NFL Injury Series- Contusions

Reviewing what contusions are, severities, and recovery times.

Today’s post will consist of several terms that come up often but aren’t well defined. My goal is to identify the rest of the terms and continue to further the knowledge base. There are many terms for the same problem or based on location, which define how it is described.

First up is the common contusion. A contusion is defined as a blow to an area that damages the small blood vessels and connective tissue in the area. This can be caused by getting hit hard or falling the ground which if severe enough can impact function. While everyone has dealt with a bruise at some point or another, not everyone gets hit by a 250 lb linebacker going at full speed.

When the contusion occurs, the blood vessels do burst and the discoloration is the result of the burst blood vessels releasing blood, rising up to the surface, then slowly reabsorbed by the body. This is why a bruise fades over time. The more severe the contusion, the more impact it can have. While nothing has been torn, the connective tissue of the muscles and other tissues including fat and skin are still impacted. The tissues of the body are quite pliable and if damaged, will respond to pain as any other portion of the body, except brain tissue. Contusions vary in recovery times to no time missed to several weeks based on location and severity.

Contusions, if severe enough can cause compartment syndrome in the area. This occurs when swelling becomes excessive and pushes on the connective tissues surrounding the muscles. If not managed quickly, the excessive pressure can begin to kill the muscle, leading to permanent damage.

Various types of contusions include hip pointer, nerve contusion, stingers, and bone bruises. Hip pointer injuries are to the bony portion of the hip known as the iliac crest. This is right above the waist line and are common due to the location players fall to the ground or are tackled in the area. This area is also where the abdominal wall attaches to which limits trunk motion and the hip abductors connect right below the area, which allow for a player to run and perform lateral movements. These can take 1-3 weeks to recover based on severity of the injury.

Nerve contusions, such as what Shaq Lawson dealt with¬†last season, is when bruising occurs to a nerve. In most cases in the body, the nerve is well insulated and protected from injury. However, in certain cases, these nerves sometimes exit the body temporarily and are exposed. Cases include the ulnar nerve that exits temporarily near the elbow and the peroneal nerve which is on the outside portion of the knee near the fibula. If you’ve ever hit your funny bone, that’s your ulnar nerve screaming at you. In Lawson’s case, he hit the peroneal nerve which causes pain and weakness to the area. These injuries can resolve relatively quickly, but are quite painful and may take some time to rehab from to ensure proper movement. Once again, depending on the location and severity determines recovery time.

Stingers are another type of nerve injury that can be incredibly painful, but can quickly resolved if managed correctly. Stingers occur when a player gets tackled violently and the shoulder is pushed in one direction and the head in the opposite, leading to traction on cervical or neck nerves. Compressive forces can also cause similar symptoms, such as a direct head blow during a poor tackle or when driven into the ground. Pain is typically felt in the neck and shoulder region, with pain also produced sometimes all the way down the arm causing pain, weakness, and numbness. Due to how the nerves connect all back to the spinal cord and brain, this is why pain can travel down the arm despite the injury occurring in a different area. These injuries can resolve with rest and proper stretching, but is not something that can be rushed.

Finally, bone bruises complete this article. Bone bruises are actually a type of fracture that is less severe than a true bone fracture that we all think of. Keeping it brief, there are 3 types of bone bruises: Sub-periosteal hematoma, inter-osseous bruising, and sub-chondral lesion.

Sub-periosteal hematoma occurs when a direct high force trauma occurs and blood forms under the periosteum, which is a membrane that covers the outside of the bone. Inter-osseous bruising occurs when the bone marrow of the bone becomes damaged, specifically the blood supply. This occurs as the result of a repetitive high compressive forces on the bone, such as excessive running or jumping. These are seen more common in the knees and ankles.

Sub-chondral lesions occur when the cartilage layer of the bone becomes damaged. This area is found at the end of the bone and is the part that articulates with another bone. An extreme crushing force or rotational/shearing force may also cause this, commonly seen in injuries such as ACL tears. ACL tears typically not isolated, but MCL damage, meniscus damage, and even a sub-chondral lesion due to the forces that occur on the joint during the injury also occur.

Recovery times are difficult to manage with mild bone bruises recover in several weeks with more severe instances can be months. It really is specific to each person and how the injury was sustained. I wish I could give a more specific timeline for these recoveries but some players respond quickly and others such as Sam Bradford could take several weeks and leave uncertainty regarding their availability for future games.

These injuries happen far too often and are a part of football. While padding, playing surfaces, and proper tackling can reduce incidence of injury; these are the types of injuries that come with playing football. Most of these injuries can be managed conservatively with rest, icing, stretching, and padding. These are injuries that do not keep players out for extended time, but can be injuries that knock out players during key games.

Continue to check back for regular updates and further in depth analysis of the latest Bills injuries. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills and at http://www.bangedupbills.com. As always, thank you and GO BILLS!!

A Hodgepodge of Contusions

Looking at what consists of a contusion, the various types, and severity associated with the injury.

Today’s post will consist of several remaining terms that come up often but aren’t well defined. My goal is to identify the rest of the terms and continue to further the knowledge base. There are many terms for the same problem or based on location, which define how it is described.

First up is the common contusion. A contusion is defined as a blow to an area that damages the small blood vessels and connective tissue in the area. This can be caused by getting hit hard or falling the ground which if severe enough can impact function. While everyone has dealt with a bruise at some point or another, not everyone gets hit by a 250 lb linebacker going at full speed.

When the contusion occurs, the blood vessels do burst and the discoloration is the result of the burst blood vessels releasing blood, rising up to the surface, then slowly reabsorbed by the body. This is why a bruise fades over time. The more severe the contusion, the more impact it can have. While nothing has been torn, the connective tissue of the muscles and other tissues including fat and skin are still impacted. The tissues of the body are quite pliable and if damaged, will respond to pain as any other portion of the body, except brain tissue. Contusions, if severe enough can cause compartment syndrome in the area. This occurs when swelling becomes excessive and pushes on the connective tissues surrounding the muscles. If not managed quickly, the excessive pressure can begin to kill the muscle, leading to permanent damage.

Various types of contusions include hip pointer, nerve contusion, stingers, and bone bruises. Hip pointer injuries are to the bony portion of the hip known as the iliac crest. This is right above the waist line and are common due to the location players fall to the ground or are tackled in the area. This area is also where the abdominal wall attaches to which limits trunk motion and the hip abductors connect right below the area, which allow for a player to run and perform lateral movements.

Nerve contusions, such as what Shaq Lawson dealt with, is when bruising occurs to a nerve. In most cases in the body, the nerve is well insulated and protected from injury. However, in certain cases, these nerves sometimes exit the body temporarily and are exposed. Cases include the ulnar nerve that exits temporarily near the elbow and the peroneal nerve which is on the outside portion of the knee near the fibula. If you’ve ever hit your funny bone, that’s your ulnar nerve screaming at you. In Lawson’s case, he hit the peroneal nerve which causes pain and weakness to the area. These injuries can resolve relatively quickly, but are quite painful and may take some time to rehab from to ensure proper movement.

Stingers are another type of nerve injury that can be incredibly painful, but can quickly resolved if managed correctly. Stingers occur when a player gets tackled violently and the shoulder is pushed in one direction and the head in the opposite, leading to traction on cervical or neck nerves. Compressive forces can also cause similar symptoms, such as a direct head blow during a poor tackle or when driven into the ground. Pain is typically felt in the neck and shoulder region, with pain also produced sometimes all the way down the arm causing pain, weakness, and numbness. Due to how the nerves connect all back to the spinal cord and brain, this is why pain can travel down the arm despite the injury occurring in a different area. These injuries can resolve with rest and proper stretching, but is not something that can be rushed.

Finally, bone bruises complete this article. Bone bruises are actually a type of fracture that is less severe than a true bone fracture that we all think of. Keeping it brief, there are 3 types of bone bruises: Sub-periosteal hematoma, inter-osseous bruising, and sub-chondral lesion.

Sub-periosteal hematoma occurs when a direct high force trauma occurs and blood forms under the periosteum, which is a membrane that covers the outside of the bone. Inter-osseous bruising occurs when the bone marrow of the bone becomes damaged, specifically the blood supply. This occurs as the result of a repetitive high compressive forces on the bone, such as excessive running or jumping. These are seen more common in the knees and ankles.

Sub-chondral lesions occur when the cartilage layer of the bone becomes damaged. This area is found at the end of the bone and is the part that articulates with another bone. An extreme crushing force or rotational/shearing force may also cause this, commonly seen in injuries such as ACL tears. ACL tears typically not isolated, but MCL damage, meniscus damage, and even a sub-chondral lesion due to the forces that occur on the joint during the injury also occur.

This wraps up the breakdown of injuries that are commonly reported, but are not fully known. These injuries happen far too often and are a part of football. While padding, playing surfaces, and proper tackling can reduce incidence of injury; these are the types of injuries that come with playing football. Most of these injuries can be managed conservatively with rest, icing, stretching, and padding. These are injuries that do not keep players out for extended time, but can be injuries that knock out players during key games.

What is most important is that the Bills continue to keep injuries to a minimum. They have suffered injuries just as any other team in the NFL, but have avoided the season ending, season altering injuries thus far. Continue to check back for regular updates and further in depth analysis of the latest Bills injuries. Thank you and GO BILLS!!

Contusion Confusion

Understanding Shaq Lawson’s nerve contusion including what it means and long term effects.

Shaq Lawson has a nerve contusion. You’re probably thinking, what is a nerve contusion and is this another crazy Bills injury? You’re also thinking, when did this occur and how will this affect him the rest of the season? During today’s post, I will help understand what happened, how it occurs, and long term effects.

First off, let’s break down a contusion. A contusion is some type of injury or blow to an area which can cause restrictions in movement or sensation. Basically a big bruise. However, a typical bruise to the area would cause a black and blue discoloration mark due to superficial blood vessels being disrupted and broken. This can cause pain during touch, muscle/joint movement, and limited mobility. In the case of Shaq, he sustained a nerve contusion, which is more specific.

A nerve contusion is a injury which can cause disruption to the conduction of the nerve. In a case like this, an injury to the area would cause numbness, pain, and weakness. This would present as a pins and needles feeling, significant pain immediately after the injury, and possible partial or temporary loss of control of the muscle that it innervates. Due to recent reports stating that Lawson sustained a nerve contusion of the leg allows me to deduct that he injured the peroneal nerve.

The peroneal nerve branches off the sciatic nerve that branches off the spinal cord. This branch of the nerve innervates the muscles of the lower leg including the anterior tibialis and extensor hallucis/digitorum longus. These, along other muscles, assist in lifting the foot up and in which is known as dorsiflexion and inversion. These muscles are vital for running, cutting, planting; basically everything that Lawson would need to perform during game day.

An injury like this would occur when the outside of the leg gets hit hard during a play such as a tackle or when a body falls on the area. The nerve runs down around the fibula which is the outer bone that makes up part of the outside of the ankle. This area is more associated with high ankle sprains such as what Odell Beckham is recovering from at the moment. While it is listed on the Bills injury report as a foot, this is the area that is being affected via the nerve, hence the designation.

Final question, how will this impact him for the long term outlook? Professionally, I don’t believe that this will be a long term issue, pending unknown severity. I expect him to possibly be limited over the next several days as the nerve continues to heal and will be a possibility to play against the Broncos. He may miss the next game if he has more damage that initially reported. The Bills have done fantastic with managing injuries thus far and I expect this trend to continue.

Thankfully, this injury was not more severe. To understand how severe it could have been, please direct your attention to the Dallas Cowboys roster and find LB Jaylon Smith. As most fans know, Jaylon Smith wrecked his knee and nearly his NFL career in his last college game, tearing his ACL/LCL and causing extensive damage to his peroneal nerve which cost him his entire first season in the NFL. In severe cases such as this, foot drop will occur. Foot drop is seen more commonly in older individuals who have suffered a stroke. These individuals will be fitted with an AFO or ankle foot orthosis which locks or assists the ankle into neutral/slight dorsiflexion allowing the foot to swing through during walking and preventing the foot from dragging. Thankfully, Smith has recovered to be the Cowboys leading tackler, but took nearly 18 months to even have the chance at playing.

While spinal cord injuries do not heal, peripheral nerve injuries can and do heal, with varying levels of success. To keep it simple, the nerve can have 3 stages of injury which impacts healing. The first stage is damage to the outer covering of the nerve which typically heals on its own. The second stage of nerve injury is where the outer covering becomes totally damaged and has disrupted regular nerve function. The final stage of nerve injury is total disruption and severance of the connection. In Lawson’s case, I can comfortably state that he suffered a stage one injury. Jaylon Smith sustained a stage 3 and his recovery was so long due to the nerve having to regenerate which can occur at a rate of 1-5 mm/day based on the size of the nerve. The fact that Smith has returned to such a high level of play is incredible in itself. The fact that Lawson escaped with a relatively minor injury is lucky.

I expect Lawson to continue building off his rookie season and increasing his level of play to be the disruptive defensive end that he was in college. I will continue to update with any changes or new information that occurs. Look for future articles to analyze the Bills injury report for Week 3 and identify any new complaints that require further breakdown. Go Bills!

Week 2 Recap- Panthers

Analyzing Buffalo Bills injuries coming off Week 2 loss against the Panthers.

Well, that game is over. That was a tough one to watch from an offensive standpoint. LeSean McCoy ran for 9 yards and the offense scored 3 points. Not the kind of football that I want to watch nor root for. While the defense kept the Panthers to 9 points in their own house, there are no moral victories. Only upside is that the Bills continue to stay relatively healthy, once again, not sustaining any significant injuries.

Today’s post will consist of any Bills players who sustained any sort injury and breakdown potential ramifications for future games. First up, Marcell Dareus sustained an ankle injury early in the 1st quarter and sat out for some time. Watching the game, there was no injury timeout or replays showing the injury. Considering that Dareus returned to the game, it does not appear to be anything concerning. Best case scenario is that Dareus suffered a mild lateral sprain which was taped up on the sidelines, giving him stability to finish the game. Expect for Dareus to be limited in the next several practices as he recovers and be a full participant next week against Denver.

Next up is CB E.J. Gaines who was down momentarily with a shoulder injury. If you recall, Gaines suffered a shoulder injury that knocked him out of last week’s contest against the Jets. While not confirmed, it appeared to be the same shoulder, believed to the left side. This injury was sustained during a tackle near the end of the 1st quarter. While it was initially reported that his shoulder was not concerning last week, re-injuring the same shoulder now makes it concerning. Considering that it was a direct hit to the area, he may have suffered an AC sprain or possible SC sprain which would limit arm elevation, vital for tackling and batting passes down. Expect to see Gaines be listed on the injury report, too early to tell if he misses next game.

Cordy Glenn was next with an ankle injury sustained in the 2nd half. No video or injury timeout occurred leading to further review, but the fact that Glenn continues to be hampered with foot and ankle injuries is concerning. No updated reports indicate that this may be a multi week injury, but expect Glenn to be out of practice the next several days. It does help that McDermott has been rotating his lineman out to keep them fresh which has allowed Dion Dawkins to get vital playing time in cases such as this. I still believe that Glenn may be dealing with some sort of ankle instability which could lead to further sprains if not conservatively managed.

Two injuries that are not concerning are Kyle Williams going down with an eye injury and Andre Holmes with a chest injury. Both returned to the game quickly indicating that no damage occurred. Williams appeared to suffer a cut above his right eye during a tackle and Holmes appeared to have the wind knocked out of him briefly. Williams is too tough to let an eye laceration slow him down and Holmes still made plays towards the end of the game which allows these injuries to become afterthoughts.

Finally, LeSean McCoy went down with a right wrist injury during a tackle at the end of the 3rd quarter but was able to return. Last week, McCoy reported that his hand went numb during a similar play last week and pulled himself out briefly. Despite his hand going numb and then returning to the game tells me professionally that no structural damage has occurred. What is most likely happening is when McCoy goes down, he may be striking the field with his elbow and hitting his funny bone. When someone hits their funny bone, they are actually directly striking their ulnar nerve which is slightly exposed on the inside part of the elbow. This can cause immediate numbness along with the pins and needles feeling as though the hand fell asleep. McCoy could reduce the incidence by wearing elbow pads, but may be a comfort issue or may limit the ability to cradle the football.

A final note, earlier today, it was reported that Shaq Lawson suffered a nerve contusion during yesterday’s game and has begun to recover. Once again, no injury timeout or detailed video indicating when this occurred. Reports also do not identify the area that the nerve contusion occurred. Until further reports are made, I will have to assume that this is a similar injury that occurred with McCoy mentioned above.

Updates will be made once the official injury report comes out and more information is released. None of these injuries except Glenn’s ankle concern me. I expect players to get injured, miss plays/time, and not always be at 100%. While the results are not what us as fans want, I would rather have a close loss with everyone coming back to play next week than a win with a major player going down with a season ending injury. Expect further articles to briefly analyze Week 2 injuries around the league and updates on any Bills injuries once more information becomes available. As always, willing to answer questions, break down injuries, and educate my fellow fans on injuries occurring with the Buffalo Bills and in the NFL.