Painkiller addiction, broken legs and depression: the shocking toll of playing through pain revealed A wide-ranging investigation by i into the issue of players playing through pain

Calls have been made for Fifa to introduce radical new rules forcing footballers to rest between matches to stop players putting their physical and mental health at risk.

The proposal is made by a leading coach at one of the top six Premier League clubs, who would only speak to i on condition of anonymity and admitted that “we’re playing with players’ health”.

It starts with the blisters in preseason training — rubbing from those thin, often bright, fashionable boots. Next to hurt are the toes and the feet and the ankles. Soon it spreads wider as the body overloads from the relentless schedule of matches: lower back, upper back, hips, knees.

Playing in pain: the concept that virtually every single footballer playing at a high level has to come to terms with if they want to succeed. But at what cost?

An investigation by i has uncovered that coaches at the highest level are growing increasingly concerned with the culture of masking pain and injury and the disregard for the welfare of the players who push their bodies beyond their boundaries in the pursuit of trophies, glory, stardom and legend. That players are displaying signs of addiction to the drugs they are taking which, while perfectly legal, are potentially seriously damaging to their physical and mental health.

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Such is the extent of the issue that at least two of the top-six managers are beginning to question how far players are going to be pushed and at what point player welfare is placed ahead of the executives, television companies and money.

A leading coach at a Premier League club competing for the title, who only spoke to i on condition of anonymity, describes it as “playing with players’ health”. Some games are already ending in tears.

England defender Danny Rose believes the cortisone and platelet-rich plasma injections he had administered while recovering from a knee injury triggered his depression. Others are masking broken bones and some believe that abusing painkillers prematurely ended their careers. Players have shared stories of completely numb limbs and black outs, yet it is still an issue which many in the game do not want to discuss publicly.

When will football’s stakeholders admit there is a serious problem? Or is everyone getting so rich they’re happy to ignore the dangerous consequences?

In the beginning

It started, i has learned, around the 1990s, when cortisone injections first became common-place. Some believe they were used in the 1980s, but Alan Smith, a manager from the 1970s through to the early 2000s, does not think they became prevalent until the introduction of the Premier League, in 1992, and the advancement in medical provisions — staff, equipment and processes — through the increased television income suddenly coming into the game.

“You used to only have one physio and a reserve team physio and that was it,” Smith says. “It used to be you’d turn to the physio aand say, ‘Strap him up.’ But the medical departments increased. There are now more doctors than ever.”

Players were regularly treated for groin problems — known as Gilmore’s Groin, named after doctor Jerry Gilmore who pioneered research into the treatment of the condition in athletes — with cortisone injections. To properly eradicate the injury, an operation would’ve been required ruling a player out for up to two months, but regularly having injections would allow them to play on and on.

The method was applied to other joints to temporarily reduce symptoms, allowing the players to continue and keep their place.

Although injections are not as common now, they are still used today. Holland manager Ronald Koeman revealed Liverpool defender Virgil van Dijk has been requiring “constant injections” to allow him to play with two broken ribs.

Yet what developed from these beginnings was a culture of masking pain with medication, which has become so commonplace that coaches at some clubs will walk around offering tablets and many players take them as part of their daily routine.

Addiction

Nowadays, drugs categorised as non-steroidal anti-inflammatories, either available over the counter or easily prescribed by a club doctor, are rife. They include ibuprofen, commonly found in households across the country, diclofenac and naproxen. Abuse of these can lead to severe kidney damage, stomach ulcers and damage to stomach lining, and issues with blood circulation.

Former striker Jason Roberts, who retired in 2014 injured, spent almost two decades at professional clubs. “I’ve seen players get to a point where pain relief becomes part of the routine,” he says. “I’ve always done it: I did it Tuesday, I had a good game I’ll do it Thursday; I did it Thursday, had a good game, and so on. That is something that possibly needs to be looked at.”

Roberts once played on for an hour with a hairline fracture in his right leg. The 40-year-old will require two hip operations and has been advised not to run again. He has metal rods in several parts of his body. “My body hurts, I’m in pain all the time,” he says, “and I was lucky with injury, there are guys in much worse states than me.”

Another former player who played in the top-flight for much of his career says: “I struggled with injury for the majority of my career. I can count on two hands in 600-plus games, 21 years, 10 times I was 100 per cent. I needed a jab, to see a chiropractor, take something, always something. If you don’t put yourself on that park someone else will. The only difference now, mentally, physically they might not have to put them on the park for financial reasons. They can choose to come out of the team.”

Doctors who treat footballers are aware of players being administered painkillers before a match and at half-time, so they can make it through. Some cannot walk, let alone train, in the days afterwards.

When he retired from playing in 2016, former Liverpool defender Daniel Agger, who struggled constantly with a prolapsed disc in his back, told Danish newspaper Jyllands-Posten that his career was ended early due to misuse of painkillers. “The body could not cope with it,” he said. “I have taken too many anti-inflammatories in my career. It could be that others take a pill or two less.”

In the case of Rose, i has been told that the tablets and injections he had in an attempt to prevent an operation he required anyway extended his time out injured by four months, and the frustration and devastation at missing key games and his club, Spurs, doing so well in his absence, when he had been in the form of his life, were significant factors in his depression diagnosis.

Circumventing doctors

While some consider the issue to be reaching breaking point, it remains divisive. Manchester City manager Pep Guardiola, for example, has been savagely criticised for his disregard of player welfare.

Guardiola clashed with Bayern Munich club doctor Hans-Wilhelm Muller-Wohlfahrt when the pair worked together at the Bundesliga club. “He completely neglected the medical profession,” Muller-Wohlfhart told German broadcaster ZDF. “It was not about recovery of the players, but only freedom from pain. It was not about the healing of injuries, it was completely against my philosophy.”

One English player says: “Doctors and physios are under pressure all the time. I’ve been there where the doctor says he’s not fit and the manager says, ‘Forget you I’m going straight to the player.’ ‘I need you on Saturday, what are you going to do?’ You’re under pressure, you’ve already been told by the physio or the doctor you’re not fit. But you go, ‘OK, I’ll play.’

“That’s the pressure you’re under. The manager will only be there short-term. They need results. Are they worried about your health and wellbeing? No. They want three points, they want results. It’s cut throat.

“Some managers ignore you when you’re injured. They walk past you: ah, you’re always on the treatment table. It’s not a healthy environment to be in long-term.”

One Premier League sports scientist believes that if a player has more than six days off during the season, they lose 53 per cent of their capacity — physically and mentally — which takes six or seven weeks to recover.

“There’s an argument if they can’t play without painkillers maybe they shouldn’t be playing at all,” said innovative coach Wayne Goldsmith, who has worked with sporting organisations across the world. “It’s another one of those cloudy issues, just because the technology is available and advanced medicines are available should you be able to use it? The counterargument is — and it’s a pretty solid one — if I’ve got a player who can’t play without eight, nine, 10 painkilling injections, so they can’t make the field, is that actually a form of performance enhancement? What it’s saying is unless they’ve got that medical intervention, unless they’re getting those injections of painkillers, they can’t possibly play the game.”

Reputation damage

Ever been baffled why Daniel Sturridge is not at a top club playing regularly? On his day, Sturridge is one of Europe’s top striker, but as he has struggled for regular games over the years at Liverpool, he has not moved elsewhere. His manager, Jurgen Klopp, said in 2015 the player has to learn “what is serious pain and what is only pain”. Sturridge, it seems, has developed a reputation, simply from discussing pain.

“From a player’s perspective you never want to show any weakness to anyone, ever,” Roberts says. “Never want to show a weakness to the manager because then he might drop you next week. You get a reputation. Daniel Sturridge: a reputation as someone who can’t play through pain. The narrative is one of a lack of character. That’s where it becomes a problem.”

But it’s 2018? “We’re still in a sport and this sport is about winning and losing,” Roberts adds. “Often it’s couched in a lack of commitment. And also, not just players: by fans, managers, the whole environment sees you as a weak character, if the perception is you can’t play through pain. You don’t show weakness to anyone, ever. That’s the rule. So if you can play through it you do.”

An unwanted reputation for having the honesty and bravery to admit you are struggling has, it appears, been prevalent in football forever.

“In my day players were known for being ‘injury prone’,” Smith says. “That was generally the term — they’d be know on the circuit and avoided.”

It is probably why Tottenham and England midfielder Harry Winks appeared so affronted when his manager, Mauricio Pochettino, revealed to the world that the player had been complaining of pain after coming back from a lengthy spell out following an ankle operation. “It is not a healthy sport,” Pochettino said. “You push your body from a very young age.”

Excesses of youth

Therein lies another problem. As the talent factories churn on, constantly looking for the next star, developing players are being forced to play more competitive games than ever. Especially those at the top level, who are adding to fixtures with their clubs to competitions with England Under 15s, 16s, 17s, 18s, 19s, 20s and 21s. One grandparent who spoke to i, whose grandson is a teenager at Fulham’s academy, described it as “intensive” and was concerned how much football they were playing.

Thirty years ago, clubs would only see schoolboys twice each week and they would spend the rest of their time with their school.

The players obviously do not want to say no; it is their dream to make it and very few of them will actually enjoy a career as a professional player, even if they are under the wing of a leading Premier League club growing up.

But putting too much of a strain on the body while it is developing can set players up for a career of pain from a young age. “There is a problem at youth level, playing all the time,” the coach at the top six club says. “Some are in competitions with youth national teams. Competition, competition, competition. You don’t get the rest you need to train.”

Cultural change

It will take, key figures in football believe, the game’s leaders and rule-makers to make bold decisions to enforce a complete cultural change in the professional sport. For them to take an interest in the safety and health of players, and place it before money.

The game is divided. Some don’t want it to change, while others consider it a necessity and the next big issue in football. Some don’t think it possible, but major cultural changes that baffle older players have slowly happened in football before.

“We’re talking about a whole change of culture, which would be better for the players, I’m sure,” Roberts says. “Maybe there could be a change of culture. I saw things at the end of my career I could never ever imagine at the start, in regards attitudes towards playing.

“I’ve seen players happy to be part of a squad. That never existed when I first started. You had 11 players who started, two senior professionals who were out of favour and some kids. It was like clockwork. This is the 11, you know you could wait by the manager’s office, you’d seen one senior pro go, then the other, you’d hear 10 minutes of shouting, then they’d get back to it.

“Now, you hear a manager say, ‘I’m going with a different formation, I know you scored two goals in the last match but I’m going to leave you out.’ And the player says: ‘Yeah, OK.’

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“I couldn’t get that out of my head as a player. If you left me out, the manager knew what was coming. Now the players understand more, the tactical balance, different formations. So it could change.”

Until it does, players will continue to put their health at risk, in search of glory.