Buffalo Bills injury analysis: Matt Milano’s pectoral injury

Buffalo Bills LB Matt Milano simply cannot catch a break sometimes. When he’s on the field, he’s a highly effective linebacker, always sniffing out the ball and providing coverage that few other linebackers in the league can accomplish. Playing in his fourth season, the Bills have a decision to make on his contract moving forward on whether to pay him or let him test free agency.

Despite his fifth-round draft status, he has far outplayed his draft slot and has made head coach Sean McDermott look like a genius. However, one hiccup in this plan to keep him in Buffalo has been his injury history. Going back to 2017, he has dealt with hamstring strains, a broken fibula, a concussion, more hamstrings, and the latest—a left pectoral strain.

A good portion of these injuries are no fault of his own, it’s simply the game of football. But the team is paying for production on the field, if he’s not out there, then that decision to extend him may become strictly a business one. But you’re not here for that—smarter people than myself make those decisions. You’re here because you want to know how soon Matt Milano will return. Check it out below.

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The Anatomy

The pectoral muscle connects from the sternum and stretches over the rib cage laterally to attach at the humerus. This is a powerful muscle required for inward rotation, flexion, and adduction—all actions required for pushing. These actions are vital for blocking, tackling, and reaching—all important motions required for football.

The Injury

In the video clip, you can see Milano, at the top of the screen, attempt to square up with RB Josh Jacobs before Jacobs shifts to his right. Milano attempts to catch Jacobs with his left arm, grabbing onto the leg as his momentum throws him by before he slides to the turf.

Milano gets up and realizes something doesn’t feel right within his arm, later motioning to the team doctor in the left shoulder roughly where the pectoral muscle attaches to the humerus.

The mechanism of the injury, forceful eccentric contraction, led to the partial tearing of the muscle belly. He was attempting to tackle Jacobs, contacting his pectoral muscle to wrap him up. Jacobs darts to the right and forces the muscle to lengthen as Milano’s momentum takes him down the field and Jacobs’s upfield. Muscles normally lengthen under tension, which is an eccentric contraction, but a sudden overload to the area causes injury.

In some pectoral injuries, the pectoral tendon outright ruptures, such as what occurred with fellow Bills G Jon Feliciano. Fortunately for Milano, this is a strain of the muscle, which means that it can heal with rest and rehab.

Recovery

Sean McDermott termed the injury as week-to-week, which usually translates to several weeks missed when looking at the anecdotal historical use of the phrase by the team. Milano is likely dealing with pain, swelling, and also noticeable bruising around the chest and armpit. He will also have moderate weakness in the area limiting him from simple arm functions.

Every muscle strain is different but there are some general guidelines. Grade I is when several muscle fibers tear and can take 1-3 weeks to recover. Grade II is where 50% of the muscle fibers tear and loss of function is noticed, these can take 4-6 weeks. Grade III is where there is severe tearing or complete loss of function in the area.

Milano likely suffered a Grade 1-2 strain based on the video alone. On the sidelines, you could see him still moving the arm around but clearly not able to lift it with ease.

The above-mentioned timelines are overall muscle strains. For a pectoral strain, specific information is lacking, but a fellow physical therapy site indicates that an expected timeline is 2-6 weeks.

Return to play

But the big question remains. How long will he be out? It’s a tough question to answer, but there are some recent players to sustain the injury and some limited research available.

One study that I found reviewed pectoral injuries on one college football team and the management of these injuries over two years. There were six cases presented as partial tears. All occurred in preseason from weightlifting. Various measurements of time were used to quantify time to recover with two cases taking six weeks off to recover. Several others missed 15-20 contact practices during the rehab process, which stretched even longer. There was one case that suffered a Grade 1 strain, stopping activity for three weeks with seven contact practices missed.

Those numbers above show similar timelines with the 2-6 weeks, skewing more towards the six-week window. However, that was the NCAA. There are more pectoral strains in the NFL than outright ruptures according to NFL research. The article goes onto say that average days missed are 77.2 +/- 72.9 days. That equates out to over two months missed on average.

But two players this season already have suffered pectoral injuries and have returned to play. Philadelphia Eagles DT Javon Hargrave suffered a pectoral injury in training camp this year on August 17th. He returned to play in Week 2, missing roughly four weeks.

Las Vegas Raiders LB Nick Kwiatkoski suffered a pectoral injury in Week 1 and returned to play in Week 4 against the Bills with a shoulder harness on. He also suffered a pectoral injury in 2017 with the Chicago Bears, missing five games.

Looking at all the numbers, the best-case scenario for Milano is a Grade 1 strain, miss two games, and return with a shoulder harness as he continues to rehabilitate. As you see above, there are other possibilities with longer recovery times. I’m not doing the evaluation, only research.

Milano is a competitor, and he wants to be out there. But if he rushes out there too quickly, he could suffer further injury with rates for recurrence of muscle injury highest 1-2 weeks following the original injury. According to the article, the rate of recurrence for injury is at 30%. However, that’s generalized muscle injuries and isn’t a true reflection of a pectoral injury in itself.

Looking at the schedule, Milano will miss the Titans game (if it’s played as originally scheduled or soon thereafter). That’s a given. A quick turnaround for a primetime game against the Kansas City Chiefs leaves Milano 11 days out from the original injury. The only way I see him return is if this was truly minor and he passes all strength testing objective measures and is cleared by the training staff. I don’t believe that to be the case.

Even if he had the three extra days on a normal week to recover (to get to two full weeks), I could make a weak case to play, but it will be truly remarkable for him to return for the Chiefs game. I hope I’m wrong simply because I’m not the one treating him.

There is a chance he could return for the New York Jets game on October 25th, which would be three weeks out from the original injury, missing two games if he goes the Nick Kwiatkoski route. If Milano does return after three weeks, I worry about him having the ability to wrap up his tackles effectively and shed blockers with his left arm to get to the offensive player. He could stay in coverage, but that would significantly hinder his true abilities.

I did not see the quality of Kwiatkoski’s play Sunday, but he did play in 87% of the defensive snaps according to pro-football-reference.com. His stat line was two solo tackles, one assisted, and one tackle for loss.

I want Matt Milano to get egg all over my face, I really do. I want him to be well and return to play quickly, But the research simply isn’t there to support a quick return, especially at the position that he plays requiring the ability to wrap tackles up, shed blockers, and play effective coverage.

There is still a chance that the team could place him on Injured Reserve once they figure out who they can sign in his place. He could go on IR for three weeks, then open his 21-day window during practice in order to maximize his healing time to six weeks, taking him to after the bye. After that, I would want to see him practicing in full before I can say he will return.

I trust the team to work in Milano’s best interest and not rush him back out there. Sometimes, they have to save the player from themselves in situations like this.

I wish Matt Milano a speedy recovery and I hope that he is out there sooner than later. Head coach Sean McDermott and defensive coordinator/assistant head coach Leslie Frazier will make this work in the interim, but his loss will be felt over the next few weeks.