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Thursday, September 8, 2011
Peyton Manning's return still unknown

There is no longer any suspense surrounding the status of Peyton Manning for the Indianapolis Colts' Week 1 opener against the Houston Texans. He is simply, as they say on official NFL injury reports, "Out."

Peyton Manning
This is how we'll see Peyton Manning this week and maybe for a few more weeks after that.

The big follow-up question naturally is how long until Manning is ready to compete. The problem is there's no real way of knowing.

It is unknown, at least to those removed from his inner medical circle, whether his slow progress is due to the natural variable course of recovery from May surgery to address a bulging disc (because the timetable can be highly variable, even when no "problem" exists) or whether there's actually a secondary issue (such as scar tissue or another structural component). It may even be a case of where Manning made progress initially that has recently plateaued and the next steps are yet to be determined based on how he responds to a period of rest (doctors recently advised Manning to discontinue practicing).

The tissue seemingly responsible for most of Manning's current problems is nerve. Typically, disc procedures in the spine are undertaken to alleviate compression of the adjacent nerve root. The nerve roots in the neck or cervical spine lead to nerves that branch and are distributed in the shoulder, arm and hand. Those nerves relay signals responsible for sensation (such as pain and temperature) and motor function (muscle contraction). If the nerve is compromised, the individual can experience altered sensation ranging from pain to tingling to complete numbness. Specific muscles in the shoulder, arm or hand associated with the compromised nerve can be weak. Following surgery, the structural issues typically have been addressed but the affected nerve pathway often takes extended time to heal itself. Regaining full strength can take anywhere from weeks to months and is not accelerated, for instance, by increasing workout intensity or frequency. If anything, overdoing it too early can result in localized inflammation or other setback that can hinder the healing process. Simply put, even if Manning is the hardest working, most determined football player in the league, this is one play call he cannot completely control.

If Manning and the Colts are concerned about his halted progress this close to Week 1, it suggests the gap between where he is now and readiness to play is significant (meaning multiple weeks potentially missed). But whether that translates to a few weeks or a few months is anyone's guess. On Thursday morning, Colts owner Jim Irsay issued the following post on his Twitter account: "NFL Season opens 2nite! We had a good practice yesterday and r guys r fired up 4 the season. #18's out for awhile, but compete, we will/BELIEVE." The noteworthy excerpt "out for awhile" has engendered much speculation about just how much time Manning could miss.

There is no definitive answer, to be sure, but the condition doesn't lend itself to one. That's the problem for Manning and the Colts, too. It just feels now as if the uncertainty element surrounding his status going forward is far greater than it was a couple of weeks ago.