Jerry Hughes’s Wrist Is A Big Problem

Did Hughes’s tweet write a check the Bills can’t cash?

The sting of the overtime playoff loss to the Texans was still very fresh in everyone’s mind when a seemingly innocuous tweet from DE Jerry Hughes was released. Below is the tweet which shows his passion & love for his team. All well and fine, we love you too Jerry! But 5 words within that statement got the Bills put on notice by the league & raised questions about the Bills injury reporting this season.

“Torn ligaments in my wrist”

Normally that statement wouldn’t be an issue because NFL players get injured. It’s a fact. But Hughes never appeared on the injury report this season with a wrist injury. This is where the league doesn’t like that news. Below is the first few paragraphs of the NFL injury report policy.

The Personnel (Injury) Report Policy has been a cornerstone of public confidence in the NFL for many decades. The credibility of the NFL, teams, owners and team personnel requires full compliance with and uniform enforcement of the policy.

The intent is to provide full and complete information on player availability. It is NFL policy that information for dissemination to the public on all injured players be reported in a satisfactory manner by clubs to the league office, the opposing team, local and national media, and broadcast partners each game week of the regular season and postseason (including for the two Super Bowl teams between the Championship Games and Super Bowl).

The information must be credible, accurate, timely, and specific within the guidelines of the policy, which is of paramount importance in maintaining the integrity of the game.

A violation of the policy may result in Commissioner discipline, which may include a fine on the involved club, fines or suspensions of involved individuals, as well as the possible forfeiture of draft choices by the involved club.

This weekly injury report is the cornerstone of what I do, commenting on Bills’ injuries. Fortunately, this injury was something I was aware of, but unaware of the severity of the injury as most teams won’t come out and give details.

I had first noted that Jerry injured his right wrist sometime in the preseason, likely occurring during the Bills vs Panthers preseason game. Hughes played 14 snaps in that game and was his usual self during the first few series he was in. Having reviewed that film several times, there didn’t appear to be any smoking gun with regards to injury either indicating that the injury was not realized until later or that it did not occur during the game.

Hughes was able to play in all 16 games & the postseason, only suffering an ankle injury at the beginning of camp & a groin injury during Week 12 which limited him that week in practice in addition to the wrist. He also had several veteran rest days, which isn’t uncommon for a player his age. Looking back at pictures from this season, it’s observed that he has a brace or tape for support every time he plays.

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Credit: Twitter.com/Iam_JerryHughes
Bills Football
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Buffalo Bills v Tennessee Titans
Credit: TheAthletic.com
NFL: Washington Redskins at Buffalo Bills
Credit: billswire.usatoday.com
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As you can see in all those pictures throughout the 2019 season, he has a wrist brace on during each game, indicating that this was a lingering injury.

The next question is, what ligaments did he tear? Based on the lack of obvious injury & previously unknown severity, it’s hard to identify what he exactly did. We obviously know he didn’t suffer any fractures or dislocations as those would have either been season altering or season-ending.

I can also say confidently he did not injure any ligaments in his thumb as supported by the picture above, specifically the one with him during practice. You can see that he has tape supporting the area but the thumb moves freely, indicating that the interphalangeal joint, metacarpal joint, and carpometacarpal joint are intact. Otherwise, a thumb spica splint would have been noticeable & higher up the thumb.

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Credit: musculoskeletalkey.com/

Evaluating the anatomy of the wrist, the carpals and distal ends of the radius & ulna make up the wrist as you can see in the picture below. There are multiple ligaments in the wrist that you can view on your own if you wish. Clinically significant ones include the scapholunate ligament, the lunotriquetral ligament, & the triangular fibrocartilage complex (TFCC), among others.

Carpal-bones

The ligaments listed above are the most common wrist ligament tears from what I could find in literature, but there are certainly others. To generalize the mechanism of injury for these injuries, it typically happens when there is a fall or sudden force that places the wrist into extension and then into radial or ulnar deviation along with possible forearm pronation or supination. The presentation includes swelling, pain, weakness with range of motion, possible clicking/grinding, point tenderness, and difficulty with specific wrist movements. According to literature, if these injuries are suspected, the patient is to be placed in some type of bracing since there is instability noted.

As mentioned above, without a specific mechanism of injury or further details, hard to say what he did. Most of the time when these injuries occur, surgery is indicated to restore stability in the area. There are always reasons for non-operative treatment, but either outcomes are poor or ineffective. The only one that can be treated after the initial injury is the scapholunate injury in where surgery can be performed within 18 months of injury & splinting may be effective with incomplete tears.

It’s possible he injured the scapholunate ligament either falling on the hand or getting his hand caught up in a blocker, getting it twisted around to the ulnar side. But this is merely a guess.

After uncorking your mind from all that anatomy jargon, we go back to why Hughes & the Bills may be in trouble. The injury never appeared on the injury report during the season. Below are the indications of why an injury would automatically be reported.

Some injuries are automatically reportable because they result in the player’s unavailability or limited availability to the club. These include any injury that:
(a) causes the player to miss a game;
(b) prevents the player from finishing a game;
(c) causes the player to miss a practice (Did Not Participate);
(d) limits the player’s participation in practice (Limited Participation); or
(e) prevents the player from finishing a practice (Limited Participation).
Other injuries may be reportable because of their effect upon the player’s performance despite his continuing availability to the club.

The club must continue to list the player on its weekly Practice Reports
until the player’s injury no longer affects the player’s performance.

Below is what makes up the practice report & define full, limited, and DNP.

The Practice Report’s player participation categories are defined as follows:
Did Not Participate: means zero percent of a player’s normal repetitions.
Limited Participation: means less than 100 percent of a player’s normal repetitions.
Full Participation: means 100 percent of a player’s normal repetitions. In general,
this category should be used for players who missed or could not complete the prior
game due to injury, but have returned to participate fully in practice the following week.
It should also be used for a player who (i) sustained an injury in the prior game that
affects his performance, but was able to finish the game, and (ii) participates fully in
practice the following week, as in the example on page 2 (injured quarterback).

I think he suffered the injury in the preseason, had it addressed with the brace & likely rehab. He probably had it evaluated and determined that he could practice/play through it & get surgery later. He did not play in the Lions or Vikings preseason games but was able to play Week 1, giving him just over 3 weeks to give the wrist some time to recover.

Furthermore, this happened in the preseason where injury reporting is not as strict & by the time it got to the regular season, he was healthy enough to play. Did the injury impact his performance? Hard to say. His stats over the years show a bell curve, indicating that his best years are behind him & that he wasn’t far off from last season, though a slight drop was noted. Why were his stats down?

Possible reasons include: he may have been double-teamed more, Hughes is no longer as effective as a defensive end, scheme fit; overall, not my place to say.

Finally, what qualifies as a torn ligament? By definition, a sprain is a ligament tear with the grades varying in severity. Hughes may have suffered partially torn ligaments; never fully healing due to the rough nature of the NFL, & they require surgery. He may have fully torn some ligaments & there’s instability noted. Hughes may have also exaggerated or been misinformed about what he was saying in his post.

We always find out later that guys were playing with injuries the team did not divulge or have to publically report on. We also find out that what appeared to be a minor injury, turned out to be more significant. I think this is one of those cases. We knew that there was some type of injury, we didn’t know what exactly happened & the severity.

Do I think the Bills get fined? It’s possible, considering the Raiders had injury reporting violations last year & the Lions had issues this year with Matt Stafford resulting in a fine. The Steelers also got hit with a fine this year following Ben Roethlisberger & the management of his elbow injury. So this isn’t a rule that doesn’t get enforced.

I think the only difference from the above-mentioned fines & what the Bills did was how far removed from the injury the players were. All the other fines were responses to acute injuries. Hughes didn’t appear on the injury report for a rest day until late September.

The only way the Bills are in violation of this rule is due to the statements below.

The supplemental entry “Not Injury Related” applies to situations in which a player is withheld from his normal repetitions for reasons other than injury. Examples include: resting veteran players, team discipline, jury duty, illness in family, personal matter, etc. In these cases, the club must explain specifically – on its own participation release issued to the media – why the player missed or was limited in practice. Use of this category is prohibited if the player in question has an injury that is otherwise reportable under the policy. An injured player cannot be listed as a “resting veteran.”

The Practice Report is expected to provide clubs and the public an accurate description of a player’s injury status and his level of participation during the practice week. All players who have reportable injuries must be listed on the Practice Report, even if the player takes all the reps in practice, and even if the team is certain that he will play in the upcoming game. This is especially true of key players and those players whose injuries have been the subject of local or national media coverage.

Looking at this as a whole & how I interpret the rules, I don’t think the Bills were in violation. Hughes is a key player, but when the injury was & how it was managed I believe make this different. Full disclosure, I am a Bills fan, but looking at it from when I put my medical hat on confirms my thought process. The Bills & the NFL know far more than I will & ever should know and the decision will be handed down. I hope I am right, but we shall wait & see.

Top Photo Credit:

Twitter.com/Iam_JerryHughes

A Winning Record & Healthy Bills, But Why?

How are the Bills so healthy?

On my latest appearance with Joe Marino on the Locked On Bills podcast, we discussed why the Bills are so healthy this late into the season, how rare this is, & why the team’s facilities are such a vital addition. There was so much information, this required its own article & it was promised to you on the pod, I better deliver!

This article will look at several different areas of how injury management has changed since 2017 & why the Bills are so healthy this late into the season. 

First off, let’s look at how rare this instance of no injuries or no one missing a game. Looking at pro-football-reference.com takes us back to 2009, the earliest recording of injuries by the site. There may be other instances of weeks where there were no injuries before then, but they may be lost to time. 

To note, the designation probable was discontinued following the 2015 season. This designation meant that there was a 75% chance the player would play. 94% of the players declared probable during 2009-2015 played. Also noted is that IR designation does not count into this assessment, only active players on the roster at that time. 

Times no player was ruled out since 2009

2012: 

Week 6 Arizona

5 players ruled questionable: Jarius Byrd, Chad Rinehart, Da’Norris Searcy, Kyle Williams, Eric Wood

 

2013:

Week 13 Atlanta

1 player ruled questionable: Kyle Williams 

 

2013:

Week 14 Tampa Bay

2 players ruled probable: Marquis Goodwin, Kyle Williams 

 

2015:

Week 9 Miami

1 player ruled questionable: Sammy Watkins 

 

2018:

Week 6 Houston 

No injury designations

 

2019:

Week 10 Cleveland 

No injury designations

 

2019:

Week 11 Miami

1 player ruled questionable: Jerry Hughes

Prior to this season, there were only 5 instances where there wasn’t anyone that was ruled out. The closest instance to last week’s injury report was 2018 before the Houston game & before that, 2013 Tampa Bay game. To have games back to back where no one was ruled out, you have to look back at Weeks 13 & 14 in the 2013 season seen above. 

To not have anyone listed at all last week is even more incredible. There are still injuries that players are dealing wit as noted in my article from Monday. But to have a “healthy” roster this late into the season may be truly the difference between making the playoffs or sitting on the couch in January. 

Why is the team getting healthier? I believe a part is due to luck, a part is due to better medical staff & resources. This isn’t to say that the medical staff before was poor by any means, but to have a great training staff plus the resources available at the AdPro Sports Training Center that opened earlier this year.

Following McDermott’s first year, the training staff changed dramatically with the retirement of Bud Carpenter & the dismissal of Shone Gipson. This allowed the team to bring in Nate Breske from Chicago who brought on his own staff which clearly made a huge difference over the past 2 seasons. 

Adding the AdPro Sports Training Center helped to individualize care to focus on the specific needs of each player rather than a one size fits all approach sometimes seen in rehab & medicine. Some of the features that the facility has included: 

Sleep pods, float tanks, yoga, massage rooms, active release technology. These all assist in getting proper rest & relaxation to allow the body to heal more completely to maximize the recovery process by reducing stress.

Sleep pods allow the players to get a power nap in when they begin to feel groggy, for example after lunch. They can go into a sleep pod for 20 minutes or however long they choose & recharge to get through the afternoon unlike the rest of us get by with coffee & clock watching. 

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Credit: https://saltfloatstudio.com.au/

Float tanks & yoga allow the body to go into deep relaxation & allow the body to rest in a variety of ways, rather than sitting in front of a TV, zoning out. The float tanks assist with sensory deprivation, blocking out all the stressors from day to day activities & yoga allows for mindful meditation along with the flexibility to reduce injury. Finally, massage rooms allow for the knots, lactic acid, and overall soreness to be worked out of the body. Training staff can also work in active release techniques to work the muscle through its specific actions to promote blood flow & break up scar tissue to maximize healing.

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Credit: https://garagegymlab.com/

Cardio room, nutrition bar, cryotherapy tanks, NormaTec boots, activity trackers. These all allow the body to recover during the healing process, think of active recovery. NormaTec boots act as a large air-filled compression stocking to assist the body in flushing out lactic acid & inflammation following games & practices.  The nutrition bar introduced proper foods for maximizing performance & recovery, taking the thinking out of the player’s hands so they can maximally fuel their bodies with the proper building blocks.

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Credit: Forbes.com

Cryotherapy tanks allow the players to be exposed to cold temperatures for brief amounts of time up to 3 minutes to assist with controlling inflammation through blood vessel restriction. This is performed by dropping the air temperature around the body for a systemic response in order to cut down on time spent recovering.  Finally, the activity trackers assist with proper load management to avoid overworking players & ensuring they are achieving their maximum functional abilities during each game & avoiding injury. 

While these are not found at all NFL facilities, this collection of resources has allowed the players to maximize their healing process & take away any excuse they may have in getting better. These resources individually in itself aren’t superior to other therapies, but having a variety of options available to find the right sequence could allow the training staff & players to maximize recovery. The players still have to perform the work, the training staff has to instruct in what’s best to get the players healthy, but the Bills are at least finding ways to get a leg up on their competition in order to stay healthy throughout the season in their push towards the playoffs.

Top Photo Credit

BuffaloBills.com

Lawson’s Gimpy Groin

Assessing Shaq Lawson’s latest injury and impact for Sunday’s showdown against the Atlanta Falcons.

It was reported that Shaq Lawson injured his groin in practice Thursday and is now a game time decision for Sunday against Atlanta. Lawson has been on a tear this season in limited action, totaling 10 tackles, 2 sacks, nearly equaling his output from last year. He has begun to live up to draft expectations coming out of Clemson in 2016 and is a reason why the Bills defense has returned to top form this season.

As Lawson is a game time decision on Sunday, it would be better to understand what a groin injury is and how it affects his play. The groin is a series of muscles that attach from the lower hip in the hip crease to the inside portion of the thigh. These muscles assist in bringing the leg to midline, flexing the hip up, and internally/externally rotating the hip. These actions are vital to the actions of the defensive end with regards to shuffling, running, and pivoting. This is typically seen when trying to run down a player or having to stop suddenly. This can also be seen during eccentric contraction of the adductors which is seen during blocking and shuffling along the line.

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Lawson reports that his groin is sore and that he will be alright. Despite a positive outlook from Lawson, it is still beneficial to understand how the groin is injured. Typically, the groin muscles are injured when the individual is sprinting or changing directions quickly. As this is a soft tissue injury, there are various grades that the muscle strain can be broken down into to assess severity based on location and mechanism of injury.

Grade 1 involves an injury to the area due to overloading the area, causing microtears and weakening the anchor point, causing pain and inflammation. This is usually a week-to-week injury and if rehabbed properly, should not be an issue long term. The injury typically is seen more in the muscle belly, which is the meaty portion of the muscle. Pain may be felt in the inner thigh or in the groin itself if the muscle is overloaded.

Grade 2 involves a partial tear to the muscle belly or attachment point leading to an inability to walk normally, much less perform the duties of the position. This injury takes longer, anywhere from 4-8 weeks based on severity and must be managed conservatively. Typically, injuries closer to the attachment points can become more chronic and lead to extended time missed. This is due to the nature of the muscle having to pull on the anchor in order to function properly. If the anchor point is not secure, pain and ineffective use of the muscle continue to occur.

Grade 3 typically involves tearing of the attachments closer to the femur, which is known as the distal insertion points. Commonly, the muscle is torn partially or fully away from the bone, leading to surgical intervention. These type of injuries do not happen often, but as with any muscle injury, can occur.

It is not known what caused Lawson’s injury, but it is certainly significant enough to cause him to be a game time decision. I believe that Lawson’s groin injury is a Grade 1, supported by the remark that it is sore and that he will be alright. An athlete knows his body best and barring any re-injury during warm ups, should play Sunday. There is always the risk to increase the severity by playing through, but with proper stretching and warm ups, along with the continued limited snap count, Lawson should be fine. Considering that Lawson has been playing up to the level we expected when drafted, it will be beneficial to have him pressuring Matt Ryan and the Falcons offense. This is a winnable game if the Bills play to the level they did last week against a very good Broncos team. Continue to check back for updates and further analysis regarding Bills injuries, GO BILLS!!

Week 3 Injury Breakdown- Broncos

Analyzing the Buffalo Bills injury report for Week 3.

Week 3 is upon us! As we head into the match up at home against the Denver Broncos, I will review the team injury report and breakdown expectations for the players on the report. Unfortunately, the Bills injury report will continue to grow through the season. However, most injuries so far have consisted of minor problems that if managed correctly, will not become a problem long term.

Getting several of the names out of the way early are LB Lorenzo Alexander, RB LeSean McCoy, and DT Jerel Worthy. I address these players first because they are not serious issues or have already been addressed. Alexander is on the list due to rest, McCoy due to his wrist which does not appear to be a serious injury as he was listed as a full participant. Finally, Worthy is still in the league concussion protocol and still not practicing, which likely means he is still having symptoms during regular aerobic activities.

Those carrying over from last weeks injury report are S Colt Anderson, TE Charles Clay, and OT Cordy Glenn. Colt Anderson continues to deal with a foot injury and continues to somehow be on the roster. Clay was on last week due to shoulder complaints; this week is knee, which continues to be a long term issue year after year. Glenn reappears on the list due to re-aggravation of the foot/ankle area.

New to the injury report are DE Shaq Lawson, WR Kaelin Clay, DT Marcell Dareus, LB Deon Lacey, LB Matt Milano, and TE Nick O’Leary. Kaelin Cray is dealing with a foot injury, yet not much is known about the current injury. Clay did suffer a broken foot last year during training camp with the Ravens. He was eventually cut in November from injured reserve and essentially sat out last season. Hopefully, this is not something that will keep him out for long. Deon Lacey, Matt Milano, and Nick O’Leary are all dealing with hamstring injuries which can continue to be tricky due to the demands of their specific positions. Lawson’s injury was detailed greatly in my last post and should not affect him for long term. To note, all were full participants on Friday which indicate that they will most likely play Sunday.

It was reported today that both Cordy Glenn and Marcell Dareus will not play Sunday due to the previously reported injuries. I had initially thought that Dareus’ injury was not major due to the fact that he returned to the game against the Panthers. He most likely sustained a sprained ankle and the team is possibly being cautious to ensure that he will be available later this season. With Dareus ruled out, the Bills signed DeAndre Coleman to the roster. Coleman was in training camp and during the offseason, released during cut down day. Considering that Jerel Worthy and Dareus is out, depth will be crucial to place pressure on the Denver offense and contain the run game.

With Cordy Glenn ruled out of the game Sunday, expect Dion Dawkins and Ryan Groy to see increased playing time. This will be the first true test for Dawkins, which I believe he will step up and fill in, demonstrating why the Bills picked him in the 2nd round. As for what Glenn is dealing with, possibly a foot sprain leading to further instability and pain. There are reports that he has issues with both feet/ankles, but unable to confirm each individual issue as that kind of detail typically isn’t released. At this point, I say keep him out until he is ready to play. I have outlined my thoughts on Glenn in the past, I still maintain that the previous issues are contributing towards this current one.

While missing Glenn and Dareus in the lineup, the depth is finally there to deal with these losses. All of the players except Worthy, Dareus, and Glenn practiced in full on Friday which leads me to believe that most of them will either be ready to play for Sunday or have their snap counts limited. Please continue to ask questions, leave comments, and educate yourself on Buffalo Bills injuries. I continue to be open to ideas and will address injuries that require further explanation. Once again, thank you for your time and GO BILLS!!!