Why Manning should retire, but won’t

“You hear about how many fourth-quarter comebacks that a guy has and I think it means a guy screwed up in the first three quarters.” – Peyton Manning

The first three quarters of the Peyton Manning neck saga have certainly been screwed up but despite my advice that he should retire, I see another fourth-quarter comeback for the Super Bowl MVP and future first-ballot NFL Hall of Famer.

When it was first announced that Peyton Manning had to undergo his third neck surgery in less than 2 years it was roundly reported he would return in 2-3 months. Stories abounded that he had chosen a new, cutting edge procedure that was more painful (harvesting bone graft from his hip) so that he could return in two months. He went to Europe for stem cell therapy to improve his chances of playing this season.

I stated that he would miss the entire season and that he should retire. Here are the reasons why I think he should retire … and why I think he will ignore my advice.

There are four essential questions that every sports fan wants answered with regards to Peyton Manning’s health.

Can he return?

Will he return?

When will he return?

Should he return?

1. Can Peyton Manning return? The answer is simple. He can return. The NFL allows players to participate who have undergone single-level spinal fusions. In addition Peyton will have little problem getting a physician to pass him on his physical providing his strength returns to anywhere near a normal level.

2. Will Peyton Manning return? The answer to the second question is far more complex. If Manning had pain only and had a simple discectomy (removal of disc material pushing on and irritating nerves) his chances of return would be 99 percent. If he had a fusion for pain only his chances are reduced to 85 percent. If he had a simple discectomy for pain and weakness, his chances of seeing the field again are reduced to 75 percent. If, as is the case, he has pain and weakness requiring a fusion the consummate QB’s chances of playing again are no better than 50-50.

3. When will Peyton Manning return? The answer to the third question was partially answered Monday morning. Colts owner Jim Irsay said Manning was done for the season at a private breakfast for Super Bowl donors. He did partially recant via Twitter later in the day but the “we’ll take it month-to-month” qualification rings hollow.

Peyton had a spinal fusion. Bones in adults heal in three to four months. No physician would allow Manning to play until a solid fusion was in place, which immediately takes you into December.

What makes the Indianapolis quarterback’s case so much more complicated is the presence of weakness. Nerves regenerate exceedingly slowly. They heal at a rate of approximately 1 millimeter per day. Peyton is 6-foot-5 and therefore has a distance of about 1 meter from his neck to his finger tip. That equates to almost three years of required neural recovery. If you assume that only his tricep is weak then at least a third of a meter of nerve needs to heal leaving you with a full year of recovery. That was my thinking when I predicted he would certainly miss the season.

4. Should Peyton Manning return? The fourth question was adequately stated on Fox NFL Sunday but poorly explained. Once weakness is present the nerves are injured and hence more susceptible to further and perhaps permanent harm. As a physician I like to approach every patient as if they were myself or a family member. It is in that vein I make my plea for Peyton to retire.

Manning is the father of two, and I have little doubt that he is a fabulous father and wants to play ball with his children in the front yard. If he recovers adequately and plays with his fusion, a significant risk of adjacent segment disease (deterioration of the spinal levels above and below the fusion) exists which could lead to irreparable nerve damage.

Peyton Manning is a first-ballot NFL Hall of Fame, Super Bowl MVP, perennial Pro-Bowl, superstar quarterback who has absolutely nothing to prove to anyone. He is in every discussion of the best quarterbacks of all-time. He has tens of millions of dollars in the bank. He has careers waiting for him after football that are the envy of every player in the league. I wouldn’t take the risk nor would I allow a family member to take the risk and I therefore strongly counsel the Colts QB to hang up the cleats.

Will the ultimate signal caller follow my advice? No, I think not. Peyton Manning calls his own plays! No one calls their own plays in the NFL. Peyton calls audibles at will, he runs the no-huddle offense when he chooses and he goes under center whenever he wishes. I do not believe he is ready to retire. He will therefore heal as best he can over the next 10 months and return next season. Peyton Manning will play well but below his standards in 2012 and retire after the season on his own terms.

I just hope Archie can convince him otherwise.