Charles Clay’s Longstanding Knee Problem

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

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

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

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

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

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

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

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

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

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


A Buffalo Bills Injury blog. Analyzing, educating and writing about the injuries of the Buffalo Bills.

My name is Dr. Kyle Trimble and I am, first and foremost, a Buffalo Bills fan!!  I am proud to call myself a Bills fan; a group of fans that commonly refer to themselves as the Bills Mafia, individuals who are passionate, devoted, and yearning for a winner after far too many years of bad to at best, mediocre football.  When I am not reading, watching, or listening about the Bills, I work as a Physical Therapist.  Being a Buffalo Bills fan for the better part of 10 years; I have experienced some highs, many lows, and a lot of what ifs.  Most commonly I hear, what if (insert player name) didn’t get hurt?  Or, too bad (insert player name) got hurt, now we have to rely on (insert horrible backup), our season is done!

My purpose of this blog is to report on the goings on of the Buffalo Bills injuries.  I will analyze different aspects such as why the player got injured, how the injury typically occurs, speculate on the extent of the injury, timeline the player may be out, and the impact it has on the team.

While I could keep busy with injuries from the Buffalo Bills, this blog will not be limited to solely the Buffalo Bills.  Based on significant player injuries around the NFL, trends, research, and questions; I will write on whatever is on my mind, and whatever questions, you, the reader may have.  I write because I enjoy it, I write because I like to educate, and I believe that a fan that is educated on how injuries affect their favorite team can have a more realistic view on the NFL season.

To give a background on myself; I was born and raised in Erie, PA, moved to Buffalo in 2006 to begin my studies at D’Youville College towards becoming a Physical Therapist at which time I became a devoted Buffalo Bills fan.  I graduate in 2013 with my Doctorate in Physical Therapy and moved home for several years.  Moving back to the Buffalo area in 2016, I have gained extensive experience in outpatient orthopedics, skilled nursing, acute care hospital, and home care.  Having obtained a significant wealth of knowledge that continues to grow, along with a undying fandom of the Bills, puts me in the unique position to educate my fellow fans about our great team. To add, I am an contributor and occasional guest on the Buffalo Bills podcast, The Rockpile Report.  I have many ideas to write about, many which I expect you will enjoy.  I welcome any comments or questions you may have.



Reggie Ragland- Return to form

Analysis of Reggie Ragland’s 2016 ACL injury and the journey back to recovery.

It’s been just over a year since Reggie Ragland ran down Reggie Bush towards the sideline, pulled up and fell to the field, ending his 2016 season with a partially torn ACL. Going into the 2017 season, the big question is whether Ragland will be ready to suit up and become the heart and soul of the Bills defense. To understand why there is so much uncertainty going into this season, we must understand why the injury is so severe.

The ACL is a ligament that connects the tibia to the femur and acts as a stabilizer in the knee to prevent the femur from shifting too far forward over the tibia; it also assists in preventing hyperextension in the knee. When the knee is placed into unnatural positions such as cutting and sudden stops, the ACL typically keeps the knee intact, but in the instance of injury, the ligament either stretches out, partially, or fully tears based on the activity. Along with the ACL tear, meniscus and MCL tears occur, referred to as the “Terrible Triad”. This does not occur in every case, such as Ragland’s, but is certainly a cause for concern for long term rehab potential.

There are two types of ACL tears, direct contact and non contact. Direct contact being a direct blow to the knee, such as a chop block. Non contact is when the player changes direction suddenly and the knee gives way, which is what occurred during Ragland’s injury. In Ragland’s case, he partially tore the ACL, leading to instability, similar to what occurred last week with Ryan Tannehill of the Dolphins. Without the ACL providing stability, the individual is unable to stop suddenly or pivot to change direction without the knee giving out, resulting in further damage to the surrounding structures in the knee. These movements are vital for any football player, regardless of position. This would increase missed playing time and significantly reduce the length of careers. It is possible to live a normal lifestyle with an ACL deficient knee, but nearly impossible to resume a high level of play post ACL tear without reconstruction as an adult.

In May 2017, Ragland reported that he has been cleared to return to full contact participation, which is 9 months after his surgery, indicating that rehab went well and that he has passed all the initial conditioning tests. This includes, but not limited to: demonstrating that his left knee is at least 90% strength wise in his quadriceps, and 80% in his hamstrings that of the right knee. He must demonstrate no pain/swelling in the right knee during activity, exhibit full range of motion, demonstrate basic agility activities and resume a running program that is pain free. A general, comprehensive ACL reconstruction protocol can be found here. (Note: this is unlikely the exact rehab protocol used with Ragland, most orthopedic surgeons vary based on personal preferences and training.) Once this has all taken place, he is cleared and able to resume football related activities. A non professional athlete would be able to resume normal activities without restriction, save a stabilizing knee brace for extra protection. In Ragland’s case, he is a multi million dollar athlete that extra precautions will be taken to ensure the surgery success. He will most likely be required to wear a knee brace, but will reduce the incidence of another non-contact ACL tear.

As of now, Ragland appears on track to return to participating in training as a full participant. This has been evident through the first week of training camp, easing back in with the 2nd team to limit reps, according to McDermott. This will allow Ragland to step on the field to knock off the rust, but between rehab and an extended look during training camp will really allow him to round back into football form. Professional opinion, I fully expect to see Ragland return to full form, easing back into game play on a snap count as the preseason begins. Currently, he’s listed as 2nd on the depth chart at MLB behind Preston Brown. This is a great spot for him as this indicates that he will see significant playing time, but not expected to contribute right away while still learning the defense. While there is a risk of retearing the ACL, as seen with RGIII, Casey Hampton, and Thomas Davis, the risks remain low. Expect to see Ragland fine tune his game in the preseason, get back up to game speed, and then released to pick up where he left off in college, shoring up the LB corps and fitting into McDermott’s defense.