Happy week 3 everyone! Man, what a ride that game was. I became very pessimistic when Miami took the lead after Jordan Howard’s TD run to put the Dolphins up 20-17. How nice was it to see the Bills have the ability to march down, score, to retake the lead? The offense looked so confident, specifically Josh Allen and the WRs. This was the first time I can remember where the offense had the confidence and ability to put up points at will and carry the defense when they had a down day (to say the least). Coming out of this game, I am very concerned about this defense. The defensive line doesn’t get as much pressure as I had anticipated, and the secondary is giving up too many plays. If it wasn’t obvious enough already how important Edmunds and Milano are to this defense and guarding the middle of the field, then it should be now after that performance.
On the positive side, the Bills came out of this game relatively healthy. Ed Oliver went down with what looked like a leg injury but was able to return just a few plays later. The team did lose second-year TE, Dawson Knox, to a concussion though, and this could be a big loss for what the offense likes to do in both the run and passing game. Things to keep our eyes on as the week progresses are the statuses of Edmunds, Milano, and Knox.
Bills injuries and the concussion protocol overview:
Dawson Knox: I can’t recall the play or moment when Dawson Knox left the game with his injury. It’s usually not hard to miss when a player leaves with a head injury, as they are relatively easy to see on TV and the hit is often replayed multiple times after it occurs. Concussions are tricky and dangerous. More knowledge about them is available now that the NFL has taken the initiative to be more cautious about them and have been requiring independent neurologists to be on the field for assessments of players who suffer head injuries. It is important to remember that a concussion is a brain injury, and these are not to be taken lightly for obvious reasons. There is a strict protocol every player must follow when they are placed in the concussion protocol by team physicians, and every player responds differently to the healing process. The concussion protocol is a 5 step process that must be completed before the player can return to action and looks like this:
Step 1 – Rest & Recovery: This one is obvious, and it requires the player to avoid all football-related activities until he can pass a basic neurological exam. The player is allowed to be at the facility and stretch in a limited capacity but cannot attend any team meetings or be on the field for any portion of practice and are supposed to stay off of social media as well. I throw in the social media fact because Knox posted on his Instagram page Tuesday morning congratulating Gilliam on his first NFL TD. The neuro exams performed will consist of a questionnaire (date, name, current president, where they live, etc.) It will also consist of simple words provided to remember and recall on-demand later on in the exam to help assess short term memory. An assessment of symptoms such as headaches or sensitivity to light and noise, etc. will also be assessed. Other examination techniques performed should include a Romberg test (which is done with the player closing his eyes and assessing him for swaying or balance issues), deep tendon reflexes (think when your doctor hits your knees with the reflex hammer looking for reflexes of the knee-jerking. Absence of these can be caused by neurological issues). Once a player can pass these tests, he can then advance to step 2.
Step 2 – Light aerobic activities: The player can participate in light exercises like riding a stationary bike, walking on a treadmill, etc. He can also begin to attend team meetings, film sessions, etc. During this phase, more neurological testing is done to ensure there is no regression in the player’s symptoms. If the player continues to pass the neuro testing and has shown to be able to handle light activities, he can then advance to step 3.
Step 3 – Increased aerobic activities and strength training: During this phase, the player can ramp up his physical activity to running, increased speed on the bike, etc. He may also participate in weight lifting, but it must be supervised by the training staff. He will be given neuro assessments again, and if he is able to pass them with the increase in activity, he may progress to step 4.
Step 4 – Football activities: The player can begin to participate in football-specific activities including catching and positional drills, but they must be done at a non-contact level, meaning no reps against other players, bags, sleds, or dummies. After practice, the player then goes through the neurological tests again. If he is able to pass the tests after being ramped up to football activities, he can proceed to step 5.
Step 5 – Full football activity: The player can return to practice in a full capacity, including contact drills and scrimmages. Once he has completed a full practice, he must be examined by the team physician again and must be cleared by that physician to return to the lineup.
It is important to remember that any increase in activity can bring back concussion symptoms. For example, while a player may feel completely healthy in step 2, he may regain symptoms from the increased workload in step 3. I don’t know exactly how it’s handled in the NFL when a player does fail a certain step, but in school, I was taught that if a patient fails in a certain step, they must return all the way to step 1. So if a player makes it to step 5, but re-experiences concussion symptoms, they must start over at step 1.
Do not expect to see Knox in the lineup this Sunday.
I’m not sure what’s going on with Tremaine Edmunds. I fully expected to see him in the lineup for game 2 with a shoulder brace under his pads, especially since he practiced all last week, albeit in a limited capacity. However, regarding the big picture, my concern increased when coach McDermott ruled him out for the game Friday morning during his segment on WGR550 and then went on to say they weren’t completely sure yet if they felt the need to place him on IR.
So we went from him being “day to day” last week Monday to possible IR (3-week minimum absence), which was very strange. It’s difficult for me to go into specific detail for you guys since the information provided to us is vague and all we’ve been told is “shoulder injury”. A good sign is that Edmunds was back at practice on Wednesday in a limited capacity wearing a red non-contact jersey, but he did have pads on unlike last week, making this an upgrade. I will refrain from being either optimistic or pessimistic since it is a good sign he’s practicing, but he practiced last week as well and still missed. This is something to closely monitor as the week goes on, and I am hopeful he can progress to a full participant by Friday.
When I wrote my blog last week, I knew Milano would be inactive against Miami, and I cautioned everyone that Milano will most likely miss the next 2-4 weeks, but it’s looking like he may be back much sooner, despite the teams usual very cautious approach with these types of injuries (Hell yes!). A positive sign is that he wasn’t placed on IR, meaning he is rehabbing well and probably suffered a minor strain. A minor strain would be caused by the muscle being outstretched and avoiding any tears of the muscle.
He did return to practice Wednesday in a full capacity (not even with a red-non contact jersey)! This will be important to monitor as the week progresses to assess if he has any setbacks or not (see Josh Norman). If he can remain a full participant, that would be great. Remember though, Vernon Butler practiced fully with his hamstring injury the week leading up to the season opener, and the team still sat him out week 1 vs the Jets. Like all of you, I’ve got my fingers crossed he plays this week.
Additional updates from Wednesday’s practice:
- Other players who did not practice include Dawson Knox, Cole Beasley, Ed Oliver, Jerry Hughes, Taron Johnson, and Del’Shawn Phillips.
- Tre’Davious White practiced but did so in a red non-contact jersey.
- Zack Moss was doing individual work on the sidelines.
Wednesdays are usually the days where the team is extra cautious, so I wouldn’t be too concerned about any of these just yet. A lot of these guys are getting rest days or nursing a very minor injury. Last week, John Brown and Jerry Hughes did not practice on Wednesday and were fine the remainder of the week. Thursday and Friday injury reports are a lot more telling!
Already declared out for Sunday is Rams starting LG, Joe Noteboom, which is a big loss for their OL. He is dealing with a grade II calf strain, which means he suffered partial tears in his calf muscle. Since it is so important to plant your legs and drive as a lineman, he is unable to do so with his calf muscle being partially torn. I wouldn’t be shocked to see him on IR, as this can hinder someone up to five weeks.
RB, Cam Akers, suffered costochondral separation during Sunday’s win in Philadelphia (man, those Eagles look BAD). Costcochondrial separation is the medical term for torn rib cartilage, which can happen from blunt trauma to the ribs like a car accident or a big football hit. While this can take months to fully heal, it is more of a pain control thing for players, as it can be very painful to breathe or get hit in that area again. I assume Akers will play and take some pain medication prior to kickoff and don a flack jacket padding his rib cage and back.
RB Malcolm Brown, who seemed to be “the guy” in week 1 in the new-look Rams backfield suffered a broken pinky on Sunday. Reports inform us that he had a small procedure performed already and will be available to play on Sunday with splinting and a brace on the hand. It would be wise for the Bills defense to punch at the ball and attempt to strip it every time he touches it.
Thanks for reading!