability before further evaluation is necessary in other areas. 

It was determined that Wallace suffered an ankle sprain, specifically a medial eversion ankle sprain. I had originally thought that he suffered a mild high ankle sprain as the mechanisms are similar, but he suffered the medial ankle sprain due to the foot being more in a neutral to plantarflexed position pushing off on the toe rather than the dorsiflexed, everted position seen with a high ankle. It is hard to decipher on film & I’m only confident in the medial ankle due to the recent reports. 

Wallace was observed leaving the locker room in a walking boot which is pretty standard following injuries such as this. He is considered day-to-day which usually translates out to missing a week or two. Medial ankle sprains have an incredibly strong ligament known as the deltoid ligament that prevents movement inward which helped reduce the severity of the injury.

We will have to see how he performs in practice this week. If he can’t go, capable CB Kevin Johnson gets the start against his former team. 

S Siran Neal (right side stinger)

Neal suffered a stinger during a tackle during the 2nd quarter where he hit directly over the top of his shoulder on a routine tackle. He was visibly uncomfortable, shaking his right arm out & moving around, trying to shake things out. 

That direct hit caused the stinger due to the sudden shoulder depression pulling on the cervical nerves just enough that he felt it down the arm to need a few plays off. Like Tre’Davious White against them Steelers game, the actual hit wore off & he was able to return. As long as Neal doesn’t continue to suffer these, then this shouldn’t be an issue moving forward. 

OT Ty Nsekhe (right ankle)

Nsekhe made his triumphant return after missing 5 weeks with a severe ankle injury in the win over Miami. Nsekhe was slowly reintroduced into the game plan & was rather unremarkable during his play. 

In a stroke of bad luck, Nsekhe went down again in the 3rd quarter with a Jets defender falling on the back of his foot as he went down. Nsekhe was immediately down on the ground rolling around in obvious pain. Trainers quickly came out to assess the ankle & got him off the field for further assessment. 

It was difficult to see what Nsekhe exactly injures as the bodies were in the way, but it’s clear that his ankle was rolled upon. He may have avoided serious injury due to his shoe getting knocked off during the play, preventing his foot from being planted. Nsekhe was also observed wearing an ankle support to limit medial/lateral movement which redistributes the forces away from the ankle. 

The hope that is he suffered a contusion to the area & can work through this injury to be available for Saturday. Some detractors may be out there saying he should have not been playing after coming off an ankle injury. I fully support the coaching & medical staff to allow him to get out there in order to get live reps and allow him to play if he’s healthy. Nsekhe is a veteran, he knows his body & the risks he would take in return to play. It comes down to simply horrible luck & there isn’t much else to be said.

OT Cody Ford (right trapezius/neck)

Ford suffered his own injury later in the 3rd quarter where he appeared to injure his right trapezius or neck. There wasn’t much of a mechanism of injury but Ford came off grabbing at his right trapezius muscle. This muscle connects up to the back of the head, out to the shoulder, and down to the middle of the back. This assists with head extension & shrugging the shoulders.

Trapezius
Credit: Youtube.com

The only possible place that I see where he could have injured this area would be when he took on the Jets defender, lost his block and had his head turned inward to the left & hit the back of G Spencer Long

Ford kept motioning to the area & even pointed to the training staff where his pain was at. He may have overstretched the muscle getting his head forced to the left & hitting Long. He may have also suffered a minor stinger due to the head stopping suddenly. 

Either way, he was able to return and outside of some stiffness & soreness, this shouldn’t limit him for Saturday.

CB Taron Johnson (right ankle)

Johnson was the last injury of the day when he got bowled over by Jets running back Le’Veon Bell. Johnson attempted to square up with Bell & plant his feet, getting knocked backward & injuring the right ankle. The injury occurred when Johnson was trying to keep his foot planted & got pushed, over pronating his foot & placing stress through the medial ankle. 

Johnson was able to walk off with a noticeable limp but was quickly able to begin running on it, even able to return at the very end to ensure that WR Isaiah McKenzie did not have to fill in at cornerback. This is similar to what Wallace dealt with earlier in the game but obviously less severe & less eversion noted at the ankle. This isn’t something that I expect will keep him out for the playoffs. 

Other observations 

Out of the inactives, the only known ones prior to the game were WR Andre Roberts & DE Shaq Lawson with their respective injuries. Having RB Devin Singletary, TE Dawson Knox, WR John Brown, WR Cole Beasley, & CB Tre’Davious White made the most sense being inactive due to how vital they are at their respective positions. 

McDermott & the medical staff did the best with what they could. There are injuries the public isn’t aware of despite my best efforts. There are also strategies in getting other players snaps in case the top players do go down. 

It wasn’t an ideal situation, but the other option was to play the starters & suffer injuries prior to the playoffs. The injuries suffered Sunday are absorbable especially at CB & OT as the team has managed without so far. 

There’s a lot going on this week prior to the game Saturday & it’ll be exciting to see how the Bills stack up against the Texans. This is a winnable game, especially with the defense that has performed all season when asked. If the Bills get beat, it will be because of talent & not because the Bills beat themselves or were too injured.

Top Photo Credit:

DemocratandChronicle.com

Week 17 Bills Injury Preview- Jets

Will this finally be the week that Nsekhe returns?

The big concern going into this game against the Jets is how long starters will play & what players will be inactive. This is especially worrisome due to the recent comments by Jets S Jamal Adams in which he stated they would be hunting along with Jets DC Gregg Williams. Along with that comment, Bills fans have to worry about cheap shots from DE Henry Anderson. If you recall, he blindsided K Stephen Hauschka last season which threw his game off for the rest of the season seen below. 

Thankfully, the Bills continue to manage their injuries well & are not forced to play players who are injured. Below are the injuries prior to the game & inactives.

OUT

WR Andre Roberts (foot)

Roberts was a surprise addition to the injury report following Saturday’s game. Reviewing the film, it’s not clear when he suffered his foot injury. There aren’t many plays that show when he could have possibly injured his foot, but a possible culprit is when he was blocking for QB Josh Allen on a designed run play early in the 3rd quarter, it appears he got kicked on the right ankle.

There was also another point in the 3rd quarter with 3:35 left in where he appeared to be limping slightly after the play. There didn’t appear to be a mechanism of injury prior to this play either which makes this difficult to identify the exact problem. Considering he hasn’t practiced this week & has already been ruled out, we can only hope that he will be ready for the playoffs. 

DE Shaq Lawson (left hamstring)

Lawson has not been able to practice this week due to a hamstring strain suffered in Saturday’s loss to the Patriots. This occurred after a tackle for loss in the backfield during the 2nd half of the game. The actual tackle itself did not appear to be an issue, but rather the celebration afterward. He began to get up & celebrate, grabbing the hamstring in the process.

He was able to continue playing for the rest of the game but the injury appeared to catch up with him later. Even after a slight strain, the muscle is still painful & sore, requiring frequent stretching & controlled movement to allow healing but not overwork the area in order to prevent further injury. As he has already been ruled out, this is the smart move to do considering how valuable he will be in the playoffs. It will be interesting to note how the coaching staff rotates the defensive ends as there are only 4 on the roster.

QUESTIONABLE

OT Ty Nsekhe (right ankle)

I feel like we have been having the same conversation for the past 6 weeks regarding his injury. But new information is available! He finally appears to have made the expected progress, participating in practice on Thursday & looking quite well on film. He is moving with the fluidity of someone who is close to returning & appears to be close to 100%. 

Considering how he is moving, I’m making the assumption that he could have returned sooner, but how OT Cody Ford was playing, he wasn’t needed immediately. At this point, it is unnecessary for Nsekhe to play in Week 17, but he has missed the last 5 games which means he would benefit from some live reps in order to prepare for the playoffs. 

CLEARED TO PLAY

C Mitch Morse (right low ankle sprain)

Morse scared many Bills fans late in the 4th quarter in which he had his ankle rolled up on, reportedly feeling several pops & having difficulty walking on it initially. Fortunately, he was able to practice in full this week & not appear to have any limitations despite what appears to be a low ankle sprain. 

Morse is yet another starter that may play several series but overall benefit from a well-deserved rest day or even being declared inactive in order to ensure his health.

OTHER INJURIES

DT Harrison Phillips (left ACL)

Phillips has been out since September, diligently working back from a torn ACL that ended his season prematurely in the win over Cincinnati. Occasionally, news is released of Phillps attending practice, performing his rehab, & still participating in team activities. While it wasn’t expected that Phillips would return until next season, it’s great to see the progress being done in rehab. In the first tweet, below is Phillips running on an underwater treadmill to reduce the stress that land-based running would cause. In the other tweet, you can see the progress that Phillips has made & is demonstrating the proper muscle control during his step-up routine with a weighted vest. 

Even though he is unable to play this year, Phillips still understands his job & purpose on the team which further validates the culture that has been instilled at One Bills Drive. I expect to see more clips in the near future & see him inch closer & closer towards returning to football activities.

Probable Inactives:

TE Lee Smith

RB Frank Gore

S Micah Hyde

S Jordan Poyer

DE Shaq Lawson

WR Andre Roberts

G Quinton Spain

This would be a game that the Bills would be foolish to not play all their reserve players for much needed live snaps. It is probably the best bet to allow some of the veteran players a true rest day, have all the starters play several series & then act as backups in order to get through the game. It would be great to get to 11 wins, but not at the cost of a key contributor going down. 

The Jets are still a talented team, this is the NFL after all. But this is the best-case scenario in where the backups can get extensive playing time & get some film for next season when the roster churns over. Plus, I don’t think in any circumstance that Terry or Kim Pegula are forcing the coach to play certain players as in the still hotly debated topic of QB Doug Flutie or Rob Johnson. This will be a good game to allow the Bills to play & not worry about the outcome. There are bigger fish to fry next week with either traveling to Kansas City or Houston, both being true tests.

Top Photo Credit:

SBNation.com