As Colts near deadline on Manning, more troublesome details emerge

While the decision-making process regarding Peyton Manning's future in Indianapolis continues to unfold, new details about his problematic neck issues and his attempts to deal with them have surfaced.

SI.com has learned from NFL sources that Manning actually underwent a fourth, unreported, medical procedure in the past two years, not three as has been widely known.

While it cannot be determined exactly when the unreported procedure on Manning's neck took place, it was at some point after his May 23 surgery in Chicago to correct a bulging disk, and before his Sept. 9 one-level cervical neck fusion surgery in Marina Del Rey, Calif. The same doctor who operated on Manning's bulging disk in May did a follow-up procedure last summer in Chicago, as a result of the original surgery. Both of those operations came while the NFL and its players were still engaged in their protracted labor fight, with clubs having very limited medical contact with injured players. At the time of Manning's September neck operation, that surgery was reported to be his third neck procedure in 19 months. In reality, it was his fourth.

In addition, league sources say Manning's neck has potentially developed bone spurs just above the point where his latest fusion surgery took place in early September, and the Colts organization is under the belief that it is nearly inevitable Manning will at some point require further surgery, and possibly another fusion procedure, even if he does successfully return to the field in 2012. It's unclear how any potential long-term neck issues will impact Manning's decision to attempt a resumption of his NFL playing career later this year.

When reached Wednesday, Manning's agent, Tom Condon, declined to comment on any specifics regarding his high-profile client, other than adding: "I wouldn't have anything to say about all of that, one way or another.''

While the new details paint a picture of Manning's health that may be more tenuous than is publicly known, NFL sources told SI.com that the Colts quarterback was strenuously trying to show team officials and coaches that he was capable of playing in the final two weeks of the regular season, but specifically in red zone situations, where his limited arm strength would be less of a liability.

Manning was targeting the Colts' Week 16 home finale against Houston for his return, league sources said, even taking part in an organized and fully-scripted 30-play practice session in the week leading up to Indy's Week 15 home game against Tennessee. In that workout, Manning performed in front of Colts team president Bill Polian, head coach Jim Caldwell and offensive coordinator Clyde Christensen, who was on hand to call plays.

Manning threw passes to Indianapolis running back Joseph Addai during the workout, as well as to some reserve or practice-squad Colts receivers. Longtime Colts center Jeff Saturday snapped the ball to Manning, who also tried to elicit the participation of Colts receiver Austin Collie, league sources said. But that move was vetoed by Polian because Collie was gimpy at the time from a foot injury. The side practice session was not in violation of any NFL rules, because all players involved were on the active roster, with the Colts checking with the league to make sure they were in compliance.

While one league source said Manning was clearly angling to play against Houston, another league source said the issue quickly became moot after the Manning-led workout, because Colts team physician Hank Feuer quickly ruled out clearing Manning for any on-field action.

Feuer said Manning's neck muscles at that time were still atrophied from his long period of inactivity following the September surgery, and he had yet to recover his full range of motion in the area. It short-circuited any possibility Manning had of getting back on the field before the 2011 season ended, with him at one point hopeful he could show the team he was capable of running its red-zone offense against the Texans and possibly the following week at Jacksonville, league sources said.

Polian was said to be initially frustrated by the extent and scope of the workout, which he then viewed as a surprising attempt to play in a meaningless situation at the end of a long and defeat-filled season in Indianapolis. League sources say the former leader of the Colts front office was taken off-guard by the intensity and pace of the 30-play session that Manning took part in. Polian was under the belief that it would be conducted at walk-through speed, but instead it was held at typical regular-season tempo with scripted play calls.

A day later, league sources said, the team's strength and conditioning staff impressed upon Polian that it had wanted to see how Manning responded to a fast-paced and scripted workout, because his recovery was not going to reach the next level if he simply continued to lob passes at a leisurely pace. And the practice was conducted from the 25-yard line on in because that was then roughly Manning's ceiling in terms of his arm strength throwing the ball.

Sources who were on hand for the practice say that while Manning was accurate with his passes, he threw nothing longer than 20-22 yards, and his passes wobbled at times, with perhaps 80 percent of his usual velocity. Manning also seemed to be visibly fatigued at times during the workout, sources said, which further convinced Caldwell and others that it would be unwise to risk further injury to their franchise quarterback with a cameo appearance against Houston or Jacksonville.

"He wanted to go on the field and try to dump red-zone passes against Houston,'' a league source said. "Even though his neck muscles hadn't even been strengthened yet. Can you imagine anyone putting him on the field in that situation? Just to throw a string of red-zone passes? But that's where things were going at that time, and it kind of speaks to the insanity of the situation.''

All four of Manning's recent surgeries or medical procedures have been on the right side of his neck, league sources said. The team is concerned that Manning's neck injuries have reached the chronic stage, and that there could be a genetic aspect to his condition. Manning's older brother, Cooper, 38, had his college football career ended before it began when he was diagnosed with spinal stenosis, a narrowing of the spinal canal that required surgery to relieve pressure on the spinal cord. In Peyton Manning's case, any evidence of stenosis is thought to be on the moderate side, league sources said, but the likelihood of further complications increase with each new surgery he undergoes.