Pain management in sport – the hidden killer

I went for a jog this morning to loosen the legs. A cruciate ligament injury from 2013 and too many knocks mean that putting my feet on the ground in the morning can be a tough ask.

I spoke with a sports injury specialist when I was home about pain management – he reckoned I was mad doing what I was, i.e. not taking anything.

Don’t get me wrong, I’m not a martyr or idiot. I just am very wary of pain management with drugs.

In 1996, a doctor who was attached to our Provincial side in Canada offered me an injection to get me “over the worst of it” before a pre-season game with the local University side.

I was recovering from broken ribs and in the position I played (workhorse midfielder) being unable to run meant I was redundant. I popped a couple of aspirin and made the injury worse.


Pain management in sport

My friend’s father was an Orthopedic Surgeon in Prince Edward Island, Canada. He served as Team Doctor for most sports teams there, including the pro hockey ones.

His stories of injecting cortisone and even morphine into players to get them up for or down from matches fascinated me. I was pretty naive in this regard and my couple of aspirin got me through the game, training or night.

I never thought of doing anything else.

Up in the A-League, in Montreal and Hershey, I saw something completely different. A then Canadian international was getting painkilling injections directly into his knee.

As one of the senior players with European experience, I wouldn’t have begrudged him sitting out the odd run, but the team doctor souped him up every time.

He told me after one two hour long running session that pain management was vital for him.

In tennis I used to get players to rest or withdraw rather than taking painkillers or injections. One Russian player had a regular routine of a massage, injection and a mildronat tablet before matches.

We changed the routine (bar the mildronat) and if her leg/ankle was tight, she iced and rested. It was difficult to get into her head, however when she listened she suddenly excelled.

Released from her contract with us, she went back to her old ways and, despite personally warning her and her mother about the damaging routine, she pushed the self-destruct button.

Playing a normal shot, she went over on her seriously unstable (and unfeeling ankle) and did catastrophic damage.

We could hear her screams from the other side of the Olympic Arena and the WTA trainers and officials decried the court, not the injections and misguided massage.

Since coming back she’s had to manage both injury and pain; a physical trainer who worked briefly with her in Moscow maintains she will need a hip replacement by age 30.

Pain management in football

I’ve already briefly mentioned a personal experience, so surely in 20 years things have changed for the better.

Question: has anyone read Roy Keane’s biography? Painkillers before every match, injections. And then the inevitable joint replacement.

Let’s go retrospectively using proven information from the “Biggest Sports Show on Earth” (tm Coca Cola) the World Cup.

During Brazil 2014 67% of players received medication of some form, 54.2% of players took non-steroidal anti-inflammatory drugs (NSAID), 12.6% took analgesics.

This number, of course, doesn’t include the uncharacteristically high number of asthmatics, though that’s a different pot of spuds.

Of 736 players, almost 500 were getting injected or pill-popping.

The abstract to this study concludes that administration of such medication needs to be reduced – by continuous education of players from a young age, and also medical staff!

Two years later and studies were showing that more than 90% of professional players were taking NSAIDs before or after exercise!

Again the report states – more education is needed for coaches and athletes. Football outstripped cycling (12%) and distance runners (70%) in consumption of Ibuprofen.

With everything else used by professional players, it’s not just education that needs to improve.

So it didn’t improve after 2014’s warning, but before? In 2012, two years before the carnival of football in South America, FIFA’s Chief Medical Officer was warning about dangers of painkiller usage.

This report was picked up by media and the sensation of “almost 40 percent of players at the 2010 World Cup in South Africa were using painkillers before every match” was recycled and forgotten.

FIFA’s study, which was published in the British Medical Journal, didn’t use the words “pain management”, instead describing the practice of players being souped up with NSAIDs and other drugs as being “potentially catastrophic”.

The year before the FIFA jamboree in South Africa, in 2009, another FIFA backed study was published using data from six FIFA tournaments for female and youth players. It is titled “The Use and Abuse of Painkillers in International Soccer”.

Two simple statistics – 1. 10,456 medications uses 72 hours before matches by 2,488 players participating in six international tournaments, and 2. Average of 0.63 substances per player per match (under-17s, 0.51; under-20s, 0.51; women, 1.0; P ≤ .001 [without contraceptive medication, 0.85; P < .001]).

These are youths and women. So that 90% of male professional players on NSAIDs is not looking too off the mark.

An odd finding is that across the three groups less than 2% of players used asthmatic medication – very interesting considering the high level of asthma sufferers among elite athletes, one puffing pic in this puff piece tells you all you need to know about the “pain” of top level stars.

How the “clean” Paula Radcliffe managed to outpace all those cheats with her asthma, we’ll never know.

Pain management after

We met in a Dunkin Donuts near Kievskaya Train Station. Not the most salubrious of surroundings for a player who I once saw sign a deal for $5,000 a week. Vanya, I’ll call him as that’s his name, was a tough ball-winning midfielder who was wasted in Russia. We got him trials in Germany and France, he stayed local as that’s what he wanted.

He had 12 years as a professional before finishing at a club in the 2nd Division Centre. The club cancelled his contract when he physically broke down in pre-season. He was 30.

He has just moved back to his nice converted four bedroom apartment in an expensive development in Moscow having spent two of the last four years since retirement virtually homeless.

He left the family home voluntarily as he was no longer able to continue the pain management he received while a footballer.

Problems with his right hip meant he couldn’t lie down and expect to stand up unaided, so for six months he was sleeping in an armchair.

His irritability and mood swings scared his wife and three kids to a point where Olga, his wife, called me when I was newly arrived in Voronezh (2013).

Using a plethora of pills he was unable to find relief and realised that it was only getting worse. Moving to a $4 a night workers hostel he shared a room with 19 others.

A graduate of a Premier League Academy whose lifetime earnings exceeded $4 million slept next to Tajik, Kyrgyz and Uzbek labourers. He survived on charity from myself and some friends.

His insurance contract from his final club was invalid as the premium was never paid and the players union (PSFT) ignored his requests for assistance.

Last March, when I moved back to Moscow, I made it a mission to meet with him regularly and try get him home. He was in turn remorseful, angry, ashamed and hopeless.

In July, he eventually went into a local hospital where myself, Olga and some former team-mates paid for his hip replacement operation.

When we met in Dunkin Donuts last week he was walking freely, in a Dublin GAA polo shirt (a gift for his birthday in 2011) and with his eldest son (now seven).

Vanya had lived with pain since he was 11 years old when over – and poor training destroyed his developing body. He is due to have his other hip replaced in 12 to 18 months, though his method of pain management is yoga.

Having endured his darkest hours as a result of the overuse of painkillers, he is now on a job hunt.

We love our heroes to play through pain, we all think we can/will do the same.

We love seeing the combative centre back cream a nippy striker and you only have to feel the rise of energy when a match turns nasty to realise how little we have moved from days when slaves slaughtered one another for the amusement of free folk in ancient arenas.

Despite FIFA’s best intentions to clean up the game and the orgasmically reported scandals of doping in tennis, cycling and rugby, very little is written or spoken about a real epidemic in sport.

If addiction to painkillers is a problem for US soccer moms, apparently for professional soccer players it’s business as usual.

The Author

Alan Moore

Russian-based sports journalist, commentator, radio host & consultant. Worked with major clubs including Hajduk Split, Eintracht Frankfurt, Lokomotiv and Spartak Moscow. Current host of Capital Sports 3.0, former international boxer and semi-professional footballer and FIFA World Cup commentator.

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