That’s A Wrap!

Assessing the injuries coming out of the 4th preseason game against the Detroit Lions. Breaking down the IR, how it compares to past seasons, and upcoming posts.

The Buffalo Bills won over the Detroit Lions on Thursday night 27-17 behind a strong showing behind Nathan Peterman and company. With that win, Buffalo finishes the preseason 1-3 on a high note and ready for the home opener against the Jets in Week 1. Overall, the Bills continue this preseason by avoiding major injury, allowing them to have some depth going into the regular season. Injuries to note are Jerel Worthy’s concussion at the end of the first quarter which sent him into the concussion protocol for the foreseeable future. Michael Ola sustained an ankle injury in the first half and was unable to return. Besides the previously two mentioned, the rest of the game consisted of bubble players getting final chances at securing their roster spots.

As it was relatively a quiet preseason injury wise for the Bills, there are still some injuries to report. Right after the Lions game, the Bills had to make some hard decisions regarding their roster. As previously mentioned, TE Keith Towbridge was placed on IR with a foot injury back on 8/3/17 and TE Jason Croom was waived with an ankle injury and settlement on 8/18/17. Right now, there are no locks for IR as Michael Ola has been waived/injured, which means he may revert to IR and then released with an injury settlement in several days. I believe this to be the case as Ola had his ankle taped up after his Thursday night injury, possibly attempting to go back in. This would suggest his ankle was sprained and cost him a roster spot as the Bills had what they thought to be enough depth at the position.

Those released with injury settlement were as follows: WR Rod Streater (Toe), S Shamiel Gary (Unknown), WR Jeremy Butler (Concussion), and LB Sam Barrington (Unknown). As previously mentioned, Streater sustained what I believed to be a turf toe injury back against the Eagles. While I still believe it was a Grade II sprain, it may have been too injured to warrant holding a roster spot. Up to that point, Streater was having a solid preseason. He could be eligible to come back later in the season if the Bills run into depth issues, but it is too early to tell.

Butler was a long shot to make the roster, but he sustained what now appears to be a fairly serious concussion back on 8/8/17 and hasn’t fully recovered. Losing reps while recovering most likely cost him a roster spot. It is unknown what stage he is at in the league concussion protocol, but considering he has not been medically cleared yet, he may be still in Phase 1-2. There was little to no information on the nature of Barrington’s or Gary’s injury or when they sustained the injury. I have only been able to find that Gary came out of the Eagles game early but no description of the issue.

As the Bills are still dealing with injuries such as Taylor, Yates, and Worthy in the concussion protocol, along with Dareus’ hip and Glenn’s foot, these should not prevent these players from missing extended time. As the front office continues to shake things up releasing RB Jonathan Williams, LB Gerald Hodges, and WR Philly Brown yesterday, I am pleased to see that they are not having to replace players out of desperation.

These injuries this preseason are a stark contrast to the past several years in which multiple, big name players found their way onto IR or had significant injuries coming into the season. Going back the past several training camps, 2016 saw 10 players start the season on IR with Shaq Lawson designated to return. 2015 saw 3 players on IR and Marquis Goodwin missing most of the season with significant issues. 2014 saw 4 players out including Kiko Alonso already out due to an off season ACL tear. Looking back further, most seasons start off with 3-4 players on IR or missing large chunks of time. I had to go back to 2011 in where only one player started on IR and the noteworthy IR placements came with Kyle Williams and Eric Wood later in the season. That team if you remember, finished 6-10.

This wraps up the preseason for the Buffalo Bills with depth appearing to finally be where it needs to be at to have a realistic shot at staying in games when a starter goes down. In the next several posts, look for a final analysis of all the preseason injuries in the NFL, dissecting the severity of injury, trends, and what this means for the upcoming season. For the dedicated Bills fan, I will be doing a post on the 10 year anniversary of TE Kevin Everett’s neck injury with a retrospective look at what occurred and the outcomes afterward. I look forward to further educating my fellow Bills fans, other football fans, and growing this endeavor! Go Bills!

Bills Concussion Woes

Reviewing the NFL concussion protocol including return to play criteria and how this affects the Bills QB situation.

It’s been well known that being a Bills fan is hard. Losing Super Bowls, long extended playoff droughts, ill-timed injuries, the list goes on and on. Right now, that trend appears to be continuing with the 2017 preseason. After the loss to the Ravens by a score of 13-9, the Bills are now 0-3, heading into a show down at New Era Field tonight against the Lions. As mentioned last post, the Bills continue to demonstrate some luck by missing all the ACL tears, sprains, and injuries that can derail a season even before it starts. Unfortunately, the Bills don’t escape totally free. Tyrod Taylor and T.J. Yates both went down with concussions, leading Nathan Peterman to play most of the game. After Taylor and Yates entered the concussion protocol, the Bills signed Keith Wenning to fill in until both QB’s are medically cleared.

After a player sustains a concussion, the player enters the NFL concussion protocol. Most of the time, that’s all we hear until the player is cleared to return to play and contribute. But what does the NFL concussion protocol consist of? What is classified as a concussion? I will break down what classifies a concussion, what the protocol looks like, and the general timeline to return. Hopefully, this will give a clearer indication of what to expect.

A concussion is defined as a violent blow to the head which can disrupt brain function temporarily. Some concussions cause loss of consciousness, but not always necessary for a official concussion diagnosis. The brain is surrounded by cerebrospinal fluid which helps bring nutrients to the brain along with providing some protection during light trauma. However, the brain does not have air bags to protect from larger impacts. In the case of a more significant blow, the brain will strike against the inside of the skull, and then possibly strike the other side of the skull. This is known as a coup-contrecoup injury. This does not always happen in every concussion, but may intensify the symptoms if more areas of the brain are affected.

Upon striking the brain, immediate changes occur with physical symptoms including headaches, confusion, amnesia, dizziness, nausea, vomiting, fatigue, and delayed response time. Further symptoms include sleep disturbances, light and noise sensitivities, irritability, and difficulty with concentration, among other symptoms.

The NFL Head, Neck, and Spine Committee came up with a comprehensive protocol to identify and effectively treat a concussion. To keep it brief, the criteria are: a direct blow to the head or a force that translates towards impact to the head; rapid onset of transient impairment of neurological function, changes in neuropathological changes, and clinical symptoms that may or may not involve a loss of consciousness.

Down on the field, the NFL uses the SCAT2 which is the Standardized Concussion Assessment Tool to assess the player. This protocol has been modified for the NFL and is consistent with the SCAT3 released in 2013. The advantage is that this test can be administered multiple times with valid results to determine a concussion immediately or if symptoms are delayed. This is a test to assess for a concussion but a more formal screening process is done during the preseason and after suspected concussion to fully diagnose.

Each NFL team has a plan in place consisting of an unaffiliated neurotrauma consultant and ATC spotter to indicate whether the player may have a concussion. The player must have been removed from the field, video replay must have occurred of the injury, and an assessment must be performed. If there is any doubt of whether a concussion has been sustained, then the full evaluation must be performed. No more will there be a player being waved back into games or being rushed back in. Numerous players have stated they went back into games and they don’t remember being a part of those games when asked later.

Players will continue to be checked periodically to ensure they do not develop symptoms later and incur further damage. These results will be checked against their baseline assessment to determine the severity. Players could exceed the baseline score but still have a diagnosis of a concussion. This prevents a physician from looking at the diagnosis of a yes/no and look at the entire situation rather than a score.

If the player has sustained a concussion, there are 5 levels of recovery that must be performed in order to return to the game. These must be achieved in order to be medically cleared to return to playing. They are as follows:

  1. Rest and recovery: Players should avoid or limit meetings, social media, electronics to allow the brain to rest and minimize symptoms until player returns to baseline function. The player may engage in stretching and balance activities that allow them to lightly stress the body and being the process to improve. During this time, neurocognitive testing will be performed to assess for clearance towards normal activities.
  2. Light Aerobic Activity: A graduated exercise program consisting of cardiovascular exercise which may include a stationary bicycle or treadmill along with stretching and balance activities. This will be gradually increased as the player remains symptom free and begin to return to team meetings, film study, etc.
  3. Continued Aerobic Exercise and Introducing Strength Training: Cardiovascular exercise will continued to increase intensity and simulate the sport specific activities, progressing to supervised strength training. Once again, if the player is symptom free, they can proceed.
  4. Football specific activity: All activities continue to increase in intensity and duration and resume football activities. These activities must remain non-contact to ensure no recurrence of symptoms.
  5. Full football activity/clearance: Once the player has achieved the first 4 steps, contact may be re-initiated and determine that they have no recurrence of symptoms. The player will be reevaluated by a team physician and if cleared, resume normal activity. If at anytime the player experiences symptoms, they are placed back in the concussion protocol and restart the process until they are symptom free.

If you would like to review the actual documents in greater detail, please click here & here.

While this is a fairly comprehensive protocol, this should continue to improve as we learn more about concussions. Unfortunately, this protocol does not give a specific timeline for return as each concussion is different. Observing the hit on Taylor showed him getting his bell rung may keep him out for an extended period of time. Yates concussion was not as clear as when it occurred which may indicate a better prognosis. While it is not guaranteed that Taylor will be ready to start, CBS Sports reports that Taylor should be ready by Week 1 and has not had any setbacks. Recent reports on Twitter that he is out signing autographs before tonight’s game, tolerating lights and music which could signify he is already on Level 2-3. I believe Taylor will be cleared to start Week 1 and lead the offense to several touchdowns. Continue to follow for updates following cut down day, full recap of preseason injuries, and analysis of the Bills going into Week 1.