Down on their knees: The footballers who are kicking themselves

The football season is drawing to an end and for many football supporters this close-season promises to be even longer than usual. There's no World Cup to look forward to as there was last year and no European Championship as there will be in 2004. It's going to be a long hot summer but not everyone will be disappointed. For some former footballers the break from soccer, and from the memories it ushers in, is as welcome as the holiday sunshine.

Remember before last year's World Cup when the tension was thicker than Des Lynam's silver locks. If the fans are excited, imagine how the players feel. It's the highlight of any career. West Ham and England striker Geoff Hurst scored 248 goals but he is famous for just three. And remember Paul Gascoigne's despair when he failed to make the 1998 England squad? But at least Gazza, who wept his way into history at the 1990 tournament, did get perform on football's greatest stage. Others weren't so lucky.

In 1986, Manchester United goalie Gary Bailey couldn't wait for the World Cup. It was February, the eve of Mexico 1986. He'd already played twice for England and been invited to the squad's pre World Cup training. But it wasn't to be. He never made the tournament that gave its name to the famous wave, never saw the Argentinian genius Diego Maradona defeat England with the two goals that arguably rank as the worst and the best the World Cup has ever seen. Would the taller Bailey have caught the ball that Maradona punched from Peter Shilton's outstretched fingertips? Who knows. Bailey had broken down at training camp with the knee injury that would force him out of the game just a year later. He had arthritis.

'Like so many facets of soccer, you only find out about the risks of arthritis through experience,' says Bailey now. He's not alone. Footballers with arthritis could fill Old Trafford. Take Tommy Smith MBE. In Rome in 1977 Liverpool's hard man defender scored the goal that brought the European Cup to Anfield for the first time. Twenty years later, seriously disabled and using a wheelchair, he was up before an appeal tribunal after his Disability Living Allowance was stopped - apparently by an Everton-supporting DSS employee. 

Coventry University's recent pioneering survey of professional footballers found that nearly half — 49% — had osteoarthritis with an average age of onset of just 40. Many had had joint replacement surgery. It's not a subject the glamorous world of soccer likes to dwell on. The Coventry survey, which included players from the biggest teams in the land, tells of unsupportive clubs, insufficient information, botched treatment, insurance companies refusing to pay out, emotional and physical pain, dependency on prescription drugs and financial hardship. 'I was very nearly suicidal,' said one player. 

Sports physician Dr Tom Crisp says: 'the biggest problem I see is players not being allowed to recover from injury.' Gary Bailey agrees. 'I played again with the injury not because I was ready but because the club had injury worries and needed a keeper. After five games I could hardly walk and that was the end for me as a pro.' As physiotherapist Peter Evans of the Association of Chartered Physiotherapists in Sports Medicine puts it: 'Physios can advocate rest but at the end of the day clubs are commercial businesses.' And players, however well-paid, are commodities.

Crisp stresses that, in general, exercise protects against arthritis. 'For a park player the benefits of regular football in terms of fitness and joint strength far outweigh the risks.' But for the elite it can be different. 'Football is the sport with the greatest risk of injuries which could lead to arthritis,' says Crisp. 'Obviously, the more games you play the greater the risk. Young players are particularly vulnerable because of their relatively immature skeleton and any injuries they do get are more likely to shorten their careers. Having said that, if they don't get injured there may be less risk of osteoarthritis later on.'

The main risks facing footballers are soft tissue injuries to muscles, tendons and ligaments, especially in the legs — these account for about 70% of injuries.

Since 1998, the FA has been auditing all footballers injuries with those to young players of particular interest. 'Injuries could be caused by playing too many games too young,' says Richard Hawkins, of the FA's Medical Education Unit. 'The trend for young players here is to play 40 games a season. This is far more than in the rest of Europe.' The FA has been promising a research paper on this for some time and it hasn't yet appeared. Another sign of just how high - or low - players injuries are within the game?

At the time the FA survey was launched, Dr Phil Bell, a GP with a special interest in sports medicine, told the BBC that the fact that adolescents' bodies are relatively immature puts them at greater risk of injury. 'For young sportsmen, the intensity and the training of their matchplay has greatly increased,' he said. 'If you impose that on a relatively immature musculo-skeletal system, they are more prone to injury.'

He said that adolescent and adult athletes were affected by different types of injury. 'Teens are more likely to suffer injuries at the growth plates - the centres of growth of the bone - and the attachment points for tendons,' he said. 'Adults are more likely to suffer tears to the muscle and ligaments.'

Younger athletes are particularly vulnerable during times of increased growth, Dr Bell said. The long-term risk is that promising young athletes may have to drop out of sport before they fulfil their potential.

As an aside, osteoarthritis isn't the only form of the disease that young players should worry about. A recent survey found that they're also particularly prone to sexually-acquired reactive arthritis. For researcher Paul Oyudo, the explanation was simple: 'They are very rich and have lots of spare time'. Rich enough to buy condoms then, with time enough to put them on.

And by the way, if you're watching the Cup Final this month, remember that it's not just playing the game that can damage your health. During the last World Cup, one Scottish fan yelled at the telly so much that he made himself deaf. And in Holland when the Dutch team were knocked out of Euro 96 in a penalty shoot-out, the number of heart attacks or strokes increased by 50%. Have a good one.

So what does it all mean for park players?

• Despite improved training and sports medicine, professional players are still at risk. You don't have these benefits. OK so the local pub league may not be as fast as the premiership but the tackles are probably just as hard.
• Make sure you warm-up before playing and, if you do get injured, get professional advice (your GP is fine - you don't need a sports specialist) and give yourself time to recover. This is particularly important when you are young - your body may feel fine but make the wrong decision now and it might not in 20 years time.
• Don't take up high-impact, contact sports such as football in order to get fit. Use this summer to get fit first so as to enjoy your football next season.

Jim Pollard

Have you any sports injuries tips to pass on or views on how to avoid getting injured.