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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 37-41

Preference of physiotherapeutic treatment over oral analgesics by Young Indian football players: A survey


1 Department of Sports Physiotherapy, Sancheti Institute College of Physiotherapy, Sancheti Healthcare Academy, Pune, Maharashtra, India
2 Department Physiotherapy, Sancheti Institute of Orthopeadic and Rehabilitation, Pune, Maharashtra, India

Date of Submission13-Nov-2018
Date of Acceptance04-Apr-2019
Date of Web Publication3-Jul-2019

Correspondence Address:
Mr. Ankit Srivastava
Department of Physiotherapy, Sancheti Institute of Orthopeadic and Rehabilitation; Sancheti Institute College of Physiotherapy, Sancheti Healthcare Academy, 11/12 Thube Park, Shivajinagar, Pune - 411 005, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_17_19

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  Abstract 


Background: Nonsteroidal anti-inflammatory drugs are widely consumed among athletes worldwide in relation to muscle injury and soreness. Physiotherapy provides effective nonpharmacological, noninvasive interventions for various musculoskeletal problems. Thus physiotherapy is an effective treatment but without the toxic buildup. This study establishes the need to educate the players about physiotherapy and the harmful effects of regular analgesic consumption.
Objective: The objective of the study is to analyze the perception of football players with injuries between physiotherapy and oral analgesics for pain reduction.
Materials and Methods: Data were collected from 107 football players by a questionnaire. Qualitative analysis of data was done.
Results: Pie diagram of all the results was made. Results showed a higher shift toward the preference of oral analgesics than physiotherapy.
Conclusion: Football players prefer oral analgesics over physiotherapeutic treatment for early symptomatic relief to hasten return to play.

Keywords: Athletes, Nonsteroidal anti-inflammatory drugs, Physical therapy


How to cite this article:
Vaidya V, Srivastava A, Gangwal A. Preference of physiotherapeutic treatment over oral analgesics by Young Indian football players: A survey. Indian J Phys Ther Res 2019;1:37-41

How to cite this URL:
Vaidya V, Srivastava A, Gangwal A. Preference of physiotherapeutic treatment over oral analgesics by Young Indian football players: A survey. Indian J Phys Ther Res [serial online] 2019 [cited 2019 Aug 21];1:37-41. Available from: http://www.ijptr.org/text.asp?2019/1/1/37/261992




  Introduction Top


Football is a sport with growing popularity in India. It is a moderate contact game causing many injuries.[1] Injuries occur when players undergo direct contact trauma or muscular overuse during participation in the sport. Injuries may occur during the training or in the competition phase.[2]

Players postinjury understand that their routine is no longer followed and instead of spending time on the training field they are going through the rehabilitation process, thus wishing for a speedy recovery. The player may be put on pressure from the coach and team manager to get back on the field. The player is also scared of losing his vocation, place in the playing-team and limited opportunities of international exposure and games. Psychologically, the player may feel like shelved or forgotten due to absence from the soccer team. As coaches have responsibilities to the team and team members they may not have adequate time to devote to the injured player, thus leading the player to feel disconnected from the coach. The psychological response of emotions to injury of athletes is frustration and anger.[3] A player in this kind of emotional state may easily take a medication for hasty recovery from the condition.

Immediate line of the management for injuries include “Protection, Optimal Loading, Icing, Compression, and Elevation,” i.e., POLICE of the injured part. Players experience pain and difficulties even after resuming the sporting activity due to weakness and decreased flexibility.[4] Nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics are medications which help decrease the inflammatory response and pain. NSAIDs or analgesics are consumed for their action of faster pain relief. These medications are commonly used by athletes worldwide for their muscle injuries and soreness.[5] NSAIDs are also consumed for postexercise muscle soreness. The symptoms of delayed onset muscle soreness are tenderness, reduced range of motion and muscle force production.[6] Consuming an NSAID takes care of the pain factor, but the muscular imbalance and weakness present are not taken care of.[7] Thus, the chances of the player landing up with injury are higher. Physicians most often recommend or prescribe oral analgesics for relief of acute pain. Physiotherapy provides effective nonpharmacological noninvasive interventions for various musculoskeletal problems. Combination therapy of exercises and electrotherapy adjuncts reduces pain by pain gate mechanism, exercise-induced analgesia, reduction of kinesiophobia, and increasing pain threshold.[8] Studies indicate that adolescents are unaware of the potential toxicities and harm of self-administered analgesic agents. Data also show that adolescent athletes consume medications with the expectation of pain relief and permitting the continuation of sports without adequate healing time.[4]


  Materials and Methods Top


The study design was an observational study, and the type of study was a survey. The sample size was 107 with convenient sampling. The study population was young football players across India. The study set up was spread across Mumbai, Pune, Goa, Kolkata, and Kerala. Following were the inclusion criteria: players aged 18–35 years who play football for more than 3 years for more than 2 days/week and those who have received physiotherapy treatment. The participants were excluded if players came with a history of injuries requiring surgical intervention and those with a full thickness ligament tear.

Procedure

Data were collected using a self-made questionnaire [Appendix A]. The face validity of the questionnaire was established by evaluation of the questionnaire by experts. Prior consent was taken. Questionnaires were sent through post, hand-delivered, and E-mail. Questionnaires were in English and Hindi. Data were collected regarding self-medication, awareness of physiotherapy, and preference for line of treatment.




  Results Top


As per the attained results, majority of the players still are more inclined toward medications for their injuries. It was also noted that a significant number of players knew that physiotherapy can also be an alternative postinjury. As shown in [Figure 1], regular use of analgesics has no harmful effect on the human boy was accepted by 37%, whereas the component which states that taking an analgesic before the game can improve performance was accepted by 45% [Figure 2]. Analgesics can be used multiple times without consulting a doctor was agreed by 45% [Figure 3] whereas 48% of individuals disagree to the component that painkillers should be taken for minor pain [Figure 4]. It was noted that 55% of individuals agree to the component that physiotherapy can help reduce pain [Figure 5]. Physiotherapy sessions can be effective as taking painkiller was disagreed by 34% [Figure 6]. A component which states that physiotherapy can prevent the musculoskeletal problems from happening again was neutrally accepted by 30% [Figure 7] it was noted that 43% disagree to that component that stated musculoskeletal problems are resolve once pain is stopped [Figure 8] the component that stated on clearance to play after injury is based only on the absence of pain was disagreed by 41% [Figure 9].
Figure 1: Regular use of analgesics has no harmful effects on human body

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Figure 2: Taking an analgesic before game can improve performance

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Figure 3: For a persistent issue analgesics can be used multiple times without consulting a doctor

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Figure 4: For any minor pain, painkillers should be taken

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Figure 5: Physiotherapy can help reduce the pain

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Figure 6: Physiotherapy session can be as effective as taking a painkiller

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Figure 7: Physiotherapy can prevent the musculoskeletal problem from happening again

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Figure 8: Musculoskeletal problems are resolved once the pain is stopped

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Figure 9: Clearance to play after injury is based only on the absence of pain

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  Discussion Top


High amount of people are still inclined toward medication as per the results maybe because of their ease of availability, low cost, and high degree of pain relief. When compared to physiotherapy for pain relief, players preferred analgesics may be because of quicker action and less amount of time spent for treatment and longer pain-free window period. Other cause of players consuming pain relief medication rather than physiotherapy may be the unavailability of physiotherapist for a particular tournament when players are travelling.

The frequency of injury among football player is high because of the high competitive nature and economic gains at elite level. Injuries happen during a match as well as training sessions. 12% of the injuries are reinjuries.[9],[10] According to a study done by Tscholl et al. there is extensive use of medications by international football players, of which NSAIDs are most commonly used by more than half of the players. One-third of the players consume NSAIDs before the match irrespective of them playing or not. The regular use of NSAIDs in sport is unsafe in the short-term and possibly also in the long-term. Continuous abuse of medications negatively affects the quality of the game and health of players. Considering its anti-inflammatory effect, NSAIDs prolong bone healing, reduce the synthesis of proteins and stop peritendinous hyperemia and satellite cells in skeletal muscle postexercise.[7] Physiotherapy provides rehabilitation by electrotherapy modalities or manual therapy taking care of the inflammation and pain; and exercises taking care of the alignment, strength, and endurance. Harmful effects of electrotherapy are burns, nausea skin irritation [11] which are avoidable by proper monitoring and constant feedback. Side effects of exercise are fatigue and pain related to muscle soreness [12] which can be easily tackled by gradual increase in resistance, rest periods, intermittent training, warm-up, and cool down.

Self-medication is practiced by the players mainly assuming the symptoms were not serious enough to report, unavailability of prescriber and busy schedule.[13] Other possible causes include dependence on internet, lack of physiotherapeutic treatment time, and to avoid doctor/physiotherapist fees. Self-medication is influenced by family members, trainers, or peer group. With increasing ease of the availability of medicines, players may overdose themselves with the analgesics. As many varieties of over the counter drugs are available, players may consume a banned athletic drug and get caught in the doping test.

A leisure or part-time football player not representing any major club may take a steroidal anti-inflammatory on a regular basis as it may be a cheap and less time-consuming alternative than visiting a physiotherapist on daily or weekly basis. A scenario where physiotherapist who is hired only for tournament dates and not for entire season starts with primary care for an injured athlete, but long-term follow-up may not be possible thus making the player consume NSAIDs instead of completing the rehabilitation process.

Physiotherapy is a proven effective alternative without toxic build-up effect and over addiction and dependency. An early return to sport only after symptomatic relief results in overuse injuries or reinjuries because of the ongoing pathomechanics and existing muscular imbalance causing inappropriate biomechanical stresses on the affected area.[9] The entire lower limb acts as a kinetic chain to produce torque and enhance muscle contraction force.[14] Inadequate rehabilitation postinjury can lead to excessive loads on other joints in the kinetic chain. Physiotherapy helps treat the underlying biomechanical cause as opposed to the analgesics which provide symptomatic relief.


  Conclusion Top


Football players prefer oral analgesics over physiotherapeutic treatment for early symptomatic relief to hasten return to play. The clinical implication was creating awareness regarding harmful effects of overusing analgesics, importance of physiotherapy, and entire injury time frame should be spread among football players. Players should be encouraged to report even minor issues and give adequate time to rehabilitation. Player education about the pathophysiological and pathomechanical issues should be given great importance.

Acknowledgment

The authors would like to express their sincere gratitude to principal Dr. Vivek Kulkarni for his support. We would also like to thank Dr. Dhara Kapoor, Dr. Sandeep Patwardhan and Dr. Ashok Shyam for their valuable guidance and constant encouragement that motivated us to complete this study. Finally, We extend warm gratitude to all the teachers and students who cooperated and the people who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fu FH, Stone David A. Sports Injuries: Mechanisms, Prevention, and Treatment. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.  Back to cited text no. 1
    
2.
Rai B, Singh W, Samuel A. Prevalence of injury among football players and its relationship with core muscles stability. Indian J Physiother Occup Ther Int J 2014;8:206.  Back to cited text no. 2
    
3.
Rapoo VM. Management of Recurrent Soccer Injuries Among the Premier Soccer League (PLS) Players (Doctoral Dissertation, University of Limpopo (Medunsa Campus); 2009.  Back to cited text no. 3
    
4.
Feucht CL, Patel DR. Analgesics and anti-inflammatory medications in sports: Use and abuse. Pediatr Clin North Am 2010;57:751-74.  Back to cited text no. 4
    
5.
Mackey AL, Mikkelsen UR, Magnusson SP, Kjaer M. Rehabilitation of muscle after injury-the role of anti-inflammatory drugs. Scand J Med Sci Sports 2012;22:e8-14.  Back to cited text no. 5
    
6.
Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train 2015;50:5-13.  Back to cited text no. 6
    
7.
Tscholl PM, Vaso M, Weber A, Dvorak J. High prevalence of medication use in professional football tournaments including the world cups between 2002 and 2014: A narrative review with a focus on NSAIDs. Br J Sports Med 2015;49:580-2.  Back to cited text no. 7
    
8.
Vaidya V, Srivastava A, Rairikar S, Shyam A, Sancheti PK. Perception of patients with musculoskeletal problems towards pain modulation; electrotherapy modalities vs. exercise therapy. Int J Health Sci Res 2017;7:165-9.  Back to cited text no. 8
    
9.
Hawkins RD, Fuller CW. An examination of the frequency and severity of injuries and incidents at three levels of professional football. Br J Sports Med 1998;32:326-32.  Back to cited text no. 9
    
10.
Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: The UEFA injury study. Br J Sports Med 2011;45:553-8.  Back to cited text no. 10
    
11.
Partridge C, Kitchen S. Adverse effects of electrotherapy used by physiotherapists. Physiotherapy 1999;85:298-303.  Back to cited text no. 11
    
12.
Newham DJ, Mills KR, Quigley BM, Edwards RH. Pain and fatigue after concentric and eccentric muscle contractions. Clin Sci (Lond) 1983;64:55-62.  Back to cited text no. 12
    
13.
Fernando AD, Bandara LM, Bandara HM, Pilapitiya S, de Silva A. A descriptive study of self-medication practices among Sri Lankan national level athletes. BMC Res Notes 2017;10:257.  Back to cited text no. 13
    
14.
Bunton EE, Pitney WA, Cappaert TA, Kane AW. The role of limb torque, muscle action and proprioception during closed kinetic chain rehabilitation of the lower extremity. J Athl Train 1993;28:10-20.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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Abstract
Introduction
Materials and Me...
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