Peyton Manning’s Plantar Fascia Tear…Is this the End?

Fantasy Football Injury of the Week:  Peyton Manning and his Plantar Fascia

Yesterday we learned that Peyton Manning has a tear in his plantar fascia and will miss at least this week’s game against Chicago.  The fantasy implications of Manning missing time might be minimal (Manning is ranked 30th in my leagues this year for QBs), but as a Denver resident and Broncos fan, this is some serious news.

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This week I want to focus on what exactly is a tear of the plantar fascia, what can be done to treat it, and will Manning play again this season or ever again?

What is the plantar fascia and why is a tear career threatening?

The plantar fascia is a thick band of connective tissue that supports the arch of the foot. In the physical therapy clinic, we most commonly see an acute inflammation or micro-tearing of the fascia near the heel bone, known as plantar fasciitis.  We also see very chronic cases in which there is a buildup of scar tissue at the same location from repetitive micro-tearing followed by healing.  Plantar fascia injuries are one of the more common diagnoses that we see in PT but also one of the hardest to treat, especially the chronic cases.  Even though this band is thick and tough, it’s job is to maintain your arch while supporting all of your body weight.  When the plantar fascia becomes irritated, inflamed or weakened by chronic injury, every step can be painfully perpetuating the injury.

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Manning’s situation is much more severe than the common plantar fasciitis diagnosis we see at Therapydia.  In his case, he has sustained a partial rupture or larger tearing of the plantar fascia.  For any of you who have experienced the pain of plantar fasciitis yourself, that pain is magnified significantly with a partial rupture.  Imagine having a cut on the knuckle of your finger.  Every time you use or bend that finger, the cut painfully reopens and the healing has to start over.  The finger is easy to keep from moving, just buddy tape it or use a splint from the drugstore to keep it from bending.  The foot on the other hand is very difficult to immobilize so the time it takes to heal can be painfully long…..and therein lies the major problem with Peyton Manning’s foot issue.  Will there be enough time for him to return and be effective this year or will this be the end of Manning’s illustrious career?

When will Manning be back and is there anything that can be done to speed up his return?  

Unfortunately, I am not privy to all the details about Manning’s injury.  I can only speculate on what I’ve read or seen on Sportscenter.  The typical time frame for a non-operative recovery of a partial tear of most soft tissue injuries is 12 weeks or more.  This is when we often consider the injured tissue to be back to or near full strength.  However, at 4-6 weeks, the injury could be 80% healed which may be sufficient enough to allow an athlete to return to their sport.  Returning too early though can increase the likelihood of reinjury or lead to another serious problem.  See Arian Foster.

Manning has a few options that may get him back on the field quickly.  Platelet rich plasma (PRP) injections are being used more often these days to speed up the healing process.  Injecting the injured tissue with PRP provides an instant proliferation of growth factors that can quickly stimulate healing. Tenex is a minimally invasive procedure that removes the damaged or injured tissue, allowing the healthy tissue to regenerate and thrive.  Finally, Manning and his doctors may decide to do a plantar fascia release or surgical cutting of the the partially torn fascia.  By fully releasing the partially torn section of the plantar fascia, tension is released and inflamed nerve endings are no longer sending painful signals to the brain.  However, the long term risk factors of this procedure are much greater than other options including nerve damage, instability in the joint of the feet, loss of normal biomechanics of foot and ankle.  The expected recovery from these procedures is 3-6 weeks versus the 8-12 weeks or more of conservative treatment.

Again, I have very limited information on the severity of Manning’s plantar fascia injury.  He is also dealing with injuries to his throwing shoulder and ribs.  As the Denver Post points out, there are also a number of scenarios that could occur in the next several weeks that impact Manning’s return.  Nonetheless, we are here to predict when or if Manning returns from his plantar fascia tear, so here it is….

Prediction: Peyton Manning misses 4 games.  The tear is either mild enough to return in four weeks or he undergoes a minimally invasive treatment that allows him to return for an important Week 15 matchup against the Pittsburgh Steelers.  

Will Blake Bortles miss Week 6 with an AC Sprain?

Fantasy Football Injury of the Week:  How bad is Blake Bortles Grade I AC Sprain?

Blake Bortles has not typically been on the radar of many fantasy players since he joined the league in 2014.  However in 2015 he has had a sneaky good start to the season despite Jacksonville’s 1-4 record.  In my Yahoo league, he is currently the 7th best QB.  He has better numbers this year than our very own Peyton Manning (by a longshot) and fantasy studs like Drew Brees and Matt Ryan.

Unfortunately, Bortles may suffer a bit of a setback if he is forced to miss Week 6 against Houston.  Bortles suffered a Grade/Type 1 acromioclavicular (AC) joint sprain of his throwing shoulder at some point during Jacksonville’s week 5 loss to the Buccaneers.  Anytime a quarterback sustains an injury to the throwing shoulder it can be a scary situation.  Fortunately for Bortles, a grade one AC sprain leaves us optimistic that he will be able to play this week and here’s why.

What’s the difference between Grade 1, 2, and 3 AC Sprains?

An AC sprain is typically graded in its severity from a one to a three.  It easy to visualize the severity of an AC sprain in the graphic below:

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A grade/type 1 sprain is mild or partial injury to the joint ligaments or capsule.  In this grade there is a slight tear or sprain of the acromioclavicular ligament.  This ligament helps to stabilize the AC joint and ultimately the shoulder itself.  Bortles likely will rest the shoulder this week and participate in physical therapy everyday to retain his range of motion, strength, and help control the pain with modalities like the Gameready ice machine:

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A grade/type 2 sprain is a more significant tear of the acromioclavicular ligament as well the ligament below the clavicle called the coracoclavicular ligament.  

A grade/type 3 sprain is a severe injury to the shoulder.  In this situation, both acromioclavicular and coracoclavicular ligaments are completely torn.  The shoulder is very unstable and an athlete will often choose to have surgery to stabilize the joint by placing a screw or looped suture into the collar bone to anchor it back down.  This grade of injury will mean the player misses weeks or months of their sport.

So What’s the Prognosis?

Fortunately for Bortles he has been diagnosed with the most mild form of an AC sprain, a grade one.  Early in the week his shoulder probably felt sore and a little weak or unstable  He may have had some difficulty reaching overhead or across his body and lifting activities might have been uncomfortable.  Kinesiotaping can be helpful in giving stability and pain relief during this phase of recovery.

 

With daily physical therapy rehab, Bortles’ symptoms will likely improve significantly or resolve completely by Sunday.  

Prediction: Blake Bortles is able to play in Week 6 against Houston

 

Fantasy Football Injury Of The Week

New for the 2015-2016 NFL season:  

Each week, the Therapydia Denver PTs will analyze and discuss the NFL injury with the most serious implications for your fantasy football team.  In this analysis and discussion, we will include a description of the injury, the most likely treatment options for the injury and a prediction as to when the injured player will be back on the field.  

We will explore all available information outlets, then employ our extensive training and experience in orthopedic and sports physical therapy to give you an informative yet concise evaluation of the injury of the week.  

We will give you all the information you need to make an informed decision.  The rest is up to you.  Start, bench, trade or hop on the waiver wire.