Labor of Pain : Pro Football Hurts, but That Doesn’t Stop Many From Playing It

Tim Green, a former defensive end of the Atlantia Falcons, tells a story about pain and pro football in his book, “The Dark Side of the Game.”

A teammate had broken his thumb and a surgeon had inserted a pin in the thumb to hold the two pieces of bone together.

The player was in the lineup a few days later and, during the combat, the pin worked itself out of the bone and broke through the skin.

The player was experiencing so much pain in other areas of his body, however, that he didn’t notice the stainless steel pin jutting from his thumb.

Not until he was at home, hours later, did he notice it, when the bloody spike dropped into his salad.

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Clever instrument, the human body. Against all the protests of the creature inhabiting it, the body understands that pain is good. It’s nature’s early-warning system.

Yet the body’s best-laid plans are frequently short-circuited by those who dwell within, who seek to dull pain. By that measure, professional football players must be among the worst tenants a body ever had. Football players should be required to put down security deposits, so badly do they treat their bodies.

The adage “No pain, no gain” accurately reflects the prevailing attitude in pro football. Playing with pain is the norm in the NFL, where players often take the field with catastrophic injuries, their bodies held together by splints, athletic tape and their own iron wills.

As chronic pain and its management have increasingly become part of the landscape, so have the painkilling agents--from ice packs to injections of Novocain and ingestion of narcotics--with addiction, disability and even death the result.

Pain doesn’t exist until it is perceived. In the NFL, pain is not acknowledged but denied, as by Gary Plummer, a linebacker for the San Francisco 49ers.

“Pain is acceptable to me,” he said in an interview conducted only days after undergoing the 14th operation of his career. “It’s something I don’t even think about. When it’s in the football season, I feel nothing until after the game. Of course, it hurts, but you focus. In the off-season--ask my wife--I’m a baby if I get a cold.”

Physicians can lecture about the benefits of rest and rehabilitation for injury, but there’s no pressure like peer pressure to make a player cast off crutches and dance a jig.

“It’s one of my roles,” Plummer said. “I’ll go right up to a guy in the locker room and ask him, ‘Why aren’t you going to play? What’s going on?’ You say it in a joking way, but they know what you’re saying. I know it sounds barbaric; it’s a form of peer pressure, but the pressure is very strong.”

NO PAIN, NO GAME

Tuesdays are the worst, when the bruises and pooled lactic acid are felt the most. It’s the day off in most teams’ practice schedule, although the training room is usually teeming. Recovery takes more time as players get older.

“It used to be that I had a little limp after the game,” Plummer, 36, said. “Then I’d feel it Monday. Tuesday was bad. But by Wednesday you’re practicing again. Now, I don’t feel right until Friday, and you play again Sunday.”

Plummer used to get through the week with painkillers, Percodan and Indocin, but they interfered with his sleep and caused stomach ulcers, so he quit. Now he uses the anti-inflammatory drug Prednisone, which features aggressive behavior among its many side effects.

Plummer and others say the pressure to ignore pain comes from the need to be in the game. Some coaches have a rule: no practice, no game.

Players, even the most intelligent, are their own worst medical advisors. The culture of football requires them to play through pain.

Quarterback Steve Young of the 49ers had to be mightily persuaded by a neurologist to sit out a game this season after suffering two concussions in two weeks.

“There’s a part of me that’s like Dr. Jekyll and Mr. Hyde,” Young said. “It’s a part of me that just doesn’t care. Let me run into something.”

It was the Dr. Jekyll side of Young that insisted on taking about 20 shots of Novocain to quiet his injured ribs so he could play in a playoff game.

Leigh Steinberg, agent to Young and others, said that NFL players and coaches view pain and injury differently than the rest of society.

“For most of us, long-term health is important,” he said.

Steinberg has conducted head-injury seminars for his clients, who shrug off the gloomy information like teenagers laughing at gory films in drivers’ education. Steinberg remains frustrated by his clients’ defiance of chronic pain.

“If there’s ever anything that would stop me from representing athletes, it would be the unrelenting pain [they suffer],” he said.

Statistics for NFL injuries are scarce, but it was claimed in a football lawsuit that a player seven years in the league will absorb 130,000 full-speed blows. Data released by the NFL Physicians Society for the years 1980-88 showed there were 16,200 casualties--the doctors’ word--65 per team, per year, or about three per team each week.

Pain, injury and sports are such kinfolk that exercise-induced injury has led to a tenfold increase in the number of sports-medicine clinics in the United States. Football injuries have spawned a cottage industry. After the First World Congress on Pain was held in 1976, pain clinics--usually run by anesthesiologists--began to multiply.

Yet, there is little sympathy for the chronic pain players experience. The average salary is $800,000, and many fans believe that being a professional football player is the greatest job available. The question--sounding vaguely like the lyrics of a country song--remains: If it’s such a great job, why does it hurt so much?

Consider that in the annual Jobs Rated Almanac, football player ranks 220th among 250 professions, just above nuclear plant decontamination technician. Under the heading of Environment and Job Description--ranking No. 247--major and minor injuries are cited as “sources of stress in this profession.”

It has always been so. The 1925 Rose Bowl game featured Pop Warner’s Stanford team against Knute Rockne’s Notre Dame squad. Stanford’s Ernie Nevers played both ways, was on the field the entire 60 minutes . . . and had two broken ankles. His only analgesic option was a heavy wrapping of athletic tape.

Injury doesn’t have to be the result of a crunching tackle. Even celebratory pileups can maim.

“There is no way you can understand what it feels like to be on the bottom of a pile and your ankle is twisted one way and your knee the other, with 1,000 pounds of guys on top of you,” Plummer said.

According to experts, pain and injury can evoke responses in an elite athlete that mirror the stages of grief: disbelief, denial, anger, bargaining and depression. Only the final stage is frequently missing among pro football players--acceptance.

Doctors say denial is the most dangerous.

Sociologists call it “the culture of risk.” Dr. Stephan Walk at Cal State Fullerton has studied athletic trainers and pain management among athletes.

“When you talk to trainers, their biggest complaint is that athletes don’t do their rehab and they deny their pain,” he said.

Many point out the potential conflict of interest inherent in being the team doctor, who is paid by the owner, who has a vested interest in keeping his players in the game.

“My problem with sports medicine all along has been that the physician has clouded loyalty,” said Dr. Doug Coleman, who treats elite athletes and also practices addiction medicine in Vancouver, Canada. “The emphasis is on performance. Start with the fact that these doctors call their patients ‘athletes.’ That implies a double-standard. Patients are patients.”

ON PILLS AND NEEDLES

Ice, although effective, is considered a crude form of pain intervention. NFL locker rooms at halftime resemble military triage units. Wounds are dressed and dehydrated players are hooked to IV drips. Joints are shot with cortisone or Novocain.

The use of painkillers is necessary and widespread. Some say their abuse is also common.

Brett Favre’s story is a case in point.

“The wonder is that there aren’t more Brett Favres,” Steinberg said. “The reality is that for most football players, pain is a never-ending constant.”

Last year, the Green Bay Packer quarterback spent 46 days in rehab for his dependency on Vicodin, a prescription narcotic painkiller. His addiction became evident after surgery to remove a bone spur and bone chips from his ankle. He had a seizure, a sign to his doctors that he might have a dependency on Vicodin.

Favre is wall-to-wall injury. He played the 1994 season with a hernia. Before the 1995 season was half over, he had a bruised throwing shoulder, turf toe, a bruised knee, a sore back and arthritis in both hips. He has played on a badly sprained ankle and through numerous concussions.

Favre’s pain is cumulative. He has had five operations in six years, including the removal of 30 feet of his intestine after a car accident when he was in college. Favre still suffers from back pain as a result of that 1990 accident. And yet, Favre has started 79 regular-season games in a row.

Favre’s is not an isolated case. Pro football players are prodigious self-medicators. Some teams make drugs easily available. Some players horde drugs left over from old prescriptions. Some get them from Mexico. In any event, drugs are there, with little stigma attached.

Says Rob Huizenga, former team physician to the Raiders, “I think the question should be: Should you be allowed to play if you are in so much pain that you require pain medication? Is it appropriate?”

Laura Giffin Audell, a pain specialist and former director of the Pain Center at Cedars-Sinai Medical Center, said sending patients who experience chronic pain back to work is complicated by the specifics of the job. Those who like their job and are eager to return, like football players, are willing to tolerate more pain.

Addiction, she said, is often a component of treating patients with pain.

“It’s important to make a distinction between addicts who take narcotics for the euphoria they feel and those who need the drugs to kill pain,” she said.

Some people, like Favre, develop a tolerance for a painkiller, so that more and more of the medication is needed. Audell said it’s the body, again, trying to allow the pain information to get through. Narcotics attach themselves to the body’s pain receptors. Once the body recognizes that the pain receptor is occupied, it creates more, so that more of the narcotic is necessary to block the pain.

Not all painkilling drugs are narcotics, and not all require a prescription. Americans spend more than half a billion dollars a year on ibuprofen, the generic anti-inflammatory and pain drug that is sold as Advil, Nuprin and Motrin. Even though such drugs are sold over the counter, they can be dangerous unless used as directed. Abuse of these nonprescription painkillers is estimated to be responsible for as many as 25% of the cases of end-stage kidney disease in the United States.

Still, anti-inflammatory drugs fill cookie jars in many training rooms and players take as many as 20 a day.

Even if the athlete is deeply in denial, and coaches look the other way, someone along the health-care road is supposed to detect a problem and file an FDA Form 1639 Adverse Reaction Report. Such attention might have prevented some of the increasing number of medical malpractice lawsuits, which seem sure to get the attention of team owners:

--This week, a federal judge ruled that former San Diego Charger lineman Walt Sweeney was entitled to $1.8 million from the NFL pension plan for football-caused disabilities, including a dependence on painkilling drugs.

--Kenny Easley sued the Seattle Seahawks after suffering kidney failure, alleging that his problem was the result of his taking huge amounts of Advil, which he got in the training room. Easley has since had a kidney transplant. The suit was settled out of court.

--Another former NFL player, Pittsburgh Steeler receiver Buddy Dial, charged that his kidney failure was the result of painkillers team doctors gave him for chronic back pain.

--Former Raider John Matuszak died of an accidental overdose of Darvocet, a prescription painkiller.

--Charley Krueger, a former 49er, successfully sued the team and its orthopedist for malpractice. He testified that he had received numerous injections of cortisone and Novocain in his knee without being advised of the possible consequences. He testified that during a game, a piece of bone in his knee chipped off. He limped to the sideline and was give a codeine pill. He went back in on the next play.

--Former Raider Curt Marsh, after more than 14 operations on his broken right ankle, finally had his leg amputated below the knee to end the cycle of pain. The injury was exacerbated by misdiagnosis and years of playing on the severely damaged joint.

Marsh took anti-inflammatory drugs and regular shots of Novocain.

“I was motivated,” Marsh said. “I had already played with pain on other occasions, and I felt like it was my responsibility to my teammates.”

As his former teammate, Matt Millen, said, “You shoot up and hope for the best. That’s the medical school we graduated from.”

Arnold Mandell, psychiatric consultant to the Chargers from 1972-74, observed to his horror the widespread use of amphetamines on the team and around the league. Mandell, writing in the Journal of Psychedelic Drugs, noted what he called “The Sunday Syndrome”: “Repetitious stereotyped pacing, uncharacteristically obscene swearing, episodes of violent vomiting and diarrhea, white-lipped staring and rageful demeanors.”

Mandell found the drugs were used for the customary “speed” effect, but he was surprised to find that players also favored amphetamines to dull pain. In his research paper, Mandell offered one interview in which a player said he used amphetamines because they “stop all the pain. . . . I can’t play without it, even in important practices.”

That era in the NFL featured games with so many players under the influence of so many pharmaceuticals that the on-field maxim was “Keep an eye on the droolers.”

Perhaps the most effective painkillers aren’t available from a physician or pharmacist. Endorphins, the body’s private stock of painkilling chemicals, have much the same effect as morphine.

Problem is, doctors say, your body must be in a state of extreme stress to produce endorphins. Situation normal, say football players.

TRAIN WRECKS AND STINGERS

How’s this for a simple equation: Hitting leads to injuries and injuries cause pain. Yet it is the impact that many players lust for and miss after the injuries from them have ended their football careers. The kinetic energy generated by strong, large men running into other strong, large men is substantial, and its shock runs through the body like an electric charge.

Former 49er safety Ronnie Lott, like so many defensive players, was a master at inflicting pain. He crystallized the experience in his book, “Total Impact”:

“If you want to find out if you can handle being hit by Ronnie Lott, here’s what you do. Grab a football, throw it in the air, and have your best friend belt you with a baseball bat. No shoulder pads. No helmet. Just you, your best friend, and the biggest Louisville Slugger you can find.”

Joey Browner, a former all-pro safety, has his own definition of total impact: “Like a train speeding up your spinal cord and coming out your ear.”

These impacts crunch bones, skew joints, tear tendons and snap the brain stem so that gray matter collides with the cranium. Spinal cord injuries and nerve damage occur, called stingers or burners by players.

Green, the former defensive end, describes a stinger: “The only description I can think of is someone plunging a thick rusty dagger into your neck while at that same instant the knife is struck by a bolt of lightning.

“When I think of a stinger, the image of tears is the first thing that comes to mind. I can see myself staggering in place in the defensive huddle, trying to keep from toppling over like a tower of poorly stacked blocks, with tears streaming uncontrollably down my face from the pain. I would emit a primal growl of anger in defiance of the pain that was threatening to force me to my knees.”

Plummer says, “Stingers--now they call them pinched nerves. I’ve had 150 of them. If you don’t come off the field disoriented and seeing stars, you haven’t busted your butt.”

One reason former players sue for compensation over injuries is because they frequently aren’t able to get medical help to deal with the lingering pain. They are stupendously uninsurable.

But despite the pain--and sometimes the crippled bodies--they are left with, most football players would do it all over again.

“I know in the back of my mind I’m doing permanent damage to my body,” Plummer said. “I know that I’ll feel the effects of this in the future. It’s a trade-off. In June and July, you forget how much it hurts. I get excited to play again. I’ll miss it when I stop.”

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Breaks OF THE Game

Why do they have injury reports in the NFL? According to data gathered by the league, through the NFL Physicians Society, there were 16,200 “casualties” from 1980 through 1988. That works out to about 65 per team per year or about three per team per week. And breaking it down anatomically:

FACE-SCALP: 2%

HEAD-NECK: 12%

SHOULDER: 8%

TORSO: 8%

HIP-PELVIS: 23%

FOREARM-HAND: 7%

KNEE: 23%

ANKLE-FOOT: 17%