Week 14 Bills Injury Preview- Ravens

Breaking down why Nsekhe is out so long.

9-3. What a sight to behold!

The Bills are 9-3 heading into the month of December. That’s pretty incredible after all the years of cold meaningless football. While the Bills still have more work to do this month, this has turned into quite a special season, making the national media take notice on the team from Western NY. As the Bills embark on vital December games, the team continues to stay healthy following a rash of injuries around a well-timed Week 6 bye. But the Bills, they’re incredibly healthy now & in prime position to capitalize on teams limping into the playoffs. With the Ravens coming to town on an 8-game winning streak, this is a true test for the Bills to create an opportunity to capture an elusive AFC East crown.

OUT

OT Ty Nsekhe (right ankle)

Nsekhe continues to rehab back from his severe ankle sprain suffered against the Dolphins back on November 17th. On Wednesday, it was reported that Nsekhe would be out on the practice field in some role, however, he was a DNP all week. This is not surprising considering the severity of the ankle sprain he suffered, assessed out at least as a Grade 2 inversion ankle sprain. 

The reason this ankle continues to require more time is due to how ligaments heal. Like all tissues, they are made up of various building blocks. In the case of ligaments, water, collagen, & amino acids create the makeup of the tissue. During normal use, the ligaments crimp & uncrimp based on the tensile loads placed through the joint as they connect bone to bone for structural support. As the joint is progressed through the range of motion, the ligaments elongate until they are maximally stretched. Prior to the injury, the striations of the ligaments are linear and allow for support during the full range during joint motion. Think of the striations in a nice steak, all linear and uniform as seen below.

blood cell types
Credit: Sportsinjuryclinic.net

When an injury occurs, the ligaments are either overstretched or outright tear. When a joint is taken to its end range, the proprioceptive nerves in the ligament start signaling for the muscles around the area to contract to prevent the joint from injury. While this attempts to reduce injury, the muscles are not always able to overcome the forces from the injury. Based on the severity, anywhere from several fibers to the entirety of the ligament can tear. 

During healing, the body attempts to heal quickly by putting scar tissue down in a haphazard fashion to heal the tissue. Because the tissue is not linear, the elasticity decreases & the tissue is not as strong as what was originally torn. What happens then is if the tissue is reinjured, it takes less force for the tissue to tear or it stretches out & does not regain its normal shape as easily. You can see below how the makeup of the tissue changes with injury.

scar-tissue-image-300x175
Credit: oregonmassageandwellnessclinic.com

All this tissue healing takes time, anywhere from 6 weeks to a few years for the tissue to fully mature. Fortunately, progressive loading movements help remodel the tissue as it heals in order to return to activity sooner. This is why we are able to gauge return to play timelines based on the severity of the injury. At the end of the day, Nsekhe needs proper rest with increasing loading of the surrounding tissue and ankle joint to ensure that he regains full function in the ankle without causing further damage to the healing tissue.

According to ESPN’s Marcel Louis-Jacques, Nsekhe is out of the walking boot this week, hopefully walking without pain. Ideally, he begins to practice in a limited capacity next week with an outside chance to play against the Steelers but more realistic chances to return against the Patriots. 

CLEARED

OG Quinton Spain & RB TJ Yeldon (illness)

Both Spain & Yeldon missed Thursday’s practice with what was described as an illness. Considering its flu season, that’s likely the cause. Neither were ruled out and while Spain won’t be 100%, enough fluids & Vitamin C should get him through the game. Just another reason to get the flu shot so you don’t get the flu. If you can’t get the shot, you know you can’t. But if you’re able, it helps keep you & others around you healthy. 

Possible Inactives:

TE Tommy Sweeney

OG Ike Boettger

OT Ty Nsekhe

WR Duke Williams

RB TJ Yeldon

S Dean Marlowe

DT Vincent Taylor

The Ravens are on an 8 game winning streak coming into New Era Field. Winning streaks in the NFL like this are rare & need to end at some point. I believe the Bills with their elite defense are primed to stop Lamar Jackson & Greg Roman’s offense. The Ravens are dealing with injury, but the Bills are healthier which with that and the ability to contain Lamar Jackson, could propel the Bills to victory. Here’s to a competitive game with the home crowd advantage, leading to a defining Bills win.
Top Photo Credit:

Baltimore Sun

Week 13 Bills Injury Preview- Cowboys

How are the Bills looking as they go down south?

The Bills travel down to Dallas with a lot at stake. Win, move to 9-3 & gain the national “respect” that they deserve? Or lose, drop to 8-4, and have continued questions whether they are actually a playoff-caliber team. With both teams playing on short weeks, this game will come down to who makes fewer mistakes & can capitalize on the opportunities given to them. Fortunately, the Bills are far healthier than the Cowboys & can make the most with their roster to secure a win before hosting Baltimore in Week 14. 

OUT

OT Ty Nsekhe (right ankle)

Nsekhe continues to work back from the sprained ankle suffered in the win over the Dolphins. He missed the Broncos game & won’t be back for the foreseeable future. He will continue to rehab & begin working on increasing his workloads to eventually return to practice with the hopes that he returns before the Patriots or Jets game. 

QUESTIONABLE

C Mitch Morse (right 5th digit)

Morse appeared to jam his right 5th digit or pinky on a play late in the 1st quarter, striking his hand into the ground towards the end of the play, coming up & grabbing at the area. He was unable to return for the rest of the game but was at times observed snapping to QB Matt Barkley & getting his finger buddy taped to the ring finger for support. He is likely dealing with some minor loss of range of motion, pain, & swelling. It also doesn’t help that 40% of grip strength comes from the muscles that move the 5th digit, significantly limiting Morse’s ability to grip & snap the ball. 

It’s possible he broke his finger, but without clear video, hard to say. However, he has been limited Monday-Wednesday with the finger injury, indicating that this may not be the case. It is very possible that he still plays with the fingers buddy taped together for support to play effectively. If he is unable to go or re-injures the finger, then G Jon Feliciano would slide back over with G Spencer Long taking his place.

WR Robert Foster (right hamstring)

Foster suffered a right hamstring injury on his biggest play of the day Sunday on a 24-yard catch & run down the sideline. Unfortunately, he got pushed out, forcing him to catch himself on his right side from falling over. As he was doing this, he was decelerating, regrettably overloading the eccentrically contracting hamstring and he suffered a strain. The team has been incredibly conservative with hamstring injuries this season with great success. 

Despite practicing in a limited role Tuesday & Wednesday, soft tissue injuries need time to heal up & with 5 days between games, the time simply is not there. As Foster is ruled questionable, WR Duke Williams will likely get the start after 4 games inactive. Hopefully, Foster’s strain is a minor one & he can return to play against Baltimore. 

CLEARED TO PLAY

S Siran Neal (concussion)

Neal managed to progress through the concussion protocol quickly, only missing the Dolphins game & not practicing at all last week. Last we knew, he was in Stage 2 of the protocol going through a pregame workout on Sunday. For him to progress to practicing in full & clearing the protocol is promising, indicating that he will resume as a vital cog in the special teams play.  

Possible Inactive’s:

TE Tommy Sweeney

DT Vincent Taylor

WR Robert Foster

OT Ty Nsekhe

S Dean Marlowe

RB TJ Yeldon

OG Ike Boettger

There isn’t much to discuss moving forward other than the Bills have to go down to Dallas & take care of business. Ideally, the Bills move to 9-3, shutting up the critics as the Bills march towards the playoffs despite a tough stretch of games. Either way, the Bills have taken care of business, winning the games they need to & putting themselves into opportune positions, rather than relying on others screwing up for the Bills to have a favorable outcome. Bills Mafia, enjoy your Thanksgiving & GO BILLS!!

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 10 Bills Injury Preview- Browns

The Bills are healthy?

So hey Bills Mafia, what do you want to talk about? Clearly not about this injury report, I mean, there are all of two names on there. By the way, it’s Week 10. Week 10 of an NFL season. An NFL season which consists of broken bones, torn tendons, ligaments, concussions, & an endless supply of heartbreak. Yet, here we are at Week 10 with a “healthy” roster. I say nearly healthy because there are still injuries that linger, injuries that are unknown, injuries that are still on the mend. 

The Bills are 6-2 with a “healthy” roster coming into Week 10 against the 2-6 Cleveland Browns. That’s an awesome sentence to think about, write, & read. While the Bills still have to go & play the game, 7-2 is looking quite good right now. Before I get ahead of myself, there are a few injuries below, take a few moments to check them out, it’ll be brief!

Injuries during the game included WR Andre Roberts (leg), DE Trent Murphy (neck), & S Micah Hyde (knee) were all minor enough that they did not show up on the injury report & shouldn’t be a concern moving forward. To note, all did return to play after getting quickly evaluated by the medical staff. 

LB Maurice Alexander (knee/calf) was placed on IR this past week clearing the way for the Bills to sign DT Corey Liuget to help shore up the run game. The exact specifics behind Alexander going to IR is right now a mystery & may not be revealed until much later. To get more information about Liuget, make sure to check the tweet below. 

S Kurt Coleman (left hamstring)

Coleman suffered a hamstring strain on a special teams play against the Dolphins back in Week 7. He has since missed 2 games & frankly, the team has soldiered on without him. He continues to fit what the Bills training staff has done in managing hamstring strains. He was limited Wednesday when it was cold & windy outside, but since able to practice in full on Thursday & Friday. I expect he’ll play Sunday as he’s fresher than some of the other players who may be able to play but could use a week off.

CB Kevin Johnson (left knee)

Johnson was a surprise addition to the injury report Wednesday with a knee injury. Looking at the video below, it appears that he gets tripped up before landing hard on his left knee as he continued downfield.

He may have slightly hyperextended his knee, he may have twisted or tweaked the knee where it was sore, it’s not quite known what he’s dealing with. However, while he didn’t practice Wednesday, he was a full participant on Thursday & Friday. Johnson has been incredibly durable this year, only suffering a stinger which limited in practice during the week prior to the Eagles game but otherwise appears to have avoided serious injury that derailed multiple seasons when he was in Houston.  Either way, he should be good to go for Sunday to continue to special teams & defensive depth.

Probable Inactive’s:

TE Tommy Sweeney

S Jaquan Johnson

OG Ike Boettger

OT Ryan Bates

WR Robert Foster

RB T.J. Yeldon

DT Vincent Taylor

The Bills are looking to move to 7-2 following a trip to Cleveland in a battle for Lake Erie supremacy. All the talk about soft schedules, DVOA, power rankings; what does it matter if a win is a win in the NFL? Previous iterations of the Bills have received winnable games on paper & blown them, leading to a loss. So if the Bills get a win on Sunday, then they’re 7-2 & that much closer to a playoff spot and that much closer to a Super Bowl, even though that seems so far off. For now, I hope the Bills keep stacking wins, soft schedules be damned! Let’s hope for minimal to no injuries Sunday as the Bills march towards the difficult portion of their schedule.

 

Week 3 Bills Injury Review- Bengals

What are Feliciano & Harrison Phillips dealing with following Sunday’s win?

The Bills once again found a way to get it done to move to 3-0 Sunday. A close fought game was won in the dying minutes of the 4th quarter with a final score of 21-17. They appeared to dominate early in the game with a 14-0 lead going into the half, but allowed the Bengals to hang around and score 17 unanswered points. Fortunately, RB Frank Gore plowed into the end zone with 1:50 left in the 4th quarter. While Bills Mafia can savor this win, several injuries dampen the excitement.

Prior to the game, it was already known that RB Devin Singletary (left hamstring), CB Taron Johnson (right hamstring), & TE Tyler Kroft (left ankle) all would not be suiting up. All appear to be tracking to return for possibly next week. However, Kroft was observed in a walking boot following the game on his left ankle. Singletary hasn’t had any updates but hamstrings are finicky with the recovery. They all would have been fine options for this week, but having them 100% for the Patriots will be key.

It appeared that CB Tre’Davious White (neck) suffered no ill effects from the last week in a red no-contact jersey as he was able to snag 2 key interceptions, the final which sealed the victory. LB Corey Thompson (ankle) appeared only on special teams due to a low ankle sprain, but was able to contribute in some fashion after being listed as questionable heading into Sunday.

Unfortunately, there was a slew of injuries that varied in severity & will be addressed below.

OG Jon Feliciano (neck)

The offensive mauler suffered a neck injury during the first scoring play late in the 1st quarter. Reviewing film, he got blocked down to the left and appeared to get hit on the right side of the head. He was able to get up and participate in the 2 point conversion before getting to the sidelines where he was initially questionable before being downgraded to out.

Afterward, he was observed walking around the locker room in a neck brace by The Athletic’s Joe Buscaglia. Considering the limited video and follow up bracing, this would indicate that he may be dealing with a whiplash injury. This type of injury is more commonly seen in motor vehicle accidents, but can occur with any rapid change in motion in relation to the head. There is always the possibility for a fracture but until the team releases more info, I am leaning towards whiplash.

The neck brace would assist with supporting the cervical region to prevent unnecessary movement. He would likely not wear a neck brace for long, possibly 1-3 days, but hopes that he would be able to begin rehab to restore motion and strength to the area is ideal.

This may be an injury he could miss a few games if my thoughts are correct. Once further information is released, a more definitive timeline can be established.

OT Ty Nsekhe (right ankle)

Nsekhe briefly left the game late in the 3rd quarter due to getting bull rushed backwards, possibly jamming his ankle. He thankfully was able to return & continue playing without any apparent drop off in play. I would categorize this more of a contusion & this is something that really should have no impact on practice or the upcoming game this week. It’s also possible that he may have suffered an Achilles strain due to getting pushed back how he did, but he fell down easily and if there was concern for that, he probably wouldn’t have returned. At worst, he may have a wrap or sleeve on the ankle, but this should not affect his availability barring any new information.

WR Cole Beasley (right knee)

The shifty receiver left the game for several plays while dealing with an injury to his right knee. Video replay shows that he got tangled up with his defensive counterpart and he appears to have fallen directly onto the area. Like Nsekhe, he could have a contusion for which he is able to play through. I also do not anticipate this being a factor this week.

DT Harrison Phillips (left knee)

With just under 2 minutes left in the game & the Bills protecting a 4 point lead, Phillips went down with what appears to be a left knee injury. He was pushing forward moving inward/outward before his left knee buckled from under him and he fell down. There did not appear to be any direct contact to the area but an injury clearly occurred. He was briefly assessed before being able to get up and jogged/walked off the field.

Later it was reported that he was going to get X-rays once he was in the locker room. Imaging may be checking to determine if he suffered an MCL sprain with associated damage such as a meniscus or a bone bruise. Considering how he fell, they may have also been checking out his tibial plateau or the kneecap which could have been injured as a result. Reports indicate that he is getting an MRI on the knee today.

UPDATE: Phillips has since been diagnosed with a torn ACL, ending his season.

He tore the same side back in 2015 while in college at Stanford.

Until we get more information on Feliciano, it is difficult to determine timelines at this time. While injuries do occur, the Bills continue to mostly avoid the season ending variety. There may be other injuries to be released later, but this is what is known at this time. If Feliciano is unable to go, rookie OT Cody Ford can slide over or OG Spencer Long can man the spot.

The team does have recent Dolphins cut DT Vincent Taylor or DT Kyle Peko they can bring up now that Phillips is out. The Bills are banged up right now heading into Week 4, but with a good practice this week, what was lost Sunday may be balanced out by with what returns.