Once or twice might have been a coincidence, but three times is a trend that should trouble the Buffalo Bills.
EJ Manuel has now been sidelined three times this season with knee injuries, casting some doubt on the durability of the Bills' presumed franchise quarterback and highlighting the need to find some insurance behind the rookie next season.
Both Manuel and coach Doug Marrone were ready for the question that came Wednesday: Is it fair to label Manuel as injury-prone?
"People are going to think that and write that. I totally understand that. But my personal opinion is this: He's not injury-prone," Marrone said.
"You obviously don't want to get the tag as 'injury-prone' or 'soft' or things like that, and I know I'm not that," Manuel said.
Manuel isn't being accused of being soft, but questions about his durability are legitimate. He has now experienced swelling in his left knee twice this season. The first instance, in the preseason, required minor surgery. This time it won't, Marrone said Wednesday.
Still, it's hard to write off Manuel's latest ailment as minor. He played through a knee sprain Sunday, but once the Bills returned to practice Wednesday, Marrone knew something wasn't right.
"You saw a guy drop back and he threw OK dropping back," he said. "But when you saw it after when he went with his fakes and his stability from side to side, you would go, 'He doesn't look too good there.'"
At times, Manuel hasn't looked too good even when he's been healthy. His high ceiling as a prospect was evident in the Bills' win over the New York Jets last month, when he passed for 245 yards and two touchdowns, and again Sunday when he completed 71 percent of his passes while defeating the Jacksonville Jaguars.
But the Bills still need to hedge their bets with Manuel. He has looked downright awful at points this season -- and that has been when he's able to stay on the field. Manuel's three injuries have forced the Bills to turn to backups Thad Lewis or Jeff Tuel in five games this season, and while both have performed well as pinch hitters, neither has the physical skills to be the long-term solution at the position.
It would be good business for the Bills to invest in another quarterback this offseason. That's not to write off Manuel; it's simply to add insurance at quarterback, which has proven to be a make-or-break position in the NFL. If a team doesn't have talent at that spot, they're not going far in this league.
Could the Bills draft a quarterback in the first round next May? It's unlikely, but it could be a wise move. There are several quarterbacks with first-round grades, and the Bills are currently projected to draft ninth overall, giving them an opportunity to dip into this class of signal-callers.
It would double Buffalo's chances of finding a franchise quarterback, and really, does a little competition really hurt? Drafting another offensive lineman, wide receiver or linebacker in the first round would help, but quarterback play is still paramount in today's NFL.
If the Bills don't go that route, and instead choose to keep just Manuel, Lewis and Tuel, it puts them in a precarious position. More inconsistent play -- or Manuel being injured again -- sets them down the same path that has left them at 5-9 this season.
The more immediate question for the Bills is whether it's smart to play Manuel in their season finale against the New England Patriots. On Wednesday, Marrone was adamant that Manuel would be ready and the team wouldn't consider "shutting him down" to preserve his health.
If you consider Manuel's shaky play at some points this season, giving him the added experience is important. But if Manuel still isn't physically right, what's the point? Take the offseason to rest and start fresh in July.
There will be plenty of questions surrounding Manuel when the Bills open training camp next summer. After Wednesday's developments, Manuel's durability can be added to that list.