A wide receiver hobbles off the field with his arms wrapped around the necks of two athletic trainers because he can’t put weight on his injured knee. A linebacker is carted off the field and taken to a nearby hospital for evaluation of a neck injury.Football injury

As fans, we are acutely aware of injuries that occur in the NFL. We tend to pay attention to them in the context of the effects those injuries will have on our favorite team’s performance. Other players are ready to take his place, so we quickly return our attention to what we see on the field.

With recent studies regarding CTE and the long-term dangers of concussions, attention has started to shift to some of the effects of football on the athletes who play the sport. It’s more than head injuries, though. NFL data has previously showed that up to 68% of players may be injured in any given year. Those musculoskeletal injuries take a tremendous toll on the competitors and significantly impact their quality of life years after they leave the game.

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Impairment ratings of retired NFL players

Looking at impairment ratings, like those measured for people injured on the job, illustrates the problem. A recent study examined former NFL players who have been retired just over three years and were an average age of only 33.5 years old. They were found to have an average whole-person impairment of 37%.

These high impairment ratings were based on daily problems experienced by the former athletes throughout their bodies. The lumbar and cervical spines were the most common sites for symptoms, but players often reported issues at the shoulders, hips, knees and ankles. 49% of the players in the study had undergone at least one knee surgery at some point in their playing days.

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Criticism of the medical staffs of NFL teams

With the recent lawsuit filed by eight former players, including former stars Jim McMahon and Richard Dent, intense scrutiny on the methods  Young football player making a tackleof dealing with these injuries will begin. These players claim that the medical staffs of their teams failed to warn them of long-term dangers of narcotics and painkilling injections. They allege that team athletic trainers and doctors prescribed these medications without prescriptions and even contributed to the players becoming addicted to painkillers. Reportedly over 500 retired players have joined the lawsuit.

Toradol use increasingly questioned

If two of every three players suffers an injury every season, then examining how these injuries are managed is critical. Recently The Washington Post surveyed over 500 former players. Almost 90% of them said that they played games while hurt, and 56% did so frequently.

Toradol, the controversial anti-inflammatory medication that players often receive as injections before games, appears to be a popular method of pain relief. According to this survey, 7 in 10 players who retired after 2000 claimed to have received Toradol injections during their careers. Almost 80% of them did so to mask pain they expected to occur during the games.

Toradol use has come under fire due to its potential for serious side effects, including gastrointestinal bleeding and kidney damage. A 2000 survey of NFL team physicians showed that 28 of 30 teams used Toradol injections. Other studies estimate that about 15 players per team received these injections before each game. Current data isn’t available, but many think Toradol use is declining among many professional organizations.

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Use of narcotic medications among current and former players

Likewise, the use of narcotic medications to treat pain from these injuries will draw media and fan scrutiny. Researchers at Washington University School of Medicine surveyed 644 retired players to evaluate the use of these drugs during and after their playing careers.Football on field

They found that 52% of those players used opioid drugs during their careers, and 71% misused them. Interestingly about one third of them got the medications from a doctor, while 12% got them from a non-medical source. 51% of the players got the prescribed narcotics from both doctors as well as teammates, athletic trainers, coaches and family members.

Pain and quality of life of retired NFL players

The most discouraging finding in this study was the players’ health in retirement. While 88% claimed to have been in excellent health at the start of their careers, only 13% claimed to have excellent health after football. 93% reported dealing with current pain, and 81% reported their pain to be moderate to severe. It shouldn’t be surprising then that the use of opioid medications among retired NFL players is three times higher than in the general population.

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Where does football go from here?

Football is a dangerous sport. This lawsuit and studies like these will force us to ask tough questions. How should doctors and athletic trainers deal with players’ injuries and pain? How should players balance the long-term risk of playing through pain and injuries with the risk of losing their jobs? And should parents discourage their children from playing a sport that can affect their health in later years?

Note: This post appears in a modified form as my sports medicine column in the May 31, 2014 issue of The Post and Courier.

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Cottler LB1, Ben Abdallah A, Cummings SM, Barr J, Banks R, Forchheimer R. Injury, pain, and prescription opioid use among former National Football League (NFL) players. Drug Alcohol Depend. 2011 Jul 1;116(1-3):188-94.

Domb BG, Carter C, Finch NA, Hammarstedt JE, Dunne KF, Stake CE. Whole-person impairment in younger retired NFL players: The orthopaedic toll of a professional football career. Orthopaedic Journal of Sports Medicine. 2014 2:5.

Halchin LE. Former NFL players: disabilities, benefits, and related issues. Congressional Research Service Report for Congress; April 8, 2008.

Pain and pain management in NFL spawn a culture of prescription drug use and abuse. By Sally Jenkins and Rick Maese. The Washington Post. April 13, 2013.