Josh Allen’s Injury Status

Somehow between the sound of tables smashing and the smell of wings, I can sense the city of Buffalo panicking after their beloved superstar quarterback suffered and elbow injury in Sunday’s game. Immediately, speculation about quarterback Josh Allen’s injury status and severity ran rampant across the internet. The speculation ranged from Tommy John surgery to nerve damage and onward. This speculation had merrit, as early reports stated concern for the Ulnar Collateral Ligament (UCL) and that Allen was experiencing nerve-like symptoms (weakness, numbness, and tingling).

A long Tuesday went by with no word of Allen’s status as the city of Buffalo continued to hope and pray that their Bills season still had hope. Typically, with a high-profile player like Allen, we will have answers about their injury no later than Tuesday.

Finally, Wednesday rolled around, and Ian Rappoport broke the news. Allen is, in fact, dealing with a UCL sprain but is not expected to be serious.  

It appears concerns for a nerve injury have died down, and news this week solely mentions a UCL injury. This would be a major relief if he did avoid a nerve injury. The nerve in question was likely the ulnar nerve. This nerve travels right next to where the UCL lives and can be affected by how Allen was injured. The ulnar nerve provides the signal to the muscles of the 4th-5th fingers. Therefore, if the ulnar nerve is injured, he may have a hard time gripping, which is obviously very important in sports.

We know that a UCL is an arm injury, but what exactly is it? And how could this impact Allen’s ability to play this week or the next several weeks? Let’s dive into the anatomy of the UCL injury, particularly for a thrower.

Josh Allen Injury Status: UCL Injury

Josh Allen’s injury is to the UCL. The UCL is a fan-shaped ligament attaching from the inside portion of the humerus (arm bone) to the inside portion of the ulna (forearm bone). The UCL supports the inside of the elbow and resists an elbow “valgus” moment. A valgus moment indicates the joint caving inward, creating a separation of the inside portion of the humerus and ulna bones. In short, the UCL helps hold the inside of the elbow together.

Josh Allen Injury Status
The UCL, shown above provides support to the inside portion of the elbow joint and is critical in throwing.

The UCL is essential for a thrower. When throwing, the whipping motion of the arm naturally creates this valgus moment of the elbow, in turn stressing the UCL. An intact UCL is not bothered by this. When the UCL is sprained, some stability can be lost due to the injury. The loss of stability of the injured throwing elbow impacts the coordination of the throw, and throwers can lose both power and accuracy. In addition to the loss of stability, a UCL injury is painful for a thrower. Pain itself inhibits muscle function and movement. It is simply human nature not to move into pain. This may cause Allen’s mechanics to be compromised as he deals with this injury.

Josh Allen Injury Status
As shown above, as the thrower begins to whip their arm forward, the UCL must provide support to the inside of the elbow for stability.

UCL Injury Management

Unfortunately for Allen and the Bills, elbow injuries are stubborn for throwers. As mentioned above, the whipping motion of throwing a football constantly stresses the UCL. A ligament will have a hard time healing when it is constantly stressed. Each time the ligament is aggravated, the healing process essentially starts over. I expect Allen to be very limited in practice in the near future and possibly the rest of the season.

A UCL injury is conservatively managed by rest (mentioned above), rehab, and injections (steroids and PRP). Rest will allow the healing process to occur. Complete rest, however, is not an available option for a professional quarterback in the middle of the season.

Rehab will consist of range of motion, muscle release techniques, elbow strengthening, gripping, and shoulder, and scapular exercises. Improving the strength of the muscles around the elbow and the muscles of the rotator cuff and scapula will take load off the UCL.

Injections can significantly reduce pain, which in itself can improve performance and can help facilitate tissue healing. Buffalo’s training staff will undoubtedly utilize injections to keep Allen on the field.

If conservative care fails, and the sprain is significant enough, the dreaded Tommy John surgery is the surgery of choice.

Josh Allen’s Injury Status Rest of Season Outlook

Allen should be able to manage this injury and play soon. However, the throwing motion will constantly stress the UCL making it challenging to heal fully. This reluctance of the UCL to heal is why I use the word “manage” when discussing Allen’s outlook. Make no mistake; this injury will last throughout the rest of the season.

Josh Allen Injury Status

Fortunately, the above-listed management strategies can allow him to play and play at a high level. Matthew Stafford has been dealing with the same injury for two seasons now. Stafford is not playing well this year but led the Rams to a Super Bowl win last season.

I would not be surprised to see Allen’s accuracy dip due to this injury. Pain inhibits motion, and any loss of stability from the injury can also impact accuracy. I expect Allen to wear a supportive sleeve to help stabilize the joint to help with this.

In the event Allen does end up needing Tommy John surgery, which could be pushed until the offseason, we would be looking at about 16 weeks post-op before he starts light throwing and several more weeks before full throwing, and his week one status would be in question.  

Josh Allen’s Fantasy Outlook

The coming weeks will answer many of our questions, but I do not feel fantasy players need to panic at this time. Allen’s legs are not impacted and will continue to be a force on the ground. The Buffalo Bills have one of the worst running back rooms in the NFL, with Allen currently outrushing any running back on the team. Devin Singletary, James Cook, and Nyheim Hines are not good enough backs for the Bills to stop using Allen’s elite rushing skills.

His passing numbers may dip due to his arm injury, particularly with his accuracy. Josh Allen has made tremendous strides in his passing accuracy over his career, but this type of arm injury Allen suffered has the ability to impact the follow-through of a throw and, therefore, the accuracy. Though he may see a decline in passing accuracy, Allen continues to be an elite fantasy quarterback option. 

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