Week 14 Bills Injury Preview- Ravens

Breaking down why Nsekhe is out so long.

9-3. What a sight to behold!

The Bills are 9-3 heading into the month of December. That’s pretty incredible after all the years of cold meaningless football. While the Bills still have more work to do this month, this has turned into quite a special season, making the national media take notice on the team from Western NY. As the Bills embark on vital December games, the team continues to stay healthy following a rash of injuries around a well-timed Week 6 bye. But the Bills, they’re incredibly healthy now & in prime position to capitalize on teams limping into the playoffs. With the Ravens coming to town on an 8-game winning streak, this is a true test for the Bills to create an opportunity to capture an elusive AFC East crown.

OUT

OT Ty Nsekhe (right ankle)

Nsekhe continues to rehab back from his severe ankle sprain suffered against the Dolphins back on November 17th. On Wednesday, it was reported that Nsekhe would be out on the practice field in some role, however, he was a DNP all week. This is not surprising considering the severity of the ankle sprain he suffered, assessed out at least as a Grade 2 inversion ankle sprain. 

The reason this ankle continues to require more time is due to how ligaments heal. Like all tissues, they are made up of various building blocks. In the case of ligaments, water, collagen, & amino acids create the makeup of the tissue. During normal use, the ligaments crimp & uncrimp based on the tensile loads placed through the joint as they connect bone to bone for structural support. As the joint is progressed through the range of motion, the ligaments elongate until they are maximally stretched. Prior to the injury, the striations of the ligaments are linear and allow for support during the full range during joint motion. Think of the striations in a nice steak, all linear and uniform as seen below.

blood cell types
Credit: Sportsinjuryclinic.net

When an injury occurs, the ligaments are either overstretched or outright tear. When a joint is taken to its end range, the proprioceptive nerves in the ligament start signaling for the muscles around the area to contract to prevent the joint from injury. While this attempts to reduce injury, the muscles are not always able to overcome the forces from the injury. Based on the severity, anywhere from several fibers to the entirety of the ligament can tear. 

During healing, the body attempts to heal quickly by putting scar tissue down in a haphazard fashion to heal the tissue. Because the tissue is not linear, the elasticity decreases & the tissue is not as strong as what was originally torn. What happens then is if the tissue is reinjured, it takes less force for the tissue to tear or it stretches out & does not regain its normal shape as easily. You can see below how the makeup of the tissue changes with injury.

scar-tissue-image-300x175
Credit: oregonmassageandwellnessclinic.com

All this tissue healing takes time, anywhere from 6 weeks to a few years for the tissue to fully mature. Fortunately, progressive loading movements help remodel the tissue as it heals in order to return to activity sooner. This is why we are able to gauge return to play timelines based on the severity of the injury. At the end of the day, Nsekhe needs proper rest with increasing loading of the surrounding tissue and ankle joint to ensure that he regains full function in the ankle without causing further damage to the healing tissue.

According to ESPN’s Marcel Louis-Jacques, Nsekhe is out of the walking boot this week, hopefully walking without pain. Ideally, he begins to practice in a limited capacity next week with an outside chance to play against the Steelers but more realistic chances to return against the Patriots. 

CLEARED

OG Quinton Spain & RB TJ Yeldon (illness)

Both Spain & Yeldon missed Thursday’s practice with what was described as an illness. Considering its flu season, that’s likely the cause. Neither were ruled out and while Spain won’t be 100%, enough fluids & Vitamin C should get him through the game. Just another reason to get the flu shot so you don’t get the flu. If you can’t get the shot, you know you can’t. But if you’re able, it helps keep you & others around you healthy. 

Possible Inactives:

TE Tommy Sweeney

OG Ike Boettger

OT Ty Nsekhe

WR Duke Williams

RB TJ Yeldon

S Dean Marlowe

DT Vincent Taylor

The Ravens are on an 8 game winning streak coming into New Era Field. Winning streaks in the NFL like this are rare & need to end at some point. I believe the Bills with their elite defense are primed to stop Lamar Jackson & Greg Roman’s offense. The Ravens are dealing with injury, but the Bills are healthier which with that and the ability to contain Lamar Jackson, could propel the Bills to victory. Here’s to a competitive game with the home crowd advantage, leading to a defining Bills win.
Top Photo Credit:

Baltimore Sun

Week 13 Bills Injury Preview- Cowboys

How are the Bills looking as they go down south?

The Bills travel down to Dallas with a lot at stake. Win, move to 9-3 & gain the national “respect” that they deserve? Or lose, drop to 8-4, and have continued questions whether they are actually a playoff-caliber team. With both teams playing on short weeks, this game will come down to who makes fewer mistakes & can capitalize on the opportunities given to them. Fortunately, the Bills are far healthier than the Cowboys & can make the most with their roster to secure a win before hosting Baltimore in Week 14. 

OUT

OT Ty Nsekhe (right ankle)

Nsekhe continues to work back from the sprained ankle suffered in the win over the Dolphins. He missed the Broncos game & won’t be back for the foreseeable future. He will continue to rehab & begin working on increasing his workloads to eventually return to practice with the hopes that he returns before the Patriots or Jets game. 

QUESTIONABLE

C Mitch Morse (right 5th digit)

Morse appeared to jam his right 5th digit or pinky on a play late in the 1st quarter, striking his hand into the ground towards the end of the play, coming up & grabbing at the area. He was unable to return for the rest of the game but was at times observed snapping to QB Matt Barkley & getting his finger buddy taped to the ring finger for support. He is likely dealing with some minor loss of range of motion, pain, & swelling. It also doesn’t help that 40% of grip strength comes from the muscles that move the 5th digit, significantly limiting Morse’s ability to grip & snap the ball. 

It’s possible he broke his finger, but without clear video, hard to say. However, he has been limited Monday-Wednesday with the finger injury, indicating that this may not be the case. It is very possible that he still plays with the fingers buddy taped together for support to play effectively. If he is unable to go or re-injures the finger, then G Jon Feliciano would slide back over with G Spencer Long taking his place.

WR Robert Foster (right hamstring)

Foster suffered a right hamstring injury on his biggest play of the day Sunday on a 24-yard catch & run down the sideline. Unfortunately, he got pushed out, forcing him to catch himself on his right side from falling over. As he was doing this, he was decelerating, regrettably overloading the eccentrically contracting hamstring and he suffered a strain. The team has been incredibly conservative with hamstring injuries this season with great success. 

Despite practicing in a limited role Tuesday & Wednesday, soft tissue injuries need time to heal up & with 5 days between games, the time simply is not there. As Foster is ruled questionable, WR Duke Williams will likely get the start after 4 games inactive. Hopefully, Foster’s strain is a minor one & he can return to play against Baltimore. 

CLEARED TO PLAY

S Siran Neal (concussion)

Neal managed to progress through the concussion protocol quickly, only missing the Dolphins game & not practicing at all last week. Last we knew, he was in Stage 2 of the protocol going through a pregame workout on Sunday. For him to progress to practicing in full & clearing the protocol is promising, indicating that he will resume as a vital cog in the special teams play.  

Possible Inactive’s:

TE Tommy Sweeney

DT Vincent Taylor

WR Robert Foster

OT Ty Nsekhe

S Dean Marlowe

RB TJ Yeldon

OG Ike Boettger

There isn’t much to discuss moving forward other than the Bills have to go down to Dallas & take care of business. Ideally, the Bills move to 9-3, shutting up the critics as the Bills march towards the playoffs despite a tough stretch of games. Either way, the Bills have taken care of business, winning the games they need to & putting themselves into opportune positions, rather than relying on others screwing up for the Bills to have a favorable outcome. Bills Mafia, enjoy your Thanksgiving & GO BILLS!!

Week 12 Bills Injury Review- Broncos

Are Morse & Beasley going to play Thursday?

No one circles the wagons like the Buffalo Bills! Circle the wagons they did with a convincing win over the Denver Broncos 20-3 on Sunday at New Era Field! From my observations, I did not see a play, series, or point in time where the Broncos were ever in control. It was not a blowout but a rather convincing win to move the Bills to 8-3, the best mark through 12 games since 1996. Think about where you were at that time; I was 8 & still watched Power Rangers. The original ones, with Jason the Green Power Ranger. Yea, that takes you back. 

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Credit: https://powerrangers.fandom.com/

Anyway, it’s a great feeling to be 8-3 with a march towards the playoffs despite a tough schedule in the coming weeks. However, to make matters difficult, the Bills have to turn around and play Thursday in prime-time against the Dallas Cowboys. Thankfully, the Bills did not suffer a major injury which gives them a better shot to compete. Below are the injuries from Sunday.

C Mitch Morse (right 5th digit)

Morse suffered a right 5th digit or pinky finger injury with 1:56 left in the 1st quarter when Broncos DE Von Miller sacked QB Josh Allen for a 5-yard loss. Morse was engaged with his blocker before falling down, landing with his right hand. He came up grabbing it & did not return for the rest of the day. He was later observed on the sideline practicing snapping to QB Matt Barkley, then going to the locker room before halftime.

I did manage to see that his 4th & 5th digits on his right hand were buddy taped indicating that he possibly jammed his finger when he fell down. To note, this is the hand that he snaps with. He did not return to play in the game but appeared to be available in case of injury. Suffering an injury to the 5th digit or pinky is crucial to Morse’s ability to play. Having pain or weakness in the hypothenar eminence which is the intrinsic hand muscles that account for 40% of grip strength really affects his ability to snap the ball. Think how painful it is when you can’t fully use your hand after it’s been hit. Now try to fully grip & squeeze an NFL football. 

It’s not to say that he couldn’t come back, but with OG Jon Feliciano as a very capable backup, there wasn’t a need for him to return. Morse stated after the game that he would take it day-to-day and that he should be fine. All he will need is some brief rehab to make sure he has full motion & strength return, possibly buddy tape the area for support & be able to play Thursday.

WR Cole Beasley (left ankle)

Beasley scared everyone when he went down late in the 2nd quarter on a designed run play by RB Devin Singletary. Beasley was blocking his assigned man when Broncos LB Todd Davis kicked his left ankle out from under him while diving trying to tackle Singletary. Beasley was in obvious pain & quickly attended to by trainers on the field. He was able to walk off under his own power & eventually return, scoring a TD in the 3rd quarter.

He finished the day 6-76-1, signaling that his ankle contusion was not going to be a problem. Like Morse, he may require brief rehab, more for pain & possible swelling in preparation for Thursday. He could possibly wear a compression sleeve under his sock but I see no scenario in where he doesn’t play against his former team Thursday.

WR Robert Foster (right hamstring)

Foster finally broke out with by far his best game in an overall disappointing season with a 22-yard run followed by a 24-yard catch in the 3rd quarter in where he was injured. He managed to catch the ball with 14:17 left in the 3rd quarter, streaking down the sideline before getting pushed out by Broncos S Justin Simmons. Foster was forced to load up his right leg to account for the sudden hit & attempted to slow down. Unfortunately, as he decelerated, he suffered what appeared to be pulled hamstring, requiring assistance from the training staff to get off the field. 

This is a common way to suffer a hamstring injury & his return was questionable, but he did not return the rest of the game. It’s possible that he was dealing with cramping in the area, but considering how he suffered the injury, it appears to be more of a strain. Barring a miraculous recovery, I do not see him suiting up Thursday against the Cowboys. Fortunately, the Bills have WR Duke Williams who is healthy & quite eager to play, having been inactive the past 4 games. 

Foster may miss the Baltimore game based on past hamstring management by the team, but considering he will have extra time to rest & rehab, there’s an outside chance he returns. We will have to see how available he is in practice following the Cowboys game.

Other notes:

As expected, OT Ty Nsekhe (right ankle) & S Siran Neal (concussion) were ruled out before Sunday. Nsekhe is nowhere near being ready to play & had shown on Instagram that he was getting rehab daily, seen below. Neal is in Stage 2 of the concussion protocol & it is unknown if he will progress fast enough to be ready to play Thursday. 

DE Jerry Hughes was held off the stat sheet Sunday by Broncos OT Garett Bolles & dealing with a groin injury. Hughes was able to provide some pressure today but overall didn’t have the impact that he typically has in the game. It’s possible that his groin may be slowing him, it’s not something I can clearly see on film. Either way, I still expect him to play Thursday because he’s playing already, why not play Thursday & then he will get 9 days off.

On a special note, congratulations to RB Frank Gore who ran into 3rd place on the NFL all-time rushing yards list. He passed the immortal Barry Sanders & continues to show everyone how the job gets done. The career he has had despite all the early injuries including ACL tears to both knees in college before entering the NFL. From a fan perspective, it’s incredible watching historic events such as that.

The Bills will have practice this week like usual but it will obviously be condensed. I expect most practices to be walkthroughs as they heal their bodies up. Besides Foster, there shouldn’t be any big losses unless someone developed concussion symptoms after the game. It will be a quick 3-day turnaround before the Bills play on Thanksgiving. By Wednesday, there will be a much clearer injury picture heading to Dallas.

Top Photo Credit:

Rochesterfirst.com

Week 12 Bills Injury Preview- Broncos

Get the comprehensive timeline on Nsekhe’s ankle & rehab process.

It was expected that the Bills couldn’t stay healthy forever. NFL games are a brutal endeavor & not everyone can avoid injury. While the Bills are down a few players going into Sunday’s game, they still appear to be on track towards making the playoffs which means they could get timely reinforcements when the health improves. The injury report is pretty cut & dry this week but there are still details to discuss especially as we are rapidly approaching 2 games in 5 days. Below is the injury breakdown prior to the game & outlook for the short week.

RULED OUT:

S Siran Neal (concussion)

Neal suffered a concussion with 7:41 left in the 2nd quarter on a routine kickoff following the 2nd FG of the day by K Stephen Hauschka. He appeared to bullrush his assignment and hit his head in the process before getting up appearing to be dazed. In a twist of irony, one of his teammates patted him on the head after the play, not exactly the ideal thing to do after a possible concussion. Neal’s day ended early, getting ruled out & placed into the concussion protocol. 

He was unable to practice all week & was observed watching practice from the sidelines which indicates that he is in Stage 2 of the protocol. He has already been ruled out & it is a guess when he will progress through the protocol to be cleared.

OT Ty Nsekhe (right ankle)

Nsekhe managed to avoid a severe ankle injury when Dolphins DE Avery Moss landed on the back of his foot during a routine run play midway through the 3rd quarter. I had originally stated that he suffered a fracture/dislocation & that his season would likely be done. I have the receipts to prove I am wrong. My buddy, Dr. Chao, aka @ProFootballDoc, also had thought the same thing but thankfully we are now looking at a week-to-week injury instead of season-ending IR. Below is a video detailing why he avoided a fibular fracture.

There were reports that Nsekhe was out at practice in a walking boot which appeared to rile up the masses in a good way thinking that the injury wasn’t as serious as it appeared to be. At the end of the day, he suffered a low ankle sprain which comes with it a still very real & arduous rehab timeline. The reason he was out in a walking boot was the fact that he didn’t have any restrictions in weight-bearing. In the rehab world, it’s encouraged to resume weight-bearing as tolerated unless specifically contraindicated in order to allow for the healing process to take place.

Yes, everyone has heard of PRICE (Protection, Rest, Ice, Compression, Elevation), but after that initial 24 hours of rest, exercise & mobility activities are encouraged for better outcomes. Multiple studies have shown that introducing exercise shortly after the injury reduces the time that one is out compared to immobilization with a 4-7 day reduction in the timeframe for return. Right now, that could be the difference between going to IR versus playing on Wild Card Weekend. 

Allowing weight-bearing allows for joint approximation is vital for the healing process. This allows the muscles in the ankle and lower leg to cocontract & increase joint stability. This also allows the joint to begin to regain proprioception which is the perception of awareness of the body in space in relation to its surroundings. These are all fancy terms, but what does this mean? This means that just by weight-bearing, he is improving his strength and joint positioning with each step he takes. As the pain & swelling reduces, he will continue to perform active strengthening in the area along with balance exercises, increasing the difficulty until he is able to begin walking without the boot. 

As he progresses to higher-level activities, jogging, running, football-specific drills will continue to increase until he is ready to resume playing. This process can take anywhere from 4-6 weeks for a Grade 2-3 sprain. As I previously mentioned in my article from Tuesday, Nsekhe is a big dude, all of 6’8” & 325 lbs. A human that big will require some extra time to fully recover from any lower-body injury. 

While this is not a great injury down this tough stretch of games, having OT Cody Ford with experience helps until Nsekhe is able to come back. The hope is that he’s back in time for the playoffs, but he could realistically come back in time for the Patriots game on the 21st. We’ll see how he progresses, but it’s hopeful that the new training center allows for him to shave more time off to shore up the offensive line. 

Final thoughts on Nsekhe, the team has been bringing in a multitude of offensive tackles to work out including former Bills Sam Young & Seantrel Henderson as possible options in case OT Ryan Bates can’t cut it as a backup or if Ford struggles. 

SUITING UP SUNDAY

DE Jerry Hughes (groin)

Hughes continues to battle through a nagging groin injury suffered sometime earlier in the season which forced him to pop up on the injury report late last week. He was able to play in a season-high 53 snaps on defense. Considering that Hughes is a right defensive end, it’s possible that he is dealing with a left-sided groin strain. He lined up most of his snaps at his natural right side but did line up several times on the left, most likely due to the particular scheme. 

Lining up on the right side means that his power is coming from his right leg driving around the corner. He appeared to not have any issues driving off the left side, but when the adrenaline is pumping, anyone can work through some pain. He was not ruled out or had any injury designation, always an excellent sign. Some may wonder why he was a DNP Wednesday & Thursday but practiced in full on Friday. This was due to veteran maintenance & to save him for Sunday. Hughes may have benefitted from sitting out the Dolphins game, but both he & the training staff felt he was ready to go.

This will be an injury that he continues to play through, unlikely practicing unless it’s a walkthrough practice in the several days between Sunday & Thursday, but barring any further injury should play Thursday as well. While Hughes has not had the stat-bursting season that was expected, he still continues to force teams to game plan for him & pressure the quarterback each and every snap. 

S Jaquan Johnson (hand)

Johnson was a full participant this week despite a hand injury that popped up on the injury report Wednesday. Trying to identify a minor hand injury on film is quite difficult & it’s not clear when he suffered the injury. Johnson is a very physical player & there were many instances where he could have got his hand caught in a jersey, fell to the ground, or during tackling. Either way, he will be able to contribute to special teams & hopefully make an impact.

DT Jordan Phillips (toe)

Phillips showed up on the injury report Thursday with a toe injury. We don’t know which side, which toe, or when it happened. My guess is that this happened Thursday in practice & that it was an injury to the big toe. The big toe accounts for 50% of body weight during walking & without the toe, significant balance & walking issues arise. Injury to the other toes are rather minor & wouldn’t warrant reporting unless they were stepped on, making it a pain issue.

If this an injury to the big toe, the team can give him a stiff-soled shoe to take the pressure off the area during running and blocking. He also did practice in full on Friday which may show that this wasn’t all that serious & that he missed some drills Thursday, but didn’t have issues Friday. If he has issues in the game Sunday, we will see them. 

Possible Inactive’s:

TE Tommy Sweeney

DT Vincent Taylor

WR Duke Williams

OT Ty Nsekhe

S Siran Neal

RB TJ Yeldon

OG Ike Boettger

The Bills host the 3-7 Broncos who despite their abysmal record, carry an elite defense into the game with several pieces on offense, making them still a very dangerous team to play even at home. Like many other games this season, this is a winnable game & the Bills have to control the run game like they did last week. To move to 8-3 would be huge as the next stretch of games against the Cowboys, Ravens, Steelers, & Patriots are no easy task. Continuing to stack wins will be vital in the march towards the playoffs. 

Top Photo Credit:

broncoswire.usatoday.com

Week 8 Bills Injury Preview- Eagles

Will Milano, Thompson, & Duke play Sunday?

The Bills continue their homestand hosting the 3-4 Philadelphia Eagles on Sunday. They are looking to defend their 2 game winning streak to move to 6-1 for their best start since 1993. While the Super Bowl is always the ultimate goal, this team continues to work towards sustained success in taking each game week by week. Following a 37-10 beating by the Cowboys on Sunday night football. Despite injuries on their side, they still come in hungry & on a mission. Fortunately, the Bills appear to be in better shape both talent & injury-wise. Below are the latest injuries prior to Sunday’s game.

QUESTIONABLE:

CB Kurt Coleman- hamstring

Coleman suffered a hamstring injury late in the 2nd quarter on Sunday on a punt play in where he was the gunner, running downfield towards the return man before pulling up lame with a hamstring injury which knocked him out of the game. This past week, he was unable to practice with the exception of Friday in which he was limited. This is not a surprise considering the conservative nature that the team takes with hamstrings. While he is questionable for Sunday, he is not expected to play until Week 10 when the Bills play the Browns. 

 

CB Kevin Johnson- neck stinger

Johnson suffered what was initially described as a head injury on a tackle to Dolphins WR DaVante Parker in where his head got twisted around and got landed on by Parker & LB Tremaine Edmunds. He suffered a stinger due to the abrupt compression to the neck area which limited him Wednesday-Friday. These types of injuries usually need rest & work back into regular activity which appears to be the case. He has a good shot chance to play Sunday, but may sit if he doesn’t feel he’s ready. 

 

LB Matt Milano- left hamstring 

The big question for the team going into Sunday is the health of Milano. His absence was noticeable in the win over the Dolphins with the offense moving the ball effectively at times. This is concerning as the Eagles offense has far more firepower than Miami brought. So far, Milano has had two weeks to fully rest and referencing reports, “maximizing his treatments”. He has looked good on film available on practice moving in a variety of directions & without obvious compensation. 

As to whether Milano plays Sunday, the jury is still out. He may feel he’s not ready, he may not be able to hit his top-end speed as he wants, or the weather may impact his decision. I am leaning towards him playing Sunday if the weather is perfect, but it will truly be up to Milano. 

 

LB Corey Thompson- ankle surgery

Thompson continues to work back from ankle surgery with the exact details not known. However, he has continued to practice on a limited basis & has moved well on film. I believe at this point he is getting back into game shape. Whether he is ready this week or next will be up to him. However, I believe that either Milano or Thompson will play, both certainly can but I don’t think both will miss, especially with how thin they are at linebacker. 

 

WR Duke Williams- right shoulder 

Williams suffered a right shoulder injury after catching a pass towards the sidelines. He landed hard on the right shoulder & missed most of the game afterward, returning in a red zone package towards the end. He later had x-rays and has been limited in practice all week. At worst, he has a mild AC joint sprain, at best, he has a contusion which is more pain limiting. 

Video has been limited, but he has been able to catch balls without any apparent bracing or compensation. According to our friends at the Coldfront Report, Duke was on the other day & indicated that his shoulder was doing fine; straight from the horse’s mouth. However, he has been wearing a red non-contact jersey indicating that they are trying to avoid re-injuring the area. Along with a pregame injection, this could potentially allow him to play Sunday. 

 

EXPECTED TO PLAY

OG Quinton Spain- foot

Spain came up on the injury report with a foot injury and did not practice Wednesday. Looking at the film, there is not anything specific that led to his foot injury which may indicate that he had his foot stepped on that wasn’t available to see on film or tweaked the foot somehow. He did deal with an ankle contusion in the preseason which wouldn’t have any impact on his current complaints. He was able to practice in full Thursday & Friday which was very promising. I do not believe this is something that will affect his performance coming Sunday unless he goes down with another injury which could shed light on the original injury. 

 

FB Patrick DiMarco- right ankle

The veteran fullback suffered what appears to be an ankle contusion late in the 4th quarter during a routine run play. DiMarco got caught from behind with a flurry of bodies landing on his ankle, dropping him to the turf. Thankfully, it appears his foot was pointed down and got hit more from the back than the side, forcing his body to go down rather than the ankle taking the brunt of the hit. There were concerns for a high ankle but considering that he was able to play in several more plays indicates that this may be more soreness than anything else leading to him not practicing Wednesday. 

He was able to return to practice Thursday confirming the contusion & will play Sunday. 

Possible Inactives:

S Kurt Coleman

OG Ike Boettger

OT Ryan Bates

LB Matt Milano

RB TJ Yeldon

TE Tommy Sweeney

WR Robert Foster

Overall, the Bills still come into the game far healthier than the Eagles. The Bills will have the upper hand if Milano & Williams are available. Getting Thompson back will also be a key depth piece in order to contain the explosive Eagles offense. The weather is forecasted to be damp and cool which may have an effect on whether they suit up. This is a game that both teams match up well & the Bills could come out with a win if they have a strong start. We can only hope that the Bills control the tempo and move to 6-1.

Top Photo Credit:

Buffalonews.com

Week 7 Bills Injury Review- Dolphins

Breaking down the severity of Williams, Coleman, & Johnson’s injuries.

I love the Buffalo Bills, I really do. But that was one hard game to watch on Sunday. The Bills, coming off a 4-1 start & a bye week, hosted the 0-5 Miami Dolphins at New Era Field. While the final score of 31-21 was not as close the game really was, the Bills nearly gave Miami a win which would have dealt a blow to their playoff chances. Fortunately, the Bills moved to 5-1 with fewer injuries than they had following the Titans win. 

Prior to the game, it was announced that both LB Corey Thompson (ankle sx) & Matt Milano (hamstring) were ruled out indicating that the Bills would be short at the position Sunday. While Milano’s presence was missed, it was still the right move to not rush him back as there is still much more football to be played.

Others coming back from injury included WR John Brown (groin), TE Tyler Kroft (ankle), RB Devin Singletary (hamstring), & CB Taron Johnson (hamstring) were all able to return and did not appear to demonstrate any restrictions, though their production in play greatly varied. Moving to the Dolphins game, reviewing the injuries below:

 

CB Kurt Coleman (hamstring)

Going in chronological order, Coleman suffered a hamstring strain late in the 2nd quarter with 2:15 left on a punt return. It was difficult to see on the broadcast, but this occurred as he ran down the field as a gunner before coming up lame before the ball was even caught. 

Like all the other hamstring injuries this season, expect the Bills to be conservative in slowly bringing Coleman back into the special teams fold. Look for a minimum of 2 games before he is able to return. Observing the hamstring injuries so far this season, most have come on full out sprinting with some change of direction or deceleration incorporated into the injury. This doesn’t mean that the Bills are doing anything wrong in preventing these injuries, it just shows that going all out on every play, even the best, most conditioned athletes can get hurt. 

 

WR Duke Williams (right shoulder)

Williams suffered a right shoulder injury on a 23-yard completion late in the 3rd quarter. After hauling in the catch, Williams fell hard onto his right shoulder before rolling out of bounds in obvious pain. Miraculously, he was able to return late in the 4th quarter in a red zone package on the WR Cole Beasley touchdown. Later, it was reported that he went in for x-rays following the game.

Looking at the actual injury itself, it appears as though Williams suffered either a contusion or AC joint sprain, also known as a separated shoulder. The mechanism of injury for this is falling directly onto a shoulder without the ability to brace against the fall. Considering that he fell more on the top of the shoulder, I believe he may have sustained an AC joint sprain. This is the area that the acromion connects with the collarbone. This allows the collarbone to connect to the scapula and create a framework for the shoulder muscles to connect in order to move freely during arm motion and overhead movement.

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Credit: http://www.dovemed.com

There is a slight chance he could have suffered a glenoid labrum tear, but that is relatively unlikely considering the shoulder was slammed into the ground versus falling on an outstretched arm. If he sustained this, then I expect to see bracing on the area which will be a dead giveaway. There was also a chance he could have sustained some type of clavicle fracture due to the hit, but if he had sustained that, he would not have been cleared to return & a public report would have been made.

The fact that he was able to return to the game even in a limited fashion indicates that this may be more of the AC sprain/contusion variety. He may be limited in practice this week as he recovers, but his availability in practice will further dictate the specifics of the injury. Looking back at past research from other articles, the average time for a player to miss is 9.8 days according to data obtained from the NFL injury surveillance system. The fact that he doesn’t have to throw a football may accelerate his return. It’s very possible he plays next week. If he does miss any time, it should be minimal one game as a precaution.

 

LB Maurice Alexander (left hip)

Alexander, filling in for the injured Matt Milano, suffered a left hip injury while tackling Dolphins TE Mike Gesicki going out of bounds. The tackle itself was clean; the injury occurred when Alexander’s left hip fell on Gesicki’s foot while going down. He attempted to walk back to the field but quickly went down for medical attention, motioning to his left hip/back region.

Thankfully, he was able to return as the Bills were only carrying four linebackers Sunday. This injury may have been a hip pointer which is a deep bruise to the iliac crest. This is the portion of the hip where the core muscles attach and give that distinctive flair out seen in the hips. Considering the muscles attach there; twisting, side-bending, & engaging the core muscles further aggravate the injury with pain being the major limitation.

This may be an injury that Alexander doesn’t miss anytime with or even show up on the injury report. If he does miss anytime, I wouldn’t expect any more than one game. But noting these minor injuries here explain why the player went down & the possibilities of the injury.

 

CB Kevin Johnson (stinger)

Johnson suffered what has now been termed a stinger following evaluation for a head injury Sunday. These injuries are subtle on film and may not be apparent, but Johnson’s last play during the game came with 3:27 left in the 4th quarter. Johnson managed to tackle Dolphins WR DeVante Parker with assistance from Bills LB Tremaine Edmunds. 

While we are not certain that this play caused the stinger injury, it’s likely due to the fact that his head bent awkwardly & was rolled over as he hit the turf. He initially appeared dazed for a moment following the play & did not return. 

A stinger occurs as the result of the neck getting forcefully sideways and down, putting pressure on the cervical nerve roots coming from the spinal cord. These can be pinched by the vertebrae stacked above & below the nerve or can be the result of a disc protruding out & pushing on the nerve root. The nerve roots can also be overstretched due to traction from the neck getting hit in the opposite direction. A direct blow is yet another way for this to occur.  The pain associated with this is what gives it the name burner or stinger. The nerve root that is compressed sends a pain signal down that nerve & gives the unwelcome sensation. 

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Credit: http://www.aafp.org

This pain would only be produced in the affected nerve roots which means if someone sustains a stinger, they could feel it down in the specific parts of the arm/hand based on which nerve has impinged. This could be felt in places such as the 4th and 5th digits on the hand with resulting grip weakness or difficulty lifting the arm up overhead, indicating the specific nerve root affected. The effects of the stinger may linger for several days or the symptoms could resolve quickly.

Most of the time, these injuries are minor & don’t cause further issues. Return to sport would be indicated when the player is pain-free, full strength and range of motion have returned, and no flare-up of symptoms occurs. If this becomes recurring or linger, then further examination is warranted. This could involve getting an MRI or nerve conduction studies to further identify the specifics of the injury. It could lead to surgical consults if there was a need for cervical fusion due to instability or if the injury was high enough in the cervical region, potentially career-ending as in the case of former Bills C Eric Wood

I do not believe this to be the case. I merely lay out the possibility of the severity of the injury & what this means regarding stingers. It is still too early to determine if he misses any games or will be limited in practice.

Fortunately, the Bills walked away from Sunday with far fewer injuries than in previous contests. The injury report will be far smaller than in past weeks & indicates that the Bills are getting healthy as a critical stretch in their season approaches. While the quality of the opponent’s vary, they still all pose a threat to the Bills playoff chances. This team is built for depth but there is a clear difference between starter & replacement level players, evident over the past few games. This week’s practice will hopefully show progress for Thompson, Milano, and Johnson as the Bills prepare to host the Eagles next Sunday. 

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http://www.predictem.com

Week 5 Bills Injury Preview- Titans

Will Allen be cleared to play in time?

While the Bills are still banged up, they are far from out of contention after the quarter pole of the season. They sit at 3-1 with the 3rd best record in the AFC and still very much in control of their own destiny. While there is a lot of uncertainty heading into Week 5 against the Titans, most of the players are starting to turn the corner injury-wise. Today’s article outlines the injuries heading into Week 5 and who is expected to play.

RULED OUT:

LB Corey Thompson (ankle) & TE Tyler Kroft (ankle)

Thompson is still dealing with surgery that was likely the result of a cleanout from a previously unknown injury. His timeline is fluid and is not expected to be back for another 2-3 weeks at best guess. Kroft is still working back from his low ankle sprain in his left ankle & I would not expect him to be back until after the bye. Until he gets 3 consecutive full days of practice in, consider him benched until further notice. 

 

QUESTIONABLE:

QB Josh Allen (concussion)

As it’s widely known, Allen is coming off a concussion sustained Sunday at the result of Patriots CB Jonathan Jones. There has been a lot of optimism that he can return to play Sunday but historically, most players who sustain a concussion miss the next week. There have been instances where last season QB Phillip Rivers cleared concussion protocol before clobbering the Bills in the 2017 season in the infamous Nathan Peterman game. Former Bill RB LeSean McCoy suffered a concussion last year in the loss to the Colts & returned in time for MNF against the Patriots. 

Concussions are unique in that no one is ever the same and timelines for recovery vary. Considering Allen was in Stage 4 of the protocol all this week & practiced in full, this still isn’t a guarantee. He still has to be cleared by the independent neurologist. The reports look promising and I’m leaning towards him playing, but until we get word that he’s cleared, there isn’t a guarantee he plays. 

S Dean Marlowe (concussion)

Marlowe suffered his concussion after the first Bills scoring drive in which he wrapped up the kick returner before getting hit in the head as he required assistance to complete the tackle. This was with about 10 minutes left in the 3rd quarter. He appeared wobbly on the field before reportedly was assessed for a head injury. Like Allen, Marlowe is in protocol & appeared to be in Stage 4 as well. If Marlowe is able to clear the protocol, he will be a key special teams player & necessary depth. If he isn’t cleared, expect S JaQuan Johnson to go.

FB Patrick DiMarco (concussion)

DiMarco was a surprise addition to the injury report this week with the 3rd concussion from Sunday. While we generally know when Marlowe’s occurred & certainly when Allen’s happened, DiMarco’s was less apparent. DiMarco was in the game with 3:19 left in the 4th quarter on punt coverage indicating he wasn’t knocked out of the game like several others. He did suffer a hard hit several times including on 2nd & 9 on the flea-flicker to RB TJ Yeldon while performing a chop block. He does get a knee to the head but doesn’t appear to be initially fazed. He also takes a hard hit on 4th & 10 with 8:44 left in the 4th quarter, but this wasn’t out of the ordinary for physical football hits. 

During Wednesday’s practice, he was able to be on the sidelines working on the stationary bike indicating that he is in Stage 2-3, working through increasing the heart rate & tolerating sustained physical activity. Thursday improved his status to Stage 4 with him participating in non-contact activities. Friday indicated that he practiced in full. It’s likely but uncertain if he will play Sunday, but considering how important he is in special teams, it would be beneficial.

Author’s Note:

I try to keep these articles as objective as possible with a little bit of opinion because, well, it’s my website. But I’ve noticed that a lot of people on Twitter are on the bandwagon that if Allen sits for an extra week, then he’ll be extra healthy, especially after the bye. Some people have commented that how do we know if the brain is fully healthy? How can he heal so quickly?

Frankly, we don’t know the brain is fully healthy. We don’t have the technology at this point to look further. But what we do have is objective measure testing. What this encompasses is testing his memory and processing through cognitive testing, his coordination & how his eyes are responding/interacting with input from the outside world with vestibular testing, his physical symptoms such as headaches, nausea, dizziness which can be measured by heart rate & blood pressure. 

We’re looking at baseline testing from the beginning of the season & compared to how he re-tests to measure where he is at. The hope is that he excels and outperforms the baseline. The baseline acts as a control in the scientific method. The experiment is objective testing. The idea is that does this objective testing correctly measure whether he is healthy & able to return? So far, we have seen this utilized successfully & with great results. 

So what does this boil down to? Once the testing shows that a player has been tested & passes protocol, then he is cleared. Simple as that. Until there are methods that further identify whether the brain is fully healthy, we go with what we know best. Remember, doctors used to use leeches for bloodletting, cocaine/heroin for nearly every remedy, & lobotomies for mental illness. We learn from these mistakes. The hope is that we work with what we know at the time & look to improve the process. 

WR Robert Foster (groin)

Foster suffered a groin injury late last week, missing Week 4 due to the acute nature of the injury. He was able to practice in full Wednesday & Thursday which was an excellent sign & may be ready to contribute in both the offense & special teams. We do not know the specifics of the injury, there is a higher risk to re-injure the area, but practicing in full is always a good sign. However, he was limited Friday and is now officially questionable for Sunday. Considering he is still dealing with the turf toe from training camp & in addition to the groin, it’s reasonable he’s questionable, but certainly more likely to play this week than last.

CB Taron Johnson (hamstring)

Johnson has missed the past 3 games with a hamstring injury dating back to the season opener. He has looked excellent in practice the past 2 weeks performing agility & football-specific drills, but was, in my opinion, a surprising inactive for Sunday. Either he felt he was not ready or had some type of setback with tweaking the area prior to the game. He has been limited the past 2 weeks in practice. 

However, looking back through the past 3 years of Bills injury reports on pro-football-reference.com, historically, with this medical staff, players have missed 2-3 games before returning to play. To go down the rabbit hole further, none of the players that suffered a hamstring strain appeared on the injury report later in the season with the same injury. I believe that the team would rather have the player miss more time to recover then rather than suffer re-injury later. I still believe he can play Sunday, but it may be truly his decision on whether he plays. 

RB Devin Singletary (hamstring)

Like Johnson, Singletary has been dealing with a hamstring strain suffered in the win over the Giants. He missed the Bengals game as expected, but was nearly able to play against the Patriots. His hamstring injury appears to be milder than Johnson’s based on games missed and reports indicating that he was almost better to play last week. He is still questionable going into Sunday from the injury report. I believe he has a better shot to play Sunday than Johnson, but it may come down how he feels & whether the weather will play a factor with a chance of rain. Along with Johnson, the slick grass could potentially aggravate any injuries if they were to slip or attempt to stop.

OT Ty Nsekhe (ankle)

Nsekhe was dealing with an ankle injury from Sunday but has been on a constant rotation with rookie Cody Ford. It’s not apparent when he suffered this ankle injury, but he was working through what appeared to be a right ankle injury last week in the Bengals game. He did leave briefly & returned to the game, but it is possible that he could have re-injured the area. We do not know what ankle he is dealing with, but I bet it’s the same ankle again. He did not participate in practice on Wednesday, Thursday, or Friday which normally indicates that a player won’t play Sunday.

 

CLEARED

OG Spencer Long (ankle)

Long suffered an ankle injury late in practice last Friday for which he was limited. As the team has several reserve linemen, they likely did not feel that it was appropriate for Long to try and play through a fresh ankle injury, whatever it may be. He has since practiced in full on Wednesday indicating that he is moving past the issues from last week. 

CB Tre’Davious White (ankle)

White is coming off an obvious low right ankle sprain suffered midway through the 2nd quarter. He was able to leave briefly before returning to finish playing. At times, he appeared to be a step slower with his coverage assignments due to the inability to pivot & push off the foot. From what is available in practice, he does not appear to be wearing any bracing & not wearing a red contact jersey as well. Barring setbacks, he should play in full Sunday & then have an extra week to rest & recover.

WR Cole Beasley (ankle)

Beasley was a new addition to the injury report with an ankle injury. Looking at the film, he played in 85% of the plays & there wasn’t any clear instance where he would have suffered an ankle injury. Without more information, it’s hard to speculate the exact injury, but considering it’s an ankle & he practiced in full, he should play Sunday. To note, he does require veteran rest days throughout the week which explains the DNP on Friday.

 

OTHER’S TO NOTE

OG Jon Feliciano (neck)

The reason I bring up Feliciano is due to a play that was tweeted from @Cover_1. It shows that Feliciano blocks effectively, but gets hit in the mouth before dropping to his knees, becoming rigid like a board, and falling to his right side, lying for a moment before getting back up. It’s unknown if this was related to the neck injury, but he hasn’t appeared on the injury report indicating he is healthy enough to play football.

WR Zay Jones (shoulder)

Jones continues to be an enigma to Bills fans this season. After having a regrettable rookie year due to a torn labrum in the shoulder, he was able to return in 2019 and produce some solid statistics. The hope was that he was able to continue building off the promising 2018 campaign, but so far, he has missed the mark. He did not appear on the injury report this week, but I still question if this shoulder injury isn’t somehow contributing to his decline in production this season. Looking back on his rookie year, the torn labrum was clearly a factor. 

WR Isaiah McKenzie (ankle)

As you can see the theme with the injury report, McKenzie is also dealing with an ankle injury. This occurred sometime late during practice last week but he was active on gameday. He only played in 1 offensive snap, indicating he probably needs to rest & recover, but the Bills required certain depth and to fill out the 46 man gameday roster. He wasn’t on the injury report this week indicating that he is getting better with & should be able to play in full if another receiver can’t go.

OT Conor McDermott- waived

McDermott was waived Thursday afternoon leaving the Bills at 52 players. While there hasn’t been a corresponding move yet, the team can go in several options. There is an outside chance that Allen can play Sunday, which means someone like WR Duke Williams could come up to show what he is able to do. If Allen can’t play Sunday, then practice squad QB Davis Webb could be called up to back up QB Matt Barkley. Another option could be if RB Devin Singletary can’t go again, then they could call up RB Byron Marshall due to DiMarco unlikely to play. 

Possible Inactives:

TE Tyler Kroft

LB Corey Thompson

S Dean Marlowe

CB Taron Johnson

WR Robert Foster

OG Ike Boettger

OT Ty Nsekhe

Overall, this bye week is coming at an opportune time. Last time this year, the Bills were incredibly healthy, dealing with little to no injuries according to records. Most of the players should be able to come back after the bye & contribute barring any new injuries Sunday. 

Top Photo Credit: CBS Sports