A short-term fix

Jiri Dvorak, FIFA Chief Medical Officer speaks
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Such is the speed and competitiveness at football’s elite level nowadays that professional players can expect to pick up the odd bruise, knock or tear as they attempt to evade tackles or snatch the ball from their opponents. Faced with the prospect of missing out on their team’s next match as a result of such injuries, however, too many of these players are choosing to use painkilling and anti-inflammatory medication to alleviate the soreness of their injuries.

With most club and national teams nowadays having a team of eager reserves waiting in the wings to step in should one of the first team drop out through injury, there is an understandable sense of anxiety among players that missing a match could lead to a prolonged spell out of the starting eleven.

Yet while painkilling medication can be helpful in the short term, enabling the player to take to the pitch and reducing the discomfort he feels during the match, overriding nature’s warning signal in this way can have potentially dangerous side effects and jeopardise the player’s long-term career, and more importantly his long-term health, by masking serious underlying damage.

According to a recently published study by the FIFA Medical Assessment and Research Centre (F-MARC), players and team doctors are not paying sufficient heed to the dangers of overusing painkillers [the generic term for any medication, ranging from heat rubs to morphine, which helps to relieve pain] and non-steroidal anti-inflammatory drugs [medication used to decrease the inflammatory response that causes pain].

During the study, which was conducted at the 2010 FIFA World Cup™, FIFA’s Medical Department asked the doctors of the 32 participating teams to submit a list of the medications taken by the players in the 72 hours preceding each match. The results show that players are using higher levels of painkillers than ever before, with 34.6% of all players at the tournament taking non-steroidal anti-inflammatory drugs before a match, compared to 29% in 2006.

“The results are striking,” says FIFA’s Chief Medical Officer Prof. Jiri Dvorak. “Even at U-17 level, between 20-25% of players are taking anti-inflammatory drugs and painkillers and this increases at senior World Cups, where we see usage levels of between 30-35%.”

Side effects *Another surprising outcome of the study was the huge variation in usage levels between different teams. *

“In one team, there was not a single player using non-steroidal anti-inflammatory drugs before games, while in another team, 22 members of the23-man squad were taking some kind of painkilling agent prior to at least one of their team’s matches,” explains study co-author Dr Philippe Tscholl. “Some players even reported that they had taken up to five different non-steroidalanti-inflammatory drugs at one time.”

Non-steroidal anti-inflammatory drugs, or NSAIDs as they are commonly known, include over-the-counter treatments such as aspirin, ibuprofen and naproxen. However, their widespread use is a cause for concern among football’s medical practitioners.

“NSAIDs can have a negative effect on the functioning of the liver and kidneys, especially if a particular medication has been taken for a long time,” says Dvorak. “Some of the medications can also irritate the gastrointestinal tract, which can lead to internal bleeding of different magnitudes.”

So firmly established is the use of NSAIDs in modern-day dressing rooms that for many players, taking them is as much a part of their pre-match routine as tying their bootlaces. “Some of the players are probably taking anti-inflammatories without a prescription from their team doctor. They’re taking the medication first and then telling the doctor.

“Others are taking them under prescription from the doctor as they’re suffering some kind of pain or discomfort. But other players could also be using these painkillers in advance to reduce the pain caused by potential discomfort during a match. It has become a pre-match ritual for them. This could be very dangerous.”

One reason for this is the concern that painkilling medication may potentially be even more harmful to professional sportsmen than the normal population. Since high-intensity exercises such as football require a player’s kidneys to continuously work hard, medical experts believe that these organs are more vulnerable to damage from strong drugs.

Societal issue *For Dr Bert Mandelbaum, team doctor of MLS side Los Angeles Galaxy and the USA national team, the abuse of painkillers and anti-inflammatories stems in part from a wider societal trend. *

“As doctors, we don’t take chances with the athlete, but the use of anti-inflammatories is ubiquitous,” Mandelbaum told FIFA World. “All over the world, pharmaceutical companies are advertising ever more powerful painkillers for headaches and neck pain. It’s a multi-billion dollar business. People have grown used to reaching for over-the-counter preparations to deal with pain, and this circumstance is exacerbated in a sports team environment, where there are greater performance requirements and greater scope for soreness and injury.

 “I’ve never been pressurised to administer painkillers or anti-inflammatories by a coach or management,” Mandelbaum continued. “Most of the coaches I work with realise that a footballer has to play for 90 minutes, because it becomes a tactical problem for them if a player’s anti-inflammatory wears off and they have to make a substitution because the player is limping or unable to continue. If anything, the pressure comes from the players themselves. Players want to play. End of story. And they’ll do whatever they can within the Laws of the Game to play.“

Education crucial *With that in mind, FIFA medical chief Dvorak insists that the role of world football’s governing body should be to raise awareness of the risks. *

“Our duty is to educate medical and paramedical personnel and players. They have to understand that if discomfort or pain is being suffered, it means that something is not functioning correctly. By masking symptoms through painkillers, you could be covering something which could be important in the long run. For example, small cartilage tears can lead to larger tears and this can lead to the early onset of osteoarthritis.”

Dvorak has been appointed to lead a think tank, involving representatives from the International Olympic Committee and the World Anti-Doping Agency, which will conduct further research and make recommendations based on their findings. One of the wider issues the think tank will also consider is the optimum number of matches a player should play in a given season, following an informal poll taken at May’s FIFA Medical Conference in Budapest which showed that doctors recommend playing no more than 60 matches a season.

”Every individual needs time for rehabilitation and recuperation and that leads to the obvious question ‘are they playing too much?’ or ‘are they under too much pressure to play?’,” says Dvorak. “We have to realise that every individual takes a different amount of time to recover. My primary aim at FIFA is to ensure that football is promoted as ahealth-enhancing activity and that means ensuring our players are treated as humans, not products.” 

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