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How long will he really be out?
OL Jon Feliciano underwent surgery today to repair a torn pectoral muscle and will be sidelined indefinitely.
— Buffalo Bills (@BuffaloBills) July 31, 2020
This injury comes on the heels of a successful rotator cuff repair performed in January on his left shoulder. As Feliciano shared in his Instagram post, it was a fluky accident and he has already had surgery.
View this post on Instagram
Worked my butt off this offseason. Made the best home gym in buffalo. Came in 15 pounds under weight + felt stronger than I’ve ever been. happens. Loyalty is what drives me. The amount of support that I got from Beane, McDermott, Dabbs, OG, my teammates and #billsmafia drives me. I won’t let them down. I’m coming back with a vengeance. See y’all in Vegas
To understand what happened and the structures involved with the injury, read the description below from my J.J. Watt article:
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.
Pectoral tendon tears occur typically at or near the insertion point, the area that connects to the humerus. These types of injuries frequently occur in weightlifters with an eccentric contraction, such as lowering the bar during a bench press but can happen in other sports such as football, boxing, and wrestling.
Surgery was required to re-attach the tendon to the bone as the tendon acts as a connector between the muscle and bone so that the muscle can contract and move the bone for its intended function. Unlike ligaments, tendons usually have a rich blood supply, which means that it receives the nutrients it requires in order to heal more effectively to the bone. Specifically, it receives the blood supply from the pectoral branch off the brachial artery in the arm. This tendon healing to the bone process takes 3-4 weeks to occur, at which point rehab can progress with range-of-motion activities.
Rehab timeline expectations
Most of the reports coming out for Feliciano to return are 8-12 weeks with some such as the Buffalo News reporting 3-4 months. Normally, this process is closer to 4-6 months and is season-ending but due to this occurring at the beginning of training camp, he could possibly come back mid-season.
Feliciano himself said that he would be back in time for the Week 4 match-up against the Las Vegas Raiders. That implies that he will be back within nine weeks, which is a fairly aggressive timeline to return to play NFL football. It’s possible but unlikely as most protocols state that strengthening begins around week 8 post-injury.
As mentioned above, it takes 3-4 weeks for the tendon to heal back to the bone, followed by range of motion work before strengthening occurs. If he were to have optimum healing in three weeks followed by full passive range of motion by the fifth week, that gives him a month to strengthen. He would then need to perform isometrics followed by active range of motion, slowly loading the muscle through various ranges to maximize the strength. He then would need to get back into football specific activities and perform at an acceptable level to get out there on game day.
Strength can come back fast, but a month is pushing it to be NFL ready. Even with blood-flow restriction training, it is still a big ask. He has a phenomenal training staff and tons of resources at his disposal to rehab quickly, but he still needs time to heal. Biology cannot be sped up despite all the treatments available.
He would really be rushing to get back out there in nine weeks and I question how effective he would be. I personally think he should wait closer to the 12-week mark to ensure that he is in game shape, putting him at the end of October.
I understand that J.J. Watt and Kwon Alexander were able to return after ten weeks last season, but this does not mean that everyone can go at their pace. They were also pushing it knowing that they were trying to return for the playoffs. They accelerated once they saw a possibility. I don’t believe it’s wise to accelerate the entire rehab process.
It’s worth noting that it’s unlikely that the previous rotator cuff repair directly led to the pectoral tear. I wasn’t able to find any correlation in research that suggested that previous rotator cuff repairs led to a higher risk of pectoral injuries. It was more probable that he would have re-torn his rotator cuff during weightlifting over suffering a pectoral tear.
It’s also important to acknowledge that while the muscles do attach in a similar area, the rotator cuff envelops the top of the humerus, whereas the pectoral tendon inserts lower and more anterior on the humerus.
The closest possibility would have been if he was bench pressing and the one side of his chest overcompensated trying to push the bar up, leading to the rupture. We do not know which side was injured, which makes it difficult to identify if there was compensation. According to this study on NFL players who suffer a pectoral tear, injury incidence is independent from arm length, strength, agility, and PED use—which limits risk factors for the injury.
Realistic return to play
I would keep Feliciano on the active roster through training camp, moving him to IR to return once cut down day occurs. This allows him to stay with the team and not count against the roster while he continues to recover. He could be activated after Week 8, allowing him to avoid rushing back. The team could go the route that they did with TE Tyler Kroft last year and keep him on active roster, but Kroft had a head start in his recovery compared to where Feliciano is starting.
Feliciano will have to play with a shoulder brace that will limit abduction and external rotation. It is one benefit that he plays inside, which reduces the need for him to reach outside his body, stressing the area.
However, whichever side he injured will be significantly weaker, preventing effective engagement with his assignment and maintaining his block. He will need to keep his hips square and have quick feet to keep the defender in front of him, preventing them from blowing by. If he gets out of position, it will be very difficult for him to get back into the play, especially if he has to use his affected arm. Fortunately he will not be required to tackle, placing less stress on reaching out to grab players who could run away from his grasp and re-injure the area.
When he does return, he should be used as a reserve lineman and have his snaps limited until he can build his strength further. He could be closer to 100% for the final quarter of the season and playoffs, which could be a welcome addition as other injuries occur.
Regardless when he returns, outcomes for a pectoral tendon repair are as high as 85% to return to play in the NFL. This will not be an injury that lingers or is likely to recur in future seasons.
This is a highly unfortunate injury but the timing is about as good as it can be considering the circumstances. As a fan, I do enjoy Feliciano’s tenacious attitude towards rehab and a willingness to return, but the Bills have the depth necessary to absorb this blow. Injuries are never timed well but this is as close as it can get for the Bills. Expect Feliciano to return midway through the season but not be effective until the very end—when it really matters.