Josh Allen’s funny bone is serious by Rhys Knott

Josh Allen’s funny bone is serious by Rhys Knott
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No laughing matter – the funny bone of Josh Allen is serious says Rhys Knott

Late in the fourth quarter of the Bills week nine game at MetLife Stadium Josh Allen suffered an Ulnar Collateral Ligament (UCL) sprain.

The UCL is the connective tissue that joins the largest bone in the forearm (the Ulnar) to the Humerus bone in the upper arm. UCL injuries are common in baseball pitchers. Who often injure theirs as a result of repeatedly throwing with extreme force. The subsequent ‘Tommy John’ surgery results in them being out of action for around 12 months. This is Allen’s second UCL injury since 2018. So, understandably, there are some pretty worried fans in western New York.

While repairing the ligament is a straightforward process the structure of the elbow is more complex than just two bones and some ligaments. The presence of the Ulnar nerve close to the ligament on the inside of the elbow complicates matters. Which is why the injury requires such a long post-op rehabilitation period. The Ulnar nerve provides the little and ring fingers with sensation. And controls muscles in the hand responsible for gripping.

The nerve also sends impulses to some of the larger muscles in the forearm. Providing the hand with a strong grip. While the proximity of the Ulnar nerve to the surface of your elbow as it travels through the “cubital tunnel” is what causes a tingling sensation along arm and hand when you knock your elbow. Any injury to this part of the body could cause serious issues. And be as bad as some fear for a Quarterback. But a second in four years could prove to be more complicated. Especially as it’s very difficult to throw accurately when you can’t grip the ball, or your fingers are tingling.

Treatment options for Josh Allen

Allen didn’t leave the game after his injury against the Jets. But it happened on the last drive of the game and with the adrenaline flowing he may not have realised just how serious the impact had been. However, as was noted on Twitter he did throw a ball 65 yards after he suffered the injury. Mind you that pass was incomplete and he looked to be in some discomfort afterwards. If the injury does require an operation, it would be very unlikely that he would be able to put enough force through his elbow to throw 65 yards. That doesn’t necessarily mean he won’t require any treatment at all and he could still miss time.

Injuries involving connective tissue and muscles are graded from 1 to 3 in terms of severity. With 1 being the least serious and 3 being a complete (or full) tear. Grade 3 tears are the ones that require reconstructive surgery. If Allen has a grade one tear it should heal on its own with rest. As we know there’s precious little time for rest during an NFL season. If the tear in the same part of the ligament he damaged in 2018 it could be a grade 2 injury. Which will take longer (in baseball it’s generally thought 8 weeks rest and rehabilitation is the minimum recovery time).

One treatment that would hasten the healing process is a Platelet Rich Plasma or PRP injection. Ligament injuries have only recently been treated using PRP injections. An injection could shorten the recovery process to somewhere between 2 to 6 weeks. Meaning Allen would definitely be fit again for the end of the regular season.

A Divisional Challenge

The BiIls have three Divisional games in the next five weeks. Obviously Allen won’t want to miss them since the AFC East is arguably the most competitive division in football. Currently two teams have six wins. One team has five, and the Dolphins, who will face the Bills on the 18th of December lead the division with seven.

Allen’s replacement if he misses any games would be 34-year-old Case Keenum. Who has just one winning season on his CV. Plus Keenum has only managed to play an entire season once in his career. So he may carry an injury risk of his own. But Keenum would have to face some particularly generous Defences over those games.

At first glance comparing Allen and Keenum is foolish. Because Josh Allen is in the prime of his life and obviously a huge human. Yet when you dive into the numbers you find that statistically they’re eerily similar. In his career up until the injury Allen had attempted 2,297 passes. Keenum has attempted 2,180 (even though Keenum has been in the league twice as long as Allen). Allen’s completion pass rate was 62.5% compared to Keenum’s 62.3%. Allen averages 7.2 yards per attempt against Keenum’s 6.8 yards per attempt. Allen had thrown 54 interceptions (with a 2.4% interception rate) to Keenum’s 48 (with a 2.2% rate). Allen’s completions had averaged 11.5 yards compared to Keenum’s 11 yards per completion. And Allen’s throws went for an average of 7.2 air yards per attempt. Whilst on average Keenum’s travel 8.5 yards through the air.

Let’s get serious about the O Line

The issue for a Quarterback replacing Allen will be the Bills Offensive line. The pass blocking has been poor so far this season. They were ranked 22nd in the league at their Bye week. While Keenum is an underrated scrambler he’s not built like Allen who is the same size as some Defensive Ends. If Ken Dorsey can make better use of the running backs and Keenum can get the ball out of his hand quickly (maybe Dawson Knox will see more looks) then Allen’s absence won’t be a huge problem. And he should be back at the business end of the season with some fresh legs.

Minnesota would have been a tough opponent for the Bills with or without Allen. Particularly as they have developed a habit of winning one score games in 2022. The only one score games the Bills have played this season have all resulted in losses. Four of the Vikings seven wins leading into week 10 had been by 7 points or fewer. On top of which they beat the Dolphins and Cardinals by just eight. They don’t seem to have any problem holding their nerve. While the Bills six wins have been by an average of 18 points. Going into week 10 though the Vikings Defence have only held one team to fewer than 16 points this season. That was the flailing Packers back in week one so a shootout that ended in overtime wasn’t a huge surprise.

It did, however, only reinforce how the Bills miss Brian Daboll. Highlighting concerns surrounding their Defence when their Head Coach is famous as a respected Defensive Coordinator. If Keenum does start any games then he will be reunited with his old Vikings teammate Stef Diggs. Who is somewhat of a lucky charm this season. Diggs has caught touchdown passes in five of the six games the Bills have won in 2022.

Leaning on the run while Allen is away

The strongest pass defence the Bills will see in the coming weeks belongs to the Patriots. But they are allowing 4.6 yards per carry on the ground. So that should offer the Bills an opportunity to use their newly acquired Running Back Nyheim Himes. he could be impactful in concert with Devin Singletary and rookie James Cook. Whose brother Dalvin played with Keenum in Minnesota.

Realistically the Bills should go 2-1 at the very worst in the next three games. After which they welcome the Jets and Dolphins to Orchard Park. For two games that should be as entertaining as they will be important.

Of course, Allen could (and probably will) tough it out and continue to play through the injury. particularly in the hope of securing the Division. While that could be fine it would certainly risk a more serious tear. With the possibility of surgery in the not-too-distant future. In such a tight Division it’s far from certain the Bills will be crowned Champions. Now, after a tough overtime loss to the Vikings they may be considering things. Especially as Allen threw a game ending interception (his second of the game). And that throw looked suspiciously like he may have been affected by the sort of nerve damage associated with a serious elbow injury. It must surely be better to be safe than sorry.

Banner Image: Josh Allen slinging it for the Bills. Image from

Rhys Knott has already made some interesting contributions to the sitte. Read more of his work here.

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