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.

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.

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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

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
Credit: billswire.usatoday.com
Buffalo Bills v Tennessee Titans
Credit: TheAthletic.com
NFL: Washington Redskins at Buffalo Bills
Credit: billswire.usatoday.com
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Credit: ESPN.com

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

Week 12 Bills Injury Review- Broncos

Are Morse & Beasley going to play Thursday?

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

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

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

C Mitch Morse (right 5th digit)

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

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

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

WR Cole Beasley (left ankle)

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

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

WR Robert Foster (right hamstring)

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

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

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

Other notes:

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

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

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

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

Top Photo Credit:

Rochesterfirst.com

Week 12 Bills Injury Preview- Broncos

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

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

RULED OUT:

S Siran Neal (concussion)

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

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

OT Ty Nsekhe (right ankle)

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

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

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

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

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

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

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

SUITING UP SUNDAY

DE Jerry Hughes (groin)

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

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

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

S Jaquan Johnson (hand)

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

DT Jordan Phillips (toe)

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

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

Possible Inactive’s:

TE Tommy Sweeney

DT Vincent Taylor

WR Duke Williams

OT Ty Nsekhe

S Siran Neal

RB TJ Yeldon

OG Ike Boettger

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

Top Photo Credit:

broncoswire.usatoday.com

Week 11 Bills Injury Review- Dolphins

How severe is Nsekhe’s injury?

Another week, another win. The Bills move to 7-3 on the season with a convincing win over the Miami Dolphins in Miami Sunday afternoon. This is the best start for the Bills since 1999 & 10th time in franchise history that they started 7-3, all previous Bills teams made the playoffs with varying degrees of success. While the Bills are continuing to march towards the postseason, they will be without a key contributor moving forward. This & other injuries will be detailed below. 

WR Isaiah McKenzie (left knee)

McKenzie suffered a left knee injury when he caught a pass going out of bounds with :55 left in the 2nd quarter. CB Nik Needham was close by but unable to break up the pass, instead falling & hitting McKenzie’s lower leg. It appeared to hyperflex his left knee, causing McKenzie to get up & limp off the field. 

Thankfully this was close to halftime where he was able to get some rest & get a quick assessment to ensure he could play in the 2nd half. This injury appeared to be minor & is not something I expect him to show up on the injury report with later this week.

S Siran Neal (concussion)

Neal suffered a concussion midway through the 2nd quarter on the kickoff with 7:41 left following Hauschka’s FG. Unfortunately, the video is not available yet as there was a touchback & the camera followed the ball & not the players. It was reported he was shaken up on the play, but once All-22 comes out, we may get a clearer view of what exactly happened. Neal enters the concussion protocol with no guarantee he is cleared for next Sunday. 

OT Ty Nsekhe (right ankle)

Nsekhe suffered a rather severe right ankle injury with 9:14 left in the 3rd quarter. This was a routine run play by Singletary up the middle when Nsekhe’s foot was caught from behind by Dolphins DE Avery Moss, landing on the back on Nsekhe’s heel, forcing the ankle to roll under the big man violently before his body caught up & he falls down in obvious pain. 

He was immediately placed into in an air cast & carted off, waving to fans but in significant discomfort. The result: a likely ankle dislocation with fibula fracture. There is a concern that he suffered a tibia fracture as well, but he may have spared the more significant bone due to the ankle rolling as much as it did before he fell over. 

300px-Fibula_Fracture
Credit: physio-pedia.com

According to Monday’s press conference, more tests were being performed on Nsekhe’s ankle with no definitive answer at this time. 

This could be for several reasons: 

  • The swelling may have been so great that imaging did not show the true extent of the damage.
  • There isn’t an actual break but significant ligament damage on the lateral portion of the ankle.
  • The Bills know exactly what is going on (they likely do) & are sitting on the info because they have no reason to release it until they feel they’re ready or can sign someone to replace his roster spot. 
images (1)
Credit: physiodirectnz.com

Looking at an alternative video angle from Thad Brown, there is the possibility that Nsekhe avoided a break but dealing with quite a severe inversion ankle sprain. He would have injured the anterior talofibular & calcaneofibular ligaments when Moss landed on his ankle. There is a slight chance he avoided a fracture due to observing the heel sliding out, relieving pressure off the fibula as he went down. 

The sheer fact that he was placed into an air cast & carted off without the ability to place weight through his leg isn’t ideal. His season is possibly done, heading to IR for surgery & rehab if my original suspicions are confirmed. I am not certain but if you go on NFL Gamepass & watch the replay, it appears as though the snap of the bone is audible. I’ve played it multiple times in a row. 

This may be a similar injury to what LB Matt Milano suffered last season. if so, a recovery timeline for Nsekhe would be 6-9 months with my guess being closer to 8-9 months. There are several factors including: 

  • Nsekhe is 34 years old, Milano was 24 during his injury.
  • Nsekhe is 6’8”, 325 lbs. Milano is 6’0”, 225 lbs. 
  • Nsekhe’s bones are thicker & are required to accept more weight than Milano’s, requiring a longer healing time & associated recovery.

While 34 is still a youthful age, it is getting up there when it comes to the NFL. Nsekhe can & should make a full recovery, but considering the mileage on his body, it’ll be interesting to see whether he is able to return to full form in order to compete for a roster spot next year. He should be close to, if not fully ready for training camp & should be able to participate in OTA’s in 2020. He is clearly a talented player, the Bills have him under contract for another year, it may come down to how he looks in camp.

For the interim, OT Cody Ford slides into the starting role he has alternated with Nsekhe all season. OT Ryan Bates will likely move to back Ford up. Once Nsekhe moves to IR, the team may elect to fill his roster spot with practice squad players OT Brandon Hitner or OT Victor Salako. The other option is to find a street free agent or another player off another team’s practice squad. Either way, GM Brandon Beane already has a preliminary plan in place. 

Other observations from today’s game injury-wise include noting Nsekhe’s replacement OT Cody Ford is still wearing a hinged elbow brace with a compression sleeve on the left elbow from the injury in the Eagles game. Each week he wears this brace further confirms that he suffered some type of injury to the UCL ligament in the right elbow & the brace provides protection as the ligament heals. 

Other injury news to note is that DE Jerry Hughes was active & played his usual snap count, highest among the DL group. I had originally stated that Hughes would miss the game & I was wrong. While I did not observe every single snap, he did not appear to be compensating or limited. This also creates the thought that the team is not sold on rookie DE Darryl Johnson. While no one expects that Johnson can be an effective player such as Hughes, it shows that an injured Hughes is still better than a healthy Johnson. 

The loss is Nsekhe is going to hurt. While he is older, he showed the ability to play very well with the offensive unit. Ford is able to step in & contribute, but his play has been marred by penalties & inconsistent play. He will suffice, but the quality of play at the position will suffer. However, the Bills are 7-3 & even with a 3-3 finish to the season will give the Bills double-digit wins for the first time this millennium. The Bills are still very much in control of their destiny & can make noise in the playoffs if they played like they did Sunday.

Week 11 Bills Injury Preview- Dolphins

Will Hughes be able to go Sunday?

Going into 2019, we all felt that this Bills team was something special. This team was built through the draft in addition to key free-agent acquisitions, & hidden gems in UDFA’s. Along with a talented coaching staff leading the team to 6-3, there has not been enough credit given to the Bills training staff. Check out the tweet below from Wednesday in regards to the difference a month makes. Back at the beginning of October prior to the Titans game, the Bills had 12 players dealing with injury with 7 ruled questionable & 2 ruled out. 

What a difference a month makes.

Heading into Week 11 against the Dolphins, the injury report is minimal with only DE Jerry Hughes & TE Dawson Knox on the injury report. 

QUESTIONABLE

DE Jerry Hughes (groin)

Hughes was a surprise addition to the injury report Thursday with a groin injury in which he was limited in practice. It has since been confirmed that he re-aggravated the injury Thursday but this is something that has been lingering from before. What we don’t know is when he sustained the original injury as I went back in my records & did not find any instance where he was down on the ground or missed any time during games. He has since been designated as questionable & is a true 50/50 shot to play. Between getting treatment daily & getting down in the warm Florida weather may do good for Hughes. 

A reminder for the importance of the groin muscles: they assist with running, jumping, cutting, side shuffling, basically all motions required to bend around the edge in the case of a defensive end. Depending on the side of the groin pull, this could affect how he lines up & how effective he is throughout the game.

However, I could see him missing as this is a game that can be potentially won without him. The injury was Thursday; even 2 days of intense rehab interventions & rest may not be enough to be ready for Sunday. He’ll be a true game-time decision with myself leaning towards that he misses out of precaution. If he misses, we could see a re-emergence of rookie DE Darryl Johnson as a depth option.

TE Dawson Knox (knee)

Knox found his way onto the injury report Thursday with what HC Sean McDermott noted as “knee soreness”. It was expected that he was to return to practice Friday and that is nothing to be concerned about. I tend to want to believe what this coaching staff says, they have been fairly honest, but if it’s that minor, then why is it showing up on the injury report? 

He did have a left fractured foot and meniscus repair during his sophomore year at Ole Miss which required surgery, but there isn’t any certainty that it is the same knee or any relation to what is going on this week. 

The only other possibility is “load management”. Those dreaded words are seen commonly in today’s NBA circles. Knox may be hitting a proverbial wall & needs an occasional day off as he is progressing through his first NFL season. I think as he adjusts to the professional schedule, he will adapt, but the team clearly wants to avoid overuse injuries to their future assets. 

Possible Inactives:

TE Tommy Sweeney

OG Ike Boettger

OT Ryan Bates

S Dean Marlowe

DE Jerry Hughes

DT Vincent Taylor

RB T.J. Yeldon

As the Bills travel down to Miami, the temperature will be drastically different from the mid-teens & low 20’s felt in Buffalo after the most recent snowstorm. Miami will be a balmy 77 degrees on Sunday. Considering the temperature will be considerably higher, hydration will be a key factor in staying healthy. As the temperature increases, the body sweats more in order to help keep itself cool. The team will have to focus on hydration & ensure that all players have a good warmup to get the muscles loose & ready. 

This is a game that we could see some strains if dehydration & muscle fatigue set in during the 2nd half. The Bills are certainly healthy enough & in shape enough to overcome some injuries, but losing players to strains once the cool weather returns won’t help down this difficult stretch. The Dolphins always play the Bills tough, no matter the year, but this could be a bounce-back game for the offense to get on the same page in order to show the NFL that they can hack it. This won’t be an easy win, but hopefully, a win that can move the Bills to 7-3 before they hit the vital portion of their schedule.

Top Photo Credit

Forbes.com