- Irish Ian
- Site Contributor
- Posts: 12246
- Joined: Fri Jan 18, 2019 5:53 pm
- Location: Directly above the centre of the Earth.
Not the first time Elite sport has thrown up Health issues either
Robbed from the Athletic
EX FOOTBALLER SURVEY " I'M IN PAIN EVERY DAY AND
CAN STRUGGLE TO WALK EVEN FOR THREE MINUTES"
After Bukayo Saka’s man-of-the-match performance against Aston Villa in March this year, Villa manager Steven Gerrard was asked about the Arsenal winger’s post-match interview, in which he called for more protection from the referee “when the opposition is trying to kick me”.
“It’s part of the game,” shrugged Gerrard (referring to physicality and aggression). Saka, he said, was an “outstanding talent” but had to learn that there are some things in football you simply don’t complain about.
“I’m sitting here now with screws in my hips,” said the former Liverpool captain. “I’ve had about 16 operations, I’m struggling to go to the gym at the moment. That’s all on the back of earning a living in English football. He’ll learn and he’ll learn quick.”
Gerrard has clearly accepted that a career in football ends in a lifetime of daily discomfort. Does that mean everyone else should accept that, too? And if he’s right, how many ex-pros are struggling to live life to the full, held back by bodies that won’t allow them to move freely or without pain?
The reality of what happens to players’ bodies after a career in football was one of the key findings from The Athletic’s ex-footballer survey, in which over 100 former professionals were asked whether they had developed osteoarthritis since the end of their playing careers. Some 36 per cent answered “yes”. Given that nearly half the people taking the survey were aged 35-44, it’s an arresting statistic.
A follow-up question asked whether, considering their quality of life now, they felt the medical support they had during their career was good enough?
Of the 110 total respondents, 54 answered “no”, with the top three reasons given including “physios not good enough” (16 responses), “forced to play through injury” (13) and “having to take injections” (11).
Although the survey was completed on the condition of anonymity, a number of former players agreed to be contacted to talk in more depth about their experiences (some only on the condition of it being off the record).
One such individual, who fits into that 35-44 age bracket and has tackled the daily discomfort of osteoarthritis in his wrists, knees, ankles and back by moving to a warmer climate since retiring, says he will discourage his son as much as possible from following in his father’s footsteps. “There is no duty of care, basically. And that’s the worrying thing. You’re looking for a governing body — someone to look after you — and it’s not there. Because essentially you don’t know what you don’t know when you’re in it.”
He recounts an example from his own career, when a groin injury forced him to have surgery under general anaesthetic. That was on a Monday, and the following Friday he was asked to have a fitness test by the club’s physiotherapist. “I couldn’t lift my arms above my head, which as a goalkeeper is quite difficult. The goalkeeper coach said, ‘This is bonkers, I don’t know what you’re doing here’. I told the physio I wasn’t fit for the game the next day and I won’t repeat what he said, but it was basically, ‘You can go and tell the manager’.”
He did just that. On his way home from the training ground, his phone rang. It was a senior member of the club’s board asking him what was going on.
He reels off other examples, like the time he got knocked out in a game and was told by the physio, “The manager says you’re not coming off.” Or playing on a broken ankle from November until May, when he finally had it operated on. “I was told it couldn’t get any worse [so might as well play on],” he says. “So many stories like that where you play knowing you’re injured and you shouldn’t be playing.”
Player knowledge and education can play a big part in trying to avoid these kinds of situations, says former Everton, Rangers, PSV and Manchester City player Michael Ball. Looking back at his 16-year career taking in more than 200 games, Ball tells The Athletic he regrets not being strong enough to say “no” to playing through injury. “It was quite a regular occurrence,” he says of playing through pain. “Firstly, for myself, because you don’t want to miss out. You want to play. But also not really understanding the seriousness of the injury you have.
“While you’re playing and doing well you feel like it can’t be that bad. It can’t be that serious. Being young and naive, you’re listening to the physios and you’re listening to the manager. So you just play and as long as you’re playing well, you don’t really think about your body. But the weeks and the games start taking their toll. And then your body breaks down. It’s only when you get older and wiser that you understand it.”
Ball was at Everton when he started suffering with pain in his right knee. To try to avoid an operation, he was given two cortisone injections, both of which initially left him in excruciating pain. He describes how the needle was inserted without the use of ultrasound guidance. Instead, he was asked to show the doctor where the pain was and a black pen was used to mark the spot.
“With patella tendonitis, it’s very difficult to find the actual spot that’s causing the sharp pain so I just put my finger on my knee and said, ‘It’s round about there’, but sometimes I couldn’t even find it myself.
“I was in agony after that first needle. When I went back for the second one, I told the doctor I was in really bad pain for four or five days. I couldn’t walk. And he said, ‘Oh, no, you shouldn’t be like that, you should be fine’. He said it shouldn’t happen this time around. But then it did; exactly the same thing.”
Everton declined to comment when approached by The Athletic.
Ball left Everton in 2001 after five years to move to Rangers, where he lasted 10 games before the right knee that had been troubling him for the previous 18 months finally “blew up”. He was sent to the United States to see renowned knee specialist Richard Steadman and an ultrasound scan revealed surgery was the only option for Ball’s patella tendon.
After the operation, Steadman asked Ball what procedure he’d had done in the past. “I told him [about the injections] and he said, ‘How did they administer it? Was it through an ultrasound needle?’ I said, ‘No, it was just a black marker pen’ and his face dropped.”
Steadman told Ball he’d found crystallisations around and inside his patella tendon and that he now had “only one fresh tendon left. He had to kill everything else away. He explained how I got this injury and that was because I wasn’t managed correctly in the first place: Not training and then playing at a high level will put your body at risk. It’s going to have an impact on you. Not just now, but in future life, after football.
“That was quite a shock to me. It was probably my first ever realisation of the long-term effects that putting your body through situations you’re not really understanding is going to have on your life.”
Ball continued with his career. Later he played on again through pain in his right knee, this time because he was chasing a new contract at Manchester City. The club had new owners and money to spend and Ball knew that taking time out to rehabilitate an injury could scupper his chances of having his contract extended.
“I was waking up and coming downstairs on my backside and then travelling from Liverpool to Manchester for training. If I sat down I couldn’t lift my right leg up. Sitting on a physio bench, I used to put my left foot behind my right calf to lift my right leg onto the bench. But I could play football on it.”
At the end of 2008, Ball played two games in the space of four days (Saturday-Tuesday) and it pushed his body over the edge. Another knee operation followed. “Then, when you come back after your operation, the manager pulls you in and says, ‘Sorry, at the end of this season I have to let you go because you’re going to be no use to me for the next six months or so and I can’t afford to wait for a year for you to come back’.
“So it was putting your body on the line chasing a contract just to keep playing football. Really pushing your body. I should have been braver.”
The problem is “bravery” isn’t always well received in elite sport. Ball describes a situation during his time at PSV when he was instructed to play a game on a 3G pitch to improve his fitness. He’d been warned by Steadman not to play on that surface and told the assistant coach he would play the match, but not on 3G. “That was it, I was kicked out of the first-team dressing room as weeks went by and put into the reserve team changing room until January. So trying to take care of my body played against me in that situation.” PSV declined to comment when approached by The Athletic.
Now aged 42 and a decade after retiring from football, Ball admits he is not in the best place physically. “I piled the weight on pretty quick after football. I put on maybe half a stone or a stone straight away and over the years it’s gradually gone up. I don’t go to the gym. I don’t like going for a run or playing football with my friends because I know for two or three days afterwards my knee’s going to be in agony.
“I don’t want to be limping around. I don’t want to be putting pressure on my body so I just don’t do it. It’s not the healthiest way but I found that’s the best way. I can sleep well. My arthritis apparently hasn’t kicked in yet. So I feel the less load I put on my body, the better it is. Whether that’s right or wrong, it’s just the way I’m getting on with things.”
Ball now runs his own agency (CCR Sports) and uses his experiences to try to help players avoid his fate. “I speak to clubs, sporting directors and even players’ parents to try to find the right balance. It’s difficult because players just want to play. They’re not thinking of the bigger picture. But I feel clubs and the sports science staff do have to be impartial a little bit.
“Medical staff want the best for the football club. But I think the protection of the players, which I’ve seen first-hand recently, is really important. Injuries are part of football. They happen, but I feel clubs can do more to protect players from having these sorts of long-term illnesses or injuries after football.”
It was a knee injury that ended the career of former Chelsea, Tottenham and Ipswich defender Jason Cundy. An incident on the training ground crushed and split the cartilage in his right knee and meant that, at the age of 30, his professional football career was over. Although when he first retired he was still able to be physically active — walk, run and play in charity games — a few years later he was in agony, unable to walk for longer than 10-15 minutes.
Jason Cundy played for six clubs during a 12-year career (Photo: Mike Hewitt/Allsport via Getty Images)
Cundy went to the Professional Footballers’ Association (PFA) and they helped him get an operation that vastly improved his quality of life. “I had screws and a plate put in there and it meant I could walk, take the dogs out — it improved dramatically.
“But over the past three or four years, it’s got worse again and I’m in pain every day. I sometimes struggle to walk three or four minutes and I get this pain in my leg. Even a walk around Tesco for 10 minutes can leave me with this burning sensation that goes down the outside of my right leg into my knee. I wake up in the mornings and the first thing I do is limp to the bathroom.
“I just live with the pain. It’s part of my life now, unfortunately. I try not to take too many painkillers. But unfortunately, there are days when the pain is just too much and I have to take them.”
During his time at Spurs, the 52-year-old also struggled with a back injury that went undiagnosed for almost a year. He was eventually told it was a bulging disc that was touching a nerve and causing him pain. “I went to see three different surgeons about what they were going to do with my back and each one gave me three different operations that they thought would rectify it. Where do you go with that? I would ask them, ‘What if this operation doesn’t work?’ And one of them said to me, ‘Well, you better pray’. I was in a world of turmoil mentally.”
Cundy eventually sought help via the PFA, who got him a referral to a physiotherapist on London’s Harley Street. A six-week course addressed the root cause of his pain (an imbalance in strength on the right and left side of his back) and gave him daily exercises to do for the rest of his career in order to keep pain and injury at bay. He never suffered a serious problem with his back again.
Former Leicester City winger Matt Piper went under the knife more than 20 times during a career that was cut short at the age of just 26 — 17 knee operations, three hernias and two ankle surgeries. His final three knee operations were conducted by Dr Steadman, who left Piper in no doubt as to his fate if he continued to try to play on: “He said, ‘Your body’s already gone through too much’. He painted the picture of what life would be like if I tried to continue. He said, ‘By 40, you’ll be in a wheelchair if you carry on’.
“At the time, I was playing Premier League football on a really good contract. But I’d already had my first two children by then — little boys who were growing up, they were four and three at the time. And I was like, ‘No, I want to be able to play with them in the back garden’ and stuff like that. So, at that point, I decided that’s it.”
Piper didn’t know it, but his most serious problems were about to begin. As he told The Athletic, without any direction in his life, he turned to drink and drugs, drinking a litre of whisky a day on top of the Valium he was taking to combat his increasing anxiety and depression. It destroyed his relationship with the mother of his children and when he was at his worst, left him unable to see them. “The injuries harmed me way more mentally than they ever did physically,” says Piper, who turned 41 this week. “When I quit due to the injuries, the stuff I went through for the first three years was horrendous.”
Though the mental scars have faded and Piper has found a new focus in owning his own academy in Leicester, the physical consequences of what he went through while still a player remain. He doesn’t do any on-field coaching at his academy and has to weigh up the consequences of playing in any charity games he’s approached about. “I’m an ambassador for a few charities that I’m really close to,” he says. “But I have to ask myself, ‘Will it be beneficial to the charity me doing it? Will it help them raise more money and raise the profile? Because if it does, I’ll do it. But it means that for three or four days after the game I can hardly walk.”
At some point soon, Piper knows he’ll need two knee replacements. ‘’It’s been bone on bone for years. My injuries were always cartilage and cruciate ligament based. Because the cartilage has very little blood flow, it doesn’t heal, so when you tear it, they just have to take that part away. So by the time I retired at 26 I didn’t have any cartilage left in either of my knees. That’s why when I do play now I get such pain and swelling in my knees.”
These days he takes cod liver oil and glucosamine to try to manage the pain. He knows that doing leg weights in the gym will leave him in more pain, so he steers clear. But that is also part of the problem: “It’s a vicious circle. Because if your muscles aren’t strong then you have more impact going through your knee. But if you do vigorous leg workouts, then my knee starts to swell and hurt.”
Piper received frequent injections in his troublesome joints during his playing career, though these weren’t the usual cortisone shots. “I had very few steroid injections. The ones I had most of and which they were just sticking in my knees and ankles every week for two or three years were called sucrose injections.
“It’s basically like a sugar injection which causes an irritant to the body inside the ligament. That makes the body respond by sending blood there and trying to thicken that area to protect itself. It was called ‘fringe medicine’. So it wasn’t to mask pain, it was just trying to create a stronger ligament.”
The needle used to administer the sucrose into the middle of his knee was “so long it used to bend” and Piper recalls being given a small injection of something in his arm first to help with the pain: pethidine. “This was a little bit risky because as I found out after football when I had my problems and started experimenting with different kinds of recreational drugs, I’ve clearly got an addictive personality.
“Pethidine is a cousin drug, really, to heroin. So every time I turned up I’d say, ‘Doc, make sure you give me that pethidine before you do the big one’. I got hooked. He’d basically put this pethidine in and all of a sudden I’m telling him I love him. Stick anything you want in my knee, doc, I don’t mind. It’s like Valium, but stronger.”
Piper was later diagnosed with something called lax ligaments, which meant his joints were less stable. When you place them into scenarios like top-flight football, where those joints are exposed to high speed and forces, it exposes the cartilage to persistent damage. Piper believes there is little that could have been done to prevent the issues he had, though he will always wonder about the first knee operation he had, which was carried out by a non-specialist knee surgeon.
Moments before Piper was placed under general anaesthetic he overheard the surgeon making a phone call to a knee surgeon to ask whether the operation he was about to do was, in his eyes, correct. “When I woke up there was a huge chunk of cartilage in a little plastic holder. I said, ‘Has that come out my knee?’ And he said, ‘Yeah, it was a huge bit that I had to take out’.
“If that was a proper knee surgeon that did it, I don’t know if they would have taken that amount of cartilage out. Obviously, the medical profession is evolving all the time. If I was playing now, I don’t think I would have had 17 knee operations. The way they would have managed me would be different.”
The improved finances in football in recent years means the medical treatment available to players at the top level is certainly vastly improved from where it once was. But how much does that matter if the priority and focus is all on results ahead of player welfare? One ex-pro who spoke to The Athletic on condition of anonymity believes this tug of war is going to be “the next big thing within football” along with mental health.
He questions the efficacy of club welfare officers, describing them as “dogsbodies” who are more focused on sorting out players’ gas bills or council tax than looking after these young professionals. His view is that the big agencies within the sport should be bringing in people who are solely concerned with duty of care. But the response from the game to this suggestion has been depressingly predictable.
“They’ll say, ‘Yes, it’s the right thing to do. But we can’t find a fiscal return for it. So until you find a guaranteed way of making money on it, then you can’t do it’.
“It’s, ‘who cares?’ Literally.”
Fast forward 10 years or so and today’s players probably will.
"Football is about the people and the players,” he said. “Then there are those who will mingle in the middle: the coaches, executives and journalists. That last group represents the worst part about football" Marcelo Bielsa