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.

knee.jpg
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!!

Week 5 Injury Breakdown- Bengals

Assessing the latest injuries prior to the showdown with the Cincinnati Bengals and how it affects depth.

The injury list continues to grow for the Buffalo Bills heading into the Week 5 match up against the Cincinnati Bengals. While the only notable players that are sure to be out are LB Ramon Humber and WR Jordan Matthews, there are still many others that are dealing with injuries. Most of these injuries appear to be players getting banged up due to the rigors of the NFL season.

Today’s article will review most everyone that has appeared on the injury list this week and attempt to determine the true severity of each player’s injury. Staring off with players who have not been limited in practice with injuries are as follows: RB LeSean McCoy (wrist), RB Mike Tolbert (thumb), and DT Jerel Worthy (thumb). It was observed that Mike Tolbert injured his hand at the end of the 3rd quarter which led to a fumble that Buffalo recovered. It is unknown how Jerel Worthy injured his thumb, but it was injured enough to appear on the injury report. Both players most likely sustained sprained thumbs which will affect play, but with proper management which may consist of taping for stability or even a wrist brace to reduce risk for further re-injury.

McCoy continues to appear weekly on the injury report due to a nagging wrist injury sustained in the season opener. While he continues to be a full participant, it does worry me that he continues to re-injure this wrist. He has been observed leaving each game briefly due to wrist pain after running the ball. He appears to jam it while cradling the ball, leading to pain and possible weakness. He could tape the wrist or wear a brace, but this limits the ability to cradle the football and effectively block. I expect him to miss some time during the game due to wrist re-injury, but the upcoming bye week may allow him to get the rest he requires to prevent worsening of the injury.

Those limited in practice were WR Kaelin Clay (back), DT Marcell Dareus (ankle), CB E.J. Gaines (groin), OT Cordy Glenn (foot/ankle), RB Taiwan Jones (knee), CB Shareece Wright (back), DE Eddie Yarbrough (thigh), DT Kyle Williams (thumb), S Micah Hyde (knee), and DE Shaq Lawson (groin). Glenn continues to deal with his chronic foot/ankle injuries and Dareus is still recovering from his sprained ankle, which is consistent with this type of injury. Lawson injured his groin last week in practice and missed the Atlanta game.

Kyle Williams thumb injury may be similar to Jerel Worthy’s injury in that it may have been sprained due to the hand fighting that a defensive lineman performs during each play, getting the thumb hyperextended or caught. Williams is tough as nails and won’t let something like this slow him down. Shareece Wright and Kaelin Clay’s back injuries are injuries that not much information is available. This may be something that occurred during practice or something that is nagging. Considering that the spine is made up of bones, ligaments, and tendon attachments, it is quite possible they pulled a muscle, over rotated, or extended; causing pain and difficulty during tackling, running, and changing direction.

Eddie Yarbrough and Taiwan Jones also have little information regarding the nature of their injuries. These may be just contusions and limit the ability to go full speed, but do not concern me about underlying issues. Yarbrough continues to be a diamond in the rough, playing exceptionally well and Jones handles kickoff duties, which affect more game play rather than another body on the sidelines.

Finally, E.J. Gaines and Micah Hyde are questionable along with Cordy Glenn and Shareece Wright. As mentioned last article, Gaines’ groin severity is unknown at this moment, the team may take the approach that they did with Lawson last week and see how he feels going into the game, shutting him down if things don’t feel right. Micah Hyde is dealing with a knee injury that was not noted until Thursday afternoon. It was initially reported that he was dealing with general soreness which has since been narrowed down to a knee issue. This may be as simple as a sprain which he needs to rehab correctly or it may be something worse that the team wants to see how it responds before taking further action. Without video, it is impossible to speculate what specific injury may be ailing him. Losing Hyde going into the Bengals game will be a huge loss in the secondary considering the offensive weapons the Bengals have and several injuries already in the Buffalo secondary.

If this game were to be a non-conference opponent, I expect more players to be out include the above mentioned Glenn, Hyde, Wright, and Gaines. As the Bills would benefit from winning every game, it is more important to win the conference games if it comes down to tiebreakers at the end for playoff seeding. Excluding Gaines, I expect all the players listed above to play. Some of these players may see a limited snap count such as Dareus did last week. It remains to be seen if his snap count is limited secondary to discipline or whether they want to ensure that the ankle heals correctly. I am in favor of limiting snap counts in order to get the best players on the field.

I believe this game is winnable with the way the defense is playing, simple as that. How things play out with the questionable players, along with Ramon Humber’s and Jordan Matthews’ replacements will dictate the quality of play. McDermott and Beane have constantly been addressing depth and finding the type of players that fit their schemes, which in turn should reduce the drop off in quality of play dealing with replacement players.

Continue to check back for injury updates after the game and break down roster depth, injuries heading into the bye, and any injury highlights from around the league. Thank you for reading and GO BILLS!!

Week 4 Recap- Falcons

Breaking down the Bills latest injuries including thumb fractures, surgical approaches, and long term outlook.

This is a Bills team that continues to impress so far into the 2017 season. The defense is looking better than ever, Tyrod Taylor is moving the ball well, and serious injuries continue to be at a minimum. The Bills pulled out a solid win against the defending NFC champions, winning 23-17. These Bills look good, but I am not getting my hopes up yet. This happened in 2008 and 2011, both of which became lost seasons.

Unfortunately, with a hard nose win, comes some tough injuries which does affect how the next few weeks play out. A total of 4 players went out with some significant injuries that some will miss extended time. LB Ramon Humber and WR Jordan Matthews are out with broken thumbs, also known as the first metacarpal, the portion of the thumb that is highlighted as the broken area in the picture. Reports indicate that both will have surgery with Matthews requiring a pin to hold the fracture in place. There are not reports that Humber will require the same technique which may indicate a different type of fracture which may affect healing time.

fr_metacIllustration 1: Credit: http://www.mdguidelines.com/fracture-metacarpal-bones

While there are multiple ways to break a thumb and various ways the bone can break, the surgical options are fairly straight forward. For Matthews’, he will require a pin or “K-wire” which is inserted into the bone to hold it in place while it heals, which typically takes 3 weeks until it can be pulled out. A small piece of the wire sticks out of the skin and is protected to reduce infection. This is called a Bennett’s type approach. He may require this surgery due to a portion of the bone that has become fractured and requires stabilization to ensure proper healing.

Humber’s surgery may take the approach known as a Rolando’s type approach due to the nature of the break. Humber may have had several small breaks in the first metacarpal requiring a surgical approach to bring together all the various pieces together using a plate and screws to secure the area while it heals. Considering that the surgical area will be sewed shut, it is possible to have a cast placed over the area and continue playing. To better understand the difference between the thumb surgeries, please check out this link. While it does have basic drawings, it is the best resource that makes understanding the differences easily.

Next up is S Colt Anderson with a broken forearm. Any of my readers, please tell me what the Bills see in this guy? He continually gets hurt and I personally fail to see the value in him being on the roster. However, he suffered a broken forearm and has since been placed on IR. Typically, an injury such as this is sustained due to a direct blow to the arm such as during blocking or hitting the arm against a helmet. It is unknown which bone he broke in his arm, but he will require surgery which typically places a rod and screws to stabilize the area to ensure that it heals properly.

Finally, E.J. Gaines suffered a pulled groin on a hard tackle after changing direction in the 4th quarter and left the game. As of now, it is unknown how severe the injury is, but if it is similar to Shaq Lawson’s injury, then he should recover well. He was able to walk off on his own power and did not need any immediate attention which may indicate a mild strain. To understand further what the groin is and how it affects the football player, check out this article.

Expect to see Gaines at worst miss the next game, but considering he has more time than Lawson to recover, it’s possible for him to play in some fashion Sunday. Depending on the severity of the Humber fracture, he could come back after the bye and play in a cast while he continues to heal. Matthews on the other hand, makes his money using his hands and will require a longer recovery time because of this and the nature of the surgery. He will come back at some point during the season, but I wouldn’t expect him to come back until the Saints game on November 12th. This will give him at least 4 weeks to recover and then with the Jets playing the Bills on Thursday night, no sense in rushing him back and gives him an extra week to recover.

To make up for these losses, the Bills signed WR Philly Brown, S Trae Elston, and S Shamarko Thomas, moving S Colt Anderson to IR and releasing S Robert Blanton and DE Eric Lee. The Bills continue to make moves to keep the depth at a premium and sign players who know the system, allowing for a smaller learning curve.

Continue to check back for updates and any new injuries. These Bills may be real, let’s see how real they can get! Go Bills!!

Lawson’s Gimpy Groin

Assessing Shaq Lawson’s latest injury and impact for Sunday’s showdown against the Atlanta Falcons.

It was reported that Shaq Lawson injured his groin in practice Thursday and is now a game time decision for Sunday against Atlanta. Lawson has been on a tear this season in limited action, totaling 10 tackles, 2 sacks, nearly equaling his output from last year. He has begun to live up to draft expectations coming out of Clemson in 2016 and is a reason why the Bills defense has returned to top form this season.

As Lawson is a game time decision on Sunday, it would be better to understand what a groin injury is and how it affects his play. The groin is a series of muscles that attach from the lower hip in the hip crease to the inside portion of the thigh. These muscles assist in bringing the leg to midline, flexing the hip up, and internally/externally rotating the hip. These actions are vital to the actions of the defensive end with regards to shuffling, running, and pivoting. This is typically seen when trying to run down a player or having to stop suddenly. This can also be seen during eccentric contraction of the adductors which is seen during blocking and shuffling along the line.

groin_injuries.jpgIllustration 1: Credit: physioworks.com.au

Lawson reports that his groin is sore and that he will be alright. Despite a positive outlook from Lawson, it is still beneficial to understand how the groin is injured. Typically, the groin muscles are injured when the individual is sprinting or changing directions quickly. As this is a soft tissue injury, there are various grades that the muscle strain can be broken down into to assess severity based on location and mechanism of injury.

Grade 1 involves an injury to the area due to overloading the area, causing microtears and weakening the anchor point, causing pain and inflammation. This is usually a week-to-week injury and if rehabbed properly, should not be an issue long term. The injury typically is seen more in the muscle belly, which is the meaty portion of the muscle. Pain may be felt in the inner thigh or in the groin itself if the muscle is overloaded.

Grade 2 involves a partial tear to the muscle belly or attachment point leading to an inability to walk normally, much less perform the duties of the position. This injury takes longer, anywhere from 4-8 weeks based on severity and must be managed conservatively. Typically, injuries closer to the attachment points can become more chronic and lead to extended time missed. This is due to the nature of the muscle having to pull on the anchor in order to function properly. If the anchor point is not secure, pain and ineffective use of the muscle continue to occur.

Grade 3 typically involves tearing of the attachments closer to the femur, which is known as the distal insertion points. Commonly, the muscle is torn partially or fully away from the bone, leading to surgical intervention. These type of injuries do not happen often, but as with any muscle injury, can occur.

It is not known what caused Lawson’s injury, but it is certainly significant enough to cause him to be a game time decision. I believe that Lawson’s groin injury is a Grade 1, supported by the remark that it is sore and that he will be alright. An athlete knows his body best and barring any re-injury during warm ups, should play Sunday. There is always the risk to increase the severity by playing through, but with proper stretching and warm ups, along with the continued limited snap count, Lawson should be fine. Considering that Lawson has been playing up to the level we expected when drafted, it will be beneficial to have him pressuring Matt Ryan and the Falcons offense. This is a winnable game if the Bills play to the level they did last week against a very good Broncos team. Continue to check back for updates and further analysis regarding Bills injuries, GO BILLS!!

Week 3 Recap- Broncos

Analyzing the Buffalo Bills injury report following the Week 3 win over the Denver Broncos.

The Buffalo Bills stole a crucial win from the Denver Broncos on Sunday, winning 26-16 during possibly the hottest game ever in Buffalo. The Bills played a solid game despite some parts of the first half that were sloppy. Tyrod Taylor pulled it together and moved the ball well, giving up no interceptions, fumbles, or making any poor choices. I do not believe he is the long term starter for this team, but he is what will work for now until Nathan Peterman develops or the Bills draft a QB next year.

Breaking down this week’s Buffalo Bill’s injury report, well, there’s not much to go over. Sunday’s game showed the first time in recent memory where a player did not go down with injury for either side. As I was at the insanely hot game Sunday, I did not have the vantage points that I normally have on TV. One Bills player did get assessed by training staff but was able to walk off on their own power. This indicates that either they were possibly dealing with cramping or got banged up. Considering the heat Sunday, cramping is the likely culprit.

There are not any new additions to the Bills injury report with many subtractions from last week. Finding their way off the injury report is S Colt Anderson, TE Charles Clay, DE Shaq Lawson, WR Kaelin Clay, LB Deon Lacey, LB Matt Milano, and TE Nick O’Leary. All of these players were dealing with a variety of complaints that do not appear to be long term issues. One note that I would like to make is Shaq Lawson. It was reported that he was dealing with a nerve contusion last week which affected his foot. As I thought previously, it did not affect his overall play with 1 solo tackle, 1 tackle for loss, 1 sack, and 1 QB hit. While he did not light up the box score in previous games, he still played in 60% of the snaps, which is in line with the other defensive starters. I do not expect that this injury will reappear again this season.

Those currently on the injury report include LB Lorenzo Alexander and DT Kyle Williams due to rest. Two veterans that give it their all every Sunday, they benefit more from rest than practice. Next up is LeSean McCoy with a wrist injury. This is 3 weeks now that he has been dealing with a wrist injury sustained in the home opener when diving into the end zone. He may be dealing with a mild wrist sprain that the team wants to ensure that does not get worse. I do not believe that this injury is any worse or is part of something larger at this time.

A positive sign for this week is that DT Jerel Worthy is listed as a full participant in practice. This is a huge step forward from the past several weeks. If you recall, Worthy sustained a significant concussion in the preseason finale against the Lions. Considering that he is a full participant indicates that he is in Stage 5 of the concussion protocol. This means that barring any recurrence of symptoms over the next several days, he should be cleared to return to play against the Falcons on Sunday. This is supported by the Bills roster cut of DT Deandre Coleman, signed last week.

DT Marcell Dareus and OT Cordy Glenn have made themselves comfy on the report this week. Dareus was listed as a limited participant. Considering there was video of him last week in an air cast performing upper body work indicates that he continues to deal with a mild lateral ankle sprain. If this injury was significant, he would not have been doing activities in standing and may have had a walking boot, creating more stability. Expect him to play Sunday and shut down the potent Falcons running game.

Finally, OT Cordy Glenn continues to deal with foot/ankle injuries. As I have said before, I continue to maintain that he has instability within the ankle/foot region due to repeatedly spraining the areas. Are these injuries that he could play through if this were the playoffs, quite possibly. However, it is still early in the season and Dion Dawkins held his own against the talented Broncos D-line. I expect the training staff to continue to bring Glenn along slowly to ensure that the O-line has the depth required to get through the season.

I still believe that McDermott is rotating through players more frequently to reduce overuse injuries and keep the integrity of the roster intact. As the season continues on, I will continue to address injuries that occur plus outline any injuries that can become common or chronic. Once again, thank you for reading and look for further updates, GO BILLS!!

Week 3 Injury Breakdown- Broncos

Analyzing the Buffalo Bills injury report for Week 3.

Week 3 is upon us! As we head into the match up at home against the Denver Broncos, I will review the team injury report and breakdown expectations for the players on the report. Unfortunately, the Bills injury report will continue to grow through the season. However, most injuries so far have consisted of minor problems that if managed correctly, will not become a problem long term.

Getting several of the names out of the way early are LB Lorenzo Alexander, RB LeSean McCoy, and DT Jerel Worthy. I address these players first because they are not serious issues or have already been addressed. Alexander is on the list due to rest, McCoy due to his wrist which does not appear to be a serious injury as he was listed as a full participant. Finally, Worthy is still in the league concussion protocol and still not practicing, which likely means he is still having symptoms during regular aerobic activities.

Those carrying over from last weeks injury report are S Colt Anderson, TE Charles Clay, and OT Cordy Glenn. Colt Anderson continues to deal with a foot injury and continues to somehow be on the roster. Clay was on last week due to shoulder complaints; this week is knee, which continues to be a long term issue year after year. Glenn reappears on the list due to re-aggravation of the foot/ankle area.

New to the injury report are DE Shaq Lawson, WR Kaelin Clay, DT Marcell Dareus, LB Deon Lacey, LB Matt Milano, and TE Nick O’Leary. Kaelin Cray is dealing with a foot injury, yet not much is known about the current injury. Clay did suffer a broken foot last year during training camp with the Ravens. He was eventually cut in November from injured reserve and essentially sat out last season. Hopefully, this is not something that will keep him out for long. Deon Lacey, Matt Milano, and Nick O’Leary are all dealing with hamstring injuries which can continue to be tricky due to the demands of their specific positions. Lawson’s injury was detailed greatly in my last post and should not affect him for long term. To note, all were full participants on Friday which indicate that they will most likely play Sunday.

It was reported today that both Cordy Glenn and Marcell Dareus will not play Sunday due to the previously reported injuries. I had initially thought that Dareus’ injury was not major due to the fact that he returned to the game against the Panthers. He most likely sustained a sprained ankle and the team is possibly being cautious to ensure that he will be available later this season. With Dareus ruled out, the Bills signed DeAndre Coleman to the roster. Coleman was in training camp and during the offseason, released during cut down day. Considering that Jerel Worthy and Dareus is out, depth will be crucial to place pressure on the Denver offense and contain the run game.

With Cordy Glenn ruled out of the game Sunday, expect Dion Dawkins and Ryan Groy to see increased playing time. This will be the first true test for Dawkins, which I believe he will step up and fill in, demonstrating why the Bills picked him in the 2nd round. As for what Glenn is dealing with, possibly a foot sprain leading to further instability and pain. There are reports that he has issues with both feet/ankles, but unable to confirm each individual issue as that kind of detail typically isn’t released. At this point, I say keep him out until he is ready to play. I have outlined my thoughts on Glenn in the past, I still maintain that the previous issues are contributing towards this current one.

While missing Glenn and Dareus in the lineup, the depth is finally there to deal with these losses. All of the players except Worthy, Dareus, and Glenn practiced in full on Friday which leads me to believe that most of them will either be ready to play for Sunday or have their snap counts limited. Please continue to ask questions, leave comments, and educate yourself on Buffalo Bills injuries. I continue to be open to ideas and will address injuries that require further explanation. Once again, thank you for your time and GO BILLS!!!

Contusion Confusion

Understanding Shaq Lawson’s nerve contusion including what it means and long term effects.

Shaq Lawson has a nerve contusion. You’re probably thinking, what is a nerve contusion and is this another crazy Bills injury? You’re also thinking, when did this occur and how will this affect him the rest of the season? During today’s post, I will help understand what happened, how it occurs, and long term effects.

First off, let’s break down a contusion. A contusion is some type of injury or blow to an area which can cause restrictions in movement or sensation. Basically a big bruise. However, a typical bruise to the area would cause a black and blue discoloration mark due to superficial blood vessels being disrupted and broken. This can cause pain during touch, muscle/joint movement, and limited mobility. In the case of Shaq, he sustained a nerve contusion, which is more specific.

A nerve contusion is a injury which can cause disruption to the conduction of the nerve. In a case like this, an injury to the area would cause numbness, pain, and weakness. This would present as a pins and needles feeling, significant pain immediately after the injury, and possible partial or temporary loss of control of the muscle that it innervates. Due to recent reports stating that Lawson sustained a nerve contusion of the leg allows me to deduct that he injured the peroneal nerve.

The peroneal nerve branches off the sciatic nerve that branches off the spinal cord. This branch of the nerve innervates the muscles of the lower leg including the anterior tibialis and extensor hallucis/digitorum longus. These, along other muscles, assist in lifting the foot up and in which is known as dorsiflexion and inversion. These muscles are vital for running, cutting, planting; basically everything that Lawson would need to perform during game day.

An injury like this would occur when the outside of the leg gets hit hard during a play such as a tackle or when a body falls on the area. The nerve runs down around the fibula which is the outer bone that makes up part of the outside of the ankle. This area is more associated with high ankle sprains such as what Odell Beckham is recovering from at the moment. While it is listed on the Bills injury report as a foot, this is the area that is being affected via the nerve, hence the designation.

Final question, how will this impact him for the long term outlook? Professionally, I don’t believe that this will be a long term issue, pending unknown severity. I expect him to possibly be limited over the next several days as the nerve continues to heal and will be a possibility to play against the Broncos. He may miss the next game if he has more damage that initially reported. The Bills have done fantastic with managing injuries thus far and I expect this trend to continue.

Thankfully, this injury was not more severe. To understand how severe it could have been, please direct your attention to the Dallas Cowboys roster and find LB Jaylon Smith. As most fans know, Jaylon Smith wrecked his knee and nearly his NFL career in his last college game, tearing his ACL/LCL and causing extensive damage to his peroneal nerve which cost him his entire first season in the NFL. In severe cases such as this, foot drop will occur. Foot drop is seen more commonly in older individuals who have suffered a stroke. These individuals will be fitted with an AFO or ankle foot orthosis which locks or assists the ankle into neutral/slight dorsiflexion allowing the foot to swing through during walking and preventing the foot from dragging. Thankfully, Smith has recovered to be the Cowboys leading tackler, but took nearly 18 months to even have the chance at playing.

While spinal cord injuries do not heal, peripheral nerve injuries can and do heal, with varying levels of success. To keep it simple, the nerve can have 3 stages of injury which impacts healing. The first stage is damage to the outer covering of the nerve which typically heals on its own. The second stage of nerve injury is where the outer covering becomes totally damaged and has disrupted regular nerve function. The final stage of nerve injury is total disruption and severance of the connection. In Lawson’s case, I can comfortably state that he suffered a stage one injury. Jaylon Smith sustained a stage 3 and his recovery was so long due to the nerve having to regenerate which can occur at a rate of 1-5 mm/day based on the size of the nerve. The fact that Smith has returned to such a high level of play is incredible in itself. The fact that Lawson escaped with a relatively minor injury is lucky.

I expect Lawson to continue building off his rookie season and increasing his level of play to be the disruptive defensive end that he was in college. I will continue to update with any changes or new information that occurs. Look for future articles to analyze the Bills injury report for Week 3 and identify any new complaints that require further breakdown. Go Bills!