Tired footballers playing in pain

By Terence J Babwah, Team Doctor, Trinidad & Tobago Football Team

soccer

In response to “The use of medications and nutritional supplements during FIFA World Cups 2002 and 2006” it must be stated that elite footballers suffer from playing too many games during a season. In elite Europeans leagues, it is not uncommon for some footballers to be eligible to play 70-75 games in a season which includes league and knockout games together with Confederation Competitions and
International matches. Even in some smaller leagues like in the Caribbean, some players may partake in 50 odd games during one season and even at the youth level some players play 3 full games per week. The end result is that players get tired and eventually get injured. Footballers suffer medical problems similar to the general population and most injuries are mild and soft tissue in
nature.(1)

As a Team Physician, there are some injuries that players have which would not prevent them from training or playing especially low grade tendinopathies and entheses. These injuries are not usually
recorded in epidemiological studies as the players do not usually miss training or playing as defined in some studies and so are under-represented in such studies.(2)Players soon learn that they can
get relief with painkillers and be allowed to play with minimal discomfort. They take painkillers and play and this cycle continues until the injuries worsen and they now have to get more formal treatment. An injury may result in the first full break that a player has for years. There is rarely any time for full rehabilitation and having a reduction of pain to an acceptable level to play is usually the
prerequisite to return to play.

Team Physicians are under tremendous pressure to return players to play that there has been a shift to alternative techniques like mesotherapy, biopuncture, injections of haemolysed calf blood and widespread use of steroidal (anti-flammatory) injections all in an attempt to hasten recovery of players.

Players get tired and may take supplements in an attempt to improve performance, reduce fatigue and may feel that they have to take supplements in an attempt to keep up with the competition. Coaches were rightly identified as being influential in footballers taking supplements. Most players do not take supplements on the recommendation of the doctor.

If there is to be a reduction of pain medications and supplements taken by players then there must be a reduction in the number of games that a player plays per season. This may mean a reduction of
competitions within an individual league.It may mean expanding squads to play players in a rotation scheme. This needs urgent looking into. Secondly evidence based injury prevention programs need to be implemented at all levels of football to reduce injuries.

References:
1.Babwah TJR,Rogers R. The team physician in football:What skills are important? International SportMed Journal 2008;9(3):108-115 (available at http://www.ismj.com)

2.Ekstrand J, Walden M, Hagglund M. Risk for injury when playing in a national football team. Scand J Med Sci Sports 2004;14:34-38

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