Painkillers and Sports: Perspectives from the Bundesliga

Yesterday, VICE Sports' Aaron Gordon published an investigation into the dangerous and improper administration of "Toradol, a non-steroidal anti-inflammatory prescription painkiller widely used in professional and college football." The piece, which details a specific case at the University of Southern California, is excellent in its own right. In a broader context, it's an important example that adds to our growing understanding of the role pain management plays not just in American football, but in high-level sports of all kinds.

On New Year's Eve, Handelsblatt, the German daily business newspaper, published another example: a fascinating interview with Dr. Thorsten Rarreck, the former team doctor at Schalke, one of Germany's largest and most successful soccer clubs. According to Rarreck, who spent two stints at Schalke spanning some 14 years before being replaced in October after the appointment of new head coach Roberto Di Matteo, the use of pain medication in the German Bundesliga—much like the NFL and college football—is widespread and troubling.

Rarreck didn't mention Toradol, but he did speak about other "non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac," which are sometimes administered at high dosages, a practice he said was legal "but questionable." He also suggested these drugs are being used preemptively, much like USC's preemptive use of Toradol, which is a no-no.

"[The use of pain mediation] has greatly increased in recent years," Rarreck told Handelsblatt. "There are figures which show that more than two-thirds of the athletes regularly take painkillers in order to train and play."

Why this is happening comes down to pressure and the fact that elite sports take place on the razor edge of what's humanly possible. In the Bundesliga, Rarreck doubts team doctors are under orders to get players on the pitch before they're ready. However, assuming doctors aren't ordered to act unethically, they're certainly under implicit pressure to do whatever it takes to get players fit as soon as possible. Wins and losses depend on it. Regulations and a strict code of ethics might help doctors fight that pressure. But for players, whose professional careers make up only a small period of their lives, that implicit pressure weighs heavily. According to Rarreck, players are incentivized to take risks and play through injury in order to secure new contracts—or play in the World Cup.

Beyond the pressure, the modern game has changed in punishing ways. "The players run at least two or three kilometers more per match as they did ten or fifteen years ago," Rarreck told Handelsblatt. "They also have up to ten more competitive matches per season." Those extra kilometers come with a greater physical toll, something the World Cup and international soccer only exacerbate. (International soccer adds yet another wrinkle to this issue: medical regulations and oversight vary widely internationally. Treatment that might be frowned upon in Germany could be perfectly acceptable elsewhere.)

It's no wonder players seem to get hurt more. And it's no wonder they're searching for a means to stay in the game, to keep going. Their livelihoods depend on it. Painkillers are one way that's happening, but they're not a solution to injuries. Playing with injuries is dangerous. Painkillers might actually be making things worse.

"For me, the end of the line has been reached," Rarreck told Handelsblatt. "To be sports doctor for a Bundesliga club certainly has nothing to do with naturopathy. Whoever says otherwise doesn't know the scene at all."