FIFA grabbed headlines in March when it declared the abuse of anti-inflammatory medicine in soccer as a bigger problem than doping.
"The medicine gives you less pain, but you worsen the situation because pain is a warning -- it is an alarm bell," FIFA medical chief Michel D'Hooghe told the Associated Press.
"At a certain point, some players start thinking they cannot play without taking the pills. The most worrying aspect is that we see the problem moving ever more into the youth
Now the club doctors for Toronto FC and the Vancouver Whitecaps as well as the head athletic trainer for the Montreal Impact have echoed those statements and are calling for better education of youth and professional players about the potential dangers of these over-the-counter drugs.
And while they say the youngest players are the most susceptible to the lure of advertising, it is the veteran professionals who are still not hearing the message on drugs that can have serious effects on the kidneys, liver, stomach and intestines.
"That's probably one of the biggest challenges, is that they're so used to taking them," Dr. Ira Smith, the medical director for Toronto FC said. "Either they've ignored the advice or they haven't been given the education about these medications.
"It is difficult. The senior players don't really want to hear what you have to say, they just want to take something that makes them feel better."
'Tough to change'
It is a similar story for Dr. Jim Bovard, the Whitecaps team physician in Vancouver.
"When we get new players, I will usually sit down with them and find out about what their habits might be," he said. "And you usually have two types of groups.
"You have the veterans who have been doing whatever they've been doing for years and it has worked, so if that includes taking anti-inflammatories more often than they should, they're going to be tough to change. The other concern is in your youth athletes.
"We're lucky. With the Whitecaps program, we get them as young as 12 years old, so they learn pretty quickly that we don't use a lot of anti-inflammatories.
"What drives them to use them at that age, though, is the great advertising. If you think about what they're pushing, it's relief for muscle aches and pains -- 'Take this when you have muscle aches and pains -- a pretty nice, non-specific symptom that we all get."
'Hardly stopping the problem'
And while educating youth players plays an important role in preventing abusive habits from forming, Montreal's head athletic trainer, Jean-Sebastien Rondeau, stresses that it's the parents who need to know more.
"Educating the youth players is important," he said. "Our youth soccer program is similar to Toronto and Vancouver's in that we get them pretty young.
"But we can tell them not to take them over and over again. But if mom and dad are handing them over every time they get a minor injury, that's hardly stopping the problem."
And the problem, Dr. Smith says, is that anti-inflammatories do little to help the healing process.
"There is more and more research that an injury does require inflammatory response in order to heal, so you don't want to potentially give someone an anti-inflammatory as it may effect how the injury heals," he said. "In a lot of cases, it may actually slow the recovery."
'Put up with the pain'
Dr. Bovard agrees.
"There is also suggestion that inflammation is a important part of the healing process," he said. "When you injure yourself, in fact, you want to allow the inflammatory process to work through.
"You might be in more pain temporarily. Put up with the pain because you'll be better off a week from now than if you take the anti-inflammatory.
"I think the takeaway message, for soccer, is that anti-inflammatories, although they are very easily available and very commonly used, are potentially dangerous medications and, for many injuries, they don't help."
Follow Ben Rycroft on Twitter @callitfootball
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