By Jaboner Jackson 8 a.m. | This week, the Indianapolis Colts and owner Jim Irsay continued to clean house on a team that went 2-14 in the 2011-12 NFL season. Earlier this month, Irsay fired Bill and Chris Polian, the father-son duo that was the de facto General Manager for the Colts. Although praise for Bill Polian had run deep during the Colts' successful years, the weaknesses throughout the roster became evident in 2011 when QB Peyton Manning sat out the season with a neck injury. This week, the Colts fired head coach Jim Caldwell, who epitomized stoicism on the Colts’ sideline by choosing to never speak into his headset. In order to understand the future of Peyton Manning on the Colts, I discussed the medical issues surrounding his neck injury with our team medical expert, Hassan A. Riaz, MD, MBA, who has extensively covered Manning's neck injury with me on this site. As always, Dr. Riaz is not treating the player in discussion.
What is the status of Peyton Manning's injury? What kind of injury does he have?
Manning has cervical degenerative disc disease. This is when the bones of the neck spine become unstable and pinch on the discs of the spine or nerves of the arm. Due to this injury, Manning was experiencing weakness, tingling, and pain in his throwing arm.
Manning has had three neck surgeries so far. He had his first neck surgery in 2010. He then had another neck surgery in 2011 during the offseason. And he had a third neck surgery a few months later at the start of the 2011 season. Why did Manning have so many surgeries?
All surgeries were related to cervical degenerative disc disease. We know that he had fusion surgery in his second and third surgeries. This is a surgery where the surgeon fuses bones of the neck together to create stability. Accordingly, the question isn't why Manning has had three surgeries. Rather, the question is whether he had surgery at the same disc level all three times or not.
We know that his second and third surgeries were done at the same level. Specifically, his third surgery was a redo of his second surgery because his second surgery did not fuse well. So this leaves us with this first surgery in 2010. If Manning had his first surgery done at the same level as his second and third surgeries, Manning has single-level cervical disc disease. But if his surgery was at a different level than his second and third surgeries, Manning has multi-level cervical disc disease.
I make this distinction between single- and multi-level disc disease because this is the key to understanding whether Manning will ever play again. If Manning has single-level disease, he has an excellent chance of playing again. Fusion surgery is a great treatment for single-level disease. But if Manning has multi-level disease, the outlook looks grim. It is less likely he will play again.
Why was Peyton Manning not on Injured Reserve (IR) for the 2011-12 NFL season?
There was never a thought by the Colts that Peyton Manning would play in the 2011 season. Everyone on the medical side knew that he wasn't going to play because cervical fusion surgeries take at least three months to fuse. But the Colts weren't interested in seeing Manning play. They were interested in seeing him practice. If Manning were placed on the IR, he would not be eligible to practice during the season. By keeping him on the active roster, the Colts could watch him practice and throw the ball towards the end of the season.
Why did the Colts want to see Manning practice?
Management wanted to see whether Manning had regained strength in his throwing arm. The Colts have an option for $28 million on Manning's contract for the 2012-13 season. This option in turn triggers a long-term extension. The Colts must decide on this option by March of this year.
By seeing Manning practice, management would have some idea as to how he has progressed from surgery. It was purely a financial decision by the Colts in keeping Manning on the active roster. If Manning were not on the active roster, they never would've been able to see Manning throw in a practice situation prior to having to make a contract decision in March.
Give us the bottom line, Doc. Will Manning be back in 2012 for the Colts?
If Irsay is acting reasonably, the answer is 'no,' Manning will not be back for the Colts in 2012. I say this because Manning will not have the opportunity to be truly healthy until at least early summer, which is well past the March deadline for picking up the option on Manning's contract. And even then, this is only the chance of being healthy. There is no way Manning's health can be evaluated effectively by March. If Irsay is acting reasonably and listening to his medical staff, he will allow Manning to become a free agent. Nonetheless, I am always wishing Peyton a speedy return to health and hope he overcomes his injuries.
ABOUT DR. RIAZ: Hassan A. Riaz, MD, MBA is President of Mercy Medical Center outside of Long Beach, CA. He went to medical school at the Keck School of Medicine of the University of Southern California and did his postgraduate training at Harbor-UCLA Medical Center. You may contact him at firstname.lastname@example.org and his assistant will try to get him to respond.