Football injuries: are players playing too many games?

Spain has defeated Italy, 4-0, in the Union of European Football Associations (UEFA) cup. After using all 3 substitutes by the 61st minute, Italian fans were devastated to see their player, Thiago Motta collapse to the ground, untouched, grasping his hamstring. Italy was forced to play on with 10 men. This saw their chances of a comeback from 2-0 down disappear.

As highlighted by our previous blog, expert opinion from a recent FIFA medical conference has stated that players should be limited to 60 games per year. This recommendation has come about with the increase concern over the long term effects of injury to cartilaginous tissue and  osteoarthritis. Reduced recovery times and an increasing number of games per season have been suggested as a major contributing factor to this problem.

This pattern could be no more evident than in the UEFA cup final where Italy was reported to be burdened with overuse injuries. Take, for example, right back player Giorgio Chiellini who in the first half came off the ground with an apparent left hamstring injury, the same injury that kept him out of the quarter final against England. Then there was the midfielder, Daniele De Rossi, who came off in the quarter final against England with a reported sciatic nerve problem and was nowhere near his playing best during the final. Then there was the substitute midfielder Thiago Motta who replaced Riccardo Montolivo for being exhausted. Four minutes later Motta suffered a hamstring injury which saw him being stretchered off the pitch and leaving Italy with no substitutes to replace him. Interestingly Motta’s physical fitness had been questioned during training in the lead up to the game.

Dr Peter Brukner, former head of Sports Medicine and Sports Science at Liverpool Football club, has previously drawn attention to the fact that most players at World Cup and European Championships will not only play several games in a short period of time, leaving less time for recovery but will most likely be carrying some minor injury. Last month Dr Brukner published an online article titled ‘Young players must be warned of the dangers of painkillers’ in which he highlights the dangers of long term use of non steriodal anti-inflammtory drugs (NSAIDs) to mask the effects of ongoing injuries. In some instances, proper recovery time and rehabilitation should be utilised to get a player back to top playing performance.

The new edition of the Clinical Sports Medicine textbook addresses the issue of NSAIDs in sport in Chapter 13, titled “Treatments used for musculoskeletal conditions.” This fully updated section highlights recent findings from prevalence studies. For example one study of the 2003-04 football season found that 86% of 743 Italian professional footballers were current users of NSAIDs. Another study demonstrated that NSAIDs were the most commonly used drug for Canadian athletes at the 2000 summer Olympic Games. So what are the side effects of NSAIDs and could this have anything to do with Italy’s injury woes in addition to poor recovery time during the EUFA grand final? For more information refer to Chapter 13 for NSAIDs and Chapter 15: Principles of rehabilitation.

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