2020 Week 4 Bills Injury Preview- Raiders

What is going on with Ed Oliver’s knee? Will Zack Moss play Sunday?

The Bills are getting healthy. Despite the injury list being longer than we would all like, several players are set to return & several more are expected to play despite dealing with injury. While the Bills are not fully healthy, they are in a far better position than the Raiders as seen below who are missing many key contributors which may make the Bills job on Sunday far easier. Below are the Bills injuries heading into Sunday’s matchup.

OUT

LB Del’Shawn Phillips (left quadriceps)

Phillips will miss his 3rd straight game following a quadricep strain in the season opener. Originally, I could not find when this occurred but after further review, I found on the All-22 film that he suffered a quadricep strain with 6:48 left in the 2nd quarter on the kickoff following the Bills 3rd score. He ran down the field and appeared to strain his left quadricep, having difficulty slowing down, occasionally hopping it off.

Since then, he has not practiced with the exception of Thursday & Friday in which he was limited. He likely suffered a Grade 2 quadriceps strain which can take anywhere from 4-6 weeks to recover based on the already established timeline. His status poses the question, why didn’t the Bills place him on IR since it is only 3 weeks now? That’s a good question. It’s possible that he was trending towards coming back sooner and had a setback or simply did not respond to rehab as expected.

While he only has 7 special teams snaps as a Bills to his name, the team clearly likes him and is keeping him around despite the ability to stash him on IR. I would need to see a string of full practices out of him before I could even consider him to play in a game.

QUESTIONABLE

DE Mario Addison (knee)

Nothing is known about Addison & his knee that popped up on Friday with a DNP. His status is officially questionable. There wasn’t anything in particular on film Sunday that suggested a knee injury. He did exit the game for cramping in what appeared to be his right leg, but this should not cause knee problems several days later.

He did have a knee injury back in 2017 that he didn’t miss any time with, but I do not believe this is connected nor do we know which side. It’s possible that he hurt his knee Thursday after practice, but any specifics are non-existent. I have to assume he doesn’t play based on the questionable diagnosis, but that guess is as good as flipping a coin and calling heads.

RB Zack Moss (toe)

Moss appears to be trending up from a toe injury sustained in the win over the Dolphins in Week 2. He likely suffered a turf toe injury which can be played through but does benefit from some time off. Fortunately, he’s not a bell cow back for the Bills and he can split carries with RB Devin Singletary and if needed, use RB TJ Yeldon like they did last week.

Moss will probably have a stiff sole and possibly tape to prevent excess movement at the big toe so that he can have that explosive first step. If he doesn’t play, then I expect him to be full-go for Week 5. Without more knowledge to sway either way, I’m leaning towards him playing.

ACTIVE

WR John Brown (calf/foot)

Brown continues to be limited with foot issues since the beginning of the season, adding in a calf strain from the Rams game that caused him to miss the 2nd half.

The foot is more of a pain issue and a nuisance more than anything. The calf strain can linger but if he took himself out Sunday in the second half as a precaution and was DNP Wednesday, limited Thursday, and full Friday, it’s likely that he is healed enough.

The team may also be conservative in his approach during practice due to the heat expected in Las Vegas. This could exacerbate a strain if he gets dehydrated, however, they are in a climate-controlled stadium which may neutralize that factor.

Brown also has sickle cell trait which could place his body under extra stress and pain if he overworks his body or becomes dehydrated. This is merely a factor the team has to account for but does not limit his abilities. Sean McDermott appeared fairly confident that Brown would be available Sunday which is a ringing endorsement from a coach who says very little.

LB Tremaine Edmunds (right shoulder)

Edmunds finally was able to practice in full following a shoulder injury in Week 1 that caused him to miss Week 2. He did return in Week 3 and was less than effective with a shoulder harness.

Another week of rest & rehab should do him well & he should improve his play. The hope is that he eventually ditches the shoulder harness which would support the AC joint sprain which makes more sense & is less severe than a labral tear. He’s not 100% yet, but I expect him to slowly continue to improve towards a Pro Bowl level. I will also be watching closely how he engages his tackles and if he accepts more hits to the right side.

TE Dawson Knox (concussion)

Knox is slated to play Sunday following a concussion in Week 2 that forced him to miss the Rams game. He has since practiced in full and only has to pass his independent neurological consult if he hasn’t already. He is at a higher risk to suffer another concussion since he has already had one but playing football, he’s at risk regardless.

T Dion Dawkins (right shoulder)

Dawkins took a hard spill on Sunday as the result of trying to avoid Rams CB Troy Hill, somersaulting over him and landing on his right shoulder. The hope is that this is a contusion and is more pain limiting. There is a possibility that he suffered a minor AC joint sprain, but Dawkins was fairly jovial and hanging around following the win Sunday while not appearing to favor the arm.

One benefit of this being his right shoulder is that he plays left tackle. He will have to engage his left arm more, blocking the defensive end around the edge, allowing Dawkins to keep the end in front of him. He will use his right arm, but he can get through the game a lot easier because of this. I really don’t expect much drop off in the quality of play Sunday.

S Micah Hyde (left ankle)

Hyde sprained his ankle going in for a blitz Sunday and rolled it engaging the Rams tackle. Low ankle sprains are painful but easily played through with bracing or tape. My only concern is if he continues to re-injure the area that he misses time. I’m not all that concerned about damage in the short term, it’s easy to manage, but he is an older player and continues to require occasional days off to recover.

DT Quinton Jefferson (foot)

Little is known about Jefferson other than that he’s an older player with a previous Jones fracture from last season. He did have foot soreness in the preseason and is dealing with this again. There are other possibilities such as the plantar fasciitis that John Brown could be dealing with or that Jefferson had his foot stepped on.

This is something that I’m aware of but not concerned about right now, but something to monitor as the season progresses. I will be looking for patterns on the injury report and if he begins to miss snaps/games. For Sunday, he will be good to go.

DT Ed Oliver (right knee)

Oliver’s knee injury appeared pretty innocuous during Week 2 when he attempted to trip the offensive player, getting hit directly at the knee and then hit on the shin.

He was limited Wednesday due to the knee continuing to bother him followed by a DNP Thursday. This sent out a lot of concern to the masses thinking he wouldn’t play, but Ian Rapoport of NFL Network indicated that it was a bruise and that the knee was structurally sound. But considering the DNP’s on Wednesday, this was probably done to stagger all the various players out. He likely hyperextended the knee during the original hit which led to the brace, but overall it does mean that the knee is sound as the knee does have some leeway with extension.

However, this picture above began making the rounds late Friday evening which makes me believe something more is going on. Clicking on the picture below, you can see that there is a bandage of Oliver’s medial right knee. Considering this is the location that he was hit, I got to wonder if he got his knee drained due to excess swelling.

This is a common procedure and the knee would be drained in that area. This picture highlights how severe the bruising may actually be. If you compare the right versus left calf, you can also see less definition on the right calf as compared to the left which would further show overall swelling in the knee and lower leg. I reached out to several Bills fans who have greater expertise in those areas and supported my thoughts. Really appreciate their input!

I wouldn’t be surprised to see both a compression sleeve on the knee and hinge brace for support Sunday. This will be something to monitor in the coming weeks.

CB Josh Norman (left hamstring)

Norman is slated to return to the active roster following a 3-week stay due to a likely Grade 2 left hamstring strain suffered during the first week of real training camp. He appeared on the mend but had a setback at the end of August, forcing him out of practices prior to Week 1.

He has since returned to practice Wednesday and has not been on the injury report. As of publication, he has not been activated, but the Bills waived CB Cam Lewis, later re-signing him to the practice squad. Considering the position and roster move, it appears a foregone conclusion that Norman will make his debut with the team Sunday. I expect him to work into a split role with CB Levi Wallace to keep the Raiders off balance and to help him adjust to game speed.

Ideally, the time off helped reduce his risk to re-injure the hamstring, but it is not completely absolved. Hopefully, he can find the fountain of youth and rekindle some of his stellar play from his days in Carolina.

Inactives:

QB Jake Fromm
DE Mario Addison
OL Ike Boettger
RB TJ Yeldon
TE Lee Smith
LB Del’Shawn Phillips

There doesn’t appear to be any surprises for the inactives, more personnel inactives than injuries besides Phillips & Addison. Based on my thoughts that Addison doesn’t play, that allows both DE Darryl Johnson & DE AJ Epenesa to get out there as they have been inactives in past weeks.

The Bills are far healthier heading into this game than the Raiders and I believe more talented. The injuries that we do have are on the mend which can help continue to develop depth in place until the starters are healthy. This is a game the Bills expect to win as they have much greater competition farther ahead, making each week more important than the last. Despite the early injuries, the rust appears to be shaken off and ideally, the quality of the defense continues to improve in order to support the hot start by the offense.

Top Photo Credit:

Chris Benoit Facebook/Nate Mendelson Twitter

2020 Week 3 Bills Injury Review- Rams

What are the latest updates on Brown, Edmunds, & Dawkins?

WHAT. A. GAME. 

I’m not sure there’s appropriate words in the English language that explain what happened Sunday. From a near meltdown to bad calls to final play heroics, this game had it all. Fortunately, the Bills ended Week 3 with a win to move to 3-0 as they prepare to face the Raiders at their new stadium. I could write an entire article on the emotions of the game. But you’re not here for that. Below, a recap of the injuries from Sunday. 

WR John Brown (calf)

Brown’s day ended early following halftime with a calf injury. Reviewing the film, there isn’t anything particular that stood out regarding his calf. He didn’t appear to be limited with any of his routes or come up limping even at the very end. 

I’m considering this injury as a wait and see, he could have hurt the calf, been fine and then halftime, everything tightened up. He could have hurt the calf and it just wasn’t on broadcast film and All-22, this could have also been a injury that isn’t spotted on film. He could also have had a previous strain that was not reported that worsened on Sunday. 

I also want to note that the foot soreness that could be plantar fasciitis could have contributed to this. Some of the interventions to address the plantar fasciitis include stretching out the calf/Achilles to reduce stress on the fascia. But I question if it did contribute because I would tend to believe they were stretching out the area already.

HC Sean McDermott wouldn’t go into specifics with the injury nor would he say which side the calf injury was on and if it was the same side as the foot soreness. I don’t have any insight as to which side is which at the present time. 

T Dion Dawkins (right shoulder)

Dawkins took a tumble prior to the 2 minute mark in the 4th quarter and was in obvious pain, requiring trainers to assess his shoulder. He tripped over CB Troy Hill, landing with his right arm extended to brace the fall. However, the heel of his wrist hit, followed by the elbow bending to break the fall and then hitting the shoulder on the ground. 

He did try to come back in immediately after an assessment by the trainers which may indicate that it isn’t serious. I am concerned about the labrum or AC joint, but this could have been simply a contusion. Considering he tried to come back in suggests that it may not be serious because some of the other injuries would have required further evaluation or time away from the field. 

S Micah Hyde (left ankle)

Hyde appeared to suffer a low ankle sprain early in the 4th quarter when he attempted to go in for a blitz and got blocked by the Rams tackle Andrew Whitworth. He attempted a spin move, turning to his left before going down in obvious pain but was able to walk to the sidelines under his own power. 

He had his ankle taped up and returned to play shortly afterward. He did suffer the same injury back in Week 1 against the Jets and it appears he re-injured it. Overall, this isn’t a concerning injury and he can play through it, but I am worried about further instances with him missing time during the games if he tweaks it. Hopefully he can continue to tape it up and avoid re-injury to the area to allow it to heal properly. 

LB Tremaine Edmunds (right shoulder)

Edmunds returned following a week off and clearly was not himself. He struggled to wrap up his tackle, he had difficulty engaging the blocks with his right arm, offensive players got by him on the right side and he just wasn’t himself. He exited the game on the final Rams TD when he hit directly on the shoulder by Rams RB Darrell Henderson. 

He did have a shoulder harness on the right shoulder which usually indicates some type of shoulder instability. I’ve seen these used more for labral tears, similar to what we saw with CB Taron Johnson in 2018.

However, I still do not think he suffered a torn labrum. The mechanism simply isn’t there from Week 1. Either he injured the shoulder another time we didn’t see or this is something else. Based on how he fell in week 1, this is worse than a contusion. This could be a Grade 2-3 AC joint sprain. There is much more instability in the area due to the damage and he would have difficulty engaging the right side due to weakness from the clavicle not providing support with arm movement. These can take anywhere from 4-6 weeks for a Grade 2 and 6-12 for a Grade 3.

I understand I keep flip flopping on the possible injury, but the idea is that my opinion changes based on new information. If this is an AC joint sprain, the hope is that he can avoid further contact to the area and provide stability in order to allow things to fully heal.

Rarely do these require surgery and can be managed, but he will be limited in the short term. I wouldn’t be surprised if Edmunds wants to continue playing and avoid the IR. The team obviously knows more than we do and is managing this as best they can.

The coaching staff is aware of the pain & restrictions he has with his shoulder in playing through it during Monday’s press conference. Hopefully Sunday’s hit did not set him back more in his recovery process.

Injury Roundup:

DE Mario Addison was noted to have cramping that caused him to miss several snaps, but he was able to return shortly after getting fluids. It was a warm day with strenuous physical activity, it’s no surprise that he was dealing with cramping. There’s no concern moving forward, just a reality of playing football.

DT Ed Oliver looked good Sunday and was noted to be wearing the right knee brace mentioned in the previous article. He did not appear to be limited with the use and the injury appeared to be a non-factor.

CB Tre’Davious White & WR Cole Beasley both looked effective despite their respective injuries they were dealing with last week. They may continue to manage these complaints into practice this week, but it does not appear concerning at the moment.

LB Matt Milano & CB Taron Johnson both looked like they didn’t miss a step with their respective soft tissue injuries. Both are still at a higher risk to re-injure, but the hopes that they continue to get the proper rehab and rest in order to reduce those risks are ideal.

G Jon Feliciano, WR Isaiah Hodgins, & WR Josh Norman are all eligible to return from the IR list this week. I could see Feliciano & Norman return to practice but only Norman possibly getting activated after a week or two ramp up. Feliciano could wait longer and they could stretch this out longer than returning immediately.

They all do have a 21 day window to practice without taking up a roster spot before they need to return to IR or go active. I don’t see any need for Hodgins unless Brown misses extended time. 

The big question marks moving forward will continue to be the health of Tremaine Edmunds & Dion Dawkins. We will see how this week’s practice goes, but these will be closely monitored. The Bills continue to avoid the season ending injuries, but this does not mean that they are immune. Hopefully these guys can return and continue to be effective.

Top Photo Credit: BillsWire

2020 Week 3 Bills Injury Preview- Rams

Make sure to scroll down to the players you’re interested in. It’s a long one.

Heading into Week 3, we got a long injury report here folks. But the Bills have been through this before. They have quality depth and the ability to call up practice squad players that have been in the system before rather than street free agents who don’t know the system. 

While there are a lot of players in today’s report, everyone is still adjusting to the regular season with hitting, conditioning, and getting back into game shape. This is where some preseason games are beneficial to prime their bodies rather than going from 0-100. Ideally we see this drop off as the season progresses. But until then, this week’s injuries are below. 

OUT

RB Zack Moss (toe)

Moss was ruled out of Sunday’s matchup due to a toe ailment suffered in Sunday’s win. This was likely the result of the catch & run midway through the 4th quarter. He eventually returned to the game later, albeit briefly before the game finished. 

Based on the designation of a toe, it sounds like it could be turf toe. There are other possibilities such as a fracture, but he was observed off to the side on the exercise bike and doing individual activities.

PTEducator.com

Turf toe is an injury where the big toe is suddenly hyperextended due to a fall or some other force such as a tackle when the foot is planted into the ground that pushes it past its normal range of motion. Like any other joint in the body, this too can be sprained. The risk for this can be increased with flexible shoes which reduce support around the area of the foot.

Any other toe injury can be conservatively managed and isn’t a problem even in day to day life. But the big toe is vital to walk a heel toe gait pattern; strike with the heel, push off on the toe. The toe is even more vital during running as sprinting is done up on the balls of the feet, placing further stress on the toe. 

The timeline for a turf toe injury can be 2-4 weeks or even more based on severity. Look back at Packers WR DaVante Adams last year for reference. Due to the demands of the big toe, especially with high end athletics, it can be easily re-injured if not managed properly. This is something that can linger for weeks and limit production. 

He is obviously missing this week and potentially next week. Once he returns after the area has had a chance to heal, he can use a stiff sole to help reduce toe extension during push off and taping/bracing to support the area. He may lose some explosiveness after coming back, but if he gives it proper time to heal, then he may be fine. It will be important not to rush back because then he will lose that first step explosiveness and top end speed if he cant push off his toe effectively.

It’s important to note that he had a toe injury back in 2016 during his freshman year at Utah. It’s not certain that it was a turf toe injury, but he missed 2 games as a result. The injuries are not directly related as we don’t know specifics or even side l along with the time span in between. But if this is another bout of turf toe, he may be able to understand his body better and rehab more effectively. I expect TJ Yeldon to get a rare crack at the game day roster. Remember, he’s a 3 down back according to Brandon Beane.

TE Dawson Knox (concussion)

Knox is out with a concussion following Sunday’s win. He has since had 3 straight DNP’s at practice and right now appears to be at about Stage 3 due to participating on the exercise bike and drills. He will now have to go through football specific drills and a full practice without symptom reproduction before he can be cleared by the neurologist. 

It’s rare that a guy is able to return from a concussion in a week’s time and hopefully he can return for Week 4. There were a lot of people who sent video of hits he sustained to the head that game. I do appreciate every one of you for doing that, but it is nearly impossible to diagnose a concussion on video alone unless the individual has been knocked unconscious. Let’s hope he’s back for Week 4.

LB Del’Shawn Phillips (quadriceps)

Phillips continues to be out with a quad injury sustained in the season opener over the Jets. He has not practiced since then and video does not exist of the injury that he sustained on special teams. 

This is appearing to be more of a quadriceps strain and literature for quadriceps strains is more limited than hamstrings, but from what I found, timelines are similar to that of hamstrings. There’s a possibility that this could be a tendonitis as well, but that is something that can be played through more than a strain.

It’s important to note that WR Andre Roberts missed the first two games of the season last year with a quadriceps injury. This may be the same course of action that the Bills take with Phillips or this could be an injury that we don’t have all the facts on yet. We continue to wait and see. 

QUESTIONABLE

LB Matt Milano (hamstring)

Milano has been able to practice in a limited fashion all week after missing Week 2 with a hamstring strain. Hamstrings can take 13-18 days on average to return to play, but his injury may have been truly minor; a term that I’ve come across is “niggle”. I believe Milano had a niggle. 

Could he benefit from another week off? Sure. But if he’s feeling good and he can play, then I can live with that. He is questionable, but a hamstring is not an automatic out for 2-3 games. Some guys can come back the next week, others take much longer. We are seeing that with the setback with CB Josh Norman & this shows that each hamstring is unique. With how practice has been this week, he is still 50/50, but I’m leaning towards him playing Sunday. 

LB Tremaine Edmunds (right shoulder)

Edmunds has been tricky for me these past 2 weeks. I initially had him as a contusion, possible AC joint sprain. Then he missed the last game which leads me to believe he may have had more of a SC joint sprain or bruised rotator cuff. I’ve studied the film, watched his practice and without a physical examination, I am stumped.

This could be Occam’s razor and I’m overthinking this. The fact that he has had a red non-contact jersey for the last two weeks is concerning, but that may be more to prevent further injury. He may have benefitted from the week off and be ready for Sunday. 

From what I’ve seen, it’s very possible he plays. Especially with the benefit of his skill set against the Rams, it’s an important game to get up for. He’s also 50/50, leaning towards seeing him playing. 

CB Taron Johnson (groin)

Not much is known about Johnson. He has a long history of injuries dating back to his rookie year with the shoulder labral tear followed by a hamstring strain last year. Now he has the groin strain which isn’t great for a defensive back with all the cutting & pivoting he has to do as part of his position. 

He did not exit the game and was a full participant on Friday which is a good sign. However, groin strains, like many other soft tissue injuries can linger and cause problems later. We do have depth at the position, he will probably play, but considering Johnson’s penchant for injury, he may be best served to sit this one out. 

ACTIVE

WR Cole Beasley (hip/right thumb)

Beasley is active despite dealing with two separate injuries. The hip is not all that concerning, it could be more of generalized hip soreness or bruising due to the fact that he had several hard falls during his catches on Sunday. 

However, the injury I am more concerned with is his right thumb injury. He had it heavily taped in practice on Thursday and was in visible pain when catching the ball. 

He may have suffered a mild/moderate thumb sprain, also known as skier’s thumb. He could have fell on the thumb during one of his catches, forcing it into extension and abduction. He could also have gotten it tangled up with a defender, it wasn’t clear on film. He’ll be able to play & still be effective, but with how hard Josh Allen throws and the injury, I hope we don’t see a drop or two due to the pain and resulting weakness in the thumb region. This will be something to monitor on Sunday. 

DT Ed Oliver (right knee)

Oliver suffered his knee injury as the result of a leg block that fortunately was not flagged on Sunday. During replay, his knee gets struck by the Dolphins offensive player and then his shin strikes the player again once the leg kicks forward.

It initially appeared that he suffered a shin contusion which would have been more pain related. But since he struck the knee, it forced the knee into hyperextension. What’s beneficial is that the leg was swinging freely and not in a fixed position. There was some stretching of the knee capsule and overall pain, but structural damage to the area appears non-existent save for maybe bruising due to the hit itself. Fortunately, the knee does have several degrees of hyperextension available in the human body, giving the knee some pliability to reduce the risk of injury. 

He was spotted by The Athletic’s Joe Buscaglia wearing a knee brace at practice. I asked Joe for clarification on the type of brace and he said that it appeared to be more hinge like. This would support that his knee was hyperextended and that he is wearing the brace for support. These braces don’t outright prevent injury, but the idea is that the side supports do lock out in full extension and if he were to get hit directly over the knee, the brace would take the forces of the hit and lessen the impact on the knee itself. In addition, the side supports limit medial/lateral movements so if they get hit from the side, the entire leg goes down rather than the valgus force that we see in ACL and MCL tears.

It will be interesting to see if he plays Sunday with the brace on or if this brace was simply used to help give him some confidence with the knee during practice. If you look closely, fellow DT Harrison Phillips wears one as well when he plays following his ACL tear last year. Overall, I don’t believe Oliver’s quality of play will be affected by the knee injury nor is he at a higher risk to suffer further injury due to Sunday’s hit.

CB Tre’Davious White (shoulder)

Virtually nothing is known about White’s shoulder ailment that had him limited at Wednesday’s practice. He is getting older, he’s a highly paid player who knows he’s valuable to the team, this may have been more of a maintenance day than anything. I could not find anything specific on film to support a shoulder injury and he was able to practice in full Thursday & Friday. I can’t even speculate what he could be dealing with because there is no mechanism of injury. Right now, this is a wait and see approach. 

He did deal with a neck injury last year that caused him to wear the red non-contact jersey for about 2 weeks last year but he did not miss any games or appear to have his play suffer as a result.

WR John Brown (foot, possible plantar fasciitis)

Brown popped back up on the injury report this week with what the team described as “foot soreness”. He was on the injury report last week briefly with the same issue. The fact that he is able to practice in full certain days and then has to be limited others indicates that this may be more of a chronic issue which I believe is plantar fasciitis.

The plantar fascia is a tough band of fascia that connects from the heel to the balls of the feet. This acts as a shock absorber and helps keep the structural integrity of the foot intact during walking and running. This effect is known as the windlass mechanism. This allows the foot to stay rigid as the foot goes into push off moving from stance to swing phase. If we did not have the plantar fascia to help keep the foot rigid, then the big toe would not have the leverage to push off as effectively and drive the entire foot forward.

ChoosePT.com

The area of the irritation of the plantar fascia is at the base of the heel, where the fascia originates. Microtears occur due to overuse or excessive running which appears to be in the case of Brown. This appears to be more of a problem this year than other years because of the change in training camp with less ramp up time. If he wears shoes that are not supportive, this could cause the foot to excessively pronate which means the foot rolls inward when walking versus maintaining support during heel toe walking. The overpronation would pull on the plantar fascia during push off using the windlass mechanism and the excessive running could cause microtears, causing inflammation.

Functionally, he will not be greatly affected by this, but it is a painful condition to deal with. He likely wakes up in the morning and has difficulty bearing weight through his foot due to the tissue tightening up throughout the night, making those first few steps during the morning painful. He can rehab to stretch the calf, Achilles, overall improve the range of motion in the ankle and big toe mobility to take stress off the area. He can also get injections to help manage the pain, but this is not something the doctors like to do often because too many injections can increase the incidence for rupture of the affected tissue. These rates are fairly low, but injecting and numbing pain is not an effective solution to manage a condition. It can be an intervention that assists with taking care of a problem, but not the only solution. 

It’s possible that Brown battles with this off and on throughout the season, using rest days and rehab to address the matter. As a treating Physical Therapist, I have found plantar fasciitis to be a stubborn diagnosis, but this does not mean that Brown will not be able to overcome this. The team does have a lot of interventions with the possibility of cupping, laser therapy, acupuncture, injections, iontophoresis with medication, stretching, using night splints, strengthening, taping, footwear modifications, among others. There are far worse injuries that can be played through, but plantar fasciitis is still a troublesome injury. This sounds all doom and gloom, but he will be alright.

Final thoughts:

The team is banged up. This is why I believe some preseason games are good to get the live reps out of the way rather than going from practice and limited contact to full blown games. Even if the starters were playing for two series a game in the preseason, it helps them acclimate slowly to game speed versus full speed right away. The Bills have been through this before with the lengthy injury report. The tweet below shows how things looked last year prior to the Titans game and how things look going into Week 3. 

You’ll also notice that the team does a fairly good job of dealing with injuries in that they don’t become a chronic issue. The training staff likes to address the injury, give it time to heal if possible, and then return to play. We are not seeing the walking wounded out there like some other teams around the league. 

I did note last year that injured players may have been active, but their snap counts significantly reduced in that particular game to prevent further injury. Two instances I can think of were WR Isaiah McKenzie during Weeks 4 & 5 last year and G Cody Ford during Week 8. This team has a plan to get guys healthy and have them available if needed, but not to rely on the walking wounded to play a full game. 

It’s also important to note that CB Josh Norman was observed on the exercise bike this week as he prepares to hopefully get activated from IR following Sunday. He may still not be 100%, but he can begin practicing with the team as they have a 21 day window where he doesn’t count against the roster. If he’s ready, they can activate him, if he’s not, he can be shut down and go back to IR. He can also just stay on there longer and activate his window later, so it’s not certain that he will begin practicing next week.

The same can be said for G Jon Feliciano. Coach McDermott even came out and said that he didn’t want to put guys out there that weren’t ready. Feliciano had said he wanted to come back by Week 4, but I have maintained that he would benefit coming back closer to Week 7 or 8 where he could be more effective. This will be something to continue to monitor.

Inactives:

QB Jake Fromm

RB Zack Moss

TE Dawson Knox

LB Del’Shawn Phillips

OL Ike Boettger

DE AJ Epenesa

The team will get through this. Years past, injuries would have decimated a promising season, see the 2011 Bills. But the team has quality depth and lots of experience to withstand some of these bumps and bruises. I would grow more concerned if we get a rash of season-ending injuries like in 2011. This is still a talented roster despite the Rams coming to town. Hopefully next week, this report will be a little shorter.

Top Photo Credit: WKBW

2020 Week 2 Bills Injury Review- Dolphins

What is the current status of Knox & Oliver?

Another week, another win! Josh Allen continues to own Miami! With a 31-28 win, the Bills move to 2-0 and into sole possession of first place in the AFC East. While the game was close than most would have liked, the defense held up despite missing Matt Milano & Tremaine Edmunds. Fortunately, Allen and the Bills offense exploded for yardage not seen in the better part of a decade and picked up the slack.

While the Bills were exploding offensively, they were also avoiding the plague of injuries cast over the NFL. McCaffery, Saquon, Sutton, Bosa, Irvin, Mosert, Lock, Hooker & many more all went down with either season ending injuries or severe injuries that will cost them most of the season. While it is impossible to predict injuries, the hope is that the Bills continue to maintain quality depth if misfortune strikes. It was truly a day of carnage not seen recently & certainly altered the course of several franchises in 2020.

Below are the Bills injuries from Week 2.

TE Dawson Knox (concussion)

Knox left the game with just under 9 minutes left in the 3rd quarter with media reporting shortly afterward that he was ruled out with a concussion. His last play before coming out, his helmet did strike a defender, but the play did not appear out of the ordinary.

He was later ruled out with a concussion for the day. Either the injury spotters saw something and pulled him from the game or he self reported symptoms. It is also not known when he suffered the concussion nor will we likely know unless Knox tells us himself.

Some on Twitter thought that he suffered the concussion when he fumbled the ball following a catch. It’s quite possible he did suffer one and then had a delayed onset of symptoms or it could have been any other play. Concussions are impossible to diagnose on film due to the unpredictability of each play.

Knox entered the concussion protocol seen below and it is anyone’s guess when he passes through to be cleared. There is a chance he could clear in time for next week as we saw happen with Josh Allen, or he could miss a game or two. Until we see him practicing symptom free, it is a waiting game.

Credit: NFL Play Smart Program

DT Ed Oliver (right shin contusion)

Oliver suffered a right shin injury while trying to trip the Miami offensive player, resulting in his shin getting struck hard. He walked gingerly off the field with trainers and was out briefly, but was able to return after several plays off.

Besides pain, there is not any structural damage that can take place unless he suffered a fracture or bone bruise. I’m sure there will be some soreness or bruising to the area which won’t be fun to deal with. He might be on the injury report Wednesday, do not be alarmed. Barring new information, there is little chance that there is structural damage. He’s dealing with pain that he can likely play through.

Other thoughts

Sean McDermott noted that Edmunds, Del’Shawn Phillips & Milano continue to work through some things. That’s coach speak for I don’t want to give the Rams anything. We will have to see how they practice this week. I am expecting to see Edmunds practice in full, possibly Phillips in some capacity & hoping for Milano to at least be limited. The former two have a decent shot at playing Sunday based on what we know whereas Milano is still a longshot unless he’s practicing in full. By Friday, the picture will be clear.

To wrap things up, some were concerned about Zack Moss being out late in the game. He limped off the field midway through the 4th after a catch and but fortunately returned at the very end.

During the catch and run, he fell hard onto his buttocks, but there was not any clear mechanism of injury from what we could see. Unless we get new information, I don’t believe there is anything to be concerned about. If he shows up on the injury report, at least we have an idea of where he could have been injured.

Finally, I mentioned the numerous injuries above. The Bills are far from immune in that sense. We will have injuries, we saw this already with Jon Feliciano this season. There’s a good chance others still happen. I can’t predict who or when or what the injury will be, but know that the Bills have the depth and football is a violent game, injuries are expected.

The Bills go back to Orchard Park to host the Rams for Week 3 on Sunday. It’ll be warm and rainy right now as the weather forecast states. Like Week 1, that could impact who plays and who sits out. Continue to check back for the latest news & injury updates on your Buffalo Bills.

DT Ed Oliver Injury Profile

#91 Ed Oliver
Position: DT
Height/Weight: 6’1/287 lbs.
Age: 22
College: Houston
Year joined Bills: 2019
Acquired: 1st round draft selection

College Injuries:

2016 Freshman year:

No publicly reported injuries

2017 Sophomore year:

Left MCL sprain, missed most of 1 game & limited in next 4 games

2018 Junior year:

Right knee injury, deep contusion, missed 4 games

Pro Injuries:

2019 Bills:

Left foot/ankle injury, Week 5, missed 0 games

Core muscle injury, required surgery, missed 0 games

2020 Bills:

Sore hip, missed week of preseason practice.

Right knee contusion, Week 2, missed 0 games. Had knee drained and wearing a brace for support, likely hyperextension as well.

General links:

Left MCL sprain

Right knee contusion

2020 Bills Injury Preview- Defensive Tackle

Ed Oliver’s Core Muscle Repair

Buffalo Bills Training Camp Injury Review- Week 2

The Bills are still dealing with injuries, what ones are concerning?

Another week of Bills training camp is completed! Fortunately, the list of injured players has shrunk considerably from last week allowing the Bills to stay healthy & participate in training camp. For last week’s recap, check out my article at Buffalo Rumblings.

New additions to the injury report:

WR Stefon Diggs (knee/back soreness)

Diggs gave everyone a scare when he went down briefly on Monday when he stayed down for a moment while trainers tended to his knee. Specifics were not given regarding how the injury occurred, but he did not stay down long and returned to practice quickly, not appearing to give it any further attention the rest of the week. This is likely nothing but still important to note.

The more concerning of the two injuries is the back soreness that caused him to miss Thursday’s scrimmage. He was observed on the sideline tossing a football with noticeable limitations. In the video below, he doesn’t exhibit any trunk rotation, he throws purely from his arm and he appears very stiff indicating the low back pain.

This may be true soreness, he may have strained muscles or a sprain, impossible to discern from the video alone. The training staff will be focusing on managing and eliminating the pain and keeping him moving to prevent this from becoming a chronic issue. Like the knee, I do not anticipate this becoming a long term issue, but simply to note.

RB Taiwan Jones (knee)

Jones went down in practice on Sunday after he stepped awkwardly followed by trainers tending to him before ending practice early. Like the Diggs injury, little is known regarding the mechanism of injury. He did not participate in practice the rest of the week and was observed in street clothes during the scrimmage.

My speculation is that he suffered a knee sprain, possibly his MCL. These are quite common during training camp and can hold him out for 1-3 weeks. Until he returns to practice, hard to establish an accurate timeline without more information.

RB Christian Wade (quadriceps)

Wade has missed the last week of practice with a quadriceps injury that appears to be a strain. He could be dealing with a contusion which can be very painful, but not even practicing in a limited fashion indicates more of a strain.

While this could tank most players’ roster hopes, Wade still has his practice squad roster exemption that the Bills will likely use again this season. He simply is not ready to yet contribute to an NFL roster yet which means this injury is a minor issue.

LB Corey Thompson (knee soreness)

Like all the other injuries, we can only go off of what is reported by the team on Tuesday. Knee soreness is a vague term that limits any timelines to be established. He doesn’t have any previous known knee injuries which reduces the possibility that this is a chronic issue.

Injury updates:

WR Robert Foster (concussion)

Foster exited the concussion protocol on Wednesday. He was able to participate in Thursday’s scrimmage but due to media restrictions on reporting, his performance was not known. Foster has a week to show the Bills why he needs to stick around on the roster, but his chances appear to be dwindling.

G Jon Feliciano (pectoral tear)

Feliciano is still out with his pectoral injury & is not expected to be ready for some time. But it’s important to highlight that he was observed out of his sling by Spectrum News’ Jon Scott.

This indicates that he is on schedule with the rehab protocol but does not indicate that he will be back as soon as Week 4. I still maintain that he will be back around mid-season which will allow him to be fully ready rather than limited.

CB Josh Norman (left hamstring)

Despite his aging vet status, Norman still commands a lot of attention for the fan base. He has been out over a week with a left hamstring strain suffered while returning an interception & tackle.

DC Leslie Frazier is hopeful that Norman will be back in time for Week 1 and he still appears on track for that. Barring any setbacks or change in severity, I anticipate that he will play but CB Levi Wallace is available to start if Norman isn’t 100%.

No changes:

FB Patrick DiMarco (neck), TE Tommy Sweeney (foot) are still not practicing & are uncertain to return anytime soon.

LB Vosean Joseph (undisclosed) was dealing with an injury last week which DC Leslie Frazier acknowledged but details were not given.

DT Ed Oliver, LB AJ Klein, & LB Tremaine Edmunds returned to practice & hopefully will not have any recurrence of the injuries sustained last week.

Housekeeping:

CB Ike Brown retired and posted his statement regarding his reasoning below.

In his place, the Bills signed CB Brian Allen after spending time with the Steelers & Seahawks. His injury history is limited but detailed below.

The Bills also settled their special teams competition with the release of K Stephen Hauschka & P Lachlan Edwards.

The Bills continue to stay in excellent shape regarding injuries & should have nearly everyone available for Week 1 besides Feliciano and Sweeney.

Image Credit: BuffaloNews.com

Bills 2020 Training Camp Injury Preview: Defensive Tackle

One of the healthiest position groups in 2019

This is Part 8 of the Buffalo Bills training camp preview revisiting injuries from 2019 & the impact it may have on their performance and availability in 2020. Part 8 consists of the defensive tackle room.

Not Returning

DT Jordan Phillips

16 games, 9 starts, 1 forced fumble, 9.5 sacks, 31 combined tackles, 25 solo, 6 assisted, 13 TFL, 16 QB hits

Phillips made quite an impact on the Bills defensive line in 2019 with 9.5 sacks & an overall career year that put the Bills into a tough spot on whether to pay him in 2020. The Bills clearly elected not to pay him and let him go get paid by the Arizona Cardinals in the open market. Beane has gone on record indicating that if a guy has earned the money through his play, then he deserves to go get paid what he feels he’s worth. 

One of the reasons that Phillips was able to be so productive was the ability to stay healthy. He appeared in all 16 regular-season games and only suffered some sort of knee injury following the Ravens game. He was limited that week in practice but ended up playing without issue. 

Phillips earned his contract and hopefully will continue to produce at a high level for Arizona in 2020.

DT Kyle Peko

4 games, 4 combined tackles, 1 solo, 3 assisted

Peko was brought onto the Bills following a stint with the practice squad as a result of the Harrison Phillips injury. He played for 4 games as a placeholder until the Bills later brought in Corey Liuget for reinforcements. 

Peko did not suffer any known injuries during his short stint with the Bills & was cut in early November, spending the rest of the season with Indianapolis & Denver practice squads. 

DT Corey Liuget

7 games, 1 sack, 10 combined tackles, 7 solo, 3 assist, 4 TFL, 1 QB hit

Liuget came to the Bills as a more permanent fixture on the defensive line as Harrison Phillips was injured and Kyle Peko & Vincent Taylor weren’t getting the job done. He came to the Bills as a former first-round pick by the Chargers with a lot of veteran experience which allowed him to adapt to the demands of the defensive scheme with greater ease than Peko & Taylor. While Liuget is on the tail end of his career, he still provided effective play and showed that he could still perform despite his previous torn quadriceps tendon in 2018. Fortunately, Liuget had a better 2020 injury-wise.

He only suffered a knee injury late in the season. Not much is known about Liuget’s knee injury sustained against the Ravens late in the season. He spent two weeks on the injury report limited in practice, missing only the Steelers game before coming back the next week.

Looking back now, it’s hard to say what he was dealing with at the time. Whatever it was, he eventually returned to finish the season but that second-half performance wasn’t enough for Liuget to earn another contract with the Bills in 2020.

Players Returning

DT Harrison Phillips 

3 games, 2 passes defended, .5 sacks, 3 combined tackles, 1 solo, 2 assisted, 1 QB hit

Phillips was coming into his own this past season as a rotational piece in the defensive rotation before his season ended prematurely. He is slowly coming into his own on the field & in the locker room, but missing most of 2019 did not help his progress.

Phillips’ injury below:

    • Left ACL tear

Phillips suffered a torn left ACL in the win over the Bengals during Week 3. This occurred due to a flurry of bodies flying around with 2 minutes left in the game & a body hit the lateral side of his knee, causing the mechanism of injury required for an ACL. Phillips attempted to play in the final defensive series but his knee buckled and he was unable to continue playing. He later had an MRI to confirm the ACL tear and had surgery shortly after. 

He has been incredibly transparent in his recovery process throughout the past year on Instagram & Twitter which does give hope to the fact that he can return to form sooner. He does play in a tighter space which requires less knee movement. This in turn should allow him to be more effective and rely less on pivoting and cutting, demands more suited for other positions. To note, he did have an ACL tear on the same side back in college at Stanford which unfortunately did give him a leg up on knowing what rehab entails. To read more about his ACL tear, check out the article at Buffalo Rumblings.

DT Ed Oliver 

16 games, 7 starts, 2 passes defended, 1 forced fumble, 5 sacks, 43 combined tackles, 24 solo, 19 assisted, 5 TFL, 8 QB hits

Oliver had a productive rookie season, especially in the second half once he lost his starting position. He came back hungry and appeared to increase his game which really made people around the league notice, justifying his ninth overall draft selection. 

In addition, Oliver was relatively healthy during the season but we later learned that he was playing through at least one injury. 

Oliver’s known injuries:

    • Left foot/ankle

Oliver suffered a left foot/ankle injury late in the win over the Titans when he flipped over trying to tackle RB Derrick Henry. His foot slammed into the turf & he was visibly in pain as he got off the field and did not return. Due to the timing of the injury & lack of need for the defense at that point, he was not needed and likely used the bye week to fully recover.

    • Core muscle repair

He surprised everyone when photos of him in the recovery room of the Vincera Institute popped up following the playoff loss to the Texans. It was later revealed that he required core muscle surgery. There were never any indicators that he was dealing with the injury and he never appeared on the injury report with the issue. To read more on the core muscle injury, check out Banged Up Bills

Within a month, Oliver was snowboarding and participating in most regular activities as shown on social media. He appears to have healed up well and should be ready for training camp. As mentioned before, most players who require core muscle repair do very well & return to play with no drop off in action. 

DT Star Lotulelei  

16 games, 16 starts, 1 INT, 1 pass defended, 2 sacks, 19 combined tackles, 12 solo, 7 assisted, 3 TFL, 3 QB hits

There is a reason the Bills keep Lotulelei around. He gets paid a lot, he knows the defense, & he’s available. While he does not get the eye-popping statistics that some elite defensive tackles accumulate, he does eat up space and allow those around him to make plays. Despite being one of the older players on the team, Lotulelei continues to be an effective player. He also did not appear to suffer any known injuries in 2019 which makes him even more valuable.

The Bills did restructure his contract to essentially ensure that he would be guaranteed a spot on the roster in 2020. If Harrison Phillips comes back strong, Lotulelei could begin to fade into a backup role as Phillips increases his playing time. 

DT Vincent Taylor 

3 games, 1 pass defended, 6 solo tackles, 1 TFL

Taylor came from the Dolphins as a 6th round pick along with season-ending injuries in consecutive years. He was waived by the Dolphins following cut down day in 2019. Taylor quickly found a home on Buffalo’s practice squad where he resided until the beginning of November when he was activated to the roster following Kyle Peko’s release

He quickly did not become an answer to replace Harrison Phillips and quickly lost playing time to Corey Liuget. In fact, he only played sparingly against Washington and Pittsburgh with most of his action coming in the regular-season finale against the Jets. Taylor did not have any publicly reported injuries and will have a long shot to make this roster in 2020.

New to the roster

DT Quinton Jefferson

Jefferson comes from Seattle, appearing to finally come into his own after a slow start to his career including two ACL tears and having an inability to stick on a roster. He eventually did become a role player with Seattle & became quite effective especially last season. However, he is coming off a Jones fracture in the postseason which required surgery.

There is a chance that he could have complications from the Jones fracture surgery, but he may be better off as he does not have to run & jump as some of his wide receiver counterparts which could place extra stress on the surgically repaired foot. To read more on Jefferson, check out the article at Buffalo Rumblings.

DT Vernon Butler

Butler comes to Buffalo via that strong Carolina pipeline that so many others have traveled. Regrettably, Butler comes with inconsistent play and several injuries to his name. Defensive tackles do take some time to adapt and as a former first-round pick, he still demonstrates some talent worth giving another shot. To read more about his injury history, check out Buffalo Rumblings.

2020 Outlook

Phillips, Oliver, Lotulelei, & Jefferson are all locks for the roster in 2020. Taylor and Butler have legitimate shots at making the roster and could benefit from roster expansion if there is a need due to the pandemic. Overall, the group is incredibly healthy with the exception of Phillips’ ACL tear when compared to other position groups.

Oliver should continue to grow as a defender & the hopes that Lotulelei can continue to be an effective player while Phillips regains his football abilities following a lost year will be key for this group to be successful. There is the option that the Bills could bring in other talents, but for now, this is a formidable group that can put pressure on the quarterback & provides a strong force upfront.

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

Ed Oliver’s Core Muscle Surgery

Will Oliver be ready in time for OTA’s?

A surprise tweet from DT Ed Oliver hit Twitter Tuesday afternoon showing two pictures that he had successful surgery following his rookie year. This created several questions as Oliver did not appear on the injury report all season & only appeared to suffer one known injury following the Titans game in which he sustained a left foot/ankle injury when he tackled RB Derrick Henry. He was able to return following the bye & did not miss any games during this season.

However, Tuesday’s tweet changed things with Oliver in a hospital gown. The Bills had recently performed their end of season exit physicals & issues are found once a full assessment has been performed. We have already observed this with the tweets last week from DE Jerry Hughes & his torn wrist ligaments. Oliver likely had his exit physical & found this issue which required corrective surgery.

Originally, I had thought that he had a routine joint cleanout from general debris such as bone chips, articular cartilage, or frayed tissue due to not appearing on the injury report. But news came out later that he had successful core muscle surgery, commonly known as a sports hernia, announced by Buffalo News reporter Vic Carucci. 

Looking back at the Oliver tweet, there were two clues that indicated that he had core muscle surgery. First, the location was in Philadelphia, PA. Oliver could have had arthroscopic surgery in Buffalo or back in his hometown Houston, or wherever he wanted, indicating that Philadelphia was a specific location. Second, the 2nd picture shows the phrase “Vincera Institute” above his head. This was not readily observed unless you were able to zoom in on the picture but this was a dead giveaway in retrospect to what he had done. Frankly, I missed it the first time around.

The Vincera Institute in Philadelphia is run by Dr. William Meyers, a nationally renowned orthopedic doctor specializing in core muscle repair. From what I’ve read, he is THE guy when it comes to core muscle repair. Meyers is also big against identifying the injury as a sports hernia, hence my use of the term core muscle. We don’t know when Oliver suffered his injury, how long he was dealing with it, & how severe it was.

With regard to the injury itself, there is a multitude of variations according to the Vincera Institute website that frankly, even as a licensed Physical Therapist, were new to me. As there are no specifics to which injury he sustained, below is a general description of a core muscle injury.

groin_injuries
Credit: https://physioworks.com.au/Injuries-Conditions/Regions/groin_pain

Core-muscles-abdominal
Credit: plankpose.com

The adductor muscles in the groin are most commonly injured pictured above, but can also affect the abdominal muscles in the 2nd picture. These injuries can occur with planting the feet & twisting maximally, causing the lower-body injury. They can also occur with violent twisting, kicking, and turning along with blows to the back, anything that overstretches or strains the muscle at its attachment.

These injuries can present as groin strains, oblique strains, or other general injuries around the hip or core region that don’t resolve with proper rest & rehab. A core muscle injury is when the tissue tears & does not heal like a normal strain, commonly with the muscle pulling away from the pubic bone attachment observed in the first picture.

This can present as sharp or stabbing pains with specific movements such as sprinting, kicking, cutting, etc. This can also be tender to touch, little to no pain during rest, and typically isolated to one side. These injuries aren’t always apparent at the time; often minor injuries are able to be played through. The severity of the injury is found later such as during a physical or if the pain becomes too intense to perform an activity.

Fortunately, surgical outcomes are great with at least 90% of repairs in the NFL have shown to resume their normal activities prior to the injury with the control group playing slightly more games and slightly longer careers than those having the surgery. However, the control group in that study were players who had similar careers in relation to experience, statistics, & position played, not indicating that the groin injury itself led to a shorter career. Another study showed 89% of repairs were able to return to the pre-injury level of play with minimal to no pain during a 4-year follow up study. 

Rehab for this surgery can be between 6-12 weeks based on the specific type of core muscle surgery & location. Rehab protocols can be found here & here with most protocols skewing towards a lengthened recovery timeline for a conservative approach.

If Oliver has any concerns regarding his recovery, he can ask fellow Bills players C Mitch Morse & WR Cole Beasley who both suffered similar injuries at the end of the 2018 season which required surgery, causing them to miss some of OTA’s last spring. As of writing, both have not had any known issues regarding re-injury to the area & should continue to stay productive. According to the 2020 NFL offseason schedule, the Bills will start OTA’s April 20th. By then, Oliver will be fully healthy without any limitations.

It’s unfortunate that Oliver suffered this injury, but injuries are a part of football. It is great that he got this addressed now so that he may be fully healthy to attack this first offseason as a professional in order to grow into the next great Bills defensive tackle. I have no concerns regarding this injury & his recovery as he was treated by one of the best in the United States & has an excellent facility to rehab at in Buffalo if he so chooses.

I expect there to be more surprise injuries & surgeries as the offseason progresses, but this is just another one that is being addressed properly & maximizing Oliver’s growth as a professional football player.

Top Photo Credit:

HoustonChronicle.com