The Buffalo Bills are in QB purgatory. We, as fans have been told this since Doug Whaley was the GM. When the Buffalo Bills 1st round QB Josh Allen left Sunday’s game, fans and administration at OBD were probably surprised to hear what the injury was.
UCL – ulnar collateral ligament injuries in NFL players, especially QBs are not nearly as common as they are in baseball players. Between 2010 and 2018 only 12 were reported in quarterbacks and of those 12 only one was treated surgically.
In contrast from 2011-2015 there were 26 UCL injuries per season reported in Major League Baseball players. Most of these were reported in pitchers because of the stress put on the pitchers arm during the repeated overhand throwing motion needed to pitch at the speed required to succeed as a MLB pitcher these days.
Almost all of the baseball players were treated with ‘Tommy John’ surgery, which is a reconstruction procedure first performed Dr Frank Jose on a pitcher named Tommy John in 1974. Prior to the advent of this surgery this injury was considered career ending.
The interesting thing about pitchers who undergo Tommy John surgery is they tend to throw even harder and faster after the surgery than they did before the surgery.
Most pitchers who have to have surgery, miss the entire next season because the recovery time is 12-18 months. Quarterbacks who experienced UCL injuries in the NFL only missed an average of about 4 weeks of playing time, 26.4 days to be exact.
Why such a discrepancy you may ask, especially if it is the same injury and the same basic rehabilitation regime. The answer is in studying the different biomechanics of a throw in baseball versus football. An NFL QB throws the ball around 30-50 times in a game and with practice guidelines and caution. Also, between games QB throws in practice can be minimized to not put undue stressors on the UCL.
In addition most QBs can still make NFL throws despite a less than perfect UCL. MLB pitchers, who throw 100+ pitches per game and might pitch 2 games a week or more put significant stressors on the UCL, and aren’t able to perform when asked to repeatedly throw at that level over a season of over 160 games.
What is a UCL Injury?
The most common UCL injury is a sprain/strain which is a partial or complete tear of the ligament. The UCL is the main ligament inside the elbow which stabilizes the bones in the elbow between the upper and lower arm.
The UCL runs from the humerus in the upper arm to the ulna in the lower arm. It is comprised of 3 heads and tearing even one of these ligamentous bands can cause significant pain and instability in the players elbow.
In football, the most common cause of injury is traumatic injury caused when the player falls on a fully extended arm. Usually when this occurs, the player feels a “pop” along the inside of the elbow with each throw and may or may not experience pain when not throwing.
The pain is maximized when the arm accelerates forward just prior to releasing the ball. Most players also experience numbness and tingling in the pinky and ring finger making gripping the ball more difficult.
UCL injuries limit the players ability to throw during rehab, but do not affect their ability to lift weights, run or do other exercises to remain in shape during the rehab. Once the initial swelling and pain of the injury has subsided the RICE protocol (rest, ice, compression, elevation) is used as it is in all sprains and strains.
The player can begin physical therapy to strengthen the other muscles around the elbow to help compensate for the torn ligament. High tech braces are also used to help stabilize the area, and while a QB can throw a football with the brace, baseball pitchers, who throw so much more aren’t able to maintain velocity and strength of pitch over a full game while wearing the currently available braces.
If an avulsion fracture is identified when advanced imaging of the area is performed, a simple arthroscopic procedure maybe performed before rehab is started to eliminate any bone shards that could interfere with the rehab process.
I would expect Josh Allen to be unable to play for a few weeks and would expect him to be ready to return to the playing field after the bye week. It is conceivable he could return sooner, but playing before the elbow is fully healed could just result in more playing time lost.
Editor’s babble: We are very grateful to Dr. Beth Sullivan for sharing her expertise with us. Hopefully Josh Allen’s injury will heal just fine so he can get back on the field. You can find Beth on Twitter @GAPeachPolymer.