This is what Andrew Luck being in Europe means

Admirer of ancient structures that he is – as a boy, he’d press his nose against the car window during weekend jaunts to Paris, or Madrid, or Berlin – Andrew Luck isn’t sight-seeing at the moment, scratching that nerdy architecture itch of his.

He didn’t travel 4,200 miles for vacation. He traveled 4,200 miles to get his shoulder working again.

“I’ve been in contact with him,” says Indianapolis Colts left tackle Anthony Castonzo, one of Luck’s closer friends on the football team he won’t take a snap for all season. “He’s working. Trust me. He’ll do everything he possibly can and go anywhere he has to in order to fix this.”

The Colts are 3-7, playoff chances vanished before Thanksgiving, and their star quarterback is in Europe, chasing answers to the conundrum that has cost him an entire season during what should be the prime of his career. That is: Why, 10 months after “a simple labrum repair,” as Colts owner Jim Irsay deemed it, is that throwing shoulder of Luck’s still not right?

For a potential solution he’s ventured abroad – exact location undisclosed – where the Colts’ franchise quarterback spent the bulk of his childhood while his father, Oliver, ran a pro football team and, later, a pro football league. He's there because the rehabilitation he’s done to this point hasn’t worked.

“He’s probably not convinced they know what’s going on,” says Dr. Luga Podesta, a regenerative orthopedic specialist at Bluetail Medical Group in Naples, Fla., who did not treat Luck but has consulted with multiple NFL teams about this type of injury and others. “They’ve given him some doubt as to how they’re treating it, or maybe his agent has some doubt.”

Or maybe Luck is, as Castonzo noted, willing to do anything, try anything, to get this nightmare over with.

Luck is abroad with the Colts’ blessing. All sides seek the same endgame: Him on the field for the 2018 season opener. Perhaps a stopover in Europe will get him there.

According to shoulder specialists and athletic trainers such as Podesta who are familiar with the alternative treatments Luck is exploring, these are maneuvers not readily available in the United States, where they are not approved by the Food and Drug Administration. The agency is expected to issue guidance soon on such treatments.

Luck’s hope: Maybe what fixed Kobe Bryant’s knee and Rafael Nadal’s back and Bartolo Colon’s elbow will fix his aching shoulder.

>> This isn’t abnormal.

What would’ve set off alarm bells decades ago – an American athlete venturing overseas for alternative treatment – no longer does. Scores of athletes from a variety of sports have traveled to Europe in the past decade seeking the very type of healing Luck is likely after.

“From my experience with elite level athletes, the world is pretty flat,” says Ralph Reiff, a veteran Indianapolis-based athletic trainer who is executive director of St. Vincent Sports Performance. “In terms of athlete development and health care, the ocean doesn’t mean much anymore. I don’t see this as being unusual at all.

“For the elite athletes, there are procedures and those who provide those procedures in Europe who have simply been doing it much longer than we have in the United States. And if you’re them, would you want to work with someone who’s been doing it for 20 years or for only five?”

>> What, exactly, is the treatment?

With no second surgery planned on the labrum Luck originally had repaired back in January, he continues to seek therapy and rehabilitation. The issue is the soreness that creeps in after Luck throws. “The shoulder is tied in a bunch of different ways, from the scapula to the other muscles around it,” Colts GM Chris Ballard explained earlier this month. “Getting them all to work together properly is a bit of the issue. (That) could be causing the soreness issues.”

The plan, then: No surgery, no throwing for the next few months, just rehab and strengthening. And, quite possibly, a biology-based treatment called Regenokine.

“My first thought was that he was in Germany to see a physician there named Peter Wehling, who a number of different athletes have gone to over the years,” Podesta said.

Wehling, based in Dusseldorf, Germany, patented the innovative procedure called Regenokine, a therapy in which the patient’s own blood is used for his benefit. Blood is drawn from the body, spun down to separate the healing and anti-inflammatory agents, then reinjected into the area of chronic pain. Bryant, the longtime Los Angeles Laker, raved about the procedure during the twilight of his career, vowing it saved his arthritic knee. Same with former Yankees star Alex Rodriguez, who reportedly went to Wehling for knee and shoulder pain. Same with golfer Fred Couples, who’s battled an aching back for a decade and then some. Same with dozens more.

Couples won a tournament shortly after returning from the Regenokine treatment, telling reporters he felt better than he had in 10 years. Bryant offered similar praise: “I can run, I can jump, I can run the track, I can practice every day,” he told Yahoo Sports then. “Those are things I couldn’t do (before the treatment).”

The Regenokine, according to Podesta, “is a series of injections over five days, six shots of a serum that’s developed.”

Luck could also very well be seeking stem-cell therapy while abroad, the same treatment Peyton Manning sought on four separate trips to Europe while he battled through his career-threatening neck issues in 2011. In the procedure, stem cells from somewhere else in the body – usually bone marrow or fat – are introduced into the injured area, and the healthy cells regenerate and repair the damaged ones. Though not identical treatments, the thinking behind Regenokine and stem-cell therapy is the same: the body heals best when the body heals itself.

In the U.S., the FDA regulates human use of biological products including blood, tissue, genes and cells. The agency has said these products can be only minimally manipulated before being subject to regulation.

The treatments have long been accepted in Europe, which is why scores of professional athletes seeking a solution to chronic pain in their knees, shoulders, backs or whatever else, have trekked across the Atlantic for the treatment. Any use of Regenokine or stem cell therapy by Luck would not violate NFL policy because the treatments don't involve a foreign substance, only those of his own body.

“It doesn’t surprise me at all that he’s over there,” Podesta explained, “but there is a lot of controversy (about this procedure). Should we use it or not? There is a lot of work being done on this now. There are some studies that have come out of France that have shown some excellent results with rotator cuff repairs.

"They say it works. We’re just not sure for how long.”

>> The potential of another (minor) operation

Dr. David Chao, an orthopedic surgeon who spent 17 years as the team physician for the San Diego Chargers and now runs the site ProFootballDoc.com, has followed the Luck saga closely over the past several months and written about it extensively.

His question: Why don’t the Colts take a look into Luck’s shoulder and find out exactly what’s going on?

The thinking: A scope into Luck’s shoulder – a minor operation that would set him back roughly two weeks, Chao says – is far more accurate than an MRI and could reveal what the nagging issue is, possibly inflammation or scar tissue in the shoulder or that the labrum has not healed completely.

That way the Colts would know whether a second surgery is required or rehabilitation is indeed the best course of action over the coming months.

"Not trying to second-guess the care that Luck has gotten, but what is the downside of a scope?" Chao said. "Can Luck and the Colts afford to wait until February to start throwing and not know until April if his shoulder will be pain-free with activity?

"At this point, I think it is time to solve the mystery," he said. "Looking inside is much more accurate than relying on an MRI."

This is an injury, remember, that was originally sustained in September 2015. It required pain-killing injections. It forced Andrew Luck to play a full season hurt. It stripped him of an entire year of football. It led him to fly across the globe in search of answers.

Its impact is stretching into 2018, and not until Luck steps foot on the field for a regular-season game will the ever-growing concerns be calmed.

Call Star reporter Zak Keefer at (317) 444-6134 and follow him on Twitter: @zkeefer.

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