Charles Clay Clunky Knee

Reviewing Week 5 loss against the Bengals and impact of Charles Clay knee injury including long term outlook.

The Bills, well, the Bills lost. They lost a very winnable game by a score of 20-16 in Cincinnati. The offense never got going, the run game doesn’t look anything like it has the past 2 seasons, and this Bills team continues to make this fan base crazy. That’s the nice, politically correct way of saying that. Two years from now, this will be a game that won’t be marked as a trap game, the kind of game that is an expected win. However, we all have to “Trust the Process” and trust I will!

Sunday was one of those games that while the depth that has been lacking in past seasons was there, the talent and cohesiveness was not. The team continues to stay relatively healthy, not losing anyone to season ending injuries. Notable injuries to the Bills are CB Leonard Johnson who left with a hamstring injury in the first half and did not return. However, the focus of today’s article is TE Charles Clay’s left knee injury sustained after catching a pass and getting hit in the knee going out of bounds towards the end of the first quarter. This resulted in Clay ending his day early and getting carted off the field.

Anytime someone sees an elite player go down with a knee or leg injury, they automatically think ACL tear. Why do we think that? Because the ACL is the sexy injury that the media loves to talk about. Everyone knows its serious, everyone knows its season ending, and it’s all over the news constantly. As you begin to hyperventilate or start cursing the Bills, R-E-L-A-X. Clay did get injured, it didn’t look pretty, and the results aren’t great. If you care to continue reading, I will help you step back from the edge and explain what really happened.

Based on reports, Charles Clay sprained his MCL, tore his meniscus, and will be out for an extended time with surgery to fix the meniscus. Most people know that if the ACL is bad, then the MCL must be bad as well. It is but it isn’t. The knee is comprised of many different structures including but not limited to: bones of the knee: femur, tibia, patella; ligaments including: medial collateral ligament, anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament; soft tissue includes cartilage and medial/lateral meniscus.

knee.jpg
Credit: webmd.com

The MCL runs on the inside portion of the knee connecting the femur to the tibia. The MCL allows for stabilization medially and along with the LCL, prevents the knee from going east/west and ensures that knee works as a hinge joint. When the MCL is sprained, the ligament is stretched and partially torn as with any other sprain. However, the MCL is more dynamic in that it connects into several muscles in the knee including the vastus medialis, sartorius, semimembranosus, semitendiosus, and gracillis. The MCL also attacks to the posteromedial portion of the medial meniscus. To simplify it, at various points, the MCL connects to parts of the quadriceps, hamstrings, adductor muscles, and part of the meniscus. Without these many connections, the knee would be far less stable and would not be able to change direction suddenly.

Despite a fantastic design by nature, design only allows for so much prevention. The MCL typically gets injured during sudden changes in movement such as cutting and pivoting. The MCL also becomes damaged during direct blows to the outside part of the knee during knee flexion, which is what occurred with Clay when a low tackle hit him out of bounds.

The MCL severity grades are broken down into 3 grades with the increasing grade indicate level of severity. Level 1 consists of some fibers torn with tenderness and no instability. There is some pain during application of force to the outside of the bent knee, but nothing else significant.

Grade 2 consists of increased pain and more noted swelling. There is moderate tenderness and laxity in the joint. Most of the pain is on the inside of the knee and patients typically poorly tolerate laxity testing to the MCL. There are varying degrees of a grade 2 sprain including 2- and 2+ depending on amount of damage.

Grade 3 is a complete rupture of the MCL, leading to instability along with extreme pain and swelling, resulting in difficulty with bending the knee. The knee also gives away during a valgus force which is when pressure is applied to the outside of the knee. Surgery is usually indicated as the ligament has been totally torn from the bone.

Credit: http://kingbrand.com/MCL-Injury-Information.php

Based on video of the play and difficulty with placing weight through the leg afterward, this indicates that he may have suffered a partial tear, possibly a Grade 2+. This is supported by the fact that he did not have surgery to repair the MCL itself.

To add insult to injury, Clay also tore his lateral meniscus. The meniscus acts as the shock absorber in the knee and helps with keeping the knee healthy during movement. Unfortunately, part of the lateral meniscus became torn during the hit. This likely occurred due to the direct blow along with the knee bent and planted on the ground, leading to twisting of the knee, resulting in a partial tear. Presentation of a partial tear involves pain, catching, and clicking during knee movement. While research has been proven that a nonsurgical approach can be just as effective as surgery to trim down the meniscus, this is the NFL and there is no wait and see approach. The procedure that Clay had today is called a meniscectomy which involved cutting out the frayed piece of meniscus and shaving down the area to smooth it over to ensure that more pieces do not fray off.

Reports indicate that Clay will be out at least a month, possibly indefinitely. I believe that he will be out closer to 6-8 weeks. The meniscus is something that could keep him out 2-3 weeks; the problem is the MCL. The body will need to heal and restore proper range of motion to the knee while regaining strength. There are therapeutic interventions that can encourage healing, but the body still has to do its job. Professionally, I would say place him on IR with designation to return. This gives him a guaranteed 8 weeks to heal up and return to full form. This would also allow the team to bring in another TE and not use up a valuable roster spot. This would place him on track for the Colts game in December. Considering the Bills have two games against Miami and one against New England after that, it would be an excellent time to come back healthy.

My final thoughts on Clay is that he has had several years of reported knee issues, of which I wrote about during the preseason. From observation during practice, I believe he had most of the issues on the left knee, of which he injured Sunday. However, this injury is independent from his previous issues. He was not at a higher risk for this injury as the result of the previous problems. If anything, this may help take care of the other issues by giving him time to rest.

The Bills are certainly hurting from this one. Clay has been a consistent producer and a favorite target of Tyrod Taylor. Clay should be back later this season, but whether his return will make a difference remains to be seen. I still believe that this season we have more depth than in previous years, but having depth just is not the same as the starters. That was evident in the secondary and linebackers on Sunday. Thankfully, the bye week could have not come at a better time. I still believe the Bills have a shot to stay competitive this season with how the rest of the AFC is playing this season. The Bills still control their destiny, Charles Clay injury will not define the season.

Continue to check back for further updates regarding new injuries and posts designed to educate my fellow Bills fans and keep you from the edge. Thank you and GO BILLS!!

That’s A Wrap!

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

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

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

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

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

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

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

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

Big Problem with Streater’s Big Toe

Analyzing Rod Streater’s Toe injury sustained during Preseason game 2.

As the preseason drags on, injuries continue to occur and further shape rosters ahead of cut down day on September 2nd. Some players are already assured roster spots, but others that need to still prove it or that are fringe players, every snap counts. One of these players that may still need to prove it is Rod Streater. Until last week’s game against the Eagles, Streater has had a solid camp, rebounding from a pair of foot injuries with Oakland that cost him sizable chunks of two seasons before regaining his footing with the 49ers last season. As Streater went undrafted coming out of Temple in 2012, he has had to fight every year for a roster spot. Seeing Streater go down with a toe injury in the 4th quarter certainly strikes a blow to his chances for a roster spot.

Today’s post will evaluate the possible injury Streater sustained in the Eagles game. I will also briefly assess any other injuries that occurred during the game, which was largely injury free Bills wise. Streater’s injury was by far the most notable injury to come out post game. Considering that later reports narrowed down the injury to a toe helped reduce the number of possible injuries significantly. Reports have indicated that he is not in a walking boot, not expected to miss any significant time, and is week-to-week.

Knowing the previously mentioned information, we can eliminate any fractures, dislocations, or any other possible areas of injury. While there are not any specific reports of the exact diagnosis, I can safely assume that Streater sustained a turf toe injury. A turf toe injury occurs when the big toe becomes injured, specifically hyperextended or bent back abruptly. This could occur during landing on the big toe, causing it to bend backwards and cause immediate pain. It was reported that he was dragged down to the turf following a catch in which the toe could have been caught, leading to the injury. As every other part of the body, each bone is connected to another bone via ligaments. An injury such as this could stretch out the ligaments supporting the big toe and create instability.

As a toe may seem insignificant when there are much greater injuries such as ACL tears, broken ribs, concussions; it is still vital to the overall function of the athlete. The big toe is vital to running due to this being the area that is pushing off the ground. If humans did not have a big toe, the running stance would be greatly altered. Try to walk without pushing off the big toe, very awkward in walking, nearly impossible in running. The toe also assists in balance stability during walking and standing, allowing us to stay upright compared to our four legged friends.

Having an unstable area that prevents pushing off limits the ability to run routes and sprint. Turf toe injuries can become a chronic problem if not managed correctly or if forced to return sooner than possible. Thankfully, Streater’s injury does force him to sit out, he will not miss any vital games. At this time, he would not be a candidate to be sent to IR, but would most likely be placed on the roster until he is fully ready to play. Considering he is week-to-week with a toe injury indicates that it may be a Grade II injury marked by moderate swelling, partial tearing of the structures around the toe, along with range of motion limitation and pain. To further differentiate between the severity of the injury, Grade I would be minimal swelling and bruising with some pain. Grade III would be significant swelling, total disruption of the surrounding structures of the toe, noted weakness during toe bending, and concurrent instability of the toe.

Surgery would only be indicated if there was an avulsion of the bone, any concurrent fractures, significant deformity, or failed conservative treatment, among other complications. As there are not reports that he is immediately having surgery, Streater will require rehab focusing on restoring range of motion to the toe, allowing pain and swelling to reduce. Once this has taken place, strengthening exercises will be performed, slowly loading the toe to build up strength and not cause further injury to the area. Once Streater is able to walk without any difficulty and report no exacerbation of symptoms, then he would be progressed to running, jumping, etc, eventually being cleared to return. Streater may also be fitted with a stiff soled shoe to limit extra stress on the toe during push off to reduce re-injury.

Expect Streater to miss the next 2 preseason games, at worst missing the first game in order to return to full health. As he is not considered to be more than a 3rd to 5th receiver, there are other players that can step up in the interim until Streater is ready to return. According to mock 53 man rosters, he is not on the bubble as some other players, but would benefit being healthy to ensure his spot and adequate playing time.

Other injuries to note coming out of the Eagles game, TE Jason Croom injured his ankle during the game and has since been placed on injured reserve. Also, S Trae Elston injured his hamstring, leaving towards the end of the game. There have not been any additional reports regarding Elston indicating that it is not serious. The Bills are halfway through the preseason with no major injuries. As a fan and professional, I do not recall a time when they did not suffer some type of major injury in the preseason. Looking at the past 2 preseasons under the Ryan/Whaley era, there had been 4 ACL tears in 2016, 1 in 2015 along with various other injuries including Sammy Watkins foot injury. This is a nice change of pace for the Bills and hopefully this trend continues. Most of the big name players will be out against the Ravens this Saturday, allowing those injured to continue resting and prevent new injuries from occurring. Continue to check back with new updates following the Ravens game.