December 28, 2015 - Dr. David Chao
Monday Morning MD: Does HGH use for Manning neck issues make sense?
The big story Sunday was off the field with the accusation of Peyton Manning and others using human growth hormone (HGH). I am going to keep to the medical aspects of this breaking story and leave the rest to the real reporters. Would HGH use even have helped Peyton Manning to recover from his neck issues? There is no proven evidence it would have. Manning had cervical fusion and decompression surgery. As an orthopedic surgeon, there is no established benefit for HGH use here. HGH is known to help with growth of muscle, bone and cartilage (primarily in kids). Peyton’s issue was radiculopathy where the nerve to the arm was compressed. There is no proven role for HGH in radiculopathy. Could it have been used to help strengthen his weakened arm? I suppose that is possible but that performance enhancement usage is also unproven. A 2010 study showed that HGH did not improve strength, power or endurance, but it did help speed in sprinting sports. Absolutely no one has accused Manning of having speed. Besides it not making sense to take HGH for neck surgery recovery, it is a shame that Manning has to defend himself. Federal HIPAA privacy laws are being violated here by the pharmacy intern/tech and/or the clinic. Although HIPAA doesn’t not apply to the reporter or media outlet, the secret recording should matter since that is illegal. Knowingly driving a stolen car makes you an accomplice. Knowingly spending money stolen from a bank is against the law. It should be illegal to spread illegally obtained material that was unlawfully recorded or obtained by violating HIPAA. I have no idea if Peyton’s wife, Ashley, was prescribed or used HGH. Anti-aging clinics are often equivalent to HGH clinics. It is typically illegally prescribed for cosmetic, weight loss and fertility purposes. Often these clinics are shut down and my guess is the Indianapolis clinic will face significant scrutiny. I don’t pretend to know if Peyton did or didn’t take HGH, but it doesn’t make medical sense in relation to his neck issues. It is a shame that because a source (who has since recanted) made that statement, we have this doubt about Manning. One cannot take it back when the “fire alarm” has been pulled. Accusations are easy to make and often makes for a sensational splash. It is hard to prove a negative where one didn’t take something. I hope any exoneration makes the same news flash, but I doubt it. MMMD 1: Why Brees plays with plantar fasciitis but Peyton can’t As expected, Drew Bress played well while leading the Saints to victory with his partial plantar fascia tear. Why has Peyton Manning been out six weeks? Brees’ injury appeared to be an acute partial tear suffered on one play last week. Once the overly tight plantar fascia tears, after the swelling and pain subsides, the problem is cured. The Saints medical staff seems to have done a good job managing this with tape, orthotics and medication/painkillers. Manning’s injury is chronic and has developed overtime. The initial announcement of taking a week off led people to believe a quick recovery was in order; however, that is never the case with chronic plantar fasciitis. In hindsight, Manning might have better served to have a plantar fascia release surgery and taken six weeks to recover. People forget that Peyton did play through his plantar fascia injury for weeks, like Brees is doing. The difference is that Manning was ineffective due to his weakened arm from neck issues. Being unable to step into throws affects Manning much more than Brees. Just like the playoffs last year, Aaron Rodgers played well with his calf injury but Manning struggled with his quad issue. For those worried about the long term, there is no real risk for Brees to tough out the end of the season. Manning’s bigger 2016 worry is father time and arm strength rather than his foot as well. MMMD 2: Sickle cell non-issue for Geno Atkins in Denver Geno Atkins will play in tonight’s showdown for a playoff bye. The Bengals defensive lineman is one of many players to have sickle cell trait but he should have no issues at altitude. Atkins played in Denver in 2011 without problems. I am sure Cincinnati’s medical staff will watch his hydration and monitor his reps. Ryan Clark famously missed a playoff game in Denver but that is the exception. The average NFL team has one or two players with sickle cell trait, thus Atkins will not be the first player with sickle cell trait to play in Denver without issue. Sickle cell anemia would be a real concern at altitude but it would be unusual for anyone with the disease to even make it to the NFL. MMMD 3: Concussion movie poorly attended After all the commercials and publicity, the Concussion movie opened in sixth-place this past weekend. Its popularity was well behind Star Wars and even was bested by Alvin and the Chipmunks. Perhaps Christmas Day is not the right time to release such a serious movie. Despite inaccuracies (CTE was discovered in 1920s), admitted “Hollywood” spin and complaints from Dave Duerson supporters, I hope the movie continues to serve as a catalyst for more concussion research. Lets not let individual agendas get in the way of progress. The National Institute of Health should continue to take the lead as it is in the best position to coordinate efforts. The NFL was accused of tampering with NIH decisions but that turned out not to be true. Lets get politics out and let scientists do their job. MMMD 4: Patriots finally get some injury luck New England has been among the league leaders in both victories and injuries. Sunday, their third left tackle was injured but the early news seems to be positive. Sebastian Vollmer had his left ankle rolled up on, was carted off the field and immediately ruled out. The best-case scenario of a high ankle sprain still would have him out for weeks but that is much better than a season-ending fracture. Depending on the extent of ligament damage seen by MRI and the amount of swelling, Vollmer should be back this season. The question is when and if he will make it for the Patriots first playoff game in the divisional round. MMMD 5: Playoff teams overcome injury The Patriots and Steelers have overcome their share of injuries. The Chiefs have won nine straight games after losing Jamaal Charles. The Jets successes may be tied to Geno Smith’s off-field injury, which cemented Ryan Fitzpatrick as the starter. Four of the six current AFC playoff starting QBs are surprises: AJ McCarron, Brock Oswwiler, Brandon Weeden and Fitzpatrick. Depth has never been more important. 6: Medical potpourri As expected, Carson Palmer’s index finger was a relative non-issue as he led the Cardinals within reach of potential home-field advantage. By video, Matt Hasselbeck separated his throwing shoulder. An AC joint sprain was later confirmed. At this point, Andrew Luck (two months out from kidney laceration) is the more likely starter as the Colts hope to get to 8-8 and win a playoff spot. Dez Bryant was inactive due to a foot injury. I hope this is unrelated to his Jones fracture. NFL athletes typically return at 6-8 weeks( Bryant came back week 7), but this doesn’t mean the 5th metatarsal is completely healed. If this is related to his previous injury, it could signal further surgery. Jadeveon Clowney left the game with a foot injury and was in a boot post-game. By video, there was no clear injury mechanism. I hope that means it is a minor injury. Tamba Hali had surgery on his thumb and was inactive this week. He certainly will be ready for the playoffs, if not Week 17. Ryan Tannehill had blood in his urine last week and was cleared to play. Blood in the urine is not unheard of in the NFL but I am sure the Dolphins medical staff took all precautions. Kenbrell Thompkins was carted off with a non-contact injury. Thankfully it was only his calf but that still puts him likely out for the final game. MMMD 7: ProFootballDoc scorecard Tyrann Mathieu unfortunately did tear his ACL. So far, Vollmer avoided season ending injury. Hasselbeck will likely miss the finale with an AC joint injury. Brees played through his foot injury. Marcus Easley was initially reported as a leg injured and carted off with a fracture type splint. By video, it appeared to be a knee ligament injury which was later confirmed. T.J. Yeldon was unable to play with his MCL. Fortunately, Adrian Peterson’s high ankle sprain was mild and he played this week while Palmer played well with his finger injury but they were already correctly tallied last week. Thompkins avoided ACL injury with his non-contact open field injury. Although, I didn’t formally make the call of a tear, my tweet was misleading and I will count it as a mistake. Last week’s 129-8 (94.1%) tally is now 135-9 (93.75%). Follow David on Twitter: @profootballdoc Dr. David Chao is a former NFL head team physician with 17 years of sideline, locker and training room experience. He currently has a successful orthopedic/sports medicine practice in San Diego.