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2022 NFL Draft: Buffalo Bills RB James Cook injury analysis

Right ankle surgery following his freshman year is the only concern.

2022 CFP National Championship - Georgia v Alabama Photo by Andy Lyons/Getty Images

After several trade backs late in the second round, the Buffalo Bills selected Georgia RB James Cook with the 63rd pick on Day 2.

The brother of Minnesota Vikings RB Dalvin Cook, the younger Cook comes to the Bills after winning a national championship with the Bulldogs this past January. He managed to avoid major injuries during his time in Athens, but he still has several notable injuries worth exploring. Below is James Cook’s publicly reported injury history.

James Cook Injury History

2019 – Right ankle injury, possible high-ankle sprain. Cook missed the team’s Sugar Bowl game with this injury possibly suffered in practice, later opting for surgery. He returned to spring practice in April.

2020 – Rib injury vs Baylor. Cook left the Sugar Bowl game early and didn’t return.

2020 – Right shoulder injury vs Auburn. Cook missed one game, on 10/10 vs Tennessee with this injury.


The biggest injury that Cook dealt with was the right ankle injury prior to the Sugar Bowl in the 2018 season. Details are scarce as to the specific injury but there are several clues as to what he dealt with. Initial reports came out that he was on crutches and in a walking boot in mid-December of 2018 at a basketball game against Arizona State.

There weren’t any reports of him dealing with an injury prior to the SEC Championship game against Alabama that year and the game recap did not mention any injuries to Cook. Early reports stated that it was a foot injury, specifically on the right side as seen in the tweets below.

Reports later clarified that he missed the Sugar Bowl game against Texas due to the injury, later having offseason ankle surgery. There aren’t any further specifics of what procedure or injury he required, but this article suggests that he suffered a high-ankle sprain that required a Tightrope procedure.

While Cook didn’t suffer an ankle fracture-dislocation as his teammate did in the article, a high-ankle sprain has a similar mechanism of injury. Furthermore, ankle fracture dislocations can be repaired using the Tightrope procedure as we saw current Bills RB Zack Moss deal with following the Bills’ the playoff win over the Indianapolis Colts.

Cook possibly suffered the high-ankle injury in practice leading up to the Sugar Bowl, attempting to let it rehab on its own. It didn’t improve as expected and he opted for surgery to restore the ankle stability. To understand more about ankle surgery and rehab, be sure to read this article at Buffalo Rumblings back in 2021.

Another injury that he suffered was a rib injury against Baylor in the Sugar Bowl the following season, forcing him to leave the game early. Details are lacking regarding the specifics of the rib injury, but it's very likely this was a rib contusion, potentially a fracture as this was the last game of the season.

During the 2020 season, Cook suffered a shoulder injury against Auburn that forced him to miss the following week against Tennessee. Several outlets reported it as a wrist/hand injury, but later reports solidified that it was a shoulder injury. This suggests a possible AC joint sprain, especially with the reports of the hand/wrist as Cook would have been holding the area to support the shoulder as he came off the field.

The Buffalo Bills released a hype video on Cook and his video showed a shoulder harness on his right shoulder, confirming the side injured.

Bills Injury Impact

Other than the ankle injury with the resulting surgery, Cook is pretty healthy. During his four-year career at Georgia, he only missed two games due to injury. He plays a tough position that absorbs a ton of contact with a short shelf life in the NFL. I’m not concerned about the ankle at all as current Bill Zack Moss hasn’t been limited by his ankle. Former Bills WR Emmanuel Sanders required the surgery in 2018 and still had several excellent years of production following the procedure.

The Tightrope procedure continues to have excellent outcomes with more and more collegiate and NFL players requiring the procedure and resuming play at elite levels.

The rib and shoulder injuries are part of football and occurred in 2020, unlikely to affect him as he transitions to the NFL. Cook loosely fits the profile of Bills players selected in the first two rounds of the NFL draft who have minimal injury concerns.

James Cook is on a rookie four-year deal and his draft selection suggests that Zack Moss is on notice. Based on the injury history and his skillset, I like the pick and the Bills also picked up a pair of sixth-round draft picks. This allows them to move around the board if they like someone, or if they want a player they won’t be able to get as a UDFA, they can grab them.

General manager Brandon Beane is always looking several steps ahead during the draft and the selection of Cook is no exception. I fully expect Cook to get banged up at some point considering the position, but there aren’t any lingering issues that could affect his abilities as he begins his NFL career.