Eric Wood’s Neck Injury

Analyzing the neck injury that forced Eric Wood to retire and long term implications.

Disappointing news coming out of One Bills Drive Friday with the sudden announcement of C Eric Wood retiring from the NFL after nearly a decade. The cause of his retirement appears to be related to neck issues that were discovered during a routine end of season physical intended to assess issues players made need to address in the off season.

This determination was made by Dr. Cappuccino, who is the orthopedic spine surgeon, along with other doctors and team officials. For the 9th year pro’s long term health, it was ruled that retirement was best to avoid further damage. As detailed information has finally been released, it has been revealed that Wood is dealing with a bulging disc in the C2-C3 region following stinger’s during Week’s 5 & 6. Today’s post will identify why this is career ending and long term implications.

While it is incredibly disheartening hearing this news, I believe all fans would want the health of each and every player to be most important. To identify what occurred with Wood, the anatomy of the area must be understood. The cervical region of the neck is comprised of 7 cervical vertebrae that stack on each other which curve in concave fashion to allow for support of the head in an upright position. In between these vertebrae, with the exception of the first two levels, cervical discs act as as shock absorbers and allow for the vertebrae to articulate with each other in order to move freely. Ligaments attach the vertebrae together for support and passing through the vertebrae are arteries, the spinal cord, and nerves. Eric Wood suffered a disc bulge at C2-C3, the first disc after the C1-C2 junction. To help put this all in perspective, please refer to the pictures below.

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Credit: backpain-guide.com

One of the issues that Eric Wood may have been dealing with that was described as wear and tear is cervical spondylosis. This occurs when the structural integrity of the vertebrae column becomes compromised and leads to instability within the region. This is is due to the cervical discs losing disc height which in turn reduce the space between, leading to laxity on the ligaments, causing further pressure on the discs. This can be the result of the aging process, trauma, or individuals that have to carry heavy loads on their head or shoulders. As a possible result of this condition, he stated he suffered a “stinger” in Week’s 5 & 6 and was evaluated without further treatment required. As cervical spondylosis progresses, this can cause other issues including degenerative disc disease, spinal stenosis, hypertrophy of the surrounding ligaments, subluxation of the vertebrae, along with both neural & vascular compression.

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Credit: mayoclinic.com

As a result of the disc bulging out, this can create spinal stenosis. In the case of cervical spinal stenosis, the vertebral foramen, or space in which the spinal cord passes through, becomes narrowed. In the case of Wood, repeated trauma/progressive disc protrusion is what led to his disc pressing on his spinal cord as seen below. Other causes that could occur include ventral spondylophyte formation, thickening of the ligamentum flavum, or hypertrophy of the dorsal facets. While all these are confusing terms, these are all structures that surround the spinal cord that could reduce space and compress on the spinal cord as you place the head into various positions. To put this into a simpler perspective, imagine squeezing a hose; as you tighten or bend the hose, the flow of the water decreases. If the spinal cord is compressed, certain head movements can increase pain and limit mobility, placing even greater pressure on the spinal cord. This could affect areas below the spinal cord level or the nerve roots that branch off to the extremities. With compression over time, this could lead to temporary or irreversible damage based on severity.

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Credit: http://www.houstonmethodist.org

This is something that Wood was aware of after Week 5 and appeared to manage up to this point. However, incidence of previous spondylosis could cause and progress the stenosis.  As the veteran center has never appeared on the injury report with a neck injury during his career, this doesn’t mean that he never had neck pain. This is evident with the report of the stingers that was resolved which lead to his omission on the injury report.

Following the stinger, there are variations in the presentation of symptoms based on severity. One of the concerning but manageable issues include cervical radiculopathy. This is where the nerve is compressed either at the neck or a later exit point down the nerve’s path. This compression could cause pain, tingling, numbness, and weakness to travel down specific nerves in the shoulder or arm. This is common to see in the general population, but far from a pleasant sensation. Several of these symptoms are more prevalent in the lower cervical vertebrae.

In Wood’s specific presentation, occipital headaches, often typical of migraine, with pain radiating to the eyes and behind the ears, blurring of vision, dizziness and nausea especially when attempting to lie down, numbness of the side of the neck, tension and “knots” in the neck and shoulder muscles, and swelling and stiffness of the fingers. He may have had several of these symptoms following the stinger which warranted further evaluation.

If Wood would have continued playing and ignored medical advice, he would be at risk of  developing cervical myelopathy as this is more severe in that actual damage to the spinal cord has occurred. This presents as bowel and bladder issues appear along with difficulty walking, coordination, and loss of strength, among other symptoms. Typically, those are emergency related symptoms and must be dealt with immediately. If Wood were to keep playing, he would be at higher risk to have this occur with the violent nature of the hits and further degeneration of the affected areas. The C2-C3 area is more severe as nerve roots branch off which affect head movement and assist in controlling breathing. Further damage to the area could include paralysis and/or death if not addressed immediately.

While all this does sound ominous, there are many options for conservative care. Physical therapy, chiropractics, and pain management including injections can manage the complaints for years. Primary focus on the area would to educate the patient on the condition and awareness of possible worsening symptoms. Other interventions include managing and reduce pain, maintain motion and strength in the area, and prevent further decline in the area. Personally, I have worked with a variety of patients with similar complaints with a variety of outcomes. Some have been able to resolve their complaints completely, some have significantly reduced their pain and have a strong understanding how to prevent further complications. Others have gone on to receive injections and surgery which in turn has improved their quality of life. Fortunately, through his decision to step away from the game of football, Eric Wood will not likely be bed bound and in a neck brace for the rest of his life. He will instead be able to participate in activities including exercise, avoiding strenuous, repetitive activities such as football and heavy weightlifting, and focus on raising his newborn son.

If Wood is to require surgery in the future, there are a variety of surgical procedures that can help to stabilize the affected area. This includes but is not limited to: spinal fusion surgeries and/or anterior cervical discectomy.  These procedures stabilize and partially remove the offending area to reduce pressure on the spinal cord. Right now, he may not require any surgery, instead altering activities to reduce further damage. If surgery is indicated, this will help with quality of life but would not allow him to safely return to football.

Severity of the neck complaints that are forcing Wood to retire early at least leaves him in good hands with Dr. Andrew Cappuccino.  If you recall, Dr. Cappuccino is best known for saving TE Kevin Everett‘s life during the season opener in 2007. To put into comparison how severe this Wood’s injury is, S Aaron Williams had similar issues with his neck in a lower level that were well documented, ending his career. It appeared that he was willing to continue playing, but teams knowing his medical history would not touch him for fear that the next big hit may kill him. Wood was not willing to take that risk and able to end on a high note with a playoff berth.

The next big question is who steps up and replaces him. Ryan Groy appears to be a natural fit as he can play multiple positions on the line and may be a stop gap until the Bills find their next player in the draft or free agency. I believe the Bills will address this position effectively as they have with other positions this past season. It is a shame that this occurred to such a great player, but, as many before Eric Wood have proven, time is the one opponent that no one can defeat.

I hope that you learned something today and helps put into perspective why Eric Wood is forced to end his career. Continue to check back with me on updates regarding Bills injury news! Thank you for reading and GO BILLS!!

Week 10 Recap- Saints

Assessing the latest injuries including Jerry Hughes’ shin injury and what exactly happened with Saints RB Daniel Lasco’s spine injury.

The Buffalo Bills know how to keep this fan base on their toes and not in a good way. After putting up a stinker of a game against the Jets on prime time, the Bills followed up with a complete throttling at home by the New Orleans Saints by a score of 47-10. As a fan, I saw nothing good come out of this game. The offensive line didn’t look as porous as the Jets game, but still could not provide effective protection for Tyrod Taylor to make effective throws or move the ball. The entire offense looked out of sorts even with all the weapons that Tyrod had at his disposal. This was not a good game and if more is said on this topic, it will not be pretty.

Thankfully, this forum is not designed for my two cents on how the Bills play. I always leave the X’s and O’s to my friends at The Rockpile Report. Give them a listen; by far the most thorough and honest analysis of our beloved Buffalo Bills. However, the goal of today is to discuss the Buffalo Bills injuries sustained after Sunday’s drubbing.

Thankfully, the Bills continue to avoid the major season changing injuries that many other teams have sustained this season. The only injury that has been reported so far is DE Jerry Hughes. His injury was sustained at the end of the 1st half in which he injured his shin. He was observed warming up on the sidelines but did not return. It is unknown whether he was unable to return or was sat out as the game was out of reach at that point.

From my standpoint, there isn’t much that Jerry Hughes could have injured in his shin. The shin (tibia) is part of the lower leg which is the bone that makes up part of the knee and the ankle. While there are a multitude of muscle attachments that connect to the area to assist in knee and ankle movement, the shin itself doesn’t have a lot of possibility for injury. I believe that he may have suffered a contusion to the skin/tissue over the bone which made it painful to run. As mentioned above, the muscles do attach to the tibia which when moved, does pull on their attachment points, which could pull on the painful tissue.

Hughes also may have sustained an injury to his tibialis anterior which assists the foot in lifting up (dorsiflexion) and moving inward (inversion). This muscle is the meaty portion of the front and outside portion of the shin. A contusion to the muscle belly could make running painful and prevent effective pivoting, especially with the demands of his position. Either way, these aren’t injuries that keep most players down for long and Hughes is known for his durability during his career.

However, I will state that Hughes did not sustain a fracture. I do not believe this to be the case as he would have had imaging performed and ruled out if there was any possibility. He would have also had a definitive diagnosis today and most likely expected to miss several weeks if that were the case.

The only serious injury that occurred Sunday was to Saints RB Daniel Lasco on a kickoff return. Lasco hit his head directly into the hip of WR Brandon Tate and dropped immediately. It appeared initially as though he was not moving which brought back immediate thoughts of Kevin Everett 10 years ago. Thankfully, his injury was nowhere as severe but is season ending. It was determined today that he has a disc bulge in his neck and will most likely require surgery to correct the issue.

To give a better understanding to what happened, it helps to understand the anatomy in the area. The spine is comprised of bones called vertebrae which stack upon one another and allow the human body to stay upright and distribute the weight of the head and the trunk effectively. These bones allow the spinal cord to pass through it and act as a cage for the spinal cord and allow the nerves to branch off into all areas of the body. This allows for the nerves to provide input to move each muscle and allow various sensations to be felt. In between each vertebrae is a vertebral disc which acts as a shock absorber, allow for fluid movement between the vertebrae, and acts as spacer to prevent pinching of the nerves.

When Lasco’s head directly collided with Tate’s hip, it compressed the vertebrae on each other so much that it bulged or herniated one of these discs in the neck (cervical). This most likely began pushing on the spinal cord or a spinal nerve, causing radicular or traveling pain down the nerve. This is typically seen as weakness, numbness, and pain in the affected area. If you were able to see Lasco being loaded into the ambulance, he was able to raise his right arm, but it did not appear to be a strong, confident motion typically seen in the movies.

In a majority of non-sport cases, these types of injuries can be effectively managed non-operatively through physical therapy, chiropractics, injections, etc. However, due to the nature of the injury as it was quite traumatic and the impact football has on the body, that may not provide the best long term options, especially if he wants to return to football. He may get a cervical discectomy and fusion to the affected area in which the herniated portion of the disc is partially or totally removed and the vertebrae above and below the area are fused together to eliminate movement and further pressure on the nerves. He is able to return to football without any long term issues, but repeated injuries to the neck may impact his long term career prospects. This is why former Bills player S Aaron Williams found his career ending prematurely due to similar injuries.

As mentioned above, while the Bills played poorly, injuries are not being added to the insult and the Bills are not losing players to injured reserve. I would still want a tired but overall healthy starter out there in Week 15 fighting for a playoff spot rather than the backup just trying to hang on and not able to provide the same level of play. The Bills are banged up right now but should have some key players return in the coming weeks.

Continue to check back for further updates including analysis of the Bills injury report come Wednesday and when more information is known. As always, thank you for reading, follow me on Twitter at @kyletrimble88 for the latest updates and GO BILLS!!

Retrospective: Kevin Everett

Looking back on the 10 year anniversary of TE Kevin Everett sustaining a nearly fatal spinal cord injury and his miraculous recovery

Ten years ago today, September 9th, 2007 was going to be a day just like any other in Buffalo Bills history. It was the season opener for the Bills against the Denver Broncos. It was the first games for Marshawn Lynch and Paul Posluszny and a slow start into the 2nd season of the Dick Jauron era. The Drought was 7, going on 8 years after that season and still to this point hasn’t stopped. But on this date in 2007, TE Kevin Everett of the Buffalo Bills nearly died on the field of Ralph Wilson Stadium.

At the beginning of the 2nd half kickoff, Everett was running downfield during kick coverage, attempting to tackle kick returner Domenik Hixon when Hixon collided with Everett’s head and Everett collapsed to the ground. There is video here to recount that moment. Up to that point, Everett was a 3rd year backup TE and special teams player, having only recorded 2 receptions for 4 years in his career.

Upon impact, Everett sustained direct compression to the cervical spinal cord, initially paralyzing him and at that moment, nearly killing him. Upon falling to the turf motionless, Everett sustained a dislocation of the cervical vertebrae at C3-C4. As the spinal cord travels through the cervical vertebrae, the dislocation compressed directly on his spinal cord, which if left untreated, could have killed him. To educate how severe this injury could have been, the phrenic nerve is the nerve that innervates into the diaphragm which assists in breathing. The phrenic nerve is comprised of C3, C4, C5 within the cervical spine. This is right where the injury occurred, f that nerve were to be severely damaged or severed, the body would lose the ability to breath.

The cervical vertebrae that were damaged assist in maintaining neck posture, supporting the weight of the head, and bend forward/backward, and sidebend the neck. Since the vertebrae dislocated over the vertebrae below it, this placed a significant pressure on the spinal cord, leading to immediate disruption to the functions below the area and without quick action, could cause lasting injury. The only reason this injury was not worse was the fact that there was not a severance of the spinal cord, leading to irreparable damage.

In another era, Kevin Everett probably would have died, at worst, been a paraplegic, due to the damage sustained. Thankfully, he sustained the injury where he did and was able to get the assistance he needed right away. Dr. Andrew Cappuccino assisted in stabilizing the injury and applying cold therapy to the body. This is very similar to placing ice on a sprained ankle after injury. The idea was that if cold was applied to the spinal cord, this would reduce the chances of immediate swelling to the injured area, leading to reduced long term damage.

Cappuccino’s theory appeared to work as while Everett’s prognosis was initially grim, it rapidly improved once surgery was completed to stabilize the cervical region. On December 23rd, he was able to eventually walk at the end of the season when the Bills played the NY Giants at Ralph Wilson Stadium. With quick thinking by the right doctors, the lack of spinal cord severing, and determination, Everett was able to regain walking and a significant portion of his mobility. Many other people in his situation may have died or been paralyzed for life.

It is hard to believe that it is 10 years since Kevin Everett sustained his neck injury. There is not many articles regarding life for Everett following his injury. Most articles state that he has begun raising his family with his wife and participated in speaking engagements. The Buffalo News did an article on Everett and his family several years ago, detailing the long term effects of the injury.

As we get further away from that moment in time, it slowly becomes a footnote in history. My goal with today’s post was to bring it to the forefront, even just for a brief moment. While as a professional and fan, I pray this never happens to any player again. As fans, we know that football is a violent sport, there are risks both short and long term. It is important that we recognize that a player’s career and possibly even life, could end in a moment on the field. As we all sit down to watch the Bills home opener against the Jets on Sunday, remember Kevin Everett and the events of 10 years ago.

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!