2020 Divisional Round Bills Injury Review- Ravens

How serious are the injuries from Sunday’s game? What is going on with Patrick Mahomes?

Being a Bills fan all these years, you kept hoping that they’d eventually be good again. Now it’s here, it still doesn’t feel real. It really is a weird feeling that the Buffalo Bills are in the AFC Championship game and one win away from a Super Bowl after beating the Baltimore Ravens 17-3 Saturday night.

They move on to play the Kansas City Chiefs dealing with several minor injuries that are worth looking at prior to Sunday night. However, the huge storyline will be whether Patrick Mahomes will be able to play following entering the concussion protocol Sunday that allowed the Cleveland Browns to almost come back and win. All the Bills injuries and thoughts on Mahomes are below.

In-Game Injuries:

DT Vernon Butler (Left foot)

Butler exited the game briefly halfway through the 1st quarter, only observed limping off to the sidelines to get looked at by training staff. Upon video review, it appeared that he had his left foot stepped on during the play. 

He left briefly to get it checked out but came back and likely played through pain for a majority of the game. He likely had x-rays to rule out any fractures, but it may be more pain than anything. 

According to Joe Buscaglia of The Athletic, Butler didn’t play the entire 4th quarter though that may have been by design rather than injury. It doesn’t appear that he should miss the game but he potentially could be limited in practice this week.

WR Gabriel Davis (Right ankle) 

Davis injured his right ankle trying to extend out for a touchdown catch midway through the 2nd quarter. He came up limping and briefly exited the game, eventually designated as questionable with an ankle injury.

Based on video, this could be a low inversion ankle sprain. He may have also jammed his ankle when his forefoot struck the ground. He was at times in obvious discomfort throughout the game and wasn’t as much of a factor for the remainder.

I would expect him to be limited this week but play Sunday. Having the extra day to rest does help things but tape and toughness will help him get through this latest injury.

QB Josh Allen (Right knee/ankle)

Allen once again scared everyone when he went down late in the 3rd quarter, pounding the ground in obvious discomfort. Upon review, he injured his right leg in a similar fashion as to when he injured it in the Chargers game. The stress through his right leg is significantly less compared to the previous injury.

It looks like he stressed the knee more so than the ankle since the foot came up off the turf as he went down. He could be wearing a knee brace again next week or he may not need it. What might have helped was the previous injury to the area giving more flexibility to the tissue as it’s still remodeling and healing. 

Allen has played through much worse injuries and thus one won’t change his availability for Sunday. 

TE Reggie Gilliam (Left leg)

Gilliam went down on kickoff following the Taron Johnson interception for a touchdown, quickly requiring the attention of trainers upon going down. His left leg was worked out on the field and left once the defense took the field. He missed the next offensive series before returning, lining up as a fullback.

Considering he came back so quickly especially after dealing with a hamstring injury earlier this season, it’s possible he was dealing with some cramping. He was moving without hesitation supporting that this may be the case. I don’t foresee that he shows up on the injury report and I expect that he’s available for Sunday. 

Other injury observations:

K Tyler Bass (Right hand) 

Bass didn’t get injured but it was noted that he injured his right hand in practice, clarifying the injury report from last week. It looks like a brace on the hand but it didn’t impact his ability to perform. This is really just something to note to clarify to what we already know. 

RB Devin Singletary (Hamstring)

There were reports that Singletary was holding his hamstring following his last carry with 2:41 left in the 4th quarter, limping to the sidelines. He did fall down to his right as though he slipped while he tried to make his cut. Looking at the video, there really isn’t much to look at. He is observed walking around post-game without any noticeable limp or requiring any assistance. It is possible that he was also dealing with cramping, but there doesn’t appear to be anything definitive. If he shows up on the injury report, then we at least know when it occurred. 

QB Patrick Mahomes (Concussion protocol/toe)

Disclaimer: There is more information that must be known throughout the week and will be updated as needed.

Quite possibly the biggest news story of the NFL playoffs, Chiefs quarterback Patrick Mahomes exited the divisional round game to be evaluated for a concussion following getting twisted down by Mack Wilson

Considering the possibility of a concussion could prevent Mahomes from playing Sunday, this is enormous in terms of whether the Bills can make the Super Bowl. From what we see right now, I have no idea whether he will play Sunday. Below are several statements regarding concussions and concussion protocol to better understand this process.

  • If someone is evaluated for a concussion but passes, they can return to the game. But if they pass, it doesn’t mean that it is automatic. If the player exhibits something out of character or still shows questionable symptoms, they can be held out as a precaution.
  • Once Mahomes enters the concussion protocol, he has to still pass through the protocol to be cleared to play. Even if he doesn’t officially have a concussion. This also prevents Mahomes from talking to the media and does allow the Chiefs to keep the Bills on their toes as to whether he will play. 
Credit: NFL
  • Most concussions take anywhere from 7-10 days but can take significantly longer to recover from based on a variety of factors. If he does not have a concussion, then that could affect his return to play timeline, but we won’t know until he is cleared. 
  • The doctors, medical staff, players, family, team, etc. will not try to game the system in order to get him to play. If he plays, he’s good to go, if he’s not, then he’s not. There’s no gray area with this decision.

We simply need more information on his head injury and see how he responds in practice this week. As for his toe, that’s where things are a little more clear. He injured the left toe when he was swung backwards on his second touchdown of the day, planting his left foot behind him, bending the toe back suddenly. He was quickly evaluated on the sidelines and eventually returned. He is likely dealing with turf toe based on the area the team was looking at and reports coming out.

He may be limited with general mobility, but this won’t affect him as a passer and only really affect him as a runner, though this late in the year, he was going to play no matter what. It also appears mild enough that it’s just another thing to play through. 

Credit: SPTNY.com

If this hasn’t already felt like the longest week ever, it certainly is considering this article is being released on Tuesday. Take a deep breath and watch the injury reports this week. I expect the Bills to put whoever they can on the report for gamesmanship. I expect Mahomes to be in concussion protocol all week. Things won’t be clear until Friday/Saturday and even then, there still may be uncertainty. Regardless of who plays and who doesn’t play, the Bills have already and will have to continue to beat extremely talented teams to make it to the Super Bowl and win. Enjoy the moment, it’s been a long wait.

Top Photo Credit: Pro Football Focus

Bills Concussion Woes

Reviewing the NFL concussion protocol including return to play criteria and how this affects the Bills QB situation.

It’s been well known that being a Bills fan is hard. Losing Super Bowls, long extended playoff droughts, ill-timed injuries, the list goes on and on. Right now, that trend appears to be continuing with the 2017 preseason. After the loss to the Ravens by a score of 13-9, the Bills are now 0-3, heading into a show down at New Era Field tonight against the Lions. As mentioned last post, the Bills continue to demonstrate some luck by missing all the ACL tears, sprains, and injuries that can derail a season even before it starts. Unfortunately, the Bills don’t escape totally free. Tyrod Taylor and T.J. Yates both went down with concussions, leading Nathan Peterman to play most of the game. After Taylor and Yates entered the concussion protocol, the Bills signed Keith Wenning to fill in until both QB’s are medically cleared.

After a player sustains a concussion, the player enters the NFL concussion protocol. Most of the time, that’s all we hear until the player is cleared to return to play and contribute. But what does the NFL concussion protocol consist of? What is classified as a concussion? I will break down what classifies a concussion, what the protocol looks like, and the general timeline to return. Hopefully, this will give a clearer indication of what to expect.

A concussion is defined as a violent blow to the head which can disrupt brain function temporarily. Some concussions cause loss of consciousness, but not always necessary for a official concussion diagnosis. The brain is surrounded by cerebrospinal fluid which helps bring nutrients to the brain along with providing some protection during light trauma. However, the brain does not have air bags to protect from larger impacts. In the case of a more significant blow, the brain will strike against the inside of the skull, and then possibly strike the other side of the skull. This is known as a coup-contrecoup injury. This does not always happen in every concussion, but may intensify the symptoms if more areas of the brain are affected.

Upon striking the brain, immediate changes occur with physical symptoms including headaches, confusion, amnesia, dizziness, nausea, vomiting, fatigue, and delayed response time. Further symptoms include sleep disturbances, light and noise sensitivities, irritability, and difficulty with concentration, among other symptoms.

The NFL Head, Neck, and Spine Committee came up with a comprehensive protocol to identify and effectively treat a concussion. To keep it brief, the criteria are: a direct blow to the head or a force that translates towards impact to the head; rapid onset of transient impairment of neurological function, changes in neuropathological changes, and clinical symptoms that may or may not involve a loss of consciousness.

Down on the field, the NFL uses the SCAT2 which is the Standardized Concussion Assessment Tool to assess the player. This protocol has been modified for the NFL and is consistent with the SCAT3 released in 2013. The advantage is that this test can be administered multiple times with valid results to determine a concussion immediately or if symptoms are delayed. This is a test to assess for a concussion but a more formal screening process is done during the preseason and after suspected concussion to fully diagnose.

Each NFL team has a plan in place consisting of an unaffiliated neurotrauma consultant and ATC spotter to indicate whether the player may have a concussion. The player must have been removed from the field, video replay must have occurred of the injury, and an assessment must be performed. If there is any doubt of whether a concussion has been sustained, then the full evaluation must be performed. No more will there be a player being waved back into games or being rushed back in. Numerous players have stated they went back into games and they don’t remember being a part of those games when asked later.

Players will continue to be checked periodically to ensure they do not develop symptoms later and incur further damage. These results will be checked against their baseline assessment to determine the severity. Players could exceed the baseline score but still have a diagnosis of a concussion. This prevents a physician from looking at the diagnosis of a yes/no and look at the entire situation rather than a score.

If the player has sustained a concussion, there are 5 levels of recovery that must be performed in order to return to the game. These must be achieved in order to be medically cleared to return to playing. They are as follows:

  1. Rest and recovery: Players should avoid or limit meetings, social media, electronics to allow the brain to rest and minimize symptoms until player returns to baseline function. The player may engage in stretching and balance activities that allow them to lightly stress the body and being the process to improve. During this time, neurocognitive testing will be performed to assess for clearance towards normal activities.
  2. Light Aerobic Activity: A graduated exercise program consisting of cardiovascular exercise which may include a stationary bicycle or treadmill along with stretching and balance activities. This will be gradually increased as the player remains symptom free and begin to return to team meetings, film study, etc.
  3. Continued Aerobic Exercise and Introducing Strength Training: Cardiovascular exercise will continued to increase intensity and simulate the sport specific activities, progressing to supervised strength training. Once again, if the player is symptom free, they can proceed.
  4. Football specific activity: All activities continue to increase in intensity and duration and resume football activities. These activities must remain non-contact to ensure no recurrence of symptoms.
  5. Full football activity/clearance: Once the player has achieved the first 4 steps, contact may be re-initiated and determine that they have no recurrence of symptoms. The player will be reevaluated by a team physician and if cleared, resume normal activity. If at anytime the player experiences symptoms, they are placed back in the concussion protocol and restart the process until they are symptom free.

If you would like to review the actual documents in greater detail, please click here & here.

While this is a fairly comprehensive protocol, this should continue to improve as we learn more about concussions. Unfortunately, this protocol does not give a specific timeline for return as each concussion is different. Observing the hit on Taylor showed him getting his bell rung may keep him out for an extended period of time. Yates concussion was not as clear as when it occurred which may indicate a better prognosis. While it is not guaranteed that Taylor will be ready to start, CBS Sports reports that Taylor should be ready by Week 1 and has not had any setbacks. Recent reports on Twitter that he is out signing autographs before tonight’s game, tolerating lights and music which could signify he is already on Level 2-3. I believe Taylor will be cleared to start Week 1 and lead the offense to several touchdowns. Continue to follow for updates following cut down day, full recap of preseason injuries, and analysis of the Bills going into Week 1.