Inside the game
21
FEELING NO PAIN! Every week some AFL players need painkilling jabs to get on the field, writes Dr Jodi Richardson.
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OOTBALL is a highly athletic physical sport and players get injured. It’s an unfortunate part of the game and can have serious consequences for player and club. We only have to see the effect of Carlton captain Chris Judd losing game time with a broken nose and how that impacted on Carlton’s performance in Round 12 against the undefeated Saints. The injuries sustained in football are many and varied. Some, such as ACL rupture, can put players like David Hille out for a season; others are minor in comparison and though they don’t result in lost match time, they can be very painful. Pain is something that AFL players become used to handling, often continuing to train and play while enduring pain that would see most everyday sportspeople resting up. At times pain affects performance, resulting in lost training and match time and potentially causing the player to miss selection altogether. Under certain circumstances, local anaesthetic injections are used to temporarily relieve a player’s pain so he can get on with the job. Sports and exercise physician Peter Larkins explains that in the AFL, local anaesthetic is regularly used for stitching cuts if a player is sent off with the blood rule, but is also commonly and safely used for injuries such as mild sprains of a finger joint, mild sprains of ankle ligaments, heel pain (related to the plantar fascia), shoulder injury (AC joint injury) and occasionally for a sore rib. The pain of these injuries is relieved and the player can mark, kick, run and tackle without hesitation. Dr Larkins suggests that most likely every club will have a player with one of those injuries injected over a season. He emphasises that the injections are “performance normalising” – not performance enhancing – and that such decisions made at the super elite level of sport would not be made in everyday (medical) practice. “In the medical world, there aren’t many jobs where you would consider injecting somebody with a painkilling agent in order for them to do their job,” he said. “I think that only happens in elite sport. There are no other medical circumstances where that would happen.” Dr Larkins said the use of local anaesthetic for select conditions did not interfere with the long-term outcome of that injury. He added though, that the player’s pain levels can be worse the next day for having played with the pain block for their injury. Local anaesthetic for injury pain relief
WHAT A HEEL: Fev laments his painful foot condition earlier in the season.
‘In the medical world, there aren’t many jobs where you would consider injecting somebody with a painkilling agent in order for them to do their job.’ is more controversial when used under other circumstances, such as for the groin, and inside weight-bearing joints such as the hip, knee and ankle. “I think when you’ve got a chronic injury that a player is regularly getting injected to play because the injury isn’t healing, blocking the pain this week and blocking the pain next week, I think that’s really where there becomes real pressure on the doctor to decide that he is not going to keep doing that if the injury is not healing or is getting worse,” Dr Larkins said. He said that at the beginning of each season, the club doctor educated the playing group about the use of local anaesthetic, the benefits and risks. At this time the players sign informed consent paperwork, but may also be asked to do so at the time of an injection during the season. The use of local anaesthetic for an
injury is often trialled in training before use on game day. It takes some 30 minutes to take full effect, so on game day a player might have his injection after the team meeting but before the warm-up. After the injection, players will do some fitness work to test for the effectiveness of the “jab”. If they are not satisfied with the pain block, some can be seen heading back down the race to the rooms during a warm-up to see the doctor for another injection. Dr Larkins said long-acting local anaesthetic lasted one to two hours for footballers, where it would last four to five hours in an operating theatre. “When you are exercising, your metabolic rate goes up … so if you get a (pain) block prior to the game, often by half time the block has lost its effectiveness. Inside InsideFootball Football
“Players then have to make a decision with the doctor as to whether or not to have it redone at half time.” The use of local anaesthetic is regularly talked about among club doctors, and the use of it for injury pain relief varies markedly across clubs. Dr Larkins said while some clubs may use local anaesthetic for injury pain relief four to five times in a season, other clubs might average one injection a week. He adds that he knows of one team using 10 injections in one game in a final, and another using five injections in a home and away game, though these are exceptions. He added that there were separate rules in the finals and that clubs probably had a lower threshold for playing an injured player when the stakes were higher. “I think these decisions are a lot easier
Wednesday, June 24, 2009
when your club is successful, and I think there are certain clubs doing very well this year where the doctor might say I can get him back on the ground and they (coaching box) say don’t worry about it, we don’t want to risk him for next week, put him on ice. “I know clubs that do that. I reckon that’s a great attitude, I wish every club would do that and I’m sure the club doctors would prefer that also. “The problem is the clubs lower on the ladder with a lot of injured players already who are not travelling well and they’ve got a star player at half time who’s got an injury and they really want that player out there.” The decision about the use of local anaesthetic ultimately rests with the experienced club doctors considering the best interests of the player. Even though a player may be willing to put his own long-term health at risk for the sake of instant pain relief and getting back on the field, the doctors have a duty of care to the players and professional accountability and won’t inject against their better judgement. It’s wise not to, as things are known to have gone wrong with the use of this drug in sport. An infamous example was Collingwood’s Mick McGuane, who received an anaesthetic injection in 1994 that saw him “streaming down the wing at Victoria Park only to completely miskick the ball as his thigh and leg were numb from his hip injection”, Dr Larkins said. “Herein lies the dilemma of the use of local anaesthetic injections in and around the major weight bearing joints. They can lead to numbness, reduced power and loss of awareness of what the joint is doing.” A recent high profile case is Carlton’s Brendan Fevola, who has talked openly about heel jabs. There was speculation that his kicking inaccuracy was due to having a numb foot. Dr Larkins said, however, this was not the case. “It wasn’t because of the heel jab – his whole foot wasn’t numb it was only his heel, it wasn’t affecting the top of the foot or anything, but I guess he wasn’t training during the week and wasn’t doing his practice so he wasn’t getting his routine right.” There are no written guidelines for doctors to follow on the use of local anaesthetic due to the medico-legal implications that can result from any deviation to guidelines which would be considered “gold standard” practice. In fact although they are reported to be used in other professional football codes, there is little published research on the use of local anaesthetic injections at all.