Week 7 Injury Breakdown- Winston’s Woes

Breaking down the Bills injury report, analyzing QB Jameis Winston’s AC sprain, and how it will impact Sunday’s match up.

Well, I was wrong. Yet I couldn’t be more happier! WR Jordan Matthews has been cleared for practice! After breaking a bone in his thumb which required surgery and a pin inserted just two weeks ago, he has already begun practicing on a limited basis. This is far faster than the anticipated month long absence the team expected. This also blew my prediction out of the water of returning at least by the Jets or Saints game.

This determination was made with full confidence of team doctors and how Matthews has responded to treatment. While there are guidelines with each surgery, they can be circumvented based on variables such as healing, pain, and strength/range of motion progress. As of today, he is listed as questionable for Sunday. He was listed as a full participant in practice today, however, it may still be beneficial to come back with an additional weeks rest. As we have found out, anything can happen, so stay tuned.

Conversely, I believed that LB Ramon Humber would be the one returning quickly as he was able to play through the Falcons game with a club on the hand until he could be examined further. As of today, he is still listed as out. This may change as he continues to be week-to-week, but LB Matt Milano is filling in place with satisfactory results.

CB E.J. Gaines continues to deal with a groin injury also sustained in the Atlanta game which indicates that it may be been more severe than DE Shaq Lawson injury. He was listed as a full participant today which is a good sign heading into Sunday. CB Leonard Johnson is listed as still dealing with a hamstring injury, but also was able to practice in full today. As previously mentioned, hamstrings can be tricky and not quite heal up completely if Johnson re-aggravates the injury. Both are listed as questionable going into Sunday’s game, but considering these are soft tissue injuries, I have much more faith in them playing than Matthews.

Finally, OT Cordy Glenn was a full participant while still dealing with a foot/ankle injury. He appears to continue to re-injure it or dealing with a chronic issue which means he may never be fully healthy this season. There was discussions that he would be moved to the Seattle Seahawks, but a trade was unable to be completed. It is also assumed that he would not pass a physical. Add into the mix that he has a hefty contract that not every team can just assume. I expect to see Cordy either get healthy and be traded, or play out his contract and leave a free agent.

While this is a Bills blog, the one big question is how QB Jameis Winston’s AC sprain will affect Sunday. Winston sustained the shoulder injury last Sunday during a tackle by LB Chandler Jones. It was reported that he was well enough to return in an emergency, but QB Ryan Fitzpatrick finished the game. As of today, Winston has participated in a limited fashion with throwing in practice and is listed as starting Sunday. While he is starting, I question the effectiveness of his abilities.

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Credit: saintlukeshealthsystem.org

To understand why this may limit Winston, the AC joint must be understood. The AC joint is important in the shoulder as this is where the top of the shoulder (acromion) articulates with the collarbone (clavicle). The AC joint is vital to the throwing motion due to the fact that as the arm is elevated, the acromion that attaches to the wingbone (scapula) begins to elevate. As the scapula begins to elevate, the articulation between the acromion and clavicle begin to move as the clavicle beings to rotate up and out of the way to allow for overhead movement. If the AC joint is sprained, this limits the ability to elevate the shoulder effectively and cock the arm back in position to throw. There are various grades of AC joint sprains as with any other sprain outlined in my previous article, but this appears to be a Grade 1 sprain.

Winston is going to attempt to play with this injury, but it’s assumed that he will not be effective to throw deep or put any speed on his throws. On average, the shoulder sprain that Winston sustained typically takes 9.8 days to fully recover from according to Dr. David Geier. He will be at day 7 by kickoff Sunday, which may affect his ability. This, and other information regarding AC joint sprains can be found at the previously linked blog. This information provided by both Dr. Geier and found by my friends from The Rockpile Report. If you aren’t already a listener, start listening, Drew and Chris are the best at what they do when it comes to Bills football!

At this point in the season, I still believe we are in a better spot both record wise and injury wise compared to previous seasons. I also believe that this team is better equipped to deal with injuries than in past years. This next month of football will really define our season, determining whether the Bills are for real or the same old Bills. Calling it now, the Bills win a close defensive battle and move to 4-2 on the year. Continue to check back for any breaking updates, new injuries, or further explanation of complex injuries. Thank you and GO BILLS!!

A Hodgepodge of Contusions

Looking at what consists of a contusion, the various types, and severity associated with the injury.

Today’s post will consist of several remaining 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, 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.

Nerve contusions, such as what Shaq Lawson dealt with, 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.

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.

This wraps up the breakdown of injuries that are commonly reported, but are not fully known. 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.

What is most important is that the Bills continue to keep injuries to a minimum. They have suffered injuries just as any other team in the NFL, but have avoided the season ending, season altering injuries thus far. Continue to check back for regular updates and further in depth analysis of the latest Bills injuries. Thank you and GO BILLS!!

Speculating Sprains

Breaking down the latest Bills news and an overview of general sprains and their severity.

As the Bills come off their well deserved bye week, two new pieces of information have arisen since last post. The Bills have signed WR Deonte Thompson and released RB Joe Banyard. Thompson has been with most recently the Chicago Bears before being released last week and had previously spent time with Buffalo the past two off seasons. This will help add depth to the WR corps and give Tyrod Taylor a deep option as WR Kaelin Clay hasn’t made much noise since acquiring him earlier this season from the Panthers.

In other news, it has been reported that WR Jordan Matthews is ahead of schedule in regards to his thumb fracture. He has been seen in practice without padding and with just a bandage over the area, though not cleared to catch balls yet. While not fully recovered, this is a promising sign. I had initially thought that Matthews would not be ready to return until the Jets or Saints game, giving him 4-6 weeks to heal. While healing times do vary person to person, it is still early to state when he will play.

Regarding return to play, I could see Matthews sitting out the Buccaneers game, possibly returning against the Oakland Raiders, giving the passing game a much-needed boost after losing Charles Clay last game. The key thing with his recovery is how quickly the bone has healed, the strength/range of motion in the hand, and his ability to manage pain effectively. I continue to hope that these players exceed expectations with return to play and contribute towards making the team more dynamic.

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.

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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. 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.

Thank you for your time today and please 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. I hope you continue to enjoy and GO BILLS!!

Studying the Strain

Educating and understanding the general muscle strain, grade severity, and complications.

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 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 week-to-week injury.

Grade 2 muscle strain is 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 take longer to heal up. 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.

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Credit: eorthopod.com

With an injury such as this close to the tendon occurs, 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 ideal effectiveness 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 tougher 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.

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Credit: mendmeshop.com

Grade 3 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 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.

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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.

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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.

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 follow a player for their career or never fully heal for sometime. 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. Continue to check back for posts regarding other general injuries and broaden your knowledge base. GO BILLS!

Time to Learn

Updating Bills injury news and previewing posts for later this week.

At this point in time, the Bills are hopefully enjoying their time off and getting the much needed rest and rehab required to go into their match up against the Buccaneers next Sunday. This week was wild enough without the Bills playing and driving us insane. The Jets looked very competitive, losing to the Patriots 24-17 with a controversial TD overturned that could have changed the outcome of the game. The Dolphins upset the Falcons in their home 20-17, possibly exposing their Super Bowl hangover. With the way the AFC East games played out today, I expect each game to be a dog fight with no one lying down to wait for 2018.

As the Bills are on the bye, news has been lacking coming out of One Bills Drive. The team has been silent with injuries since last week, offering no updates or return to play expectations regarding Charles Clay, Ramon Humber, or Nick O’Leary. At time of publication of the game recap against the Bengals, it wasn’t known that Nick O’Leary suffered an injury against the Bengals. It was listed as undisclosed and as of today, still is not known what he is dealing with.

In other news, it is also worth noting that Charles Clay has not been moved to IR with designation to return. This tells me several things. This tells me that his injury may not be as severe as originally thought and may be back sooner than 8 weeks. This tells me that the team has faith in their training and medical staff, in that they keep a roster spot for him despite lacking depth at the position. Finally, the team has not gone out and found a big name free agent TE, indicating that they will rely on what they have. I have also stated before that I have no insider knowledge; just knowledge of the injuries and recovery process. With that said, I want Charles Clay to prove me wrong. I want him to return faster than expected. I want him to return healthy and contribute to the team as he was prior to his injury. Time will tell how this one plays out.

As there is little Bills information regarding injuries to report this week, I will go in a different direction. While there are a multitude of injuries that can be covered, I will look to outline general injuries so that you may understand the differences between each issue. My goal this week is to allow you to decipher what is going on when an injury occurs, how severe it may be, and generally, what to expect even before more information is publicly known. Continue to check back daily for new posts regarding these injuries and learn a thing or two! GO BILLS!!

Handling the Hamstrings

Educating on the all too common hamstring strain, levels of severity, and prevention.

As the Bills are on a bye this upcoming Sunday, this allows some deviation away from Bills injury talks to discuss general matters, my thoughts and opinions, and review ideas/thoughts that may get lost in the shuffle of the busy season filled with injuries. Already this season, we have seen Pro Bowl, All-Pro, and HOF caliber players go down with injuries that are potentially career ending, career altering, and just plain unfortunate. Over the next week, I will look to identify and explain general injuries that regularly occur and how to differentiate between injuries and their severity.

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.

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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.

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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. 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.

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.

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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, several players on the Bills such as Marcell Dareus, E.J. Gaines, Matt Milano, Nick O’Leary, and Deon Lacey have all spent some time on the injury report this season due to this malady.

I hope this helped educate your understanding on the purpose of the hamstring, why it gets injured, and what it means when a Bills player or another player you follow goes down with the injury. Over the next week, I will continue to outline other common injuries or any specific injuries that occur. Thank you for your time; just doing my job one post at a time to help educate the fellow Bills fan and realize that not every injury is season ending or dashing the team’s success each year.

Charles Clay Clunky Knee

Reviewing Week 5 loss against the Bengals and impact of Charles Clay knee injury including long term outlook.

The Bills, well, the Bills lost. They lost a very winnable game by a score of 20-16 in Cincinnati. The offense never got going, the run game doesn’t look anything like it has the past 2 seasons, and this Bills team continues to make this fan base crazy. That’s the nice, politically correct way of saying that. Two years from now, this will be a game that won’t be marked as a trap game, the kind of game that is an expected win. However, we all have to “Trust the Process” and trust I will!

Sunday was one of those games that while the depth that has been lacking in past seasons was there, the talent and cohesiveness was not. The team continues to stay relatively healthy, not losing anyone to season ending injuries. Notable injuries to the Bills are CB Leonard Johnson who left with a hamstring injury in the first half and did not return. However, the focus of today’s article is TE Charles Clay’s left knee injury sustained after catching a pass and getting hit in the knee going out of bounds towards the end of the first quarter. This resulted in Clay ending his day early and getting carted off the field.

Anytime someone sees an elite player go down with a knee or leg injury, they automatically think ACL tear. Why do we think that? Because the ACL is the sexy injury that the media loves to talk about. Everyone knows its serious, everyone knows its season ending, and it’s all over the news constantly. As you begin to hyperventilate or start cursing the Bills, R-E-L-A-X. Clay did get injured, it didn’t look pretty, and the results aren’t great. If you care to continue reading, I will help you step back from the edge and explain what really happened.

Based on reports, Charles Clay sprained his MCL, tore his meniscus, and will be out for an extended time with surgery to fix the meniscus. Most people know that if the ACL is bad, then the MCL must be bad as well. It is but it isn’t. The knee is comprised of many different structures including but not limited to: bones of the knee: femur, tibia, patella; ligaments including: medial collateral ligament, anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament; soft tissue includes cartilage and medial/lateral meniscus.

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Credit: webmd.com

The MCL runs on the inside portion of the knee connecting the femur to the tibia. The MCL allows for stabilization medially and along with the LCL, prevents the knee from going east/west and ensures that knee works as a hinge joint. When the MCL is sprained, the ligament is stretched and partially torn as with any other sprain. However, the MCL is more dynamic in that it connects into several muscles in the knee including the vastus medialis, sartorius, semimembranosus, semitendiosus, and gracillis. The MCL also attacks to the posteromedial portion of the medial meniscus. To simplify it, at various points, the MCL connects to parts of the quadriceps, hamstrings, adductor muscles, and part of the meniscus. Without these many connections, the knee would be far less stable and would not be able to change direction suddenly.

Despite a fantastic design by nature, design only allows for so much prevention. The MCL typically gets injured during sudden changes in movement such as cutting and pivoting. The MCL also becomes damaged during direct blows to the outside part of the knee during knee flexion, which is what occurred with Clay when a low tackle hit him out of bounds.

The MCL severity grades are broken down into 3 grades with the increasing grade indicate level of severity. Level 1 consists of some fibers torn with tenderness and no instability. There is some pain during application of force to the outside of the bent knee, but nothing else significant.

Grade 2 consists of increased pain and more noted swelling. There is moderate tenderness and laxity in the joint. Most of the pain is on the inside of the knee and patients typically poorly tolerate laxity testing to the MCL. There are varying degrees of a grade 2 sprain including 2- and 2+ depending on amount of damage.

Grade 3 is a complete rupture of the MCL, leading to instability along with extreme pain and swelling, resulting in difficulty with bending the knee. The knee also gives away during a valgus force which is when pressure is applied to the outside of the knee. Surgery is usually indicated as the ligament has been totally torn from the bone.

Credit: http://kingbrand.com/MCL-Injury-Information.php

Based on video of the play and difficulty with placing weight through the leg afterward, this indicates that he may have suffered a partial tear, possibly a Grade 2+. This is supported by the fact that he did not have surgery to repair the MCL itself.

To add insult to injury, Clay also tore his lateral meniscus. The meniscus acts as the shock absorber in the knee and helps with keeping the knee healthy during movement. Unfortunately, part of the lateral meniscus became torn during the hit. This likely occurred due to the direct blow along with the knee bent and planted on the ground, leading to twisting of the knee, resulting in a partial tear. Presentation of a partial tear involves pain, catching, and clicking during knee movement. While research has been proven that a nonsurgical approach can be just as effective as surgery to trim down the meniscus, this is the NFL and there is no wait and see approach. The procedure that Clay had today is called a meniscectomy which involved cutting out the frayed piece of meniscus and shaving down the area to smooth it over to ensure that more pieces do not fray off.

Reports indicate that Clay will be out at least a month, possibly indefinitely. I believe that he will be out closer to 6-8 weeks. The meniscus is something that could keep him out 2-3 weeks; the problem is the MCL. The body will need to heal and restore proper range of motion to the knee while regaining strength. There are therapeutic interventions that can encourage healing, but the body still has to do its job. Professionally, I would say place him on IR with designation to return. This gives him a guaranteed 8 weeks to heal up and return to full form. This would also allow the team to bring in another TE and not use up a valuable roster spot. This would place him on track for the Colts game in December. Considering the Bills have two games against Miami and one against New England after that, it would be an excellent time to come back healthy.

My final thoughts on Clay is that he has had several years of reported knee issues, of which I wrote about during the preseason. From observation during practice, I believe he had most of the issues on the left knee, of which he injured Sunday. However, this injury is independent from his previous issues. He was not at a higher risk for this injury as the result of the previous problems. If anything, this may help take care of the other issues by giving him time to rest.

The Bills are certainly hurting from this one. Clay has been a consistent producer and a favorite target of Tyrod Taylor. Clay should be back later this season, but whether his return will make a difference remains to be seen. I still believe that this season we have more depth than in previous years, but having depth just is not the same as the starters. That was evident in the secondary and linebackers on Sunday. Thankfully, the bye week could have not come at a better time. I still believe the Bills have a shot to stay competitive this season with how the rest of the AFC is playing this season. The Bills still control their destiny, Charles Clay injury will not define the season.

Continue to check back for further updates regarding new injuries and posts designed to educate my fellow Bills fans and keep you from the edge. Thank you and GO BILLS!!