As the Colts and Peyton Manning go their separate ways, I have much to reflect on the past and predict for the future. As one of the doctors that has worked with him over the past several years, I can assure you that no one works harder on performance and preparation than Peyton. I was happy to hear that his throwing motion and mechanics have improved significantly over the past few weeks which is a signal that the nerve is finally showing signs of healing and conducting the neurological impulses that control the muscles involved in the throwing motion. Usually, if there are improvements as significant as this, a near full recovery can be expected which means whichever team has the good fortune of netting this Hall of Famer will be a contender immediately. Peyton has property in Miami, and that team has a good core on offense and defense as well as an all pro receiver in Brandon Marshall and plenty of cap space. This would be my bet for the team that the quarterback will settle. The situation with the Colts will leave the Indianapolis fan base depressed, but with Jim Irsay's commitment to rebuilding the team, it is natural for Peyton to reach out to a contender. You may see some of the veterans of this team go into retirement or not resign as a result of the same new philosophy and changes in the coaching staff. The Colts and their fans may have an exciting prospect in Andrew Luck waiting in the wings, but the process of rebuilding will take time. It will be interesting to see how the small market fan base will react and what effect it will have on attendance and sponsorship. Good luck wherever you land Peyton, it will be fun to watch.

The Portland Trail Blazer center Greg Oden is out for the season again as a result of knee injury. It is fairly obvious that Oden's congenital makeup other than his height did not set him up for professional sports and especially basketball, where the load on the knees is significant. He has undergone a second microfracture surgery on the affected knee and has had a similar procedure done on the other one. The nature of this surgery is essentially to create small fractures in the bone around the joint which causes the marrow in the bone to "bleed" in essence a stem cell version of the cartilage that provides the cushion and glue that holds the knee together. This procedure is most often done in patients that require joint replacement as an alternative. The healing time is similar to a hairline fracture which can be 3-4 months before significant improvements in the ability to bear weight and regain function return. Thus Oden is out for the season again and with the repetitive nature of this injury and the degenerative condition that follows, it can be predicted that his career as a productive center in the NBA is in doubt.

Initial reports coming from the doctors that took imaging evaluations of the Chicago Bulls and NBA MVP Derrick Rose's back came up with no significant structural findings in the spine. This is good news from the standpoint that the discs and bone structure is healthy, which could lead to surgery or significant lost time on the court. However, with the absence of these findings, it is likely that the problem is instability and/or dysfunction of the joints in the spine. This would not show on MRI, and is the prime reason why a muscle will go into involuntary spasms. These spasms feel like a cramp and often will bring the patient to their knees in pain and restriction. The body attempts to stabilize the segment or joint that is unstable and uses muscle contraction to create stability or balance. The pounding of landing jumps, banging other players bodies as well as twisting and turning can stimulate the reflex that causes these spasms. The common remedy for this is stabilization exercises, sometimes bracing or kinesiotaping the unstable area, chiropractic care and neuromuscular re-education to teach the muscles not to react in the loaded environment. Rose hopefully is experimenting with all of these therapies to find the right mix that puts him among the world's elite.

LA Clippers veteran guard Chauncey Billups suffered what appeared to be a serious left achilles tendon injury in their game last evening. This type of injury can vary in severity and the nature of treatment and rehabilitation that goes with it. Billups was reported to be absent from the locker room after the game which suggests that the injury required immediate attention. Best case scenario is a low grade muscle strain to the muscle/tendon attachment of the calf muscles which means that there is minimal tearing and the injury is more of an aggravation to the soft tissue. This would result is traditional treatment to target inflammation and stretching to restore function and may only result in a few lost days on the court. Worst case scenario is a tear or rupture of the tendon, which would require surgical reattachment and significant rehabilitation. This would likely sideline him for the remainder of the season and the likelihood of healing to his previous form at this stage of his career is unlikely and would probably result in an end to his illustrious playing days. The atmosphere in the locker room after the game in spite of the victory was reported to be somber, suggesting a reason for concern.

The big story here in Indianapolis is the status of record setting tight end Rob Gronkowski and his high ankle sprain. The big tight end has been a favorite target of Tom Brady and set single season records for receiving touchdowns. The fact that he appeared at media day without a walking boot tells us nothing more than he is able to bear weight on the bad ankle. His ability to perform at a high level will be determined by his ability to accelerate, decelerate and cut using the joint that absorbs a significant amount of the body's weight and force. Realistically, 2 weeks in not enough time for even the slightest of sprains, but the feeling is that this was at minimum a moderate tear to the ligaments involved. Treatment options before game day include icing, massage, accupuncture, ARPwave therapy, stim, ultrasound and manipulation to accelerate the healing and promote stability and function. On game day, injections of Toradol to reduce pain and inflammation is likely and although not often used on weight bearing structures, a local anaesthetic injection such as lidocaine to numb the pain. These last procedures can present risk of severely increasing the nature and severity of the injury so you can be assured that the training staff will have the ankle taped heavily and stabilized as much as function will allow. This will limit his normal speed and agility some, but will still allow some degree of effectiveness.

Rob Gronkowski suffered would have appeared to be a serious ankle injury in the New England Patriots win over the Ravens last weekend. Considering the Patriots history of vague injury disclosure, the speculation would be that this is a high ankle sprain. This injury would have allowed him to return as he did late in the game with support, although his production was limited to a blocking role. Reports are that he left the stadium in a walking boot which is fairly standard procedure for any foot or ankle injury to create stability and control inflammation, so don't read too much into those reports. As did Dwight Freeney in the Indianapolis Colts Super Bowl a few years back where a significant ankle injury occurred in the game before the championship, regular treatment and rehabilitation should allow him to participate in a fairly high level on Super Bowl Sunday in Indianapolis. The damage to the ligaments which provide the stability in the ankle are stretched and partially torn in this type of injury and speed and mobility are typically affected. The taping procedure done provides the stability that the damaged ligaments cannot, but normal ankle motion is lost as a result reducing speed and ability to cut and change direction. Gronkowski has enough tools to overcome some of these losses and should play a significant role in the Patriots quest for this season's top prize.

Fortunately, initial reports suggest that the injury bug will not be a significant factor in the 2 NFL Conference Championship games. Barring unreported or practice injury this week, the Baltimore Ravens Ed Reed is the key focus on the injury report. Reed was helped off the field by teammates after what appeared to be an ankle sprain. X-Rays were negative and he says that he expects to play against the Patriots. Ankle injuries limit speed and mobility based on the severity of the sprain. Assuming Reed is weight bearing and expecting to practice, we can assume this is a low grade sprain and I would anticipate him to play at the Pro Bowl caliber we are accustomed to. Aaron Hernandez, who saw time in the backfield for the Pats was reported to have suffered a head injury in the game with the Broncos, but also is expected to play. Assuming he has passed the unpredictable concussion tests, the only limitation here would be if he actually had concussed and takes another blow to the head. The 49ers Ted Ginn Jr. who has been plagued with an ankle injury much of the season is reported to have injured his knee on Saturday. He has had a limited role throughout the ankle recovery and likely will be a non-significant factor against the Giants and his spark on special teams will be missed.

Following the tragic X-Games training accident of skier Sarah Burke, the progress is being held by the family following more medical procedures at the University of Utah. The nature of this injury in which upon an awkward landing, she tore the vertebral artery in her neck. This blood vessel is a key oxygen supply to the brain stem and runs through small channels in the cervical vertebrae of the top 6 bones of the neck. She was reported to have gone into immediate cardiac arrest and was treated by EMT's at the scene. Tearing of the vertebral artery can create 2 significant health issues, one being the obvious internal bleeding and pressure around sensitive nerve tissue of the brain stem and spinal cord and secondly the real potential loss of oxygen to the brain that resembles the effects of a stroke. This type of injury often results in either some form of paralysis, loss of motor skill, vision, breathing, speech loss and many other neurological conditions. The medical staff induced a coma in the trauma center to help slow brain function and better be able to assess and treat and surgically repair the tear. The long term prognosis will be a direct result of the amount and time of oxygen and blood loss to the brain tissue that the artery feeds. It is all hopes and prayers that she suffers little permanent injury, but unfortunately the possibility of long term disability lingers.

After wildcard weekend, the bye teams got healthier and those teams that did move on did not see any key injuries to marque players. For the NY Giants, Aaron Ross has been cleared to practice after suffering a concussion in the Falcons game in a collision with his own player. This has been a very difficult protocol for diagnosis and in my own experience treating NFL players, the concussion testing appears to be very erratic in it's outcomes and reliability. It will be interesting to see how Ross responds to contact and how effective he will be in that game. His teammate DJ Ware has not been cleared for a similar injury and is questionable according to team reports. The ankle injury that has sidelined Ted Ginn Jr of the 49ers appears to be healed enough for him to give it a go this weekend. Ankle sprains certainly can take a hair off his quickness and ability to cut and avoid tackles which has been his main credential. I don't expect that he will be as effective as the 49ers would like. Eric Decker of the Broncos has an MCL sprain which will allow him to participate in practice and drills but will eliminate his ability to move laterally in coverage without a brace. These braces give stability to the knee and give the player confidence, but can be cumbersome in mobility and function. The Texans key weapons of QB TJ Yates (non-throwing shoulder separation), Andre Johnson and Arian Foster (hamstring) did not appear to be significant in the wildcard game and the rest in the season finale likely has helped. Expect these 3 to be close to full effectiveness against the Ravens. Owen Daniels was suspected to have fractured his hand, but team officials expect him to play his normal role. Obviously, any significant injury to the hand (especially fracture) will cause significant pain when attempting to catch passes. Expect his role to be in freeing up the running game and protecting the quarterback.

It is good to see that the injury bug will not play a significant role in the Divisional Round and hopefully teams and players will stay healthy through this week's games. A report will be posted next week to get the real breakdown of key NFL injuries going into Conference Championships.

On the week before the start of the NFL Playoffs, it appears that the Pittsburgh Steelers and Houston Texans will be affected by the injury bug more than any others. With Rashard Mendenhall out for the season with an ACL injury and the certain surgical repair that will be required there, even more of the Steeler offense will depend on quarterback Ben Roethlisberger and his high ankle sprain. In hindsight, with the Ravens hanging on to the number 2 seed, Big Ben would have been best suited to rest and rehabilitate the high ankle sprain that obviously has disturbed his throwing motion and movement in the pocket. TJ Yates has stated that he will be ready for the playoffs already as the backup QB for the Texans with a separated non-throwing shoulder. Pain should be the main restriction here, but he may be a little apprehensive to pressure from the Bengals front defensive line. Both Arian Foster and Andre Johnson have been nursing nagging muscle injuries all season also which may affect performance slightly, but the team did well in giving them last week off to recover and rehabilitate. Mark Ingram's toe injury will require surgery, but the Saints offense has significant depth at this position and shouldn't have the same effect of Mendenhall's absence. Let's see what the first weekend brings and look forward to a report mid week.