Suffering from Chronic Pain? You Favorite NFL Players Are Too.

American football is the most popular sport in the country and shows no signs of decline anytime soon, with even college-level play becoming a national spectacle and some high schools producing multi-million-dollar football stadiums for their athletic departments. Even as watchers tune in from across the country each week to watch their teams face off, they may be unaware of the pain players go through in order to provide their entertainment. Today, we’ll be taking a brief look at common injuries that football players face, how players respond to those injuries, and what the National Football League (NFL) is doing about them.

Even fans of the sport can’t overlook its aggressive nature -- for some, big hits and pileups are the main attraction. Every play, particularly those that are ended by contact, reminds the audience how violent football can get. Even in full protective equipment, those hits can cause serious damage to players’ bodies. Concussions, spinal cord injuries, broken bones, and ligament/tendon injuries are particularly common. While not every injury is career-ending or even game-ending for a player, it is imperative that medical staff take even suspected injuries seriously and verify their condition before sending them to the locker room or back out on the field.

Concussions are among the most dangerous injuries suffered by players because they increase the rate of incidence of chronic traumatic encephalopathy (CTE), a degenerative brain condition triggered by repeated blows to the head. While no method yet exists to diagnose CTE in living individuals, it is known to follow a four-stage progression starting roughly eight to ten years after the repetitive injury. The symptoms are largely neurological, but manifest in ways that make differentiating CTE from other degenerative conditions difficult. Dozens of former players have pledged to donate their brains to the Concussion Legacy Foundation after their deaths, when it is possible to definitely diagnose CTE.

Injuries to the neck and spinal column can lead to chronic conditions. Pinched nerves tend to recur and cause numbness in the player’s extremities, typically sidelining the player. Damage to disks, on the other hand, is quite painful and can potentially be season-ending. Ligament injuries tend to occur in the knees due to the movements carried out by football players and the fact that the legs carry the body’s weight. There are four ligaments in the knee joint: anterior cruciate (ACL), posterior cruciate (PCL), medial collateral (MCL), and lateral collateral (LCL). The ACL is not only the most prone to injury but also takes the longest to heal, sidelining some players for up to two years. This is not to say that the other three are quick and easy recoveries, however -- any injury to a knee ligament will cause severe pain and hinder mobility. Rest, braces, or surgical intervention may be required depending on the grade of the injury.

Clearly, these players are facing a level of risk and harm unknown to the average person. In addition to the physical and emotional stress they suffer every week on the field, many of their occupational injuries tend to leave lingering chronic pain. How, then, do they recover between games and find treatment that fits their lifestyle? The sad and unfortunate truth is that many players simply do not receive the level of care that they need, for a variety of reasons. Some players may choose to play through an injury, knowing that the corrective surgery necessary would end their career. Even if the treatment isn’t career-ending, many are reluctant to step away from the game and get help for fear of looking weak or letting their team down. This complex situation breeds an uneasy culture of drug abuse in the absence of proper interventional pain management.

Before games, many teams offer their players a potent nonsteroidal anti-inflammatory drug (NSAID) known as Toradol. Essentially, Toradol is stronger version of Advil or Aleve with more rapid onset. Some players describe it as a means to “zap” their pain away, though none claim that it reduces their pain to zero. Initially, very little was known about Toradol besides its seemingly effective pain-relieving qualities. As players began experiencing side effects, however, some began to turn away. Even in the absence of side effects, the initial pain will always come back as the drug wears off. This is because Toradol merely masks the sensation of pain, rather than addressing the root of the problem. Despite all this, Toradol is far from the riskiest relief available -- that dubious honor belongs to opioids. A 2011 study commissioned by ESPN and performed by Washington University in St. Louis School of Medicine found that over half of the retired players they interviewed used opioids over the course of their career, with over 70 percent of those admitting to misusing the drugs. When doctors prescribe opioids to players, there is a high probability that at least some of the prescription will end up being shared with teammates. Use of opioids without a prescription naturally precedes abuse or addiction, which could point to why retired NFL players abuse those medications at a significantly higher rate than the rest of the population.

Some players lament the fact that, per league policy, they cannot use marijuana for pain relief while the more dangerous opioid prescriptions continue to flow freely. This policy may even be responsible for sufferers of chronic pain turning to opioids for relief. So what does the NFL make of all of this? Though the current substance abuse policy that restricts marijuana use isn’t going anywhere for the moment, it has been challenged by both owners and players and seems likely to encounter further resistance as misconceptions and stigma surrounding marijuana fade with increasing legalization. The NFL has made progress elsewhere, though, such as their revamped concussion protocol and their investment in equipment and CTE research.

Their new concussion protocol emerged in the wake of an incident in which a quarterback for the St. Louis Rams sustained a concussion after a dramatic hit without being removed from the game, drawing heavy scrutiny from both players and doctors. In addition to generally screening more effectively for concussions, the new protocol enforces severe punishments for teams that fail to remove players who have sustained concussions. In a similar effort, the NFL pledged over one hundred million dollars to concussion and CTE research in 2016.

Though the league has a long way to go in terms of addressing player health concerns, their ongoing commitment to research and safety paints a hopeful picture of its future.

Maheen MohammadComment