Scans on Josh Allen’s elbow confirmed what the video showed. The Bills QB has damage to the UCL in his throwing elbow. Allen was hit as his arm was in the back of his throwing motion. This led to two things – excessive rotation in a backward and downward motion as his arm was cocked and resistance as he brought the arm forward to release the ball. Both of these things put stress on the UCL.
The UCL (ulnar collateral ligament) runs along the inside of the elbow and provides stability for certain overhead motions, including throwing the football. It is often an overuse injury, making it a common one for MLB pitchers. It’s much less common for quarterbacks and tends to be an acute injury instead.
Josh Allen previously suffered this injury in 2018 and missed four games. It’s unclear how this one compares, but it is the second time he has damaged the ligament. I don’t believe the ligament was much more vulnerable due to the previous injury, but it could slightly complicate his recovery.
So how will the Bills handle Josh Allen going forward? It will come down to how conservative they want to be and how well Allen can function if he tries to play through the injury. When the UCL is damaged it can lead to pain, decreased range of motion and even numbness through the arm and fingers (this is more likely if the ulnar nerve is also damaged, which often happens alongside UCL damage). All of this affects how well he can grip the football and how much zip he can get behind his passes. It even influences accuracy.
Based on the reports so far, this is likely a grade 1-2 sprain. It won’t end his season, and it will eventually heal on its own, but it won’t happen this week. It also won’t happen next week or the week after. If it’s a grade 1 sprain, meaning it is very mild, it would likely take 3-4 weeks to fully heal. A grade 2 sprain would take 4-6 weeks. That doesn’t mean Allen would have to miss that much time, but he wouldn’t be playing at 100% if he does return before then. If the Bills can maintain a solid position in the standings over the next few weeks, it’s best to sit Allen to give the ligament more time to heal. Getting the elbow healthy now means an overall quicker recovery and a better performance late in the season. It also reduces his overall Injury Risk.
While it is possible for Allen to make the sprain significantly worse, it would take a very specific type of play (the same mechanism of injury that led to the sprain). Allen could prolong his recovery by trying to play through it though. If he does try to fight through the pain, the ligament would take longer to heal and therefore affect his performance for additional games. The best decision the Bills can make for Allen’s long-term health and their success the rest of the season is to sit him for 2-4 games. If they do that Allen will have a much better chance to return and sustain his high level of play.
All of this is relatively good news considering how significant this injury could hav been, but it leaves Allen with a murky outlook for the next month or so.