What's The Prognosis For Manning?

What is a bursa sac and what does its removal mean to Peyton Manning's future? How long will he be out of commission? What are the Colts holding back? How "standard" is this procedure? ColtPower went digging and found some answers to those and many other questions.

For most Colt fans, the headline, "Manning Has Knee Surgery," is about as disconcerting as, "Godzilla Destroys Lucas Oil Stadium."  A number of questions have swirled around the recent news that Peyton Manning had a bursa sac removed from his knee.  Here are the answers ColtPower was able to track down.

Most of the information for this article is taken from general research, which is best stated in this article, so that is a good point of reference to go back to in order to elaborate on the information presented here.

Q: What is a bursa sac?

A: A soft, pad-like sac found near a joint, so there are hundreds of them in the human body.  They help to lubricate joints and provide easy, fluid movement, as well as preventing friction.

Q: What happened to Manning's bursa?

A: From general wear and tear, or possibly a hit that knocked something out of place, the joint began to rub the bursa the wrong way and it became inflamed.

This inflammation is called bursitis and can vary from slight discomfort to agonizing pain.  Bursitis is generally treated with anti-inflammatory medicine to ease the pain and usually goes away on its own — with rest and medication, the swelling goes down and eventually disappears, alleviating the problem.

Manning should be back dissecting NFL defenses by the start of the regular season
Brian Bahr/Getty Images

Q: If the problem usually goes away on its own, why remove it?

A: Knowing Manning and his work ethic, he probably didn't stay off of it long enough for the swelling to subside.  If that's the case, the "slight discomfort" probably progressed to "agonizing pain" and it was easier to remove the inflammation than to treat it and trust that Manning would stay off of it.

With the season coming up, it's safe to say that he would be on it more than ever, so the problem would get worse before it got better.

Q: The official reports say 4-6 weeks for recovery.  How realistic is that?

A: Very realistic. A source at the University of Pittsburgh Medical Center's Sports Complex — the same doctors that work on football-related injuries for the Panthers and Steelers — says the removal of a bursa sac is an outpatient procedure requiring 14 or 15 stitches.

According to the source, the recovery time is short and the rehabilitation work is limited, so, with the doctors that the Colts have on staff, it may be closer to a four-week recovery time.

Our own Eric Hartz has had a similar experience and expects that, if Manning's condition is anything like his, that Peyton already feels considerably better with the sac excised, if for nothing else than the fact that the effects brought on from the infection begin to subside and much of the pain of swelling is relieved immediately.

Q: Not so fast.  Marvin Harrison had bursitis issues last season and ended up missing 11 games.  What makes Manning's situation different?

A: That he had the sac removed, basically.  Harrison's injury was allowed to fester last season because, as stated previously, the problem usually sorts itself out with rest and medication.

Harrison's knee issues plagued the Colts last season
Andy Lyons/Getty Images

Since surgery requires a 4-6 week shutdown period, Harrison and the Colts were inclined to take a week-to-week approach.  The gamble ended up not working, as Harrison probably would have been better off having surgery early on in the process.

Harrison also had some ligament damage and a good deal more of his time spent on the field is spent running, so that is another big difference between the two injuries.  It's not that Manning doesn't need two strong, healthy legs to be effective, but his job is tied more to footwork than running.

Q: Why have the surgery now?  Why not have it in February?  Or April?  Or May?  Or any month when training camp isn't about to start?

A: Since the Colts are generally tight-lipped regarding player injuries, we may never know for sure. However, knowing Manning, knowing the nature of the injury, and knowing the organization, it becomes easier to speculate.

Since the nature of the injury is that it starts out mild, then either becomes more severe or subsides, both Manning and the Colts were probably hoping that the end result would be latter rather than the former and that it was best not to risk surgery.

Surely Manning wanted to get as many reps in as possible and didn't want an injury — not to mention one that was probably going to go away in good time anyway — to slow him down.

As the condition exacerbated and the regular season drew closer and closer, Manning probably traded reps with pain for the possibility that it will still go away.  With a six week timeframe, the "point of safe return" would fall at about the middle of July, which is where we are now.

His condition obviously did not improve and, given the experiences with Marvin Harrison last season, both parties decided to bite the bullet and have the surgery and recovery during what is still considered the offseason.

Q: Is everything going to be OK?

A: All signs point to yes.  Even at six weeks, that means that Manning should be ready for the Aug. 28 pre-season game against the Bengals and probably in enough time for the fourth preseason contest against Buffalo on Aug. 25 — although his playing time, if any, will probably will be limited.

Though he would definitely prefer to refine his timing and get the extra work in with his receivers, all of his top targets return from last season, with the only new additions being rookie tight ends Jacob Tamme and Tom Santi, so he should have enough time in practice sessions leading up to the regular season to get on the same page with them.

Expect to see plenty of Jim Sorgi in the preseason
Otto Greule Jr/Getty Images

Where this might end up being of value to the Colts — and possibly, but not likely why they chose to have the surgery now — will be getting extra reps for the reserves, particularly Jim Sorgi and Josh Betts.  Rookie Adam Tafralis should get some work as well, which is important.

The most significant trickle-down effect of this injury, though, will be whether or not Manning suffers a setback and is not ready in time for the regular season — or, at least by the time the cuts for the 53 man roster are determined.

If the Colts coaches don't have 100 percent confidence that Manning will be ready, that means they will carry three quarterbacks — as opposed to the two they have carried historically, hiding Betts on the practice squad — and that will take up a roster spot that could be used on someone that may not clear waivers and could possibly help the Colts later in the season.

As injuries mount during the season and depth is tested, there's always the fear that the Colts will look back on this injury and say, "We'd be fine if we could have kept Linebacker X instead of a third quarterback in September."

It appears to be a highly unlikely scenario, but is something to keep an eye on as we get closer to the start of the regular season and the cutdown to 53 players.

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