Understanding Peyton Manning's Plantar Fascia Injury, Can He Return In 2015?

Doc Bear breaks down Peyton Manning's plantar tear, giving us insight into what he's going through and perhaps a timetable to return. Every wonder why he is called 'Doc'?

It’s amazing how often we complain about our players’ performance being subpar, then find out that they were struggling with injuries. That’s at least part of the issue with Peyton Manning.

Here are the facts: Manning has multiple injuries, including his shoulder and a partial tear in his plantar fascia. The prognosis isn’t that good for his play this year. If he does come back, he’s probably going to play with a lot of pain. He’s been doing that for years, but this time is different.

The plantar fascia stretches from its attachment to the heel all the way to the toes. Medically, that’s from the calcaneus to the base of the proximal phalanges.

It’s a thick, tough chunk of connective tissue, but it can also be vulnerable. Causes of fasciitis include overuse, failure to stretch the tissue properly and impact experiences.

There are others. Which created the partial tear in the fascia on Manning would be guesswork, so I’ll pass on that. The question becomes, can Manning even return to the team?

This isn’t a  simple question. Some tears are worse than others. Strangely, a full tear of the plantar fascia doesn’t hurt, while partial tears can be like walking on spikes.

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That’s true of many connective tissue tears. I used to run a clinic and school in Summit County, CO, and I saw a lot of full tears of the tendon leading to the thumb. They were often caused by the type of ski poles that were used at the time.

Those aren’t used now, but a full tear carried no pain — the patient just lost use of the thumb. I sent them to a surgeon. Frank Scott, at Rose Hospital, did delicate and beautiful work on many of them.  

But Manning is dealing with a partial tear. How partial becomes the question of the day, and we don’t know. All we have is the rote comments from the team on giving him time to heal. That time could be between two and 12 weeks, depending on the severity of the tear and Manning’s pain tolerance.

This injury is common among runners. It’s normal for it to take 12 weeks to fully heal. During that time, you take the patient off of all running or load-bearing as much as possible for about dix weeks. Pool exercises and use of an exercise bike are common to maintain conditioning. Then, the patient has to slowly work back to full strength.

It’s worth knowing that every pass Manning has thrown was made possible by the plantar fascia. Every pass he makes requires that tissue to ‘load’ and ‘unload’ the body weight and the force from the action of throwing. That isn’t small.

Causes of partial tears include overuse (yes, you can train too much), improper stretching and physical blows. I strongly doubt that Manning fails to stretch properly. Overuse and/or trauma are far more likely.

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Typically for Manning, he didn’t report the injury until he could barely throw. He’s totally focused on performing, but this is a case where you can’t ‘gut it out’ through this injury.

Surgery bears the risk of creating more scar tissue than it solves. Manning doesn’t need that approach. He needs to do something that’s utterly foreign to him. He needs to rest.

That doesn’t mean that he can’t wear himself out in the pool and/or on an exercise bike. It means no throwing. Throwing a pass starts at the foot and the plantar fascia is at the heart of that.

It’s going to be rough on him. He’ll want to come back early, and to play through the pain. That runs a high risk of re-injury. I’m hoping that they don’t let him do that.

If he takes the full 12 weeks to completely heal, that takes us past the Super Bowl. If he comes back sooner, he’s likely to re-injure it. There really isn’t an upside to this. It could spell the end of his career.

You don’t heal at 40 years old, like you did at 20. It’s life its own self. I’m very glad that they let him beat the all time passing yardage record — he’d earned it. But now it’s time for him to rest. That might sound the bells on his career. He’s getting injured more and more easily. That’s not going to change.

Manning’s set so many records that I won’t list them all. Suffice it to say, he’s been the class of the quarterback in the NFL for a long time. Getting to see him has been an honor and a pleasure.

But everything ends. Will he try to come back. Almost certainly. Is that the best option? No. The best option is to fully heal, then deal with the realities of life. Everyone loses to time.

It’s ‘only’ the death of his football career. Since that’s all he’s ever known, that’s a huge milestone in his life. For the Denver Broncos, though, I think the time has come to move ever forward. Brock Osweiler has been absorbing Manning’s knowledge and skills for the last four years. It’s time to find out what we have in him.

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While hopeful, I don’t expect Brock to come out like gangbusters. Aaron Rodgers took three seasons to have a winning record. Osweiler may have a much better team around him, though. I’m hopeful that he has learned enough to make a run in the playoffs.

Keep in mind, it’s still possible, dependent on the severity of the tear, that Peyton will play again this year. I’m just not convinced that it’s the best thing for the Broncos.

But if this does end Peyton’s football days, I would wish the man all the best in his next career. I’ve been entranced by his skills, humbled by his knowledge and grateful for the chance to watch him play over the last two decades.

Thank you, Peyton, for making me a better fan of the game. Thanks for showing that you can be the best and still be a humble, hardworking and deeply caring man.

We should all do half as well.

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Doc Bear is a Featured Columnist for MileHighHuddle. You can find him on Twitter @alloverfatman.

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