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!!

Eric Wood’s Neck Injury

Analyzing the neck injury that forced Eric Wood to retire and long term implications.

Disappointing news coming out of One Bills Drive Friday with the sudden announcement of C Eric Wood retiring from the NFL after nearly a decade. The cause of his retirement appears to be related to neck issues that were discovered during a routine end of season physical intended to assess issues players made need to address in the off season.

This determination was made by Dr. Cappuccino, who is the orthopedic spine surgeon, along with other doctors and team officials. For the 9th year pro’s long term health, it was ruled that retirement was best to avoid further damage. As detailed information has finally been released, it has been revealed that Wood is dealing with a bulging disc in the C2-C3 region following stinger’s during Week’s 5 & 6. Today’s post will identify why this is career ending and long term implications.

While it is incredibly disheartening hearing this news, I believe all fans would want the health of each and every player to be most important. To identify what occurred with Wood, the anatomy of the area must be understood. The cervical region of the neck is comprised of 7 cervical vertebrae that stack on each other which curve in concave fashion to allow for support of the head in an upright position. In between these vertebrae, with the exception of the first two levels, cervical discs act as as shock absorbers and allow for the vertebrae to articulate with each other in order to move freely. Ligaments attach the vertebrae together for support and passing through the vertebrae are arteries, the spinal cord, and nerves. Eric Wood suffered a disc bulge at C2-C3, the first disc after the C1-C2 junction. To help put this all in perspective, please refer to the pictures below.

05-2_Cervical_Vertebrae.jpg
Credit: backpain-guide.com

One of the issues that Eric Wood may have been dealing with that was described as wear and tear is cervical spondylosis. This occurs when the structural integrity of the vertebrae column becomes compromised and leads to instability within the region. This is is due to the cervical discs losing disc height which in turn reduce the space between, leading to laxity on the ligaments, causing further pressure on the discs. This can be the result of the aging process, trauma, or individuals that have to carry heavy loads on their head or shoulders. As a possible result of this condition, he stated he suffered a “stinger” in Week’s 5 & 6 and was evaluated without further treatment required. As cervical spondylosis progresses, this can cause other issues including degenerative disc disease, spinal stenosis, hypertrophy of the surrounding ligaments, subluxation of the vertebrae, along with both neural & vascular compression.

ds00697_im02193_mcdc_7_spondylosisthu_jpg.jpg
Credit: mayoclinic.com

As a result of the disc bulging out, this can create spinal stenosis. In the case of cervical spinal stenosis, the vertebral foramen, or space in which the spinal cord passes through, becomes narrowed. In the case of Wood, repeated trauma/progressive disc protrusion is what led to his disc pressing on his spinal cord as seen below. Other causes that could occur include ventral spondylophyte formation, thickening of the ligamentum flavum, or hypertrophy of the dorsal facets. While all these are confusing terms, these are all structures that surround the spinal cord that could reduce space and compress on the spinal cord as you place the head into various positions. To put this into a simpler perspective, imagine squeezing a hose; as you tighten or bend the hose, the flow of the water decreases. If the spinal cord is compressed, certain head movements can increase pain and limit mobility, placing even greater pressure on the spinal cord. This could affect areas below the spinal cord level or the nerve roots that branch off to the extremities. With compression over time, this could lead to temporary or irreversible damage based on severity.

cervical_stenosis_cause02.jpg
Credit: http://www.houstonmethodist.org

This is something that Wood was aware of after Week 5 and appeared to manage up to this point. However, incidence of previous spondylosis could cause and progress the stenosis.  As the veteran center has never appeared on the injury report with a neck injury during his career, this doesn’t mean that he never had neck pain. This is evident with the report of the stingers that was resolved which lead to his omission on the injury report.

Following the stinger, there are variations in the presentation of symptoms based on severity. One of the concerning but manageable issues include cervical radiculopathy. This is where the nerve is compressed either at the neck or a later exit point down the nerve’s path. This compression could cause pain, tingling, numbness, and weakness to travel down specific nerves in the shoulder or arm. This is common to see in the general population, but far from a pleasant sensation. Several of these symptoms are more prevalent in the lower cervical vertebrae.

In Wood’s specific presentation, occipital headaches, often typical of migraine, with pain radiating to the eyes and behind the ears, blurring of vision, dizziness and nausea especially when attempting to lie down, numbness of the side of the neck, tension and “knots” in the neck and shoulder muscles, and swelling and stiffness of the fingers. He may have had several of these symptoms following the stinger which warranted further evaluation.

If Wood would have continued playing and ignored medical advice, he would be at risk of  developing cervical myelopathy as this is more severe in that actual damage to the spinal cord has occurred. This presents as bowel and bladder issues appear along with difficulty walking, coordination, and loss of strength, among other symptoms. Typically, those are emergency related symptoms and must be dealt with immediately. If Wood were to keep playing, he would be at higher risk to have this occur with the violent nature of the hits and further degeneration of the affected areas. The C2-C3 area is more severe as nerve roots branch off which affect head movement and assist in controlling breathing. Further damage to the area could include paralysis and/or death if not addressed immediately.

While all this does sound ominous, there are many options for conservative care. Physical therapy, chiropractics, and pain management including injections can manage the complaints for years. Primary focus on the area would to educate the patient on the condition and awareness of possible worsening symptoms. Other interventions include managing and reduce pain, maintain motion and strength in the area, and prevent further decline in the area. Personally, I have worked with a variety of patients with similar complaints with a variety of outcomes. Some have been able to resolve their complaints completely, some have significantly reduced their pain and have a strong understanding how to prevent further complications. Others have gone on to receive injections and surgery which in turn has improved their quality of life. Fortunately, through his decision to step away from the game of football, Eric Wood will not likely be bed bound and in a neck brace for the rest of his life. He will instead be able to participate in activities including exercise, avoiding strenuous, repetitive activities such as football and heavy weightlifting, and focus on raising his newborn son.

If Wood is to require surgery in the future, there are a variety of surgical procedures that can help to stabilize the affected area. This includes but is not limited to: spinal fusion surgeries and/or anterior cervical discectomy.  These procedures stabilize and partially remove the offending area to reduce pressure on the spinal cord. Right now, he may not require any surgery, instead altering activities to reduce further damage. If surgery is indicated, this will help with quality of life but would not allow him to safely return to football.

Severity of the neck complaints that are forcing Wood to retire early at least leaves him in good hands with Dr. Andrew Cappuccino.  If you recall, Dr. Cappuccino is best known for saving TE Kevin Everett‘s life during the season opener in 2007. To put into comparison how severe this Wood’s injury is, S Aaron Williams had similar issues with his neck in a lower level that were well documented, ending his career. It appeared that he was willing to continue playing, but teams knowing his medical history would not touch him for fear that the next big hit may kill him. Wood was not willing to take that risk and able to end on a high note with a playoff berth.

The next big question is who steps up and replaces him. Ryan Groy appears to be a natural fit as he can play multiple positions on the line and may be a stop gap until the Bills find their next player in the draft or free agency. I believe the Bills will address this position effectively as they have with other positions this past season. It is a shame that this occurred to such a great player, but, as many before Eric Wood have proven, time is the one opponent that no one can defeat.

I hope that you learned something today and helps put into perspective why Eric Wood is forced to end his career. Continue to check back with me on updates regarding Bills injury news! Thank you for reading and GO BILLS!!

Week 10 Recap- Saints

Assessing the latest injuries including Jerry Hughes’ shin injury and what exactly happened with Saints RB Daniel Lasco’s spine injury.

The Buffalo Bills know how to keep this fan base on their toes and not in a good way. After putting up a stinker of a game against the Jets on prime time, the Bills followed up with a complete throttling at home by the New Orleans Saints by a score of 47-10. As a fan, I saw nothing good come out of this game. The offensive line didn’t look as porous as the Jets game, but still could not provide effective protection for Tyrod Taylor to make effective throws or move the ball. The entire offense looked out of sorts even with all the weapons that Tyrod had at his disposal. This was not a good game and if more is said on this topic, it will not be pretty.

Thankfully, this forum is not designed for my two cents on how the Bills play. I always leave the X’s and O’s to my friends at The Rockpile Report. Give them a listen; by far the most thorough and honest analysis of our beloved Buffalo Bills. However, the goal of today is to discuss the Buffalo Bills injuries sustained after Sunday’s drubbing.

Thankfully, the Bills continue to avoid the major season changing injuries that many other teams have sustained this season. The only injury that has been reported so far is DE Jerry Hughes. His injury was sustained at the end of the 1st half in which he injured his shin. He was observed warming up on the sidelines but did not return. It is unknown whether he was unable to return or was sat out as the game was out of reach at that point.

From my standpoint, there isn’t much that Jerry Hughes could have injured in his shin. The shin (tibia) is part of the lower leg which is the bone that makes up part of the knee and the ankle. While there are a multitude of muscle attachments that connect to the area to assist in knee and ankle movement, the shin itself doesn’t have a lot of possibility for injury. I believe that he may have suffered a contusion to the skin/tissue over the bone which made it painful to run. As mentioned above, the muscles do attach to the tibia which when moved, does pull on their attachment points, which could pull on the painful tissue.

Hughes also may have sustained an injury to his tibialis anterior which assists the foot in lifting up (dorsiflexion) and moving inward (inversion). This muscle is the meaty portion of the front and outside portion of the shin. A contusion to the muscle belly could make running painful and prevent effective pivoting, especially with the demands of his position. Either way, these aren’t injuries that keep most players down for long and Hughes is known for his durability during his career.

However, I will state that Hughes did not sustain a fracture. I do not believe this to be the case as he would have had imaging performed and ruled out if there was any possibility. He would have also had a definitive diagnosis today and most likely expected to miss several weeks if that were the case.

The only serious injury that occurred Sunday was to Saints RB Daniel Lasco on a kickoff return. Lasco hit his head directly into the hip of WR Brandon Tate and dropped immediately. It appeared initially as though he was not moving which brought back immediate thoughts of Kevin Everett 10 years ago. Thankfully, his injury was nowhere as severe but is season ending. It was determined today that he has a disc bulge in his neck and will most likely require surgery to correct the issue.

To give a better understanding to what happened, it helps to understand the anatomy in the area. The spine is comprised of bones called vertebrae which stack upon one another and allow the human body to stay upright and distribute the weight of the head and the trunk effectively. These bones allow the spinal cord to pass through it and act as a cage for the spinal cord and allow the nerves to branch off into all areas of the body. This allows for the nerves to provide input to move each muscle and allow various sensations to be felt. In between each vertebrae is a vertebral disc which acts as a shock absorber, allow for fluid movement between the vertebrae, and acts as spacer to prevent pinching of the nerves.

When Lasco’s head directly collided with Tate’s hip, it compressed the vertebrae on each other so much that it bulged or herniated one of these discs in the neck (cervical). This most likely began pushing on the spinal cord or a spinal nerve, causing radicular or traveling pain down the nerve. This is typically seen as weakness, numbness, and pain in the affected area. If you were able to see Lasco being loaded into the ambulance, he was able to raise his right arm, but it did not appear to be a strong, confident motion typically seen in the movies.

In a majority of non-sport cases, these types of injuries can be effectively managed non-operatively through physical therapy, chiropractics, injections, etc. However, due to the nature of the injury as it was quite traumatic and the impact football has on the body, that may not provide the best long term options, especially if he wants to return to football. He may get a cervical discectomy and fusion to the affected area in which the herniated portion of the disc is partially or totally removed and the vertebrae above and below the area are fused together to eliminate movement and further pressure on the nerves. He is able to return to football without any long term issues, but repeated injuries to the neck may impact his long term career prospects. This is why former Bills player S Aaron Williams found his career ending prematurely due to similar injuries.

As mentioned above, while the Bills played poorly, injuries are not being added to the insult and the Bills are not losing players to injured reserve. I would still want a tired but overall healthy starter out there in Week 15 fighting for a playoff spot rather than the backup just trying to hang on and not able to provide the same level of play. The Bills are banged up right now but should have some key players return in the coming weeks.

Continue to check back for further updates including analysis of the Bills injury report come Wednesday and when more information is known. As always, thank you for reading, follow me on Twitter at @kyletrimble88 for the latest updates and GO BILLS!!