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.

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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.

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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!!

McCarron’s Buffaloed Clavicle

Detailing the confusion behind why A.J. McCarron was initially diagnosed with a fracture but found to have later not have one.

It’s been several frustrating days for both the Buffalo Bills and QB A.J. McCarron. First, McCarron has a less than stellar performance against the Cleveland Browns which alone appeared to place his job in question. Then to add injury to insult, he suffered a shoulder injury that was initially reported as a hairline fracture in his clavicle. The original timetable for McCarron would have been 4-6 weeks, leaving him possibly without a job by the time he was healthy. However, McCarron sought out a second opinion and was recently reexamined to find that he did not suffer any breaks in his collarbone and that he has essentially a shoulder contusion. Today’s post will identify what the clavicle is, it’s function, and possibly why there was so much confusion regarding the original injury.

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Credit: humanbodyanatomy.co

The clavicle is a bone in the chest region that acts as a strut as part of a framework that makes up the shoulder girdle. It connects the scapula or shoulder blade via the acromion to the sternum or breastbone and allows the scapula to move freely on the back for proper arm movement. During motion, it rotates up and out of the way so that the shoulder can move without restriction. The clavicle also protects nerves and blood vessels that pass through to the shoulder to the arm. Finally, the clavicle also acts as an attachment point for several muscles in the chest and neck region including the pectoralis major, the sternocleidomastoid, deltoid, and trapezius muscles.

It is usually injured during a fall on an outstretched arm or shoulder or a direct blow as the clavicle is compressed between the sternum and shoulder on impact. The injury appears to be a direct blow to McCarron’s shoulder according to video. The clavicle is the most common bone to break in the body and we have seen NFL quarterbacks that have suffered this injury at the hands of a hungry defensive end. Based on the mechanism of injury described above, these types of injuries occur as the quarterback is driven onto the shoulder during a tackle. We have seen this befall QB Tony Romo and QB Aaron Rodgers in previous seasons. The mechanism for injury appeared to be similar for McCarron when he had the entirety of DE Myles Garrett come down on him. Interestingly, McCarron was able to finish the series despite appearing to fall onto his right shoulder, which is his throwing arm.

It was revealed after the game that McCarron allegedly suffered a hairline fracture by Buffalo News writer Vic Carruci. While this initial injury prognosis was grim, it did not deter McCarron as he sought out a second opinion. As he is fighting for a roster spot and starting job, he needed to be absolutely sure he was unable to play. Fortunately, he was found that he did not suffer a fracture and that he would be able to return to practice very soon. The big question is, why the change?

After doing some reading and asking some questions to other medical providers who deal with imaging far more often than I do in my line of work, I found some possibilities. There was thought that if he found another doctor to evaluate, they could give the green light to play despite a small fracture. It was also possible that the imaging could have been misread. As the saying goes, a picture is worth a thousand words, imaging can be interpreted differently by various medical professionals, especially when there is possibly swelling in the area which could occlude a proper view. It is worth noting that the clavicle is one of the last bones in the human body to fully ossify, or harden. This does not usually occur until ages 21-25. As McCarron is only 27, it is possible that someone saw a fused growth plate and mistook that for a fracture or the results were inconclusive but the source that reported the injury may have took inconclusive as close enough and ran with it.

Thankfully, X-rays are not the only imaging that we have to diagnose fractures. We have CT scans, MRI’s, bone scans, etc. at our disposal to help identify exactly what we cannot see. As described to me, the method for determining imaging need is known as ALARA: As low as reasonably achievable. This means that whatever they are looking for, they will use the cheapest, most efficient means possible to get the results, but move up in diagnostic imaging in order to find the problem if inconclusive. In certain cases, there may be limited options available as CT and X-ray’s use radiation and MRI’s use magnetics to view the structures inside the body. There may be contraindications that would prevent a patient from getting one type of image but be appropriate for another.

As to what method the second opinion used to identify that he did not have a fracture will probably not be revealed. However, now knowing this, McCarron will only miss several days of practice. This comes down to the injury being reclassified as a contusion. I have detailed contusions in previous articles and it is really up to McCarron when he is ready. From the original injury, my best guess is missing a week at most as he will push to get back to practicing but his major limitation will be pain. Unfortunately, with pain, it can affect function. So we may see some less zip on his throw or less reps as he works his way back into practice. After Friday’s game, he may be relegated to backup but he will still compete until he is told otherwise.

This is certainly a blow to McCarron’s starting chances but this does allow him to fight for a roster spot instead of finding a job elsewhere. He does provide a veteran presence that each team looks to have especially with younger players on the roster. I do not foresee McCarron having any long term issues following this injury.

Continue to follow for the latest updates and news coming out of One Bills Drive. Special thanks go out to @GAPeachpolymer, @Frosini_thomas, and @FischerWilliamsPhoto for their specific knowledge on imaging for injuries, I could not have completed this article without you! Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, http://www.bangedupbills.com and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

Preseason Injury Review- Browns

Analyzing the latest injuries following the preseason win over the Browns including AJ McCarron, Kyle Williams, and Cory Carter.

The Bills got their first win of the preseason with a decisive 19-17 win over the Cleveland Browns Friday night. While we saw some good things including the continued emergence of RB Marcus Murphy and darts thrown by QB Josh Allen show that there is some talent on this team and should be a force to reckon with this coming season. However, with all the good also comes the bad. The Bills have been relatively healthy over the course of this preseason, getting some bumps and bruises along the way but avoiding serious injury. Unfortunately, the Bills luck ran out Friday night on the shores of Lake Erie. Today’s post will review injuries sustained Friday and what this means going forward.

Prior to the game, DE Trent Murphy and WR Brandon Reilly were ruled out prior to the game with groin and rib injuries respectively. Hopefully both will be able to return to full health very soon and bolster depth going forward. The biggest injuries sustained Friday night with regards to name recognition were QB AJ McCarron and DT Kyle Williams. The former Alabama QB came from Cincinnati in the off season and was expected to compete for the starting job. Regrettably, McCarron reportedly sustained a hairline fracture in his collarbone towards the end of the 1st quarter.

The play that McCarron potentially suffered his collarbone fracture seemed pretty innocuous. He was tackled hard with most of his weight coming down onto his right shoulder but was able to finish the series. He did not appear to have any initial discomfort or favoring the injured area. Reports do not state which collarbone he fractured but my guess is the right side which is his throwing arm. However, after today’s press conference, there is question regarding the severity of the injury as McCarron is getting a second opinion which may change his availability. Once we have confirmation one way or another, I will be able to elaborate more.

DT Kyle Williams suffered what appeared to be a season ending injury early in the 2nd quarter. This occurred when he was getting blocked and a Browns offensive player fell into his right leg and he went down immediately in pain. The initial fear when a knee is bent like that with an outside force on the knee is an ACL tear. Thankfully, he avoided the dreaded injury and only sustained a MCL tear. The MCL is the ligament on the inside of the knee and is a commonly injured ligament during knee sprains. It appears as though Williams suffered a Grade 2 sprain which should heal on its own and will not require surgery.

Had Williams foot been planted in the ground when he got hit, he would have most likely torn his ACL and ended his final season. This is an injury that will take 4-6 weeks to heal which means he should be able to come back for Week 4 against the Packers. If things go well, Week 2 against the Chargers. As he is older, he will most likely be on the slower side of this timeline and lets face it, Kyle Williams is a national treasure when it comes to Bills fans. Training staff will not rush him back to the field unless he is truly ready to play. Once he returns, he should have no performance issues with the exception of some pain/swelling initially after playing.

One player who was hit hard by the injury bug was P Cory Carter who suffered a torn ACL after a collision late in the 3rd quarter. His plant leg was fully extended as he came down and the Browns defender rolled into his leg, preventing him from landing safely, causing his knee to hyper extend and tear the ACL on the second small hop in the above posted video. Prior to this injury, reports were coming out that he was having a solid camp and really challenging for the starting position. I have detailed ACL tears in a previous article, please check it out. Carter will be out for the entire year. I wish him the best of luck in his recovery. To note, this is the first ACL tear for the Bills since TE Chris Gragg tore in the preseason in 2016.

Another player that has had a very strong camp and warrants a roster spot is TE Jason Croom. The WR turned TE injured what appeared to be his left ankle on a punt return play the next play after Carter was injured. On the play, Croom went downfield and changed direction quickly to tackle the punt returner and LB Tanner Vallejo attempted to do the same thing, missed, and rolled into Croom’s ankle. He was able to walk off under his own power with a noticeable limp and was done for the night. It appeared as though he may have a low ankle sprain at worst. However, he was able to practice today according to reports which is something to watch for as the week progresses.

Others injured Friday include S Siran Neal, CB Taron Johnson, and OT De’Ondre Wesley. Neal was injured after a hard tackle and appeared to have the wind knocked out of him but was able to return later in the game. Johnson suffered a crackback block at the hands of WR Jarvis Landry who infamously ended the career of former Bills S Aaron Williams, thankfully no long term issues. Finally, OT De’Ondre Wesley appeared to tweak his ankle and came off the field but was able to return. I don’t see anything that warrants further concern. Also today, S Kelcie McCray was not practicing but film did not reveal any injuries at first glance.

Finally, QB Nathan Peterman appeared to sustain an injury in the last series of the game. Upon review, he took a low tackle which appeared to hit his knee but when he came up, he was hopping on his right leg and favoring his left. He was able to walk it off and finish the series but when he kneeled down to run out the clock, he did a reverse lunge and appeared to stumble backwards. It appeared as though he injured his left ankle. He may have twisted/tweaked it but as he was practicing today, it does not appear to be serious. Further reports will be made available if this becomes a problem.

Overall, the Bills escaped Cleveland without major losses.  They also have 9 days before their next game against the Cincinnati Bengals. Unfortunately, there are two more preseason games which mean two more possibilities for players to get hurt before the regular season. While all injuries cannot be prevented, preventative measures such as exercises/practice and limiting playing time appear to be the only way for now.

Continue to check back for the latest updates and injury analysis as the season progresses. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills, online www.bangedupbills.com and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

Groin Pains for Murphy

Exploring why Trent Murphy’s groin injury isn’t healed yet & what this means for the rest of preseason.

As the local media continues to find story lines to report on, injuries are always an easy topic to report because it usually affects the quality of play on the field for that particular game and can affect the season as a whole. New Bills DE Trent Murphy is no exception. As detailed in past posts, he is coming off an ACL tear that caused him to miss the entire 2017 season. Unfortunately, Murphy has not been able to show off the talents that scored him a new contract due to a groin strain suffered a week into training camp. Today’s post will explore why Murphy is slowed with his groin and how it’ll affect him the rest of the preseason.

Previous posts have explored muscle strains including severity and general healing times. Murphy’s groin is no exception. The groin muscles are also known as adductor muscles. They attach from the pubic region of the hips and go down to the inside portion of the femur or thigh bones. These muscles allow the leg to adduct/cross midline and medially/laterally the femur rotate based on hip position. They also assist with hip flexion; all of these motions assist with running/cutting/juking motions required of football players.

We know that Murphy tore his left ACL last year and has worked steadily back into athletic shape. As for his groin injury, regrettably, I have unable to find which side of his groin he has injured as media reports do not specify. Overall, this won’t really affect recovery time but may shed light on how his body is compensating following the surgery. It’s possible that both sides are injured but we are unsure. He wasn’t able to really participate in OTA’s due to his recovery from the ACL surgery. Since then, he has been cleared for full practice but is still attempting to overcome a full year of restricted activity due to rehab. Normal population may have an ACL reconstruction and not deal with injuries with returning to sport, but as a high level athlete in the case of Murphy, small deficits can become bigger detriments as he asks the most out of his body. Despite being functionally strong enough for football, his body is still relearning the proprioceptive movements required for the position and this is most likely the reason why he is suffering other injuries because the hips/groin and ankle are having to compensate for the knee as he regains his football abilities. A quick refresher, proprioception is the ability to understand where your body is in space in relation to movement. Think of your leg like a chain in which each link is the ankle, knee, and hip. If there is a weak link in the chain, it will break. Same thing can happen in people, if one joint is injured or weak, others begin compensating and may cause further injury.

What does this mean for Murphy going forward? I believe he will eventually be able to play without restrictions by the time the regular season starts. It appears as though he initially suffered a Grade 1 strain which can take anywhere from 1-2 weeks to heal after injury, with some taking up to 3 weeks. This is supported by the fact that he first reportedly sustained the injury August 1st, which is 2 weeks ago today. As stated above, it normally takes 1-2 weeks to heal under normal circumstances. I believe Murphy felt as he was able to return to practice after a week, re-injured going full speed and will require further rest. He will probably need another 1-2 weeks max to fully recover. While teams do want their athletes to heal fully, re-injuries still occur. The big question is whether that timeline for recovery restarted or this is a minor setback. I personally believe this is a minor setback but allows other guys including DE Shaq Lawson to get more looks and earn their way onto the roster.

He will most certainly miss the Browns game, should be able to play against the Bengals game if practice goes well, and ideally have no issues and be available for the Bears game. There is a possibility this could linger all season, but considering this is the preseason, the Bills will allow for extra rest time over return to play.

I expect Murphy to start against the Ravens on opening day. I’m going to also state that this won’t be an issue that lingers all season. I also believe that Murphy may have a slow start to the season and come on later in the second half as his body re-acclimates to football. I may be totally wrong on everything as this is only speculation, but this is highly educated speculation. However, I fully believe Murphy should be ready to go soon.

Continue to check back for the latest updates on the latest injury news and updates. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills, online at www.bangedupbills.com, 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.

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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. 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.

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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, 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!!

Preseason Injury Review- Panthers

Reviewing the injuries sustained during the loss to the Carolina Panthers.

Football is back! The Bills opened the 2018 season with a preseason tilt against the Carolina Panthers with an unfavorable outcome in a 28-23 loss. Overall, it appeared as though the Bills played pretty well despite the loss with the QB competition beginning to parse itself out. Today’s post will review the injuries sustained in the Panthers game and what these mean going forward. Thankfully, the Bills didn’t suffer any season ending injuries and move onto next week against the Browns with a healthy roster.

Prior to the game WR Zay Jones, WR Corey Coleman, WR Cam Phillips, LB Corey Thompson, and DE Trent Murphy were all ruled out prior to the game. Jones did not play as he is still recovering from off-season knee surgery and while he is medically cleared, he is not quite ready to participate in full contact football. I expect that he should be ready next week against the Browns once he gets in better shape. It was reported that he was participating in 11-on-11 drills today at practice.

Coleman was ruled out due to his recent trade and inability to learn the offense quickly enough to participate. Prior to the acquisition, it was reported that he was having a strong training camp after initially being slowed up with a hamstring injury. It was not disclosed what Thompson is dealing with and no further information has been revealed since then. Phillips is still dealing with a groin injury sustained late last week in practice and is most likely what is still affecting his availability.

Finally, Murphy has been dealing what appears to be a Grade 1 groin strain. He has been limited in practice over the past week and the team is not willing to let their new DE injure himself further after coming back from an ACL tear which wiped out his entire 2017 season. Expect Murphy to play against the Browns barring any setback.

Following the loss, several players along the defensive line were reported injured which may affect their availability next week. First up is DT Star Lotulelei who suffered a back/neck injury. While I do not have video to fully assess the specifics, I can speculate that he may have sustained a trapezius injury. The trapezius muscle is a large muscle that covers the upper back and neck which provides support to the arms and shoulders which in turn assist in raising the arms. It also assists in extending the neck and adduction of the scapula which allows a person to pinch their shoulder blades together.Trapezius.jpg

I suspect a trapezius injury due to the fact that the muscle covers such a large area, it connects from the head down to middle of the back as seen above and the nature of the injury falls in line with his positional duties. He may have sustained a neck injury which is affecting his upper back with movement. Typically, violent twisting or collisions cause trapezius injuries which could explain the back/neck designation due to the location. Either way, it was reportedly not severe which may limit his practice availability but should be able to play next week.

DT John Hughes suffered a groin injury and while there is not video, it appears to be a Grade 1 strain according to the team. He may ideally need a week off similar to what DE Trent Murphy is going through but Hughes may not have the opportunity to rest as he has not exactly stood out in practice and is in danger of being cut. DT Marquavius Lewis also suffered an ankle injury which may appear to be a mild lateral ankle sprain. This is something that Lewis should be able to play through with some rest and rehab along with taping to support the area.

Finally, WR Brandon Reilly suffered a rib injury as reported. Rib injuries are typically more painful limitations than functional issues. As it was reported not serious, it may be bruised ribs which will require rest and extra padding but could resolve over the next week with no long lasting issues.

Fortunately, the Bills did not suffer any major injuries unlike the Redskins and Colts who suffered ACL tears in their respective games last night. The Bills continue to manage their injuries effectively and have been fortuitous in maintaining their depth players. Expect to see all these players be available for next week against the Browns with continued limited participation from starters.

Continue to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, and at www.bangedupbills.com. Continue to look for new articles on common NFL injuries and the latest injury news. As always, thank you for reading 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!!