Of all the things to worry about with Johnny Manziel, his health was never a particular concern until now. Manziel has been sitting out practice all week with elbow soreness, something he said he’d battled since high school and which the Browns believe is a function of his throwing motion: it’s a fundamental problem.

Coach Mike Pettine announced yesterday that pain in Manziel’s right elbow flared up again for the second time this month and isn’t getting better fast enough, so his No. 2-listed QB will miss the Browns’ crucial third preseason game, the one that traditionally most resembles the regular season in speed and intensity. It’s a wasted opportunity for Manziel to take a step to unseat Josh McCown, who has failed to impress in camp, and maybe a harbinger of future issues.

Pettine tried to downplay the seriousness of Manziel’s pain, saying the QB could “more than likely” play if he had to. But it was worrying enough for the Browns to send Manziel for an MRI, which didn’t turn up any structural issues. And though Manziel never missed a game at Texas A&M, Pettine revealed Manziel has struggled with pain in his throwing elbow since his high school days.

Elbow pain in a quarterback is somewhat rare: a standard throwing motion is instead particularly rough on the shoulder. But Manziel’s dropdown motion is different, Pettine explained, and more of that torque falls on the elbow.

“As [offensive coordinator John DeFilippo] talked about, sometimes when a guy drops the elbow and has that three-quarter release, it’s going to put a little bit more pressure on the elbow than it is on the shoulder.”

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The Browns don’t intend to change Manziel’s delivery:

“I think that’s an advantage that he has,’’ said Pettine. “There are times he’ll change his arm angle to make a throw. If you stick with your traditional throwing motion, the ball’s either going to get knocked down, (or) you’ve got a guy in your way, you’ve got an outstretched arm, you want to go ahead and drop the ball down a little bit and make a throw.’’

But there’s danger in doing nothing, too: the risk that Manziel could unconsciously alter his motion to avoid pain, and in doing so start to mess up other things in his arm. Former Browns QB Tim Couch says elbow tendinitis led him to tweak his delivery, which he believes caused him to require two shoulder surgeries that shortened his career.

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Meanwhile, the Browns will find another arm to replace Manziel, for as long as that ends up being necessary. They’ve said they won’t convert WR Terrelle Pryor back to QB, and will work out Pat Devlin today. Tyler Thigpen, Josh Johnson, and Jason Campbell have also been mentioned as possibilities. That’s a short-term concern though; the much larger one is Manziel, who came in with so much hype, missing out on valuable chances to prove he could live up to it.