2020 Week 6 Bills Injury Review- Chiefs

How did Ford hurt himself & when is Milano coming back?

Primetime is not an ideal time for the Bills to play in the year 2020. Two primetime games, albeit, an altered schedule with the end result being two losses. To keep things in perspective, the Titans and Chiefs losses come at the hands of the AFC finalists from 2019 & the defending Super Bowl champions. 

Either way, a 4-2 record and first place in the division is still nothing to scoff at. On top of it, the Bills continue to trend towards getting healthier after appearing to regress towards the mean in regards to total injuries. They continue to avoid the season-ending variety of injuries and progressing towards getting healthy for the second half of the season. Below are the known injuries from Monday night. 

In game injuries:

G Cody Ford (knee)

Ford went down at the beginning of the 4th quarter with 14:36 left as the result of a right knee injury. Looking back at the film, Ford actually injures the knee on the 3rd down play just prior with a pile of bodies falling on top of him. He stayed in during the 4th down play and injured the knee further when he got rolled up on from behind, forcing his knee to the ground. He reportedly was able to walk off under his own power but required the cart to get to the locker room.

By video, it appears he suffered a right MCL sprain due to the mechanism of the injury & the Bills designated the injury as a knee. I had originally thought he could have suffered a high ankle sprain based on having his leg rolled upon. Having an MCL sprain is a far better outcome than a high ankle sprain. MCL sprains vary by severity and it may appear that he suffered a Grade 1-2 sprain due to his week-to-week designation by the team. These can take 2-4 weeks to recover based on the literature and falls in line with what we have seen termed as week-to-week. That designation may have been made considering his other injuries as well.

Credit: PTHealth.ca

This is an injury that isn’t all that concerning as these injuries heal up well and do not have lingering problems once healed. While Ford may only miss 1-3 games, I question whether he wouldn’t benefit from a short IR stay from a pure injury standpoint. This is despite him playing some of his best football over the past few weeks. This would help the team in two ways. 

This would allow Ford to address his groin, possible left shoulder/elbow injuries, and now right knee. This would also open the door for G Jon Feliciano to return to the active roster without having to outright cut someone. Expect Ford to miss the Jets game & possibly the Patriots game as well. 

LB Tyrel Dodson (hamstring)

Dodson left the game early in the 3rd quarter on the punt return with 10:37 left with what appears to be a right hamstring strain. He appears to injure the hamstring trying to slow down once the fair catch was called. He began walking to the sideline motioning to his right leg indicating something was wrong. His night ended as a result and he has also been deemed week-to-week. 

Credit: Orthoinfo.aaos.org

Considering this is a hamstring injury & we see how conservative the team is with management, he will probably miss at least the Jets game, possibly the Patriots game as well. We typically see these hamstring strains miss anywhere from 1-3 games based on previous management by the team.

The only upside to his injury is that LB Matt Milano will possibly be returning after a two-game absence which helps cushion the loss of Dodson as depth. 

CB Cam Lewis (left wrist)

Lewis had his night end early with a wrist injury midway through the 1st quarter. This was the result of a missed tackle on Chiefs RB Clyde Edwards-Helaire. It is not clear what he injured, but he came back out to the sidelines with a heavy wrap to the area, but ultimately did not return. 

It’s hard to say what he exactly injured because he attempted to tackle Edwards-Helaire, missing the tackle and getting swung past him. The left wrist hits Edwards-Helaire and then Lewis falls to the ground. Looking at other angles doesn’t suggest he did anything differently. I don’t have clear information about the exact injury. As the week progresses, we will see in practice his availability or bracing he may have on the wrist. Right now, this one is inconclusive.

WR John Brown (calf/knee)

Brown can’t seem to get out of his own way this season when it comes to injuries. He has been dealing with the foot sorenesss/injury, likely calf strains, and recent knee injury. His lack of production Monday night could also be tied to injury as he appeared to tweak something early in the game on a catch going out of bounds. He never quite looked right in his play and finished with 0 catches on 4 targets. 

It’s difficult to identify what he injured on film early on due to the sideline being in the way, but All-22 shows that he appears to strike his left knee while he was falling to the ground to catch the ball. He came up walking gingerly, appearing to favor his left leg, the same one he appeared to injure in practice prior to the Titans game.

Regardless of the injury, he simply is not performing up to his standard of play and satisfying the needs of the offense. It appears that Brown’s injuries are not severe enough to outright bench him, but he is clearly not the effective player that he was last year. He may have to continue to battle through these nagging injuries until he gets to the bye week for some much-needed rest.

Other injury observations 

 LB Tremaine Edmunds (right shoulder) & QB Josh Allen (left shoulder)

Both Edmunds & Allen both shed their respective shoulder braces at different times for Monday’s game which was an interesting decision. Edmunds shed the brace just prior to the game which is a good sign in his healing process. The team continues to acknowledge he is working through a shoulder injury, the fact that he has ditched the shoulder brace tells me that this injury is more of an AC joint sprain.

If he had torn his labrum, instability would still be present & the chance to partially dislocate or fully dislocate would still be there. I have no doubt it is still painful for Edmunds to play, but there are pain management strategies along with rehab available to help him as he continues to heal.

Allen removed the shoulder brace for the final drive of the game which ended in an interception. I’m not certain why he ditched the brace as I do believe there is some instability present in the shoulder due to the original injury. I have thought that Allen has been forced to change his throwing mechanics as a result of the injury the past two weeks, keeping his left arm closer to his chest during throwing which limits the ability to rotate the trunk. This is something I am going to continue to dig into and reflect back on as there is more data & film available. 

He may have shed the brace for the sheer fact that he wanted no restrictions in his ability to construct a game-winning drive. Allen did not come through in the clutch but he also avoided injury. It’s also important to note that he took more runs this game, but they appeared to be more designed runs, allowing him to follow his blockers & reduce the chances for an errant hit. This will be something to continue to assess as the season progresses. 

G Jon Feliciano (pectoral injury)

Feliciano continues to practice within his 21-day window to return to the active roster following his pectoral injury from July. He has until October 27th to become activated by the team or return to the IR for the season. Sean McDermott would not comment on whether he would be activating Feliciano due to not wanting to give the Jets any possible advantage in game planning. 

I see one of two scenarios play out. The team could activate him Saturday & cut someone in time for Sunday and he begins working back into the lineup. Or he misses Sunday’s game and is activated that Monday or Tuesday when the team has the possibility of putting someone on IR in his place like I had suggested earlier in the article with Ford.

Feliciano should come back & I had suggested a return date of the end of October in my Buffalo Rumblings article from August. The only way he doesn’t come back is if he had a setback, but nothing appears to be suggesting that. Look for the big man to play against the Jets or Patriots.

LB Matt Milano (left pectoral injury)

Milano has been sorely missed the past two weeks dealing with a pectoral injury sustained against the Raiders. He was questionable leading up to this game and there were hopes that he would play. But the research did not suggest it and unfortunately, it was accurate. Considering he was close to 50/50 on playing Monday, that opens the door to return in Week 7 against the Jets. 

We still have to see him practice in full this week, but considering he was limited with also a full practice in there indicates that he is progressing. A matchup against the NFL’s worst team could be a nice welcome back game for Milano as he gears up for the second half.

G Quinton Spain (foot soreness)

There still isn’t any new information on Spain’s foot soreness from Tuesday’s game. This is something to continue to monitor but not well-timed due to the fact that Cody Ford is dealing with his injuries. Hopefully, this foot soreness is mild and he can begin practicing more this week.

The team is getting healthier, the injuries they have sustained continue to be overall minor but have prevented the team from fielding an effective roster. A bounce-back game against the Jets is needed to move to 5-2 both in terms of confidence and health. The team will need both as the following 3 games against the Patriots, Seahawks, and upstart Cardinals are true tests if the Bills want to show that the first quarter of the season wasn’t a fluke. We will see what the rest of the week brings as the team prepares for Sunday against the New York Jets.

Top Photo Credit: Rochester First

2020 Week 5 Bills Injury Preview- Titans

Which of the questionable players will suit up?

Heading into Tuesday’s unusual matchup against the Tennessee Titans, the Bills are fairly beat up with injury designations already determined on Saturday afternoon. While the injury list looks dire, things actually aren’t all that bad. Check out the details below. Let’s hope this game gets played & put in the rearview mirror.

OUT

LB Matt Milano (Left pectoral)

Milano has since been ruled out for Tuesday’s contest which isn’t a surprise considering he did not practice all week.

Milano is coming off what appears to be a left pectoral strain. Based on the literature, it’s no surprise that he will be out for the short term. In my article at Buffalo Rumblings, I had detailed that he would be out at least 2 games and potentially more. The fact that he hasn’t been placed on IR also hints at the timeline the team thinks he may return sooner than later.

QUESTIONABLE

WR John Brown (Left knee)

Brown has been battling calf and foot problems all season, none of which have been serious enough to miss any time. Brown did appear to tweak something on the left side as shown in the video below.

Per the injury report, he is dealing with a knee injury now. While there is video of the injury, it’s hard to discern what he exactly did. In the video, he planted his left foot and pushed right before taking another step and then began hopping in pain.

He took several hard steps on his left leg to turn back to the right to catch the pass. His knee appeared to bow out on the next step, but it’s possible he could have tweaked the MCL or inside knee ligament on the prior step, felt it, took an uneven step which where we saw the bowing out, and then the final hopping off the field.

Credit: PTHealth.ca

If this injury was in isolation, I would say he’s alright to play especially with the few extra days off. But considering he’s dealing with foot & calf injuries, he may be best suited to take a week off. May come down to how he feels. This is one position where the team has healthy depth.

G Cody Ford (Groin/left shoulder)

Ford is battling a groin strain apparently suffered in the Raiders game. Sean McDermott did note that Ford was battling through some things during the Raiders game. I believe he was referring more to the left shoulder which could be anything at this point. There is nothing definitive on film & would need more information for a specific injury. There is a possibility that he’s dealing with a rotator cuff issue or labral injury due to the brace, but something to monitor.

As for the groin, also not sure when he injured it which makes it difficult to determine how it will affect him. The one upside is that playing on the interior part of the line; he will not have to use as much lateral movement or sprinting which can reduce strain on the area. If he doesn’t go, then G Quinton Spain would likely get the start.

RB Zack Moss (Toe)

Moss continues to be limited with a toe injury that appears to be turf toe. He was potentially able to play Sunday against the Raiders, but he ultimately did not suit up.

He has missed the last 2 games which fits in the timeline for a turf toe. The hope is that he returns for Tuesday’s game with a few extra days rest & is more of a factor than RB TJ Yeldon. Considering all the questionable players & that he practiced in full leads me to believe he will play.

LB Del’Shawn Phillips (Left quadriceps)

Phillips has returned to practice & began practicing in full which is an excellent sign for the special teams linebacker. He has missed the last 3 games following a quadriceps injury that appeared to be a strain by video.

I expect most of his playing time to be on special teams once again unless he is called upon to play on defense if injury occurs. I also expect that he will continue to be slowly worked back in as he acclimates to not playing football for nearly a month.

Update: Phillips has since been placed on IR. The team promoted LB Deon Lacey in his spot.

WR Andre Roberts (Ankle)

There is no information on Roberts other than he injured his ankle. Nothing on film indicates that he suffered an injury and nothing in the media reports indicate the type of injury he is dealing with. The fact that he hasn’t practiced all week isn’t a great sign either.

The only two instances I could find for a possible injury came in the 1st quarter. The first was a right end around where Roberts lost 3 yards when he was flipped upside down by S Johnathan Abram. The other, three plays later, when Roberts caught a 6 yard pass to the left and was taken down by CB Nevin Lawson.

He had his left ankle get clipped on the first tackle and on the second, he was twisted down. Hard to identify if this is when he hurt his ankle or what the exact injury could be.

This will be something to monitor as the season progresses.

CB Tre’Davious White (Back)

This has been a mystery. White played in every defensive snap on Sunday & has been fairly durable throughout this season & career. He has not practiced this past week & it’s not clear whether he is even at the facility.

Watching film from Week 4, he appears to move well around the field and is not labored or slow to get up. As this is a back injury, these are harder to identify the injuries as there is typically not bracing or specific movements that are limited by the injury.

More information would be needed in order to identify what he’s dealing with. I could list a bunch of injuries & conditions, but trying to identify this injury is like throwing a dart in the dark at the dart board. The only reason that he could possibly be questionable after not practicing is if it’s a pain related issue where the team is hoping that things can calm down before Tuesday. But even that doesn’t narrow things down.

I have heard severe people say that he got his money & is not playing as hard anymore or that he is attempting to opt out because of the COVID concerns with the Titans with the team saying he has a back injury. Sure, there’s always that possibility that he is phoning it in now that he got paid. If he was, then that was a poor decision by the team to sign him to an extension. If he is not trying anymore, that’s on him. I don’t believe the Bills want guys on the team like that. I personally don’t believe this to be the case.

The COVID concerns are real, but to have the team say he has a back injury in order to keep him away from the facility, that’s a stretch. They could list him with an injury, we do see guys on injury reports often every week and don’t appear to have anything wrong. If I recall, Tom Brady was notorious for that with his right shoulder.

But to fake an injury would go against the competitive balance & intention of the injury report. To use it to cover up for something else makes me think the NFL wouldn’t take too kindly to that.

Right now, I am going with the fact that he has a back injury, details are not available, and the hope is that it isn’t serious. If he doesn’t go, the team has CB Dane Jackson they can call up for depth.

G Brian Winters (Right knee)

Winters appeared to injure his right knee on the same play that Josh Allen injured his shoulder. He fell hard on the right knee and was labored upon getting up and trying to get back into the play.

It appears to be a generalized contusion, but considering he hasn’t practiced in the past week, there’s potential it could be other things. He could have injured the bursa which is a fluid filled sac that helps lubricate the joint. A direct blow to that could cause inflammation to the area, limiting range of motion.

There are other possible injuries that he could have suffered but without more information, hard to establish a timeline. Considering the team has a bevy of offensive lineman, he could afford to sit this week.

INJURED RESERVE

CB Levi Wallace (Left ankle)

This move was a possibility but not certain as low ankle sprains can be played through, depending on the severity. Unfortunately for Wallace, he appears to have suffered a Grade 2 low ankle sprain early against the Raiders. This is due to the fact that he was placed on IR on Wednesday which requires a 3 week stay indicating a timeline for severity.

Credit: Medium.com

According to this picture sent in by a fellow Twitter user, Wallace appears to be off crutches and the swelling in the left ankle looks minimal. However, there is still likely instability due to the ligaments getting stretched out from the injury.

What we also don’t see in this picture is if he is on crutches and he put them down for the picture. We also don’t see how much weight he is putting through his left foot. Both feet could be down but he could be leaning more to the right to off weight the leg. Whatever he’s doing, he can rest for the next 3 weeks now that CB Josh Norman has returned from IR.

ACTIVE

WR Cole Beasley (Left foot)

Beasley continues to battle with numerous injuries including previous injuries to his thumb and hip. After being limited in practice earlier this week, Beasley was a full participant which signifies that he is healthy enough to play. The extra days off will certainly help his foot to heal further which will allow him to make those cuts over the middle effectively and use his speed to work around the field.

QB Josh Allen (left shoulder)

Allen practiced in full every day despite the left shoulder designation from Sunday’s injury. The injury designation officially notes that he does have an injury and that it could affect his ability to play. The concern is that he has either an AC joint sprain, rotator cuff injury, or labral tear.

He did have a brace on for Wednesday’s practice and kinesiotape on for Thursday’s practice. The hope is that he has the AC joint sprain & it’ll heal on its own. My worry still remains that he had more damage in there as mentioned above. I would anticipate to see some bracing on for Tuesday regardless of the injury.

As the season progresses, the injury will become more clear if he takes further hits to the shoulder or if he continues to wear bracing.

Inactives:

LB Matt Milano
TE Lee Smith
G Brian Winters
QB Jake Fromm
RB TJ Yeldon

A bye week would be beneficial like it was last year at this time, but the Bills are not due for one for some time. These kinds of weeks will really test the depth at each position and the training staff’s ability to get each guy ready. It is important to note that a player may be active but may not get much play, only available for depth if needed. The team was forced to do this several times last year.

While the Titans are healthier as evidenced by the list below, they also have not had the ability to practice as a team in the last 2 weeks, unless you could the unauthorized practices after their facility closed. They also still have a number of players on the COVID reserve list.

Even if they’re healthier, I would be concerned about in-game injuries due to the sudden ramping back up of game play. I do not wish injury on anyone, but there is a greater risk. That along with not having the ability to fully implement their game plan may help be an equalizer in the game.

Remember, this is a team that was an AFC finalist last year. This team is no slouch. I would expect the Bills to win because I am biased and believe we have the better team. But if they lose, they are a worthy opponent. I’d like to see a win, but more importantly, minimal injuries as the Bills prepare for a short week against the Chiefs in Week 6 at home.

Top Photo Credit: Bleacher Report

2020 Week 4 Bills Injury Review- Raiders

Is Josh Allen going to be ok? What happened to Levi Wallace? How long will Matt Milano be out for?

The Bills are 4-0 for the first time since 2008 and the fanbase is buzzing! That was about the time I began to sink my teeth into what is now my full-fledged Bills fandom & totally embraced it. While the beginning of the season was fun, the later half clearly wasn’t. However, this 2020 team is something else! 4-0 including two wins over division opponents in the Dolphins & Jets and two more wins over playoff contenders in the Rams & Raiders. 

While it’s unrealistic to run the table to a Super Bowl, the Bills are showing they know how to win games that they are expected to win. There are still several games on the schedule that aren’t automatic & realistically, they will suffer some losses. But for now, the Bills are getting stacking wins as they continue to march forward in the season.

In light of the win, there were several injuries to note of varying concern. Below you will find my thoughts and expectations for each injury moving forward.

CB Levi Wallace (left ankle)

Wallace injured his ankle with 8:22 left in the first quarter with what appeared to be a calf/ankle injury. Upon review & just prior to falling to the turf, Wallace changed directions suddenly, going backwards in order to get the tipped ball. As he was going backwards, he rolled his ankle inward. That sudden weight through the rolled ankle likely worsened the severity of the ankle sprain observed on film. He was down on the ground in obvious pain and required assistance to get back up and off the field. Regrettably, he was unable to return.

Noted above, following the game, he was on crutches as Coach McDermott was giving his post game speech. From the video, it isn’t determined whether he had a boot on, but considering the possible severity of the sprain along with the crutches, it’s very likely he did. 

McDermott has since stated that he is week-to-week which translates out to several weeks missed. Grade 1 ankle sprains can usually be played through. Grade 2, which I believe is what Wallace has, is anywhere from 3-6 weeks. Considering they have not put him on IR yet, I believe he can come back after missing 2-3 games, barring setbacks.

They do have Josh Norman available and may be the only option until Wallace is ready to return. 

WR Cole Beasley (left foot)

Beasley suffered what he termed a foot sprain on his TD catch when he got flipped into the air before coming down hard for the score. As he came down, his left foot smashed into the turf.

This appears to be a generalized foot sprain, more specifically to the midfoot. He had it taped up and returned later in the game, at times labored. He’s a guy who could benefit from some time off but he’s a baller and he’s going to play. I expect him to be limited in practice or have a day off this week. Unless the foot gets much worse Tuesday & Wednesday, I expect that he’ll have it taped up for next Sunday.

QB Josh Allen (left shoulder)

Allen scared the entire NFL when he got tackled scrambling out of the pocket before getting taken down from behind, falling with his arm outstretched, hitting at the elbow then rolling onto his left side, grabbing at his non-throwing shoulder. 

There’s a lot to unpack with the injury so stick with me here. It initially appeared that he injured his hand due to shaking it out with noticeable discomfort. Due to the elbow striking the ground, he likely hit the ulnar nerve that runs on the medial portion of the elbow, aka, the funny bone. 

That would explain the hand component. When the elbow struck the ground, he immediately grabbed at the shoulder. There are several things that he could have injured with that fall including an AC joint sprain, rotator cuff, or labrum tear due to subluxation/dislocation.

I would take the above order of injury based on severity. Best case he could have injured his AC joint with the fall. He can wear a brace for a few weeks and have no lasting effects, especially considering this is his non-throwing shoulder. 

The rotator cuff could have been strained due to the elbow hitting the turf, jamming the humerus up into the acromion, causing injury. This injury would also take several weeks to recover from. Think QB Drew Lock of the Broncos from Week 2 below.

However, the worst and I feel is most likely is the labral tear due to a subluxation/dislocation. The elbow hitting the turf and forcing the arm up and into the shoulder socket could have forced the head of the humerus away from the labrum which helps deepen the socket for the shoulder to articulate.

Credit: https://link.springer.com/article/10.1007/s00167-015-3979-8

If this is the case, I see a scenario where he wears the brace the rest of the season as he rehabs in order to keep the shoulder strong and as stable as possible. My hope is that he subluxed the shoulder, it caused a small tear in the labrum that he plays through and then the team can evaluate if he needs to undergo surgery in the offseason. There is concern that he injures the shoulder further if he falls on it.

Check out Bears QB Mitch Trubisky’s shoulder injury from two years ago for similarities.

My biggest worry if he continues to sublux or dislocate the shoulder, leading to missed time. This could cause further damage to the labrum or a significant dislocation could lead to a brachial plexus injury which is the bundle of nerves that supply the arm for sensation and movement. This is less common, but still possible. A non-throwing shoulder injury isn’t as big of a deal, but if he takes further shots, this could take him out of games even temporarily.

As it’s not his throwing shoulder, the team will unlikely give any further information and we will have to read the tea leaves. 

RG Brian Winters (right knee)

Winters suffered what appears to be a right knee contusion on the same play that Josh Allen got injured on. He was engaging his block before getting shoved down way behind the line of scrimmage, falling directly onto his right knee. He was able to get back up & finish the play, but was laboring to get back towards the action. 

He was later ruled questionable with a right knee injury & did not return. This isn’t something that should linger outside of dealing with pain. He could have played through, but considering that the team has depth & still wants to get reps for all their guys, it was a smart move to avoid having him continue to play. This might show up on the injury report but it doesn’t appear to have lasting concerns.

LB Matt Milano (left pectoral)

Milano injured his left shoulder/pectoral area attempting to tackle RB Josh Jacobs near the line of scrimmage. As he went to wrap him up, Milano’s momentum kept him moving upfield as Jacobs began to run downfield. In the process, his left arm was pulled away by Jacobs running. Milano got up, having his left shoulder/pectoral muscle checked out by the team doctor on the sidelines.

This is the exact mechanism of injury for a pectoral tear, maximal eccentric contraction of the muscle, leading to overload and tearing. However, it does not appear that a full tear is the case. This appears to be more of a strain by how Milano responded and how quickly he fell to the ground, allowing the ground to stop some of his momentum. This could be an injury that he does miss some time for, but isn’t something that I expect to hinder him all season. 

He has since been termed as week-to-week, which isn’t promising. Most of the literature I found spoke more of the pectoral tendon rupture, exactly what G Jon Feliciano is recovering from. There are some resources that note that this strain could be a 2-6 week recovery.

Considering they’re not placing him on IR at the moment, this leads me to believe that he’ll be out 2-4 weeks. Not quite enough to be placed on IR but not a quick return. I will say he’ll miss probably 2 games which will put him on track to return for the Jets game. Unfortunately, that second game missed would line up with the Chiefs game which would be vital for him to be available. More information will have to be available in order to change my mind on the timeline.

Already this season we have seen Eagles DT Javon Hargrave miss almost 4 weeks with the injury before returning to play in Week 2. Raiders LB Nick Kwiatkoski missed 2 games with a pectoral injury and returned to play with bracing. So to put him on track to return after 2-3 games should be reasonable. Had he outright ruptured, this wouldn’t even be a discussion. This is highly unfortunate considering he already missed one game with a hamstring strain. This will be another injury he simply has to battle back from. 

S Jaquan Johnson (right lower leg)

Johnson continues to show why he is active every Sunday as a special teams contributor. He successfully recovered the onside kick that the Raiders attempted to try and recover to get one more shot at the end zone. During the recovery, he was kicked hard in the lateral lower leg area during the scramble for the recovery. That kick, along with at least a dozen grown men landing on him would make even the toughest of men hurt.

Like Winters, there will be pain, but outside of that, he should be alright for next week.

Other observations:

G Cody Ford (left shoulder)

Ford was noted wearing a brace on his left shoulder signifying some type of instability. This was first noticed by Erik Turner over at Cover 1.

Looking back at the Miami game, there wasn’t any apparent instance of an AC joint sprain or even a labral tear. You could make the case for some pectoral strain possibilities, but nothing was definitive and I would have expected he would miss some time.

I then also grew concerned for a labral tear. These are highly common in NFL lineman & something that can be played through. Finding that on film would be difficult due to repeated blocking with the arms extended & I’m not certain that he even suffered this during a game. He could have injured the shoulder at practice In between the Rams and Raiders game.

Like all the others, something to monitor. To note, he had surgery on the opposite shoulder last year but details were never made public on whether it was a labrum or rotator cuff. We are once again left to speculate. 

All these injuries, most of them aren’t things that could have been prevented with preseason. These are just unfortunate and the reality of the Bills returning to the mean in regards to injuries. None of these injuries are season ending and most can return to full health. Football is a physical sport, there are injuries, I am glad that we are not seeing season ending ones yet. Looking forward, the Bills move on to play the Titans in Week 5 as they continue to maintain control of the AFC East. 

Top Photo Credit: larrybrownsports.com

OT Cody Ford Injury Profile

#70 Cody Ford
Position: OT
Height/Weight: 6’3”/329 lbs.
Age: 23
College: Oklahoma
Year joined Bills: 2019
Acquired: 2nd round draft selection

College Injuries:

2016 Freshman year:

Broken left fibula, Week 3, required surgery, missed 9 games

2017 Sophomore year:

Undisclosed injury, missed 2 games.

2018 Junior year:

No publicly reported injuries.

Pro Injuries:

Concussion, Week 5, missed 0 games

Left elbow injury, possible UCL sprain, required bracing during rest of season, missed 0 games

Right shoulder injury requiring offseason surgery, possible labrum or rotator cuff, missed 0 games

2020 Bills:

Left shoulder issue, specifics unknown, began wearing a shoulder harness Week 3, possible labral tear.

Groin strain, Week 4, missed 0 games.

Right knee injury, Week 6, MCL sprain, missed 2 games.

Right ankle injury, Week 9, missed 1 game.

Torn meniscus, suffered in practice prior to Week 12, sent to IR, missed 6 games.

General links:

Broken fibula

Bills Offseason Injury Review

2020 Bills Injury Preview- Offensive Tackle

Bills 2020 Training Camp Injury Preview: Offensive Tackle

Will Ford & Nsekhe come into 2020 healthy?

This is Part 5 of the Buffalo Bills training camp preview revisiting injuries from 2019 & the impact it may have on their performance and availability in 2020. Part 5 consists of the offensive tackle room.

Not Returning

OT LaAdrian Waddle

Waddle was a Buffalo Bill barely in name, having gone through OTA’s & 2 weeks of training camp before an awful quadriceps tear ended his 2019 season. 

This occurred on a routine practice drill in which Waddle took a step and went down hard, injuring his right leg. He had surgery shortly after suffering the injury and was done for the year. While he was best suited as a swing tackle, the depth on the offensive line for 2020 indicates that he will not be returning. He has yet to find a home this offseason. 

OT Conor McDermott

McDermott appeared to be a favorite of the. Ills coaching staff over the previous two seasons. He was too good to be exposed to the practice squad, but never good enough to garner any playing time on the field. 

During training camp with the Bills, McDermott suffered a concussion during the win over the Panthers. This head injury, unfortunately, cost him a chunk of the preseason, finally playing against the Vikings. 

He then spent the first month of the season with the Bills, not seeing any action before getting waived to make room for WR Duke Williams. Unfortunately, N.Y. Jets needed offensive line help & grabbed him off waivers. He ended up playing 7 games with them and appears to be staying. 

Players Returning

OT Dion Dawkins

1 reception, 1 yard, 1 TD, 16 games, 16 starts, 1016 snaps, 3 holding, 3 false starts, 1 fumble recovery

Dawkins had a bounce-back year in 2019 that firmly established himself as the franchise left tackle. As evident above, Dawkins was durable, not missing any games and showing versatility in the offense, catching a TD pass. He has quickly become a leader in the locker room as this young core continues to develop.

As for injuries, Dawkins has been incredibly healthy during 2019 and relatively over his career. There were no instances of known injuries & he proved to be a valuable anchor in a supremely improved offensive line. He is a lock for this roster in 2020 & while his lack of injuries does not prevent him from suffering future ones, he does not have anything known that may restrict him this fall. 

OT Ty Nsekhe

10 games, 1 start, 359 snaps, 1 holding, 4 false starts

Nsekhe didn’t quite have the 2019 season he wanted to. As an aging veteran, he split snaps with rookie Cody Ford through the season to help reduce the burden as Ford transitioned to the NFL. Unfortunately, Nsekhe suffered several injuries which forced the rookie into action more frequently than the coaching staff likely wanted. One particular injury cost him nearly half of the season.

Nsekhe’s injuries below:

    • Knee tweak

He suffered a knee sprain towards the end of preseason that kept him out of the final game that was described as a “tweak”. It was not known which knee he injured and it did not prevent him from playing Week 1.

    • Left Knee

Nsekhe suffered another knee injury, this time in the win over the Giants. He injured it during the 2nd quarter where he slipped and fell on the knee. He required some time to sit out but was able to return to play to finish the game. The one thing that was never established was whether this was the same knee from preseason and if it was a re-injury or a new occurrence.

    • Right ankle

The veteran lineman suffered yet another injury, this time against the Bengals where he was bull-rushed backward, appearing to ham the right ankle. Like the knee injury, he was able to return to play in that game, getting 83% of the total snaps offensively.

He returned to play in the Patriots game the next week, re-injuring the area again, though it was not clear when he suffered the re-aggravation or it was the same side. He once again split snaps with Ford at the position and finished out the game. 

This ankle injury became so tough to deal with that Nsekhe ended up missing the following week against the Titans. He was unable to practice that entire week and sat out as injuries started piling up just prior to the bye week.

Regrettably, this is not the last instance of ankle injuries for Nsekhe.

    • Grade II-III Right low ankle sprain

Nsekhe was not finished with injuries for 2019 when he injured his right ankle yet again. This time midway through the 3rd quarter. His foot was caught from behind by a Dolphins defender, landing on the back of his heel, forcing the ankle to roll under violently.

He was in obvious pain and was quickly put on a cart for imaging and acute pain management. The initial thought was that he dislocated and fractured his distal fibula, but tests came back negative and was determined that he suffered a severe sprain.

Looking back over his early-season struggles with the ankle, it’s possible that the ankle injury could have contributed to this, but it may have also saved him. There was no way that Nsekhe could have prevented getting his ankle rolled on as bad as it did. But the previous laxity in the area along with the heel sliding out on video replay may have allowed the ankle joint to take the brunt of the forces rather than his distal fibula breaking. Check out the video of the injury below.

Nsekhe ended up missing 5 games due to that injury and while he looked healthy enough to play, his troubles were not over. A more detailed timeline of the ankle injury can be found at Buffalo Rumblings.

    • Right ankle

Nsekhe suffered yet another injury to the right ankle in the season finale over the Jets. Similar to his previous injury, he had a Jets defender fall on the back of his foot which took him down to the ground. He was observed wearing an ankle brace which helped support the area and limits inversion/eversion movement. His shoe also fell off during the play which prevented his foot from getting caught in the turf. As a result of that injury, his day was done in a meaningless game.

Looking back on all the injuries Nsekhe suffered during the season, it’s incredible that he continued to play. His knee injuries are not all that concerning and didn’t appear to cause him issues later on. However, it’s evident that his right ankle will be a big concern moving forward. It is not known whether he had surgery to the area, but it is expected that he required rehab to the ankle to tighten and strengthen it back up.

The risk for a re-injury for a lateral ankle sprain is as high as 80% in athletes which isn’t surprising considering the demands of the position. The re-injury to the ankle alone wasn’t a huge deal early on in the season. The fact that he missed 5 games with the severe ankle injury is the concern moving forward. 

It would not surprise me at all if Nsekhe continues to battle ankle issues. Prior to 2019, he did not have any documented NFL ankle injuries, though his path to the NFL was unusual, so it’s expected that there is an incomplete public record. Ideally, he rehabbed his ankle, will have bracing, and come into the season healthy. There is concern that he now has chronic ankle instability due to the repeated ankle injuries of 2019. The downside of that is he will be more likely to suffer an injury to the area. The upside is that if he does, he will miss time, but he may not miss as much time due to the laxity of the joint. This is similar to what Jaguars RB Leonard Fournette deals with dating back to college.

OT Cody Ford

While Ford is a lock to make the roster heading into 2020, he is one player that got beat up a lot during his transition to the NFL. Splitting time with Ty Nsekhe as he adjusted, Ford held his own at times as the season progressed, but several injuries could have made that transition more difficult. 

Listed below are Ford’s known injuries:

    • Concussion

Ford suffered a concussion following the win over the Titans in Week 5. Like many other players that got injured in that game, the bye week was timed well to allow everyone to recover. Ford likely was a beneficiary of the bye week as he did not miss any games with the concussion, able to progress through the NFL concussion protocol on a tight timeline.

    • Left elbow

Ford injured his left elbow late in the loss to the Eagles during Week 8 where he had his medial elbow struck while trying to maintain a block. While there are bumps and bruises during each play, this injury lingered for the rest of the season indicating that Ford may have injured his UCL, similar to the injury Josh Allen suffered in 2018. 

Due to Ford not having to throw the ball and repeatedly stress the area, the team was able to put a brace and wrap on the area to protect it while he continued to play through the season. He essentially missed the next week against Washington, playing only special teams with Ty Nsekhe getting all the offensive snaps. How much it restricted him could be up to discussion when reviewing film from last season but it certainly didn’t help make his job any easier.

    • Right trapezius/neck strain

In the regular-season finale against the Jets, Ford came off the field grabbing at his right neck/trapezius area following a play where he took on a Jets defender before losing the battle and getting hit into Spencer Long. This could have presented more like a minor whiplash injury which required some brief rest, but Ford was eventually able to return.

    • Right shoulder surgery

Following the conclusion of the season, Ford quickly had shoulder surgery on his right side with little information available. My thoughts can be found at Banged Up Bills, but he either had a rotator cuff or labrum repair based on the timeline and position he plays. He is a player who should be healthy coming into training camp, but may not quite be 100% as the season starts. 

OT Ryan Bates

8 games, 78 snaps

Bates proved to be valuable to the Bills this past season despite not playing a lot. After coming over from the Eagles during a training camp trade, he quickly found himself on the roster as insurance in case injury occurred. 

He only played in 78 snaps during his rookie year over 8 games, most of those games in the second half of the season, but his versatility is valuable as he can play every position if needed. He did not have any known injuries during 2019 & his versatility along with health suggests that he has a strong case to make the roster in 2020.

New to the roster

OT Trey Adams

Adams is an incredibly unique player in that he has the ability to play at a first-round talent level. However, his injuries are documented throughout his time at Washington. Stinger, herniated discs, torn ACL, hamstring strain. Along with a poor combine performance, he went undrafted and signed with the Bills. 

To understand his injury history, go read the article over at Cover 1. At the time, this was a purely objective analysis of the player & his injuries. For a briefer, more Bills-centric view on Adams, check out the article at Buffalo Rumblings.

Adams has a legitimate shot to make the team. If he stays healthy in this truncated training camp, he could find a home on the 53 man roster. It’s possible that he drops to the practice squad, but there is concern losing him to waivers. 

There has been discussion of putting Adams on PUP or IR and stashing him there all season to allow his body to acclimate to the NFL. Since he suffered these injuries during college football, he would be put on the Non-Football Injury list instead of PUP.  As for IR, the Bills have been known to get creative to hold onto their guys, but Adams would have to have a documented injury that could prevent him from playing, allowing them to hold onto him that way. Never want to wish injury on a player, but also want to protect all your assets.

OT Daryl Williams

The Carolina connection is strong! Williams is yet another former Panther to come up north to help bring the Bills to the promised land. Regrettably, Williams also comes with several notable injuries that have cost him considerable playing time over the years including all of 2018. His versatility on the offensive line and ability to return from the 2018 injury indicates he may still have something left. To read more about the torn right MCL & dislocated patella from 2018, check it out at Buffalo Rumblings.

Williams isn’t a lock to make the roster, but he’s a pretty close one. He could be an excellent trade candidate if the Bills suffer an injury elsewhere or could just be excellent depth at a strong tackle position. Even if he doesn’t grab a tackle job, his versatility allows him to move to guard in order to find a home for 2020.

OT Victor Salako

Salako is a well-traveled man who like McDermott mentioned above, is good enough to stick around on teams but not good enough to play. He is likely a camp body but does have health on his side as evident by this injury review at Banged Up Bills

OT Brandon Walton

Walton, a UDFA out of FAU, comes to the Bills as a developmental piece following the 2020 NFL draft. He doesn’t carry with him any serious medical injuries & he does have familiarity with RB Devin Singletary from their time together. Due to the depth at this position, Walton may have a better shot at the practice squad as he adjusts to the NFL. You can read his injury history here at Banged Up Bills

OT Garrett McGhin

McGhin is a familiar face to the Bills going through training camp with them last year before an ankle injury led to an injury settlement release. He eventually found a home in Carolina where he got some playing time before another ankle injury ended his season on IR.

In the Buffalo Rumblings article, it goes into further detail regarding the thoughts on the injury and impacts it may have in 2020. McGhin may have more of an issue cracking the depth chart than worrying about previous injuries in order to make this roster.

Outlook for 2020

This tackle position is a deep position and may stay deep even with the threat of premature roster cutdowns due to the ongoing pandemic. Dawkins, Ford, Nsekhe, Williams and Bates are likely to make this roster due to previous experience. There is a strong chance that Adams makes the roster due to the potential; this will be determined if he has a strong preseason & the team cannot risk exposing him to waivers. 

McGhin has a chance at the roster but will more likely find himself on the practice squad along with Walton and if Salako has eligibility and upside left. The two big question marks heading into 2020 will be the health of Ford’s right shoulder and Nsekhe’s right ankle. If both are ready to go, then the depth chart is set. If they are not ready or have setbacks, expect Williams, Adams, or McGhin to find a bigger role on this team. Tackle is such a vital position that the Bills have begun to lock down, but setbacks at either position on the line could result in unfavorable outcomes on the offense.

Bills Offseason Injury Updates

Get the #Bills latest injury news during these long lulls in the offseason as we inch closer to OTA’s Phase 1

Talk about some offseason doldrums! Mock draft after mock draft, continuous speculation about what player goes where. On top of that, the underwear Olympics are coming up at the end of February which will take the draft season to a whole new level of madness.

To make matters worse, there has been little to no updates regarding anything Bills content outside of DT Star Lotulelei’s restructuring of his contract. That and TE Greg Olsen signed with the Seahawks after meeting with the Bills.

But there’s still love for you Bills fans over here at Banged Up Bills. It’s been about a month since any major news was released regarding offseason surgeries. While there has been little new information, I still feel it’s beneficial to provide updates on the surgeries. This is to attempt to further identify what each player is dealing with and any possible updated timelines.

Jerry Hughes

Jerry got the Bills in some hot water over his tweet below right after the season ended. To recap, he announced that he was playing all season with torn wrist ligaments in his right wrist.

I attempted to speculate what type of injury he may have been dealing with right after the news broke. Make sure to go check it out if you haven’t already. Since then, Jerry had surgery about two and a half weeks after the news with this picture below.

Fortunately, Hughes did not get the Bills in trouble and no fines were assessed due to the injury.

While we won’t know the specifics of the wrist injury, social media does allow us to gather some information on specifics based on rehab timelines. While this is not conclusive, it appears that Hughes still has some type of cast or splint on his wrist that he attempts to hide under the table during the picture.

Click to access scapholunate-ligament-repair.pdf

If that is indeed the case, then this points more towards the theory that he had a scapholunate ligament repair as the timeline for rehab protocols indicate that he is to be in the cast/bracing for six weeks. At the time of this article, he will be a few days shy of four weeks. At this point in rehab, he will be performing any range of motion activities with his fingers, elbow, and turning of the forearm, known as pronation and supination.

He will still likely be limited for most of OTA’s, but he should be active and present as he gears up for yet another season. There should be no limitations come training camp.

Ed Oliver

Oliver’s rookie season progressively got better as he adjusted to the demands of the NFL. He began to show why the Bills selected him ninth overall in last year’s draft. Despite the improvement during the season, it was a surprise when Oliver announced that he had core muscle surgery back on January 14th.

Bills fans got some details with news stories detailing the exact reason he got the surgery later on. But these did not detail the exact area, when he injured it, how he injured it, and the severity. To get some background information on core muscle injuries, check out my article.

Since then, it has been nearly radio silent with little information. The only indication that Oliver is doing alright is that he made it down to Houston at the beginning of February. Based on general rehab guidelines, Oliver is still working on flexibility and reintroducing strengthening exercises, progressing the level of difficulty and resistance as tolerated.

He may also be limited during part of OTA’s, but should be able to participate during Phase Three when there is actual contact. He should also be fully ready for training camp.

Jon Feliciano

Feliciano continued the trend of players requiring surgery after the season, specifically for a left rotator cuff tear. He had noted that he was playing all season with the tear that dated back to the scrimmage at New Era Field in early August.

Feliciano is about five weeks out from surgery which means he has either just begun or will begin to get his arm out of the sling more. He will be progressing his range of motion, careful to not stress the healing tissue and possibly begin working on isometrics based on the doctor’s protocol. For more details regarding a rotator cuff repair, read this article I wrote last month.

Feliciano will take his time to get through the rehab and will not be available for OTA’s. Thankfully, he should be ready for training camp this summer.

Levi Wallace

Wallace was the most recent surgery added to the list, requiring shoulder surgery back on January 28th.

Unfortunately, outside of what Jay Skurski stated, there has not been any other information released. It is known he suffered a shoulder injury back against the Philadelphia Eagles, but the specifics are not available. Unless details are released, I believe he may have had a general cleanout of the shoulder arthroscopically.

It is too soon to tell if he will be able to participate in any fashion during OTA’s. But I remain hopeful that he can participate and be ready for training camp.

Cody Ford

Finally, we get to the last player who required surgery this offseason. Ford was a surprise announcement that he required surgery on his right shoulder. Like Wallace, details are scarce, but there is some information to be interpreted from pictures.

Based on the picture below, Ford is dealing with either a torn labrum in his right shoulder or a rotator cuff repair, both of which would take four to six weeks in the sling. Based on the most recent picture, he would be four weeks out.

Details may emerge later with the exact injury, but seeing updates such as this helps narrow down what the player could be dealing with. If he is dealing with either injury, range of motion is vital early on and performing isometrics to take his rehab to the next stage for strengthening is key. Regardless of the injury repair, he should be fully cleared in either case for training camp barring any unforeseen complications.

While this doesn’t get into the nitty-gritty details that people want to know, it does establish several injury timelines. This also provides updates on how the players are responding to surgery and if anything seems out of the ordinary.

I expect that more details will emerge regarding some of the injuries, but not a given. The Bills are still on track to bring nearly everyone back onto the team to maintain the culture the coaching staff strived to establish. As fans, we can only hope that the Bills are maximizing the quality of starters at each position. If any go down, it’s important to have a capable backup who can carry the torch until the starter returns.

For the latest up-to-date content, check out @BangedUpBills on Twitter and here on the website. Make sure to also check out Cover1.net for my draft injury analysis on prospects as the NFL draft approaches.

Jon Feliciano’s Rotator Cuff Repair

How did Feliciano manage to play all season with a torn rotator cuff?

The injuries continue to pile up! The latest injury comes Wednesday afternoon when a tweet dropped from OG Jon Feliciano. The tweet shows him in a recovery room with a brace on his left arm with bulky padding on the shoulder. Considering it was at a lower angle, it was initially hard to determine if there were other telltale signs that could be observed signifying the specific procedure. 

This surgery is another in a line with DT Ed Oliver Tuesday with his core muscle surgery & Wednesday morning’s tweet of OT Cody Ford with a right shoulder surgeryShortly after the Feliciano tweet, Matt Parrino from NY Upstate reported that Feliciano had a rotator cuff repair Wednesday & that the original injury occurred during the Blue & Red scrimmage on August 2nd.

I noted back in August that he suffered an injury during the scrimmage after I attended, but the actual injury was unable to be observed due to the vantage point of the stadium & the multitude of activity going on at the time. What wasn’t known at the time was that Feliciano suffered a rotator cuff tear to his left shoulder that he managed to play for  5 months. 

To understand why he was able to play that length of time, the anatomy & function of the rotator cuff must be understood. The rotator cuff is made up of 4 muscles that include the supraspinatus, infraspinatus, teres minor, & subscapularis. These muscles assist in shoulder abduction, internal & external rotation. These motions are vital for a variety of activities that we perform daily from washing hair, putting a shirt on, throwing objects, reaching behind the back, & general overhead activities. The rotator cuff also helps keep the humeral head depressed and against the labrum so that it can create enough space within the joint for the humerus to move & not ram into the acromion during elevation. There are other muscles that assist with all these functions, but these are primary movers for the above-mentioned functions. 

301px-Muscles_Rotator_Cuff
Credit: Physio-pedia.com

We tend to hear more about rotator cuff injuries in baseball but they can & do occur in football at a variety of positions. The mechanism for injury to the rotator cuff can happen in a number of ways. It can occur as a result of landing on your arm outstretched, jamming the head of the humerus into the scapula. It can occur with a fall directly onto the shoulder area, throwing an object either with increased frequency or if the object is too heavy. It can also occur from an overload of the area such as a sudden pull on the area. Finally, it can occur over a period of time with impingement due to weakness in the area with altered biomechanics leading to a wearing down on the tendon insertion.  

There are two types of rotator cuff tears that can affect any of the muscles in the cuff area: Partial-thickness and full-thickness. Based on the names, the partial-thickness is a partial tear to the tendon that can be small & can even heal on its own at times. Full-thickness is when the tendon tears completely through & there is a significant loss of function noted in the area. Any of the muscles in the rotator cuff can tear but the supraspinatus is the most commonly torn muscle. It is anchored at the top of the humerus head & is more likely to bear the brunt of an injury or become worn down. 

Size-of-Rotator-Cuff-Tear-do-I-need-surgery-or-can-physical-therapy-help-300x138
Credit: physioworkshsv.com

There are also varying grades of partial vs full-thickness tears which further indicate the severity as seen above. The tear is measured in both size & depth. So it’s possible that there could be a big superficial tear that could be managed conservatively or there could be a tear that is deep that requires surgery as seen below. Most surgeries are indicated for tears medium & above.

full-thickness-rotator-cuff-tears-value-of-clinical-tests-2-638
Credit: Google Images

Feliciano likely suffered a partial thickness tear to at least the supraspinatus & possibly others as the rotator cuff covers the humeral head like a blanket. The injury could have started out as a partial thickness tear, potentially progressing towards closer to a full-thickness tear as the season wore on. The other possibility is that the partial-thickness tear just never got better, requiring surgery.

I don’t believe that he initially had a full-thickness tear as he would have missed some time due to profound weakness in the area and positive signs of several special tests. In the clinical setting, a full-thickness tear is quite apparent & even the toughest of people have difficulty moving the shoulder. If his shoulder were to be assessed during the season, there would have likely been a painful arc noted in the picture below. This is due to the activation of the rotator cuff muscles assisting in elevation of the humerus during the range of motion from 60-120 degrees

sh5-243x300
Credit: pivotalphysio.com

There was likely pain during every movement that Feliciano encountered throughout the season due to this tear. Between rehab, strengthening of the surrounding muscles & medications, he was still able to suit up for every game & at times play center. Thankfully, he didn’t have any issues with snapping the ball due to being right-handed. 

Feliciano’s glaring weakness would have been forcing to move his arm in abduction and external rotation, both of which would have been more difficult as a tackle, trying to keep the defensive end from bending around the edge. Thankfully, he was able to play inside & keep his arms closer to his body, taking stress off the cuff. Despite the rotator cuff not directly assisting with shoulder flexion, he still would have likely had pain with a general elevation of the arm due to the imbalance of the rotator cuff due to the injury. This could cause impingement where the rotator cuff gets pinched between the acromion & greater trochanter due to decreased space during shoulder elevation.

It will be curious to see if he did get beat more often on the left side when the pocket broke down & he was forced to use that shoulder more. It would also be interesting to note if Feliciano’s punching ability when engaging with his block was decreased due to not being able to put as much power through the left.

Either way, to play through this injury isn’t unprecedented in the NFL, but it is difficult. Cam Newton, Drew Brees, Kawaan Short, Alshon Jeffery & Johnathan Abram are just some of the examples that have torn their rotator cuffs & either tried to play through it or had their seasons end as a result. However, most of the names on this list continued to have incredibly productive careers, indicating that the injury alone isn’t a game-changer. 

To add insult to injury, the rehab for a torn rotator cuff isn’t fun either. It’s roughly a 4-6 month recovery & in some cases, take up to a year with severe tears. This is a tough surgery due to the variety of movements of the shoulder. In addition, the area where the rotator cuff attaches to the humerus contains a poor blood supply which means that it does not receive the needed nutrients to heal as quickly as other parts of the body. Reports indicate that Feliciano will take between 4-6 months which further supports the partial thickness tear that I had mentioned earlier.

The surgery is typically done arthroscopically unless there is a massive tear & they need to open up the shoulder to fully address the issue. Once inside, the tear can be further assessed, cleaned out & repaired. The repair is done by placing anchors that reconnect the tendon back to the bone to allow for proper healing of the area. Based on the severity of the tear will determine how many suture anchors are required.

449px-Rotator_cuff_high
Credit: Physio-pedia.com

Rehab protocols dictating the specifics of the timeline for rehab can be accessed here & here, but to simplify it, it is tedious having worked on a number of these during my career. The first 4-6 weeks are spent in a sling with PROM initiated to work on the motion but avoiding any strengthening directly to the shoulder area. Motion is slowly progressed to stretch the tissue but not place stress on the healing area with range of motion limitations set by the doctor.

Once the patient has been cleared to begin strengthening, isometrics are initiated which is when the muscle tensed up but is not actively moving, like pushing with all your might against a wall. As strengthening progresses, higher-level activities are incorporated to increase stability in the joint. The rotator cuff has to improve with strength, but the surrounding muscles also have to strengthen in order to help move the scapula up and out of the way in order to allow the humerus to elevate. 

Eventually, the muscles are all moving properly with scapulohumeral rhythm, there is full ROM/strength and no pain, this allows the ability to return to sport-specific strengthening & activity. Rotator cuff repairs do have overall good outcomes, up to 95%, but they need a lot of patience to get there. Fortunately, delaying surgery does not appear to have negative outcomes, hence why Feliciano likely chose to play the season with the injury.

Risks for re-tear are as high as 26% in the literature, but is relatively lower in younger patients as the quality of the tissue is improved compared to older patients with more chronic tears. Furthermore, there is a correlation that for every 1 cm the initial tear increases in size, the risk to re-tear increases two-fold.

As a PT, these repairs are rewarding to observe the improvement, but there is a distinct process to them. There may be areas where a patient progresses faster & can shave some time off the overall recovery time, but you can’t speed up the biology & healing portion of the surgery. These can be successful surgeries, but they just require a lot of time & patience in order to maximize the results. 

Feliciano will be around during OTA’s but expected to be limited. He should be able to perform cardio activities & perform non-contact drills as long as he’s cleared by the MD, which is very possible. There is a chance he would be able to perform at mandatory minicamp in June during Phase 3 of the OTA’s but may be held out as a precaution as he is a veteran. Barring any setbacks, he should have no concerns going into training camp for 2020.

This sort of injury is just the reality of the game of football & is a look into how tough these guys really are when it comes to suiting up every week. The only benefit to having an early exit to the playoffs is that these injuries can get addressed sooner. However, I believe most, if not all of the players in that Bills locker room would go through hell if it meant hoisting that Lombardi trophy in February. With how this team is built, the chances for that increase daily. 

Top Photo Credit:

Kiss985.radio.com

Wild Card Weekend Bills Injury Preview- Texans

What is the status of Nsekhe, Roberts, Lawson, & Wallace?

Well, we’re finally here, the playoffs are upon us! We are moments away from the Bills playing in Houston on Wild Card Weekend for the first NFL game of 2020! The Bills are beat up but still in a better spot than the Texans. While I could detail out every injury for Houston & compare it to how the Bills could take advantage, I may be better off writing the sequel to War & Peace. But if you want to get some detailed analysis of the Texans injuries, check out my latest appearance on Locked On Bills with Joe Marino. I have nuggets on JJ Watt, Johnathan Joseph, Bradley Roby, & Will Fuller V. Make sure to check out the pod below!

Locked On Bills 

If you want to know why Houston DE JJ Watt is able to come back so quickly from his pectoral tendon tear, check out my latest article at Buffalo Rumblings!

JJ Watt’s Unexpected Return

As this blog is a Bills based site, the Bills injuries are below & my impressions of them.

QUESTIONABLE

DE Shaq Lawson (left hamstring strain)

Lawson continues to recover from his hamstring strain suffered late in the Patriots loss but appears on the right track. He has been limited the past week, but with controlled activities, he has looked great on film.

I’ve stated all season that the hamstrings are vital for running & blocking, important responsibilities for a defensive end. It’s not a muscle group that can be babied or managed with certain bracing or necessarily protected. Even with the best rehab & rest, injuries can still occur and Lawson may be a casualty of that. 

He missed the Jets game & would probably benefit from another week off, but considering each game now is single elimination, Lawson should not miss. I have a strong suspicion that he plays.

WR Andre Roberts (foot)

Little is still known about Roberts’s foot other than it cost him another game against the Jets. Matt Parrino of NYUp.com noted that he was taking punt & kick returns in practice, accelerating up the field without issue. Any foot injury would limit sudden acceleration as the toes & foot act as a lever to push off the ground to move forward. 

If he had something such as turf toe, a foot sprain, fracture; there would be difficulty getting up to speed & slowing down. As long as Roberts is able to play Saturday, then it won’t really matter what’s wrong as long as he can add another dimension to the team.

OT Ty Nsekhe (right ankle contusion)

Nsekhe continues to work back from his right ankle that cost him 5 games this season. He was rolled up on again Sunday & but appears to be working through the injury just fine. This appears to be more of a contusion which was supported by the fact that he’s practicing all week & only has a brace on, the same one that he appeared to be wearing on Sunday.

I feel strongly that Nsekhe will suit up Sunday & will be in a rotation with OT Cody Ford with Ford taking a bulk of the snaps. 

CB Levi Wallace (right medial ankle sprain)

Wallace is the big iffy for Saturday. At the end of the day, he is still dealing with an ankle sprain that requires rest. The part of the ankle he injured was the medial side which is the inside portion of the ankle. The deltoid ligament is the strong inside portion of the ankle that provides stability between the tibia, talus, calcaneus, & navicular. This is the reason why it is so difficult for the inside portion of the ankle to suffer a sprain. If the outside portion of the ankle had the same type of structure, I would imagine we would all run very differently. You can see the makeup of the deltoid ligament below.

Deltoid-Ligament-Structure-location
Credit: medicpassion.com

The next picture below is a great example of how the injury occurred with Wallace with regards to the motion & the area injured. To note, the ligament does not likely tear that severely for Wallace or a fracture sustained as dictated in the picture.

medial-ankle-sprain419
Credit: http://www.sportsinjuryclinic.net/

If this was a regular-season game, Wallace would surely miss Saturday. Considering it’s the playoffs, I imagine that he will try to suit up with a heavy tape job similar to the one seen below. His major limitations will be pivoting, attempting to stay with his assignments. He will be able to run straight & cut off the left ankle, but forcing Wallace to jump, cut to the right, and backpedal will limit his effectiveness. I expect that CB Kevin Johnson gets the start & majority of snaps with Wallace as a backup or used in certain packages. 

Probable Inactives:

TE Tommy Sweeney

DT Vincent Taylor

S Kurt Coleman

S Dean Marlowe

OG Ike Boettger

RB TJ Yeldon

OG Ryan Bates

The Bills are in a great position to win their first playoff game since 1995 & move to the divisional round against a likely rematch with the Ravens. I could see this Bills team make a run like the Jaguars did a few years ago; anything can happen in the playoffs. 

On top of that, the injuries listed today won’t be real factors outside of Wallace heading into next week. There is always the possibility of new injuries, but thankfully the injuries we do have are at positions of depth at OT & CB. 

Regardless of the outcome, you will be hearing from me next week. However, I highly anticipate that I will be coming to you with an injury review & preview heading into the divisional round. GO BILLS!

Top Photo Credit:

USAToday.com

Week 17 Bills Injury Review- Jets

How bad are Wallace & Nsekhe’s ankle injuries?

Good thing that the game didn’t count for anything as the Bills finished 10-6. That 13-6 loss to the Jets was a rough one to watch, bringing shades of the past decade back with backups & fresh players off the street merely competing because there was no one else healthy. On Sunday, that wasn’t the case as Sean McDermott did his best to rest as many starters as he could in order to prepare for the playoffs. Unfortunately, there were a number of injuries varying in severity that will put some player’s availability in question for Saturday. 

CB Levi Wallace (right ankle)

Wallace scared a lot of people when he went down while catching an interception early in the 1st quarter without being touched. He was able to secure the ball before requiring assistance from training staff to get off the field. As with any non-contact injury, the knee is quickly assessed for any ligamentous instability before further evaluation is necessary in other areas. 

It was determined that Wallace suffered an ankle sprain, specifically a medial eversion ankle sprain. I had originally thought that he suffered a mild high ankle sprain as the mechanisms are similar, but he suffered the medial ankle sprain due to the foot being more in a neutral to plantarflexed position pushing off on the toe rather than the dorsiflexed, everted position seen with a high ankle. It is hard to decipher on film & I’m only confident in the medial ankle due to the recent reports. 

Wallace was observed leaving the locker room in a walking boot which is pretty standard following injuries such as this. He is considered day-to-day which usually translates out to missing a week or two. Medial ankle sprains have an incredibly strong ligament known as the deltoid ligament that prevents movement inward which helped reduce the severity of the injury.

We will have to see how he performs in practice this week. If he can’t go, capable CB Kevin Johnson gets the start against his former team. 

S Siran Neal (right side stinger)

Neal suffered a stinger during a tackle during the 2nd quarter where he hit directly over the top of his shoulder on a routine tackle. He was visibly uncomfortable, shaking his right arm out & moving around, trying to shake things out. 

That direct hit caused the stinger due to the sudden shoulder depression pulling on the cervical nerves just enough that he felt it down the arm to need a few plays off. Like Tre’Davious White against them Steelers game, the actual hit wore off & he was able to return. As long as Neal doesn’t continue to suffer these, then this shouldn’t be an issue moving forward. 

OT Ty Nsekhe (right ankle)

Nsekhe made his triumphant return after missing 5 weeks with a severe ankle injury in the win over Miami. Nsekhe was slowly reintroduced into the game plan & was rather unremarkable during his play. 

In a stroke of bad luck, Nsekhe went down again in the 3rd quarter with a Jets defender falling on the back of his foot as he went down. Nsekhe was immediately down on the ground rolling around in obvious pain. Trainers quickly came out to assess the ankle & got him off the field for further assessment. 

It was difficult to see what Nsekhe exactly injures as the bodies were in the way, but it’s clear that his ankle was rolled upon. He may have avoided serious injury due to his shoe getting knocked off during the play, preventing his foot from being planted. Nsekhe was also observed wearing an ankle support to limit medial/lateral movement which redistributes the forces away from the ankle. 

The hope that is he suffered a contusion to the area & can work through this injury to be available for Saturday. Some detractors may be out there saying he should have not been playing after coming off an ankle injury. I fully support the coaching & medical staff to allow him to get out there in order to get live reps and allow him to play if he’s healthy. Nsekhe is a veteran, he knows his body & the risks he would take in return to play. It comes down to simply horrible luck & there isn’t much else to be said.

OT Cody Ford (right trapezius/neck)

Ford suffered his own injury later in the 3rd quarter where he appeared to injure his right trapezius or neck. There wasn’t much of a mechanism of injury but Ford came off grabbing at his right trapezius muscle. This muscle connects up to the back of the head, out to the shoulder, and down to the middle of the back. This assists with head extension & shrugging the shoulders.

Trapezius
Credit: Youtube.com

The only possible place that I see where he could have injured this area would be when he took on the Jets defender, lost his block and had his head turned inward to the left & hit the back of G Spencer Long

Ford kept motioning to the area & even pointed to the training staff where his pain was at. He may have overstretched the muscle getting his head forced to the left & hitting Long. He may have also suffered a minor stinger due to the head stopping suddenly. 

Either way, he was able to return and outside of some stiffness & soreness, this shouldn’t limit him for Saturday.

CB Taron Johnson (right ankle)

Johnson was the last injury of the day when he got bowled over by Jets running back Le’Veon Bell. Johnson attempted to square up with Bell & plant his feet, getting knocked backward & injuring the right ankle. The injury occurred when Johnson was trying to keep his foot planted & got pushed, over pronating his foot & placing stress through the medial ankle. 

Johnson was able to walk off with a noticeable limp but was quickly able to begin running on it, even able to return at the very end to ensure that WR Isaiah McKenzie did not have to fill in at cornerback. This is similar to what Wallace dealt with earlier in the game but obviously less severe & less eversion noted at the ankle. This isn’t something that I expect will keep him out for the playoffs. 

Other observations 

Out of the inactives, the only known ones prior to the game were WR Andre Roberts & DE Shaq Lawson with their respective injuries. Having RB Devin Singletary, TE Dawson Knox, WR John Brown, WR Cole Beasley, & CB Tre’Davious White made the most sense being inactive due to how vital they are at their respective positions. 

McDermott & the medical staff did the best with what they could. There are injuries the public isn’t aware of despite my best efforts. There are also strategies in getting other players snaps in case the top players do go down. 

It wasn’t an ideal situation, but the other option was to play the starters & suffer injuries prior to the playoffs. The injuries suffered Sunday are absorbable especially at CB & OT as the team has managed without so far. 

There’s a lot going on this week prior to the game Saturday & it’ll be exciting to see how the Bills stack up against the Texans. This is a winnable game, especially with the defense that has performed all season when asked. If the Bills get beat, it will be because of talent & not because the Bills beat themselves or were too injured.

Top Photo Credit:

DemocratandChronicle.com

Week 17 Bills Injury Preview- Jets

Will this finally be the week that Nsekhe returns?

The big concern going into this game against the Jets is how long starters will play & what players will be inactive. This is especially worrisome due to the recent comments by Jets S Jamal Adams in which he stated they would be hunting along with Jets DC Gregg Williams. Along with that comment, Bills fans have to worry about cheap shots from DE Henry Anderson. If you recall, he blindsided K Stephen Hauschka last season which threw his game off for the rest of the season seen below. 

Thankfully, the Bills continue to manage their injuries well & are not forced to play players who are injured. Below are the injuries prior to the game & inactives.

OUT

WR Andre Roberts (foot)

Roberts was a surprise addition to the injury report following Saturday’s game. Reviewing the film, it’s not clear when he suffered his foot injury. There aren’t many plays that show when he could have possibly injured his foot, but a possible culprit is when he was blocking for QB Josh Allen on a designed run play early in the 3rd quarter, it appears he got kicked on the right ankle.

There was also another point in the 3rd quarter with 3:35 left in where he appeared to be limping slightly after the play. There didn’t appear to be a mechanism of injury prior to this play either which makes this difficult to identify the exact problem. Considering he hasn’t practiced this week & has already been ruled out, we can only hope that he will be ready for the playoffs. 

DE Shaq Lawson (left hamstring)

Lawson has not been able to practice this week due to a hamstring strain suffered in Saturday’s loss to the Patriots. This occurred after a tackle for loss in the backfield during the 2nd half of the game. The actual tackle itself did not appear to be an issue, but rather the celebration afterward. He began to get up & celebrate, grabbing the hamstring in the process.

He was able to continue playing for the rest of the game but the injury appeared to catch up with him later. Even after a slight strain, the muscle is still painful & sore, requiring frequent stretching & controlled movement to allow healing but not overwork the area in order to prevent further injury. As he has already been ruled out, this is the smart move to do considering how valuable he will be in the playoffs. It will be interesting to note how the coaching staff rotates the defensive ends as there are only 4 on the roster.

QUESTIONABLE

OT Ty Nsekhe (right ankle)

I feel like we have been having the same conversation for the past 6 weeks regarding his injury. But new information is available! He finally appears to have made the expected progress, participating in practice on Thursday & looking quite well on film. He is moving with the fluidity of someone who is close to returning & appears to be close to 100%. 

Considering how he is moving, I’m making the assumption that he could have returned sooner, but how OT Cody Ford was playing, he wasn’t needed immediately. At this point, it is unnecessary for Nsekhe to play in Week 17, but he has missed the last 5 games which means he would benefit from some live reps in order to prepare for the playoffs. 

CLEARED TO PLAY

C Mitch Morse (right low ankle sprain)

Morse scared many Bills fans late in the 4th quarter in which he had his ankle rolled up on, reportedly feeling several pops & having difficulty walking on it initially. Fortunately, he was able to practice in full this week & not appear to have any limitations despite what appears to be a low ankle sprain. 

Morse is yet another starter that may play several series but overall benefit from a well-deserved rest day or even being declared inactive in order to ensure his health.

OTHER INJURIES

DT Harrison Phillips (left ACL)

Phillips has been out since September, diligently working back from a torn ACL that ended his season prematurely in the win over Cincinnati. Occasionally, news is released of Phillps attending practice, performing his rehab, & still participating in team activities. While it wasn’t expected that Phillips would return until next season, it’s great to see the progress being done in rehab. In the first tweet, below is Phillips running on an underwater treadmill to reduce the stress that land-based running would cause. In the other tweet, you can see the progress that Phillips has made & is demonstrating the proper muscle control during his step-up routine with a weighted vest. 

Even though he is unable to play this year, Phillips still understands his job & purpose on the team which further validates the culture that has been instilled at One Bills Drive. I expect to see more clips in the near future & see him inch closer & closer towards returning to football activities.

Probable Inactives:

TE Lee Smith

RB Frank Gore

S Micah Hyde

S Jordan Poyer

DE Shaq Lawson

WR Andre Roberts

G Quinton Spain

This would be a game that the Bills would be foolish to not play all their reserve players for much needed live snaps. It is probably the best bet to allow some of the veteran players a true rest day, have all the starters play several series & then act as backups in order to get through the game. It would be great to get to 11 wins, but not at the cost of a key contributor going down. 

The Jets are still a talented team, this is the NFL after all. But this is the best-case scenario in where the backups can get extensive playing time & get some film for next season when the roster churns over. Plus, I don’t think in any circumstance that Terry or Kim Pegula are forcing the coach to play certain players as in the still hotly debated topic of QB Doug Flutie or Rob Johnson. This will be a good game to allow the Bills to play & not worry about the outcome. There are bigger fish to fry next week with either traveling to Kansas City or Houston, both being true tests.

Top Photo Credit:

SBNation.com