What is taking so long for Manning to get back?  His neck surgery was on May 23, which puts him 13 weeks out since his surgery.  According to an article in ESPN on May 25th, “Manning told The Indianapolis Star on Tuesday that the procedure was ‘minimally invasive’ and said he expects to make ‘a quick recovery.’” ¹ Is he still in pain?  Does he not have full motion or function back in his neck at more than 12 weeks out?  What’s the hold up?

Let’s contrast a conventional neck therapy approach to a 3D, QB specific, neck performance, bottom up approach.  Here are a few pics of traditional neck therapy and rehab (they are in a chaotic layout because it matches the reasoning behind them):



"Why am I doing this?"

OK, so the first one with the lady that is about to be hung, is a bit of a stretch.  But, not really.  Traction as a treatment for disc injuries may have it’s place.  Yet, it is limited in what it can do for a QB that has to take big hits and deal with gravity and increased G’s (not decreased) due to the nature of the position.  I don’t know if Manning had traction or not and it may feel good while he was on it, but it will not help him deal with the torque of the throw or the force of impact of a hit.

The ROM blue pick is just typical therapy exercises for a neck.  Typical, boring, and irrelevant for specificity of the QB position.  This is completely non-functional and does not prepare the neck to react to the demands of the sport.  It is TOP-DOWN.  The QB needs a BOTTOM-UP approach.  We’ll get there in a minute.

The middle one is manual therapy.  Yes, it may have it’s place in restoring motion and helping with symptoms.  But I wouldn’t put my money there.  It is very limited and does not prepare the tissue in regards to gravity, ground reaction forces, chain reaction, and overall performance.  It is passive.  It is TOP-DOWN as opposed to BOTTOM-UP.  The QB position is a BOTTOM-UP position at every level and with every move.  Why treat and train the neck in a passive laying down position?  If the neck could talk it would say, “Wow, this is great.  I love it when he’s on his back.  I don’t have to do anything.  Just so relaxing.  I can move better like this because Mr. Gravity is out of my way.  Wish the waiter would hurry up with my drink.” Then when Manning has to get back on the field, the neck might be more like, “Wait a minute, what the heck is going on here.  I’ve been on vacation, laying on the beach, and you want me to what?  Too much force coming up from the trunk.  I can’t open up that far as he takes the throwing arm back.  That follow through is killing me.  No way I can do all those looks down and across the field while the body is moving in opposite directions.  I’d rather him be on his back again.”

The pic with the guy that has his hands on his head in various positions is an isometric strengthening exercise scheme.  It is absolutely ridiculous.  Not in my house.  Completely artificial and has nothing to do with any sport.  As Rome would say…….NAAAAA!  BLOCKED.  Same for the next pic with the tubing wrapped around his head.  I’m surprised they didn’t wrap it around his neck since it’s a “neck” exercise.  BLOCKED!!

The last one with the Everlast chick sums it up.  It looks like she is slapping herself upside the head as in, “Duh, why did I do that?”  But actually this is an exercise.  It really is.  It’s so stupid looking you probably think I’m joking, I know.  But it’s another isometric exercise where she is pushing her head into her hand to get certain neck muscles to fire.  Hopefully I have made my point and you’re saying, “You’ve got to be kidding me, surely Manning isn’t doing this stuff?”  I don’t know for sure, but my hunch is that he has done some of these because this is the standard diet of neck rehab regardless of the context.  Unbelievable.

Traditional therapy and training uses a TOP-DOWN approach.  What I mean by that is they drive the neck on the body, hence, top-down.  Manual therapy drives the neck on the body usually laying down, the range of motion exercises above drive the neck on a stationary body, those strengthening exercises really don’t drive anything in that it is mostly stationary.  Everything is aimed at the head and neck with little to no attention paid to how the body moves and its impact on the neck.  This is not sport specific and neglects so many pieces of the puzzle that if left unchecked, could wreak havoc on the neck and decrease QB performance and his ability to execute on the field.

Typically, a post-op neck athlete will have limited motion (rotation or side bending) more on one side than the other.  For example, say Manning has limited rotation to the right.  Lets look at this from the TOP-DOWN and the BOTTOM-UP.  From the TOP-DOWN it’s pretty straight forward.  To get right cervical/neck rotation, you simply turn your head to the right.  Driving is more TOP-DOWN in that your body is mostly locked in and you turn your head on your body as needed.


Let’s look at right rotation from a BOTTOM-UP approach.  Manning’s eyes are fixed straight ahead with little to no movement from his head.  Manning then takes his right arm and reaches across his body towards his left hip (hint hint, as he would in a follow through of a pass), thus causing right cervical/neck  rotation because his body and shoulders moved left on his stationary head.  So…..arm, shoulders, body rotating LEFT on a fixed head causes RIGHT cervical/neck rotation.

It’s hard to find a perfect pic of this, but by time a QB follows through on the throw with his head and eyes fixed down field (unless a lineman is about to plow him over), then his body rotates left on a mostly fixed head causing right cervical/neck rotation.   Make sense?  Golf is a BOTTOM-UP approach: The head and neck are fixed and the body rotates around it.  Baseball is BOTTOM-UP: The batter rotates his body on a fixed head.  And yes, the QB position is a huge BOTTOM-UP driven position.  But this isn’t anything like “please turn your head to the right.”  This is power.  This is force.  This is fast and explosive.  This is QB quick release.  This is QB looks all over the field while his body is cutting and moving all over the place.  This is a ton of force being driven through that neck.  The neck is mostly the reactor and is NOT the initiator as in a TOP-DOWN approach.  Sure it is a combo of both approaches, but primarily it’s BOTTOM-UP.  And if it’s BOTTOM-UP then the elephant question in the room that needs to be asked is what?  You got it….why do all the other neck training exercises in the above pics? And what affect will the the rest of the body have on the neck?

If Manning can’t rotate through the left hip on the follow through as he transfers onto that left leg, then he could take the hit in his neck.  If he can’t open up through his right hip, core, scapula and pec on the right side as he cocks his arm back in the pocket then his neck can take up the slack for the lack of power generated and needed from below—-from the BOTTOM-UP.  The neck gets chewed up.  If force cannot be driven from downtown at the hips and core (or even the big toe) then a compensation will occur somewhere and in Manning’s case it could certainly happen uptown at the neck.  Even  if there were no deficits from below, he still needs to be trained from the BOTTOM-UP to help him deal with what he’s about to get himself into this season.

If I was working with Manning, I would look under every rock to find any possible biomechanical deficits that can play into his neck, or even his knee, to make him efficient as possible.   At least in reference to his rehab, every component needs to have a BOTTOM-UP, QB specific, position specific progression that drives his neck into intense parameters that will prepare him for the rigors of the game.  Anything less will set hip up for potential failure.

Just a few examples of a 3D BOTTOM-UP approach would be aggressive arm and trunk rotation drills with resistance (dumbbells, medballs, tubing) to drive the BOTTOM segment into as much rotation as possible, even beyond what he would normally do on the field, in order to expand the envelope so when he gets in the game his neck can say, “No problem, we’ve been doing way more than that.” I would do those drills with his neck fixed straight ahead and his body rotating all over the place with as much force as possible.  Then I would have him turning his head in the OPPOSITE direction so his neck would have to tolerate even MORE force and motion.  I would have him do this in a static position then dynamically going in a QB back peddle then shuffle drills around cones all with trunk and neck rotation drivers.  I would do my thing with the biomechanical analysis to see if there are any glitches in his legs or hips or even his ability to load off of his First Ray (Big Toe)  so he can generate all the power he needs to scramble or throw.

The BOTTOM-Up approach is a football approach, a functional approach, a 3D approach and can be configured into a QB specific program.

¹ESPN News “Peyton Manning had neck surgery”, May 25,

Michael Griffith