Time to Learn

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

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

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

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

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

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 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!!!

Week 2 Injury Breakdown- Panthers

Breaking down the Bills injury report for Week 2 against the Panthers.

Going into Week 2, the Bills continue to look healthy as they travel down to North Carolina to battle McDermott/Beane’s former employer, the Carolina Panthers. While the Bills are not immune to injuries, they still continue to look better than other teams around the league injury wise, losing no big pieces such as the Chiefs and Jaguars did last week.

Breaking down the injury report, DT Jerel Worthy is still out with a concussion from the preseason game against the Lions on 8/31. As he is not practicing, he is still most likely in the early stages of the concussion protocol, most likely on Level 2-3 at best. To refresh, he may be cleared to begin light aerobic activity with watching game film and participating in team meetings. He may also be cleared for lifting and increasing intensity with aerobic activity. Considering he has not been moved to IR with designation to return, it appears as though he is continuing to recover and may be ready by Week 3-4. The fact that he has not recovered as quickly as Tyrod Taylor did indicates that it may be a more severe concussion; also consider positional demands. Though he is not a starting player, he is crucial for depth and can continue to provide effective play in place of the starters.

Those limited in practice are as follows: S Colt Anderson (foot), CB Leonard Johnson (quad) and LB Tanner Vallejo (knee). Thankfully, none of these players are starters, but for a team to be successful, they must have depth. Colt Anderson has rarely seen the field since joining the Bills last year. He has been described as a special teams ace, but has yet to show his array of skills so far. Considering that he has not been outright waived yet, this indicates that the team will continue to wait for his recovery. As for what is ailing him, professionally, I have been unable to truly assess as there is no film or detailed description of injury on him. Leonard Johnson is listed with a quad; due to the position and demands, possibly could be a quad contusion, which is typically known as a deep bruise. This would limit running forward/backwards and prevent planting effectively to perform coverage duties in the secondary. Finally, Tanner Vallejo is listed as a knee and continues to be limited. Early in the preseason, Vallejo sustained a shoulder injury which knocked him out for several preseason games. It is unknown when Vallejo sustained his knee injury, but it was reported that he had a knee scope which indicates that he may have had fraying of the meniscus or a loose body, causing pain and discomfort. As a knee scope is a surgical procedure, as minimal as it is, will still require rehab and rest. He will have to ensure that his knee does not swell up frequently and can adjust to game time activity. Regardless, this is not a good start to Vallejo’s rookie campaign.

Those cleared for full practice were as follows: TE Charles Clay (shoulder), CB E.J. Gaines (shoulder), OT Cordy Glenn (foot), RB LeSean McCoy (wrist/groin), and FB Mike Tolbert (knee). In my previous article, Gaines and McCoy sustained injuries in the win over the Jets that knocked McCoy out briefly and knocked Gaines out for the game. Gaines’ injury was not reported to be serious and does not appear to have any long lasting effects. McCoy is worrisome as he is the force that drives the offense. McCoy stated after the game that he did not injure his wrist severely, but that it went numb briefly during the previous run into the end zone. It has also been reported later that he is dealing with a groin injury that was most likely sustained in practice. While he is a full participant, this is still something that must be watched due to requiring the groin to be ready for bursts and cutting, moves especially crucial to any running back.

Other injuries including Glenn, Tolbert, and Clay do not appear to be serious. While Glenn continues to have issues with his foot, it appears to now be different from the ankle injuries he dealt with at the beginning of training camp. There is not much information regarding the exact ailment; he is able to play, splitting time with Dion Dawkins to keep both lineman fresh and healthy. Clay and Tolbert did not appear to be removed from the Jets game for injury, possibly indicating that they are banged up due to the physical nature of the game. As practice is important, rest is more important. Teams under the current CBA are allowed 14 padded practices during the first 11 weeks of the season and coaches are not required to use all of them. I believe that McDermott will limit padded practices and provide maintenance days for veterans, focusing on proper play calling, technique, and keeping everyone healthy to maintain depth.

The Bills certainly have a winnable game later today. Cam Newton is coming off a rotator cuff tear repair which should not limit him physically, but the rust was evident in Week 1. Add in the fact that McDermott knows the nuances of the Carolina defense and personnel, expect to see the Bills to exploit those weaknesses. Continue to look for updates after the game with injury review, analysis around the league of significant injuries, and any other big news. Thank you for your time and Go Bills!

Charles Clay’s Longstanding Knee Problem

Assessing Charles Clay longstanding knee complaints and identifying the root cause of the problem

Injury wise, things are slow right now at One Bills Drive and I couldn’t be happier!! If you read my last post, you were able to see that the Buffalo Bills have so far been very fortunate keeping the injuries to a minimum. Jury is still out on whether it is the practice habits of Sean McDermott and company or if the football gods have mercy on all that is Buffalo. If the fans have to suffer through 2 preseason losses with 10+ penalties a game or a star player going down with a season ending injury, I’ll gladly take the former. As there have been no serious injuries to report, I have been able to look at nagging injuries such as Cordy Glenn and recoveries such as Reggie Ragland. Today’s post will evaluate TE Charles Clay knee complaints.

Charles Clay was drafted by the Miami Dolphins in the 6th round of the 2011 NFL draft out of Tulsa. Clay spent four productive years in Miami, after which time, during the 2015 off season, signed a five-year, $38 million contract with the Bills to add a new dimension to the passing game. Going into his 3rd year with the Bills, Clay has managed to play 27 of a 32 possible games for the Bills, bringing in 105 receptions for 1,060 yards and 7 TD’s. However, since Clay has come to Buffalo, the games and practices that he has missed have been due to knee complaints.

The fact that Clay only misses practice and occasional games immediately eliminates the possible serious injuries such as fractures and ligament tears. This allows creates the possibility of chronic conditions leaving several to consider. Sports Injury Predictor lists all of Clay’s significant injury history and Fox Sports lists when he has been on the weekly injury report. Most of his injury history consists of his knee along with occasional back, hamstring, and calf injuries. Knowing what is published from media reports, this is a chronic condition. Reports from various sources that can be found from ESPN, The Phins Insider, and Palm Beach Post all indicate that this has been an ongoing issue, that there have been complications, but never identify the exact injury.

Diving into the differential diagnosis of the possible complaint, there are several options. I have already ruled out serious ligament damage or fractures. There are other possible diagnosis that do not warrant consideration at this time due to unlikelihood or rarity. This leaves 3 potential diagnosis to consider: Osteoarthritis, meniscal injury, or knee bursitis. Osteoarthritis, known generally as arthritis, is a degenerative condition in where the ends of the joint are covered in a smooth material called articular cartilage. This material is found on the ends of every freely moving joint surface in the body. Over time, this cartilage can wear down due to injury and poor management/healing. Studies have been performed demonstrating that consistent exercise and proper injury recovery over time can help keep these joint surfaces healthy. This supports why not everyone requires knee replacements once they hit a certain age. In addition, my clinical experiences have shown that arthritic knees do not swell up rapidly and often, especially at Clay’s young age. Unfortunately, this may be an expected outcome once Clay’s playing days are completed. He may already have some degenerative changes, but I can say with strong certainty that this is not the source of Clay’s complaints.

Another diagnosis that is a strong consideration is meniscal injury. This diagnosis is possible due to his known surgical history from 2012 to repair a torn meniscus which sent him to the IR while with the Dolphins. The meniscus acts as a shock absorber in the knee, helps disperse weight between the femur and tibia, and maintain structural integrity during movement. However, a repaired meniscus typically would not cause chronic issues for 4+ years in my professional experience. Clay did have an arthroscopic surgery during the 2014 off season to clean out his knee which most likely cleaned out any loose bodies or shaving down the meniscus due to fraying. He was cleared to practice shortly after, but then began experiencing further complications limiting his practice during the preseason. However, if he were to have a meniscal tear or fraying, the surgery would have corrected it and would not continue to have chronic issues.

This leaves knee bursitis as the reasonable diagnosis. Bursitis is a condition in where the bursa in the joint becomes inflamed. Bursa are fluid filled pockets in the joint that secrete a fluid known as synovial fluid which helps keep the joint lubricated and reduce the friction between joints. Think of the effects of motor oil in an engine. Sometimes, when a separate injury occurs, the bursa in the injured joint can become inflamed as a result. Returning back to practice sooner than expected could add extra stress to the joint and cause swelling. Direct blows to the knee can also cause the bursa to become inflamed, such as falling directly on the knee or striking it against a helmet/body part. There are multiple bursa around the knee resides that could be damaged. Surgery could be performed to remove the offending bursa, but this may cause the player to miss more time than expected and is rarely performed. This can be a chronic condition that takes some time to resolve.

I believe this is the appropriate diagnosis due to this supporting articles from ESPN and The Buffalo News. This indicates that it is knee bursitis due to repeated swelling and drainage, the lack of immediate concern, and his ability to play most games despite the current complaints. At worst, it is an annoyance which can cause pain, swelling, and keep Clay from producing on the field. If you would like additional information on knee bursitis, you can find them here, here, and here.

Having been to Bills preseason practice along with observing game film and pictures, Clay has not been seen wearing a bulky brace, indicating possible joint instability. Instead, he is seen wearing a neoprene sleeve, allowing for compression of the joint and reducing the possible incidence of recurring swelling during strenuous activity. Clay’s production has not been significantly slowed compared to others at his position. Considering the amount of money that Clay is paid, it is the public expectations that he produces at a greater output. It would also be beneficial if Tyrod Taylor were able to improve his passing abilities, but that’s a discussion better left to my friends at The Rockpile Report.

Considering that Clay hasn’t missed any games yet this preseason and has only been slowed at practice, this is not a cause for concern. However, the team must continue to effectively manage the knee so as not to exacerbate it and cause further complications. He may be dealing with something that is not aware to anyone but him, the coaches, and his doctors which if known, could drastically alter my thought process and discussion. I believe that Clay will be able to perform at a consistent level this season, occasionally requiring down time to ensure that he does not create further damage to the knee.