Lions vs Bills: Initial injury report and medical analysis

Lions vs Bills: Initial injury report and medical analysis for the Week 15 matchup at Ford Field

With three games in 12 days, the Lions players (and fans) needed this mini-bye after a slew of injuries accumulated. The main concern is the defensive line which has many players out with short and long-term injuries. Fortunately, the trend is positive with multiple key questionable players in Alim McNeill, Levi Onwuzurike, and Josh Paschal practicing today.

The Bills report consists of mostly FP’s (full practice) and has a couple key pass catchers returning in Dalton Kincaid and Keon Coleman. They are also returning two players from IR, Baylon Spector and Dawuane Smoot, who are eligible to play this weekend. In bad news, there are a couple recent concerns in the secondary in Rasul Douglas and Taylor Rapp.

DETROIT LIONS

Alim McNeill DT, concussion (FP)

Here’s the timeline of his injury on December 5.

• At the 7-minute mark of the 1st quarter, he was helped off the field. Video was obscured but he may have taken a mild hit to the back of the head when Jamal Adams jumped on him towards the end of the play. He also had his facemask slightly jarred when he made the tackle but this trauma seemed minimal.
• He was taken to the locker room and passed the concussion evaluation.
• Returned to play at the 13-minute mark of 2nd quarter and finished out the first half.
• He did not come out of the locker room at halftime and was officially ruled out with a “head” injury, not a concussion.
• On Monday, December 9, Dan Campbell stated he was in the “protocol” which implied he was diagnosed with a concussion at some point.

Previous history of head trauma:

  • November 10, 2024 – Right TMJ (temporomandibular joint) symptoms. Moving jaw around and palpating directly at the TMJ. No concussion diagnosis.
  • November 23, 2023 – Blow to the right jaw area. Down on field for a while and left game temporarily. No concussion diagnosis.

Analysis: McNeill had a delayed concussion diagnosis from last game. A delayed diagnosis does not represent an oversight by the medical staff or player. Many concussion symptoms are vague such as headache, fogginess, and nausea and can be attributed to other causes.

With a history of TMJ symptoms just four weeks prior, it’s possible that his symptoms were initially thought to be a recurrence of the TMJ. The subsequent concussion diagnosis does not rule out a concurrent TMJ or other “head” injury as his symptoms could be multi-factorial.

With an FP today, it means that McNeill has already passed through multiple stages of the concussion protocol and is firmly on track to play Sunday.

Here is recent Lions concussion history data:

2024: Alex Anzalone and Brian Branch both missed one game following their concussions. Technically, Branch missed the game due to an “illness” but his concussion may have played at least a small part in the decision.

2023: No official concussions during the season. Penei Sewell had one in training camp.

2022: Amon-Ra St. Brown, Brock Wright, DeShon Elliott, and Kerby Joseph all returned in one week without missing a game. Jonah Jackson and Jeff Okudah missed the short-week Thanksgiving game.

Taylor Decker OT, knee (FP)

A suspected right MCL and right high or medial ankle sprain on November 24 has caused him to miss two games. The FP means he should play this weekend.

DJ Reader DT, shoulder (NP)

Reader hurt his left shoulder on Thanksgiving in a manner that is concerning for a shoulder subluxation and has missed one game. A subluxation is a partial, transient dislocation of the shoulder. The injury can be rehabbed without surgery but may take multiple weeks. DeShon Elliott in 2022 with the Lions missed two games with a shoulder subluxation/dislocation.

With an NP today, I expect Reader to miss another game.

Levi Onwuzurike DT, hamstring (LP)

A left hamstring strain on Thanksgiving caused him to miss one game. Since hamstrings can get aggravated easily, a gradual ramp-up is advisable. The LP early in the week is a good sign that he is firmly on the ramp and getting close to a return. There is a good chance he will play on Sunday.

Josh Paschal DE, knee (LP)

A right knee injury on Thanksgiving caused him to miss one game. Video did not suggest anything too concerning. A mild bone bruise or knee sprain is likely. The LP gives him a good chance to play this weekend.

 

NOTABLES

Christian Mahogany, OG

This 6th-round rookie got three snaps when Kevin Zeitler exited briefly with a suspected left eye issue. After missing all of training camp and the first half of the season due to mono, it’s notable that Mahogany has already become the primary guard backup. This is good news heading into next season as Zeitler is an unrestricted free agent at the end of this year.

Injured reserve status updates

Returning soon
• Alex Anzalone, left forearm fracture – Expected around week 17-18.
• Kalif Raymond, left foot – Expected by the start of the playoffs.

Uncertain return
• Ennis Rakestraw, hamstring – Eligible to return December 22.
• Ifeatu Melifonwu, left finger – Eligible to return December 22.
• Jalen Reeves-Maybin, neck – He is eligible to return anytime but has not had his 21-day practice window opened yet. This implies he is at least 3 weeks away. Dan Campbell on December 9 corroborated a multi-week timeline stating he’s “better… There’s a chance we could get him in a few weeks.” While there are no details about his neck injury, this update is reassuring that it isn’t anything overly serious.

Late playoffs at best
• Aidan Hutchinson, left tib/fib fracture – Expecting very limited action in the Super Bowl although Jay Glazer reported a few days ago that the NFC championship game is a possibility. Hutchinson is not even walking normally yet so his return depends on how quickly he recovers.
• John Cominsky, MCL surgery – Initial estimate projected a January return at best.
• Derrick Barnes, right MCL/PCL surgery – Unlikely to be back.

Not expected to return
• Malcolm Rodriguez, right ACL
• Marcus Davenport, left elbow
• Kyle Peko, left pec
• Mekhi Wingo, right knee

BUFFALO BILLS

Credit @BangedUpBills for help with the analysis.

Rasul Douglas CB, knee (NP)

This starting CB has not missed a game this year but exited last game with a left knee injury. Video wasn’t clear but a mild MCL sprain is possible.

Taylor Rapp S, neck/shoulder (NP)

This starting safety hurt his neck two weeks ago but still was able to play every snap last game.

Casey Toohill DE, ribs (LP)

Toohill is a backup DE who plays about 25% of snaps.

Dalton Kincaid TE, knee (FP)

Kincaid has missed the last three games due to a PCL and has 34 receptions for 356 yards this year. The FP suggests he will be in.

Keon Coleman WR, wrist (FP)

This 2nd-round rookie has missed the last four games. He has 22 catches for 417 yards. The FP suggests he will be in.

Dawuane Smoot DE, wrist (FP)

Smoot missed the last four games on IR with wrist surgery but is eligible to return on Sunday. He typically plays about 50% of snaps.

Baylon Spector LB, calf (FP)

After missing four games on IR, Spector is eligible to return on Sunday. He has started multiple games this year.

Here is the full Bills report: