A Winning Record & Healthy Bills, But Why?

How are the Bills so healthy?

On my latest appearance with Joe Marino on the Locked On Bills podcast, we discussed why the Bills are so healthy this late into the season, how rare this is, & why the team’s facilities are such a vital addition. There was so much information, this required its own article & it was promised to you on the pod, I better deliver!

This article will look at several different areas of how injury management has changed since 2017 & why the Bills are so healthy this late into the season. 

First off, let’s look at how rare this instance of no injuries or no one missing a game. Looking at pro-football-reference.com takes us back to 2009, the earliest recording of injuries by the site. There may be other instances of weeks where there were no injuries before then, but they may be lost to time. 

To note, the designation probable was discontinued following the 2015 season. This designation meant that there was a 75% chance the player would play. 94% of the players declared probable during 2009-2015 played. Also noted is that IR designation does not count into this assessment, only active players on the roster at that time. 

Times no player was ruled out since 2009


Week 6 Arizona

5 players ruled questionable: Jarius Byrd, Chad Rinehart, Da’Norris Searcy, Kyle Williams, Eric Wood



Week 13 Atlanta

1 player ruled questionable: Kyle Williams 



Week 14 Tampa Bay

2 players ruled probable: Marquis Goodwin, Kyle Williams 



Week 9 Miami

1 player ruled questionable: Sammy Watkins 



Week 6 Houston 

No injury designations



Week 10 Cleveland 

No injury designations



Week 11 Miami

1 player ruled questionable: Jerry Hughes

Prior to this season, there were only 5 instances where there wasn’t anyone that was ruled out. The closest instance to last week’s injury report was 2018 before the Houston game & before that, 2013 Tampa Bay game. To have games back to back where no one was ruled out, you have to look back at Weeks 13 & 14 in the 2013 season seen above. 

To not have anyone listed at all last week is even more incredible. There are still injuries that players are dealing wit as noted in my article from Monday. But to have a “healthy” roster this late into the season may be truly the difference between making the playoffs or sitting on the couch in January. 

Why is the team getting healthier? I believe a part is due to luck, a part is due to better medical staff & resources. This isn’t to say that the medical staff before was poor by any means, but to have a great training staff plus the resources available at the AdPro Sports Training Center that opened earlier this year.

Following McDermott’s first year, the training staff changed dramatically with the retirement of Bud Carpenter & the dismissal of Shone Gipson. This allowed the team to bring in Nate Breske from Chicago who brought on his own staff which clearly made a huge difference over the past 2 seasons. 

Adding the AdPro Sports Training Center helped to individualize care to focus on the specific needs of each player rather than a one size fits all approach sometimes seen in rehab & medicine. Some of the features that the facility has included: 

Sleep pods, float tanks, yoga, massage rooms, active release technology. These all assist in getting proper rest & relaxation to allow the body to heal more completely to maximize the recovery process by reducing stress.

Sleep pods allow the players to get a power nap in when they begin to feel groggy, for example after lunch. They can go into a sleep pod for 20 minutes or however long they choose & recharge to get through the afternoon unlike the rest of us get by with coffee & clock watching. 

Credit: https://saltfloatstudio.com.au/

Float tanks & yoga allow the body to go into deep relaxation & allow the body to rest in a variety of ways, rather than sitting in front of a TV, zoning out. The float tanks assist with sensory deprivation, blocking out all the stressors from day to day activities & yoga allows for mindful meditation along with the flexibility to reduce injury. Finally, massage rooms allow for the knots, lactic acid, and overall soreness to be worked out of the body. Training staff can also work in active release techniques to work the muscle through its specific actions to promote blood flow & break up scar tissue to maximize healing.

Credit: https://garagegymlab.com/

Cardio room, nutrition bar, cryotherapy tanks, NormaTec boots, activity trackers. These all allow the body to recover during the healing process, think of active recovery. NormaTec boots act as a large air-filled compression stocking to assist the body in flushing out lactic acid & inflammation following games & practices.  The nutrition bar introduced proper foods for maximizing performance & recovery, taking the thinking out of the player’s hands so they can maximally fuel their bodies with the proper building blocks.

Credit: Forbes.com

Cryotherapy tanks allow the players to be exposed to cold temperatures for brief amounts of time up to 3 minutes to assist with controlling inflammation through blood vessel restriction. This is performed by dropping the air temperature around the body for a systemic response in order to cut down on time spent recovering.  Finally, the activity trackers assist with proper load management to avoid overworking players & ensuring they are achieving their maximum functional abilities during each game & avoiding injury. 

While these are not found at all NFL facilities, this collection of resources has allowed the players to maximize their healing process & take away any excuse they may have in getting better. These resources individually in itself aren’t superior to other therapies, but having a variety of options available to find the right sequence could allow the training staff & players to maximize recovery. The players still have to perform the work, the training staff has to instruct in what’s best to get the players healthy, but the Bills are at least finding ways to get a leg up on their competition in order to stay healthy throughout the season in their push towards the playoffs.

Top Photo Credit


NFL Injury Series- High Ankle Sprain

Read the latest article in the NFL Injury Series on High Ankle Sprains.

Thankfully, we are in the midst of a bye week. This is a long deserved break from the rigors of the NFL season. While the players physically rest, as fans, we can mentally rest. This is a trying season and while there are some positives to take away from this season, we all still need a repose. We have seen flashes of potential from QB Josh Allen, the stellar play of a top 10 ranked Bills defense built for long term production, and the emergence of top draft picks growing into their positions. Along with growth, we have seen several moves made to improve and reshape the roster including the cuts of QB Nathan Peterman, WR Terrell Pryor, and LB Ramon Humber. The Bills have also brought back a familiar face in WR Deonte Thompson to give Allen another veteran weapon to stretch the field. As there is no game this week, today’s article will add to the NFL Injury Series with a review of the dreaded high ankle sprain.

The ankle is comprised of the distal end of the tibia which is the medial malleolus and the distal fibula which is the lateral malleolus. These structures articulate with the talus bone which connect the lower leg to the foot. Ligaments connect these bones together to create the ankle as seen below which allow the joint to move in a multitude of directions required for running, jumping, and cutting.

Credit: loptonline.com

Additional tissues connecting the fibula to the tibia include but not limited to are the syndesmotic ligaments and interosseous membrane. The syndesmotic ligaments comprise of the anterior inferior tibiofibular ligament (ATFL), posterior inferior tibial ligament (PTL), anterior talofibular ligaments, (ATL), posterior talofibular ligament (PTL), and calcaneofibular ligament (CFL) as seen below. These structures connect the tibia and fibula to provide near immovable stability between the two bones so that the muscles that attach to the respective bones can allow the ankle joint to function as intended, prevent excessive movement, and tolerate weight bearing.

Credit: http://www.premierortho.com

In the event of a high ankle sprain, the ligaments that attach the tibia and fibula above the talus become injured as the result of a fixed foot with sudden and forceful rotation to the leg inward, forcing the foot outward. Excessive dorsiflexion or pointing up of the foot can also injure the ankle significantly. These injurious motions do not have to be high speed but strong enough to cause damage. These are both commonly seen in football when bodies are falling on each other and feet are getting caught in the turf or getting hit falling forward, though not limited to those specific activities. To note, this motion does mimic the mechanism for an MCL/ACL injury though positioning of the knee/ankle during the activity affects which structure is injured. 

Credit: physioworks.au

The reason these injuries are much more severe is due to the demands of the joint. In a low ankle sprain, the outside ligaments are typically injured below the lateral malleolus and make cutting difficult but preserve the plantarflexion/dorsiflexion required for running. Taping/bracing can usually provide the necessary support to complete the activity. In the event of the high ankle sprain to the syndesmotic ligaments, immense demand with the plantarflexion/dorsiflexion motion along with compression during weight bearing is put through the tibia/fibula and talus complex. This creates an instability when attempting to perform walking/running after initial injury. To give a real world example, imagine a wedge being placed into wood to split it, once external pressure is placed on that wedge, the log eventually splits. Turn that upside down in the ankle complex, but that is how motion and compression would affect the connection between the tibia/fibula connection, separating the two bones, leading to greater instability and loss of function in the ankle than a lateral ankle sprain. 

Once this injury occurs, there are a variety of special tests that can help determine the severity of the sprain. These include but are not limited to: anterior drawer test, external rotation test, and squeeze test. These all mimic the mechanism of injury and place stress through the suspected area injured with reproduction of pain noted. Also used is the Ottawa ankle rules in determining injury. The Ottawa ankle rules are a series of tests that involve assessing tenderness in specific parts of the ankle along with the ability to weight bear initially after the injury. This would assist with determining whether there was a suspected fracture or whether further imaging is warranted. As with any other strain or sprain, there are various grades of injury. Grade 1-2 are common and can be treated non-operatively, Grade 3-4 are more severe and surgery is considered in Grade 3 if conservative management fails or surgery is performed with significant damage to the surrounding ligaments along with a fracture in Grade 4. Imaging such as X-Ray and MRI are commonly used to assess the damage of the surrounding ligaments in addition to a physical exam.

Once the extent of the damage has been known, the athlete is typically put in a walking boot with non-weightbearing restrictions put in place to reduce stress on the injured structures and prevent further separation between the tibia and fibula region. With nonoperative conservative management, most recoveries are between 4-8 weeks based on severity of the injury according to research here and here.  Recovery consists of eventual weight bearing progression along with rehab focused on strength, range of motion, proprioception, and pain reduction. Once the athlete can perform activities such as walking/running without pain/limp, single leg hop/calf raise, and all position specific related activities, then the athlete can be cleared to return to sport. As with other sprains, there is always a higher chance to re-injure the ankle, but with proper rehab the first time, this can reduce the likelihood.

The most recent Bills player to suffer a high ankle sprain is DE Shaq Lawson in Week 13 of the 2017 season against the New England Patriots, placing him on IR for the remainder of the season. The Bills have been lucky to avoid these injuries more frequently as a player missing 4-8 weeks could be a huge blow to any team. To note, Buffalo Sabres C Jack Eichel also suffered the same injury back in February of 2018, missing 15 games. Overall, this is also an injury that cannot be truly prevented, but having good situational awareness during play may help a player avoid an unintended collision, leading to this result.

This wraps up another injury seen in the NFL and its implications on a player’s availability. Continue to follow for the latest updates and news coming out of One Bills Drive. Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit u/BangedUpBills, and online at http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!

NFL Injury Series- Meniscus Tear

Read up on what the meniscus is, how it is injured, indications for surgery, and recovery times.

Today on Banged Up Bills, we will detail the ever common meniscus tear. This post will identify what the meniscus is, it’s function, and the severity of a tear which could affect whether a player misses weeks or the season. This is an injury that we have seen in past seasons and will continue to see.

Last season, we saw TE Charles Clay and WR Kelvin Benjamin both tear their meniscus during different points of the season with varying availability following the injury. Clay missed 3 games while Benjamin missed 2. Clay required surgery to fix his issue immediately while Benjamin was able to tough it out the rest of the season with eventual surgery. There are many reasons why there are differences in meniscus tear management despite the same outcomes.

To understand proper management of the meniscus after injury, the structure must be understood. The meniscus is two concave structures that are c-shaped and lie over the tibia in each knee. The meniscus is comprised of a medial and lateral meniscus and act as shock absorbers during activity. These meniscus also help deepen the joint so that the femur can articulate with the tibia, providing stability. During meniscus tears, a rotational force is applied to the area while the knee is bent and causes a shearing motion, causing a portion of the meniscus to tear.

Credit: physio-pedia.com

There are various types of tears which include but are not limited to: complete or partial, horizontal or vertical, longitudinal or transverse. Acute tears are more likely to present as longitudinal/bucket handle and radial tears most likely seen in football players. Symptoms of a meniscal tear typically consist of pain, tenderness, and swelling, locking or clicking during knee movement, and initially difficulty in placing weight through the knee. Meniscal tears are typically seen in conjunction with MCL sprains/tears and ACL tears due to the rotational forces through the knee during impact.

Overall, these types of injuries can slow up a player but not entirely derail their season. Several tests to identify meniscal tears include Apley’s, McMurray’s, joint line tenderness, and Thessaly’s test all assist in identifying whether a meniscal tear is present. However, these tests are not always reliable or specific which means they may identify pain and restrictions but will not be able to identify type or severity of tear. These tests replicate the mechanism that would cause the meniscal tear. This typically warrants further imaging such as MRI to identify specific lesions which will determine the appropriate interventions.

Once a tear has been identified, the type of tear can affect healing rates: longitudinal tears heal better than radial; simple tears heal better than complex; traumatic and acute tears heal better than degenerative. Based on location and length of tear will determine proper management. The meniscus has several “zones of vascularity” which include: red-red zone, red-white zone, and white-white zone. The red-red zone has the highest blood supply and lie on the outermost portion of the meniscus. The red-white zone is the area that connects the red-red and white-white zone and contains some blood supply. The white-white zone has a poor blood supply and demonstrate the poorest area for healing. If the tear is small, conservative management or a meniscectomy may be performed to remove to remove the offending piece. If the tear is larger, then a suture repair of the meniscus is warranted and an extended rehab is required.

Credit: physio-pedia.com

Regardless of whether surgery is required, rehab typically consists of restoring range of motion, controlling swelling/pain, and restoring strength to the knee. Once the immediate objectives are met, then further increasing strength and return to play activities are initiated to ensure that the athlete can play at their full abilities. In the event of WR Kelvin Benjamin, he was able to play through his minor tear due to effective rehab and an understanding of the type of tear which most likely allowed him to rest, recover, and eventually return to full participation knowing the tear was stable enough to play through. In the event of TE Charles Clay, his tear may have been blocking motion and been more severe, warranting surgery to remove the offending piece before rehab could begin.

In the option that surgery is performed during the season, recovery times for a meniscectomy can last anywhere from 2-6 weeks or even longer based on the severity of the tear and corresponding damage. In the event of a major tear, surgery is indicated and recovery time can last for up to 3 months which could end a season for most players depending on the time in the season it was torn. The preferred method years ago used to be cut out the offending piece. However, surgeons later found out that each time they cut a piece out, it accelerated arthritic changes in the knee which reduced healing and the ability for players to return to full health for a prolonged career. They have also found recently that surgeries do no better than rehab alone when compared to long term results in the normal population. However, surgery is still recommended when a return to sport is necessary and will quicken the recovery in dealing with the NFL.

Meniscal injuries are still concerning but can still allow a player to play through the injury despite requiring further interventions in the future. If a player sustains a meniscus injury, they will miss some time but can return to play later in the season with favorable results after testing and a positive response to rehab. Despite returning to play, there are still instances where players will not be 100% and their production will noticeably decrease. Overall, a concerning but not season ending injury.

Continue to check back regarding further updates and injuries throughout the season. Follow on Twitter @BangedUpBills, Facebook at Banged Up Bills, on Reddit at u/BangedUpBills and http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!

NFL Injury Series- Achilles Tear

Analyzing the Achilles’ tear, causes, rehab, and return to play rates in the NFL.

Training camp is in full swing and the Buffalo Bills continue to stay healthy despite significant injuries elsewhere in the league. One injury that the Bills have avoided for some time is the Achilles tear which is the topic of today’s article on Banged Up Bills NFL Injury series.

Credit: http://www.medi.de

The Achilles tendon is a thick tendon that connects the gastrocnemius and soleus muscle to the calcaneus which is the heel bone. The gastrocnemius muscle or calf muscle allows the foot to point down or plantar flex which is required for the leg to push off during walking and running. It also assists in flexing the lower leg at the knee joint along with the hamstrings. The gastrocnemius and soleus help drive the body forward in walking and running and are especially in maximum use during sprinting.

Like other tendons, the Achilles tendon can become injured which can develop into a tendonitis. This occurs when pain/inflammation affects the insertion point of the muscle and it becomes painful with activity. This can eventually lead to microtears occurring in the tissue during injury and the tendon heals improperly. Normal tendon and muscle striations are linear in nature allowing for maximum contraction of the muscle. In the event of tendonitis, the tissue heals improperly and instead of consistent striations, there is a disorganized mess of muscle fibers that does not allow the muscle to contract as efficiently which can lead to further pain and inflammation with continued overuse.

Risk factors seen in football players which could increase the incidence of an Achilles tendon rupture include: excessive body weight, heavy weightlifting, use of anabolic steroids, long term use of corticosteroids, immobilization of the ankle/foot, of the male sex, and muscle weakness/imbalance. While some of these risk factors are preventable, others are not and this is where doctors have to use best judgement when performing interventions for both short term and long term implications following injury.

With improper rest or not performing preventative exercises such as stretching or regular strengthening, an Achilles can eventually tear with either chronic overuse or suddenly. Unfortunately, most traumatic Achilles rupture warning signs can be asymptomatic and do not usually present with problems until after the major injury occurs. This means that because you have Achilles tendinitis, does not mean you will have rupture. However, because you do not have symptoms, does not mean you won’t have further injury.

In the event of a tear, most athletes are jumping, sprinting, or cutting with such great force that the tendon ruptured suddenly. The muscle is stretched past its limits suddenly or asked to do more than it is capable of after periods of inactivity. Even in conditioned athletes, this can still occur as the athlete is continuously pushing themselves to their limits. When rupture occurs, it is likened to a shotgun blast and loss of function and pain is immediate. This is an injury that even the strongest, most determined athletes cannot work through. The ability to push off the foot simply is not there. Here is an excellent clip of an Achilles tendon rupturing in real time.

Credit: http://www.sportsinjuryclinic.com

In the event that there is a suspected Achilles tear, a Thompson test would be performed. This is where an athlete would lie on their stomach with their foot hanging off a table and the calf would be squeezed. If the foot moves, the Achilles is intact. If there is no movement, then this confirms the tear. Imaging may be done to assess severity but if the Thompson test is positive, then it is a tear. Tests such as this are typically accurate, similar to the anterior drawer test with ACL injuries.

Once the Achilles tear is confirmed, surgery is usually recommended immediately as tendon ruptures tend to retract back to the origin or attachment point of the muscle which means the longer surgery waits, the more difficult it will be to reattach the tendon. Rehab typically takes 6  months to a year to fully recover. Once the procedure is performed, the patient is placed in a boot that encourages the foot to point down to place slack on the tendon so that it can heal properly. If the foot were to be flat, that would place stress on the healing tendon with the foot in neutral and there would be a lesser chance of it healing properly.

Once the foot/ankle is immobilized with progressive weight bearing as instructed until 8 weeks to allow the tendon to fully heal back to the attachment point that is the bone. Light strengthening begins after 8 weeks with active stretching to the surgically repaired area occurring after 12 weeks. Progressive strengthening up to 6 months occurs with focus to avoid high forces on the tendon to reduce re-rupture. Similar to the ACL of the knee, full return to sports takes 9-12 months due to the demands of the structure.

Fortunately, re-rupture rates are exceptionally low in the repaired Achilles. While it is a long recovery, re-rupture rates following a repair are between 3.5%4.5% which indicate the overall long term success of the intervention. Non-surgical methods are available but are not recommended unless the person is a poor surgical candidate. While the re-rupture rates are fairly low, return to play rates are much poorer in comparison. Roughly 30% of athletes who sustain an Achilles tendon rupture and repair are never able to return to the NFL. Those that do typically suffer a decrease in performance up to 50% according to research. Those that do have a surgical repair have about a 6% chance to tear the contralateral or opposite Achilles.

Interestingly, the last confirmed Achilles tear that the Buffalo Bills had suffered dates all the way back to 2005 when LB Takeo Spikes tore his in the early in the season. There may have been more recent ones but pro-football-reference.com only goes back to 2009 with injury reports for the Bills and I was unable to find any Achilles tears after 2009. I pray that this is one streak that we don’t end for some time.

This is another nasty injury that occurs far too often in the NFL. Regrettably, it is a sad reality and there can only be so much done to prevent these injuries. So far, only two have been reported, CB Jason Verett of the LA Chargers and Patriots OL Isaiah Wynn. However, this will not be the last one by any stretch as it is still early in preseason and unfortunately many more injuries will occur.

This wraps up another article in the NFL injury series. As the preseason progresses, continue to watch for more Bills camp updates, injury articles, and any other breaking news coming out of One Bills Drive. Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

NFL Injury Series- Hamstrings

Reviewing the hamstring strain, severity, and rehabilitation.

Today’s post will look at the all too common hamstring strain. This is an injury even the best conditioned athlete can sustain. This article will not focus on one specific player, but rather educate and inform what the hamstrings are, how they operate, why they’re injured, and prevention.

Credit: myprotein.com

The hamstrings are made up of 3 muscles in the back of the thigh consisting of the biceps femoris on the outside and the semimembranosis and semitendonosis on the inside. Together these three muscles attach to parts of the upper femur and bottom of the hip which is called the ischial tuberosity . This is the bony part that everyone sits on when they are in a chair. At the other end, they connect to the top of the tibia and fibula, which is the lower leg bones. Due to the muscles crossing over two joints, they have different functions. Together, these muscles allow the leg to extend and drive the body forward, along with bending the knee. During running and blocking, these muscles cycle through the process of shortening and lengthening at regular intervals depending on the position of the leg.

Credit: livestrong.com

To help you envision the hamstring functioning, picture a sprinting athlete. Typically, one foot is in contact with the ground, the other in the air. During the foot that is in contact with the ground, the hamstrings with other muscles assist in extending the thigh to assist in moving the body forward. As the body moves forward and begins to push off, the other leg begins the process towards beginning to make contact with the ground. Once the original leg finishes pushing off, the knee begins to bend to assist in clearing the foot to bring the leg forward. Even during the portion where the leg makes contact with the ground, the hamstring is loading back up and eccentrically contracting which means that it is accepting a load while lengthening, which is the most taxing type of muscle contraction. When the foot makes contact with the ground is where most hamstring injuries can occur which is why you see most players stop quickly due to the sudden nature of the injury. While the hamstring does sound confusing, it can be, but know that without them, you’re not doing much walking without them

During times of injury, the muscle can be overworked, overstretched, or fatigued, leading to part of the muscle to become injured. Depending on the severity and location can dictate the recovery time. A strain is due to the injury to the muscle or the muscle bone attachment. Grade 1 tears are the least severe in which a small portion of the muscle tears during excessive activity. This can heal up rather quickly but several days of rest, stretching, and light exercise can remedy the muscle.

Grade 2 hamstring tear is where at a moderate portion of the muscle tears with a greater force, leading the player to limp and be unable to properly use the affected leg as intended. Typically, there is greater bruising and swelling with initial difficulty placing weight, keeping the player off it for some time. Bruising, poor functional control, and tenderness may occur during this time which could cause the athlete to miss several weeks before they are back to playing shape.

Grade 3 hamstring tear is where the muscle nearly or completely tears. It can also pull a chunk of the bone away from the bony attachment, most likely at the ischial tuberosity, known as an avulsion. This is due to this area being the anchor point, meaning the harder the muscle contracts, the harder it pulls on the anchor point, leading to eventual overload. At this level of injury, the muscle is quite weak and function is no longer normal. With this injury, the athlete is in danger of missing significant time or can be potentially season ending. Recovery time with surgery can be anywhere from 3-6 months with some resources stating closer to 8 months.

Credit: physioprescription.com

These types of injuries occur when an athlete suddenly tries to decelerate and change direction, hurdling a player, or trying to push their body faster and faster. This can also occur during blocking, trying to maintain their ground as their being pushed forward and backwards, eventually the muscle gives out and the player becomes injured as a result. There are countless ways for the hamstring to be injured, these are just several of the more common mechanisms of injury.

While the injury is not fully preventable, there are certain steps that can be taken to reduce the incidence. Some preventable measures that can be taken is ensuring proper hydration, conditioning, stretching, and strengthening. Some things that can’t be controlled is previous hamstring injury and increased age. The best method to treat an injury is to prevent. However, I would be hard pressed to find an athlete that has not sustained some sort of hamstring injury during the course of their athletic endeavors.

As Bills fan, we have already seen several players deal with hamstring injuries this season with varying degrees of severity. As a PT, I am not concerned about the long term management of the injuries. I know these players need time to rest, recover, and not to rush back. I would expect to see these injuries increase as the season wears on and the bodies begin to break down. So far, only Matt Milano has been slowed up by hamstring strains and has been brought along slow so far in training camp after re-injuring in OTA’s.

Continue to check back for the latest Bills news and injury updates. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills and on reddit at u/BangedUpBills. As always, thank you and GO BILLS!!

NFL Injury Series- Contusions

Reviewing what contusions are, severities, and recovery times.

Today’s post will consist of several terms that come up often but aren’t well defined. My goal is to identify the rest of the terms and continue to further the knowledge base. There are many terms for the same problem or based on location, which define how it is described.

First up is the common contusion. A contusion is defined as a blow to an area that damages the small blood vessels and connective tissue in the area. This can be caused by getting hit hard or falling the ground which if severe enough can impact function. While everyone has dealt with a bruise at some point or another, not everyone gets hit by a 250 lb linebacker going at full speed.

When the contusion occurs, the blood vessels do burst and the discoloration is the result of the burst blood vessels releasing blood, rising up to the surface, then slowly reabsorbed by the body. This is why a bruise fades over time. The more severe the contusion, the more impact it can have. While nothing has been torn, the connective tissue of the muscles and other tissues including fat and skin are still impacted. The tissues of the body are quite pliable and if damaged, will respond to pain as any other portion of the body, except brain tissue. Contusions vary in recovery times to no time missed to several weeks based on location and severity.

Contusions, if severe enough can cause compartment syndrome in the area. This occurs when swelling becomes excessive and pushes on the connective tissues surrounding the muscles. If not managed quickly, the excessive pressure can begin to kill the muscle, leading to permanent damage.

Various types of contusions include hip pointer, nerve contusion, stingers, and bone bruises. Hip pointer injuries are to the bony portion of the hip known as the iliac crest. This is right above the waist line and are common due to the location players fall to the ground or are tackled in the area. This area is also where the abdominal wall attaches to which limits trunk motion and the hip abductors connect right below the area, which allow for a player to run and perform lateral movements. These can take 1-3 weeks to recover based on severity of the injury.

Nerve contusions, such as what Shaq Lawson dealt with last season, is when bruising occurs to a nerve. In most cases in the body, the nerve is well insulated and protected from injury. However, in certain cases, these nerves sometimes exit the body temporarily and are exposed. Cases include the ulnar nerve that exits temporarily near the elbow and the peroneal nerve which is on the outside portion of the knee near the fibula. If you’ve ever hit your funny bone, that’s your ulnar nerve screaming at you. In Lawson’s case, he hit the peroneal nerve which causes pain and weakness to the area. These injuries can resolve relatively quickly, but are quite painful and may take some time to rehab from to ensure proper movement. Once again, depending on the location and severity determines recovery time.

Stingers are another type of nerve injury that can be incredibly painful, but can quickly resolved if managed correctly. Stingers occur when a player gets tackled violently and the shoulder is pushed in one direction and the head in the opposite, leading to traction on cervical or neck nerves. Compressive forces can also cause similar symptoms, such as a direct head blow during a poor tackle or when driven into the ground. Pain is typically felt in the neck and shoulder region, with pain also produced sometimes all the way down the arm causing pain, weakness, and numbness. Due to how the nerves connect all back to the spinal cord and brain, this is why pain can travel down the arm despite the injury occurring in a different area. These injuries can resolve with rest and proper stretching, but is not something that can be rushed.

Finally, bone bruises complete this article. Bone bruises are actually a type of fracture that is less severe than a true bone fracture that we all think of. Keeping it brief, there are 3 types of bone bruises: Sub-periosteal hematoma, inter-osseous bruising, and sub-chondral lesion.

Sub-periosteal hematoma occurs when a direct high force trauma occurs and blood forms under the periosteum, which is a membrane that covers the outside of the bone. Inter-osseous bruising occurs when the bone marrow of the bone becomes damaged, specifically the blood supply. This occurs as the result of a repetitive high compressive forces on the bone, such as excessive running or jumping. These are seen more common in the knees and ankles.

Sub-chondral lesions occur when the cartilage layer of the bone becomes damaged. This area is found at the end of the bone and is the part that articulates with another bone. An extreme crushing force or rotational/shearing force may also cause this, commonly seen in injuries such as ACL tears. ACL tears typically not isolated, but MCL damage, meniscus damage, and even a sub-chondral lesion due to the forces that occur on the joint during the injury also occur.

Recovery times are difficult to manage with mild bone bruises recover in several weeks with more severe instances can be months. It really is specific to each person and how the injury was sustained. I wish I could give a more specific timeline for these recoveries but some players respond quickly and others such as Sam Bradford could take several weeks and leave uncertainty regarding their availability for future games.

These injuries happen far too often and are a part of football. While padding, playing surfaces, and proper tackling can reduce incidence of injury; these are the types of injuries that come with playing football. Most of these injuries can be managed conservatively with rest, icing, stretching, and padding. These are injuries that do not keep players out for extended time, but can be injuries that knock out players during key games.

Continue to check back for regular updates and further in depth analysis of the latest Bills injuries. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills and at http://www.bangedupbills.com. As always, thank you and GO BILLS!!

NFL Injury Series- Sprains

An overview of general sprains, severity, and recovery times

As we continue to delve into common injuries seen around the NFL, today’s post will consist of an overview of general sprains. Sprains are very similar to strains, but differ in function and location. Sprains are an injury to a ligament or multiple ligaments based on location. Ligaments are found all over the body and provide connections between bones to create a joint. When an injury occurs to the area, instability, pain, and swelling occurs based on severity.

Credit: therapydiadenver.com

Grade 1 sprains are when the ligament is stretched minimally and minor swelling/pain occurs. This can cause some players to miss time based on location and position, but typically can be managed conservatively in order to return to prior level of function. These types of injuries are week-to-week and can be played through if absolutely required, though increased risk of injury occurs. X-rays may be performed to ensure no fractures have occurred but are usually diagnosed through physical examination.

Grade 2 sprains are when the ligament is partially torn and moderate swelling/pain occur. These types of sprains typically keep players out for some time and cause moderate loss of function. A conservative expectation for a Grade 2 sprain could be anywhere from 4-6 weeks, though could vary based on location. At this time, an X-ray is performed to rule out any fractures. An MRI is performed to support physical examination and determine extent of damage.

Grade 3 sprains typically involve near or complete tearing of the ligament leading to significant loss of function and possible season ending surgery based on location of area. At this point, the ligament is classified more of a tear than a sprain which is why you do not see this as a Grade 3 sprain. Typically, ACL, PCL, and severe MCL tears can be categorized as such along with AC joint sprains. Ankles, shoulders, and wrists are also common areas for complex ligament damage to occur. It is common to see other structures become damaged as the result of a severe sprain/tear. MRI’s are performed to determine severity of tear and to assess for any injuries missed by physical examination or initial swelling.

In most cases, a sprain can be due to an overload to the joint as a direct blow, violent twisting/pivoting, or excessive tension on the ligament. As with all other materials in the body and in nature, everything has a breaking point. Injuries such as these can be reduced but not totally prevented. Preventative measures include playing on forgiving surfaces such as grass which reduce the friction and prevent cleats from sticking in the surface. Proper strengthening to the area and proprioceptive exercises which include body awareness activities help keep the body from overloading the joint. Bracing and taping may also give support to an area if there is a high risk for injury or prior instability. Taped wrists, knee braces on lineman, and ankles braces assist in limiting excessive range of motion, reducing the risk.

Continue to check back regarding updates on Bills news and general injuries in the coming days. While it is impossible to review every injury, this is merely a guide to assist you in understanding the severity and expected timeline upon injury. Follow on Twitter @BangedUpBills and at http://www.bangedupbills. As always, thank you and GO BILLS!!

NFL Injury Series- Muscle Strain

An overview of general muscle strains, grade severities, and recovery times.

The Buffalo Bills training camp continues to roll right along with no major injuries to report. The only reported injuries so far is TE Nick O’Leary who suffered an ankle injury which kept him out of practice for a short time but did not appear to be anything serious as he was able to return to full practice after several days rest. TE Logan Thomas was limited in practice but no further updates have been released regarding his current injury.

As we continue with the NFL injury series, today’s post will consist of identifying several terms used to describe injuries and educate on how to differentiate on what is being reported. I have used many of these terms before and have done my best to describe them, but I believe they are worthy of their own article. Today’s overviews will consist of the common muscle strain.

A muscle strain can occur in virtually any muscle within the body if the muscle is suddenly overworked, stretched, or fatigued to the point where the muscle becomes injured. A strain is classified as a strain due to an injury to the muscle itself or the muscle bone attachment which is called the tendon. There are varying grades of muscle strains which can progress up to a muscle tear, avulsion fracture, or rupture.

Grade 1 muscle strains are relatively minor and is when a small portion of the muscle is torn; function may be limited, but is typically not serious and can heal up relatively quickly with proper management. This usually consists of stretching, icing, anti-inflammatory medications, and light strengthening exercises to restore proper movement. With effective management, this can be a day-to-day injury with some lasting up to a week or two. Most of these injuries are able to be played through with proper rehab and rest.

Grade 2 muscle strains are where a moderate portion of the muscle is torn which is typically associated with bruising, swelling, and partial loss of function which is demonstrated as difficulty performing the muscle movement and is typically limited secondary to pain. Rehab management will consist of generally the same procedures as Grade 1, but will require a longer duration to recover. I can not make a blanket statement and state that a Grade 2 muscle strain will take “X” number of weeks to heal up. It is typically more than week-to-week, but based on location and job duties of the position may dictate how long the player is out.

Credit: eorthopod.com

If a Grade 1 or 2 muscle strain occurs close to the tendon attachment, if not healed up correctly or chronically injured/overused, the muscle or tendon may develop into a tendinitis based on healing. The suffix “-itis” is Latin for inflammation, which indicates that the tendon is irritated and may become painful over time. Most muscle/tendon fibers have consistent, linear striations, such as in a nice cut of beef or in the picture above. When the tendon does not heal correctly, the connective tissue heals in an uneven pattern as seen in the picture below. This does not allow for effective contraction of the tendon, leading to increased pain, weakness, and loss of function. This could lead to tendonosis which is the chronic form of tendinitis and becomes even more difficult to treat. Eventually, this can lead to a higher risk of rupture in the tendon later but is not a requirement for a rupture to occur.

Credit: mendmeshop.com

However, when a severe muscle strain occurs, this is classified as Grade 3. This is where most of the muscle is torn, there is typically significant damage and surgery is possibly required to repair the structural damage. There is significant swelling, bruising, and pain to the area due to the sudden and forceful nature of the injury. The muscle no longer is able to function as intended and pain limits the possibility to attempt. At this point, several other injuries may have occurred including an avulsion fracture or ruptures. If an avulsion fracture or rupture has not occurred, surgery still many be indicated to assist the muscle in healing correctly.

Credit: physicaltherapyct.com

In the case of an avulsion fracture, the tendon that attaches the muscle to the bone and acts as the anchor pulls away from the attachment point and takes a chunk of the bone with it. While this injury is uncommon, it still does happen. Surgery is sometimes indicated to reattach the bone to the original area and requires extended time missed, requiring the body to build up toleration to the muscle pulling on the attachment point without re-injuring the area.

Credit: tylerfootclinic.com

Finally, a tendon rupture is when the tendon tears away from the attachment point but does not take a piece of bone with it. This is commonly seen in biceps and Achilles’ injuries, among other areas. If this injury occurs, the player may feel a pop with immediate loss of function. The muscle may act like a bungee cord and rebound violently and become balled up, leading to a deformity. These types of injuries also require surgery and cause a player to miss extended time due to the requirements of the muscle contraction and the actions of the muscle. As there are a variety of potential tendon ruptures and recovery times, it is difficult to state a general timeline without having specific information.

This is just a brief overview of the muscle strain and how to understand the various nuances of the wording and injury. Sometimes injuries such as calf and hamstring strains can appear to follow a player for their career or never fully heal without significant rest. The best thing that a player can do is hydrate well, stretch effectively, strengthen properly, and listen to their bodies. While the NFL is a tough sport, pain is expected, but trying to play through an injury may only worsen it and cause further complications down the line.

This completes another article in the NFL injury series as we prepare for pre-season games and the regular season. There is much more to come regarding the common injuries we will inevitably see over the next several weeks. Continue to check back for posts regarding other general injuries and broaden your knowledge base. Follow on Twitter @BangedUpBills and at http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!!

History of the ACL Reconstruction

Analyzing the history of the ACL injury including high level athletes who were able to succeed without an ACL and potential complications later in life.

Welcome back to Banged Up Bills! Today’s post will take us back in time to the 1970’s and 80’s, before the Bills reached untold greatness and the legends of Orchard Park were coming into their own. Looking back to 1986, RB Thurman Thomas of the Oklahoma State Cowboys partially tore his left ACL in a pickup basketball game in the off-season, placing his junior season into question. Fortunately, despite recovering and achieving All-American status his senior year, the known history of this partially torn ACL ultimately caused his draft stock to slip, allowing the Bills to steal the future HOF in the 2nd round of 1988. The article above mentions that he suffered the ACL injury and had arthroscopic surgery to assess the damage, but the ACL was ultimately never reconstructed at the time. Recently, it was revealed on Twitter that Thomas successfully played his entire career with a partially torn ACL; according to him, 85%.

While some said he was a GOAT for playing with an injury of that magnitude, it is more astonishing that he was able to perform at such a high level despite knowing what we know now about ACL tears. Today’s post will explore the history of ACL repair, why Thomas most likely did not have the surgery, other NFL players who were able to succeed without an ACL, and potential complications they may have today as a result.

Looking at a brief history of the ACL injury, these types of maladies have been explored for centuries, going back to ancient times when the true gladiators battled against each other. When injuries such as the ACL tear occurred, doctors such as Galen would be able to further explore the inner workings of the knee through gashes suffered in battle and identify these complaints, though surgical intervention was centuries away. Fast forward to the late 1800’s, further examination and surgical intervention came into vogue with the advent of X-ray and a better understanding of the function of the ACL.

However, it would still take nearly 100 years to develop effective treatment of the ACL to what it is known today. In the 1970’s, doctors were aware that the ACL had an impact on knee function but testing for injury and surgical intervention were still in its infancy which led to many methods of repair with a wide variety of overall poor outcomes. Initial surgeries would open the knee up with rather large incisions and attempt to repair the knee with a variety of material including hamstring, patellar, cadaver, and synthetic grafts.

Surgical techniques were improved in the 1980’s with the use of arthroscopy, however, this time period also saw high rates of materials failure and complications several years after a repair due to synthetic grafts. There was also not a general consensus on the best method to repair the damaged ligament. In addition, there was published research arguing that nonsurgical interventions was just as effective as surgery in outcome scores with regards to function, though they did note that surgical repairs led to a more stable knee in comparison.

Attempts were made to identify a consistent rehab plan for the ACL as surgery techniques improved. Regrettably, the rehab plans were determined later to hinder the patient recovery and led to greater failure rates after returning to sport. Several pearls from the above mentioned ACL rehab plan that would not be considered today include:

  • casting and immobilization of the surgically repaired leg for 6-8 weeks
  • immobilization between 30-60 degrees in flexion
  • either toe touch weight-bearing or no weight-bearing allowed during this time frame

Most of these interventions were thought to preserve the integrity of the ligament by limiting movement with the ACL on slack with the knee in a flexed position. The thought was a fully extended knee placed undue stress on the repair and could cause premature rupture in weight-bearing.

Research later found patients that were non-compliant with their rehab protocol actually had better outcomes than those who followed the rehab precisely. Those that were non-compliant were removing their casts and beginning movement/strengthening sooner than advised but were found to be able to return to full function with less pain and overall greater satisfaction which forced the medical community to reevaluate the protocols.

As there was so many varieties of materials for repair, no gold standard for repair technique, and a poor understanding on proper rehabilitation, its no wonder that Thurman Thomas avoided having the surgery all together. He would most likely been worse off having the surgery than playing without a repair. I believe that with all the uncertainty of surgery methods/outcomes, the experience with ACL repairs of the treating orthopedic surgeon, and his potential career prospects, reconstruction was not performed. Fortunately, his knee was able to withstand the demands required of his position with protective bracing throughout his career despite the tear.

Thomas was not the only one that declined surgery and managed to play with an ACL deficient knee through their career. HOF QB John Elway tore his ACL in high school but was still able to recover without surgery and have a long career in the NFL. It is noted that this was his non-plant leg which reduced the incidence of pivoting which may have allowed him to avoid further issues. It has also been reported that Yankees great OF Mickey Mantle tore his ACL during his rookie season and was able to play his entire career without an ACL. I believe that Yankee fans are unanimous with how great he was despite his injuries. As I stated in my previous article, it is possible to live a normal life without an ACL, though still very difficult to play at a high level without one. Thomas, Elway, Mantle, and a more recent example of WR Hines Ward of the Steelers are several exceptions.

The only consistency that I see is that all of these players were relatively young; >20 years when they tore and may have still been growing into themselves, which allowed their bodies to adapt and compensate with the deficiency. However, pediatric ACL tears still benefit from surgical intervention with nonoperative management and potentially causes problems later in life which refutes the statement above regarding youth ACL tears.

Research supports the use of surgical intervention with some variances in techniques and rehab but generally, surgery is the gold standard in order to return to full ability. We have seen the power to return to sport after ACL reconstruction with an 82-95% success rate. Through rigorous studies, the medical community has also found that proper reconstruction has reduced future injuries and complications significantly. These included future meniscus tears, corresponding ligament injuries, and arthritis. In Thurman Thomas’ case, it is unknown whether he has had any further complications, though several reports in 2001 indicate that he tore the right ACL which ended his NFL career in Miami.

With these complications arising from avoiding ACL surgery as several studies supported in the 1980’s, eventually the ACL injury could have degraded the knee to where loss of function was significant and few interventions available to provide relief once it got to that stage. Knee replacements are available which restore function and movement, but those are typically reserved for those patients that are much older with ages into 50+ and have reduced their athletic activities. People in their 20’s-30’s are not ideal for a knee replacement and should not be considered unless certain exceptions arise which are typically not sport related. If the players mentioned above have not already had a knee replacement due to the punishment of the sport, they are most likely considering the possibility.

As a whole, ACL reconstruction continues to be the primary intervention to allow athletes to return to sport. There are doctors that have begun to swing the other way again, rejecting surgery in the case of Miami Dolphins QB Ryan Tannehill when he partially tore his ACL late in the 2016 season. The corresponding rehab was ultimately unsuccessful as he re-injured his knee in training camp the next year. Eventually there will be interventions which reduce the healing time in the surgically repaired knee or there may be effective non-surgical interventions. It took over 20 years to really establish a consistency for ACL repair; it may take even longer to identify interventions that don’t involve surgery.

I found this research to be fascinating as the history of medicine has changed so drastically over the years and its incredible to think that these previous methods were cutting edge at the time. Thankfully, studies and constant refinement of the process has allowed high level athletes return to full ability instead of potentially ending their careers. The quality of interventions will continue to improve with medical advances and maybe 30 years from now, we will be looking back and say “what were we thinking?” Until then, we will work with what we know best.

Continue to check back for the latest updates from @BangedUpBills on Twitter and at www.bangedupbills.com. I will be pumping out a lot of content with training camp coming up and as players begin to suffer injuries. As always, thank you for reading and GO BILLS!!

NFL Injury Series- ACL Tears

Complete analysis of the ACL injury and associated rehab including timelines for recovery.

Today’s article begins a series that precludes the start of training camp and will review the most commonly sustained season-ending injuries in the NFL. Objectives of this series are to help educate fellow fans on the severity of each injury and timelines for recovery. Unfortunately, when these injuries occur, Banged Up Bills will have you covered. Nearly all of these injuries are season ending or become chronic if not managed properly. The first post will assess ACL injuries.

The ACL is a ligament that connects the tibia to the femur and runs medial to lateral or inside to outside, acting as a stabilizer in the knee to prevent the femur from shifting too far forward over the tibia during movement; it also assists in preventing hyperextension in the knee. When the knee is loaded during activity such as cutting and sudden stops, the ACL is designed to keeps the knee stable, but in the presence of injury, the ligament is overloaded which either stretches and partially tears or fully tears based on the activity. It is possible to live a normal lifestyle with an ACL deficient knee, but nearly impossible to resume a high level of play post ACL tear without reconstruction as an adult.

Credit: kneesurgerysydney.com.au/acl-reconstruction/

Activities that cause the ACL to tear are direct blows such as a low block or a blow to the knee while the foot is planted. Non-contact typically happen when a player doesn’t land properly after jumping in the air, when they perform a sudden change in direction at a high speed, or when they attempt to quickly decelerate. Tears also occur with hyperflexion or hyperextension of the knee. In the event of ACL rupture, the knee buckles and there is usually immediate swelling, tenderness, loss of ROM, and pain. Risk factors include but are not limited to: sex, age, playing surface, level of play, biomechanical variances, previous injuries to the knee, equipment, and environmental conditions. Recent research has also shown that concussions can possibly increase the risk for injuries such as ACL due to slower reaction times.

Credit: medline.gov

As with many injuries, players are not able to return to playing and require further evaluation once in the locker room. X-rays are taken to rule out fractures and special tests are performed including but not limited to: Lachman’s test, anterior drawer test, and pivot shift test. All of these tests rule assist in physically identifying that the ACL is damaged. Typically, when performing the Lachman’s or anterior drawer test, there will be increased laxity when moving the tibia in the opposite direction of the femur. There are 4 grades to determine ACL severity which grade out how much the tibia pulls out in relation to the femur. Grade 1 is <5 mm progressing in severity up to Grade 4 which is >15mm.

Another test that may be performed is a posterior drawer test. This is the opposite of anterior in that it tests for a PCL injury. The reason this is performed is due to the possibility of PCL injury instead leading the tibia to sag back which could initially mimic the laxity seen with the anterior drawer test. A pivot shift test mimics the injury mechanism of the ACL tear and will typically illicit pain and possible clunking which would signify a subluxation of the tibia. To confirm the ACL tear, MRI imaging will be performed once swelling is subsided. Otherwise, the excess fluid could occlude the view of the tear and make the imaging inconclusive.

Once the tear is confirmed and swelling has reduced, surgery is scheduled to repair the structural damage. Regrettably, the ligament cannot be repaired through simple means such as sewing it back together. The ligament has to be cleaned out and repaired through use of a graft. These grafts come from commonly the hamstring or the patellar tendon which are known as autografts or through the use of a cadaver also know as allograft. There are other options which include xenografts which come from animals and lastly, synthetic grafts made from carbon materials or Gore-Tex. While medical research has improved drastically, the preferred method still appears to be the autografts as this comes from within the patients body and have lower rates of failure. The surgery is performed by anatomically lining up the graft as the ACL would normally be in and screwed in to allow to heal to the bone.

Recovery from an ACL tear takes anywhere from 9-12 months to return to full, unrestricted activity. However, there may be concurrent damage sustained in the knee which could include meniscus tear, MCL/PCL/LCL tears, or cartilage damage which could lengthen recovery time. Once the surgery is completed, the first 2 weeks is spent allowing swelling and initial tissue healing to begin. Passive range of motion along with light strengthening of the surrounding muscles is performed. After several weeks have passed, range of motion is increased with emphasis placed on full extension or straightening of the knee which will allow the person to be able to walk fluidly through the gait cycle and fully bear weight.

As the range of motion increases, higher level strengthening activities may begin through the saggital plane which involves motion going forward/backward over the next 10 weeks. During this time, strengthening exercises are primarily composed of closed chain exercises. This means that the foot is in contact with the ground or other surface as the knee performs its movements. Open chain involved exercises that allow the lower limb to move freely which if performed too soon, may place excess torque on the repaired ligament which could cause potential failure if pushed excessively.

Once full ROM is re-established, balance exercises are incorporated to regain proprioception which allows a person to sense their joint and body in space. This awareness is crucial as if the athlete has a poor awareness where their body is at during movement, they are at a much greater risk for injury. After 3 months out, they may continue progressing to running exercises going forward, backwards, and slowly begin agility drills once fitted for an ACL brace. These braces are commonly used to prevent future ACL injuries by restricting rotary and hyperextension forces. The recovery timeline is so long due to the purpose of the ligament and its makeup. As stated before, a ligament attaches bone to bone which creates stability for the joint. Add in the stresses that the joint goes through during running, jumping, and cutting motions, proper healing is required so that the ligament can perform effectively. Lastly, ligaments unfortunately have poor blood supplies which slow down healing time unlike muscles or tendons which have a rich blood supply allowing those tissues to heal quicker.

Credit: betterbraces.com

Once a patient has reached the 6 month plateau in recovery, they must meet certain minimum criteria to begin even considering returning to sport. They must:

  • demonstrate quadriceps and hamstring strength at least 80% that of the noninvolved leg
  • full motion
  • no recurring swelling
  • demonstrate stability both with physical testing and mobility
  • completing a running program

In higher level athletes, the running, jumping, agility set them apart from the general population and because of that, these athletes require further training in order to return to their respective sport. Athletes must be re-educated to safely land, cut and change direction, and essentially relearn how to use their reconstructed knee. Overall, 6 months is a considerable amount of time to heal properly which explains why this is a season ending injury. As the NFL season is only 6 months long, even with the best rehab, it wouldn’t be realistic to return.

However, why if a person is able to get to full recovery after 6 months, why are they out longer than that? Research has shown that the risk for re-injury decreases by over half each month up to 9 months before returning to sport. Once a player does return from an ACL repair, they are at a much higher risk to re-injure with rates up to 20-30% for up to two years after injury. These are the reasons why it takes nearly a year to return to full ability prior to the injury. Overall, ACL reconstruction success rates today are between 82-95%, a significant increase from 50/50% success in the 70’s & 80’s.

Many high level players can and do return to full abilities with proper rehab and training. It is terrible to see a player put all that hard work and training into getting ready for a season for it to all end with an injury such as this, but until medical science improves the healing process so much that players can shorten that 6 month window for healing, we are stuck with the current system. As a fan, I am praying that the Bills continue to avoid major injuries such as this as they were fortunate last season.

This wraps up the first article in the sports injury series. Continue to check back at Banged Up Bills on Facebook and on Twitter @BangedUpBills for the latest articles. As always, thank you for reading and GO BILLS!!