The NFL season began last week and for the first time since 1998, Peyton Manning was not leading the offense for the Indianapolis Colts. The reason: He is recuperating from neck surgery.

In fact, Manning underwent three procedures over the last several months. His story demonstrates some of the dangers inherent in severe disc injuries.

The spine is very complex. It is composed of bones, joints, ligaments, nerves and intervertebral discs.

The discs are a little bit like jelly donuts. They are tough on the outside and have a softer substance in the middle.

When a disc is subjected to a lot of force, it can herniate. The jelly is squeezed out of the disc and it can place pressure on nearby nerves. This condition, called a herniated disc, can be extremely painful.

Disc disorders like Manning’s affect a large number of athletes. The parts of the spine most commonly affected are the neck, or cervical spine, and the lumbar spine, lower in the back. Of the two, injuries in the neck can be more painful and more difficult to heal without surgery.

There are a number of conditions that can make discs more vulnerable. Smoking, arthritis of the back and some forms of heavy lifting can predispose patients to back problems.

Genetics play a role, too, and most people I see with back problems can think of relatives similarly affected.

Frustratingly, even small movements can cause discs to herniate in susceptible people. I have seen patients herniate their discs by turning around to back out of a parking space.

There are two approaches to dealing with disc injuries. The first is patience. Over time, our bodies begin to metabolize the herniated material and stabilize the disc.

Our discs never really heal in the sense that they’re always anatomically abnormal. Once herniated, a damaged disc will always be prone to re-injury, but symptoms improve and most people lead normal lives.

Working on neck strength and motion is essential. Injured necks become stiff, and stiffness leads to advancing arthritis and pain. Most people with disc problems should be working with a physical therapist to improve neck strength and stability.

Occasionally, patients do not have relief after waiting as much as eight weeks. In some cases, this is because the herniation is too large to re-absorb on its own or because the patient is developing symptoms of nerve damage.

These patients typically undergo surgery to stabilize the disc. A surgeon can clear out some of the extruded disc material and relieve the pressure on the adjacent nerves.

If decompression procedures don’t work or if the disc is so severely damaged that material keeps herniating out of it, another type of procedure is used. Surgeons can remove the entire disc and do a spinal fusion, which sometimes involves metal rods that connect the bones in our spine and prevent movement.

These are not minor procedures and can lead to stiffness and increased risk of disc injuries elsewhere in the spine. A fusion usually is done when there are no other options.

If you’ve got a neck injury and especially if you’re feeling pain radiating into your shoulders or arms, your disc could be affected.

Your doctor can diagnose the problem and steer you in the right direction.

Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the U.S. ski team.