When pain stops play

You strain the back, damage a knee or twist an ankle and the doctor says stay out of the gym for a couple of weeks

You strain the back, damage a knee or twist an ankle and the doctor says stay out of the gym for a couple of weeks. For most of us, it's the excuse we've been looking for, but for those at the top of professional sport, it can sound like a death sentence.

Nobody is more sensitive to imbalances in their fitness equilibrium than those who play sport for a living, whatever the game. It has nothing to do with a higher perception of pain or discomfort. Success in sport has never been more demanding nor well rewarded, and in the gruelling climb to reach the summit, it's inevitable that at times the body will break down. With the amount of money floating around sporting arenas these days, even a minor ailment can be an expensive thing.

The problems, however, are not just financial. It's the psychological dilemma of being forced out of action which is often the most difficult to deal with. To sit back and watch championships or tournaments go by without participating can crush morale, and questions begin to niggle. Is this career-ending? Time for the day job?

As the pressures of modern sport increase, so too does the depth and range of the setbacks - as a quick glance at any of the sports pages testifies. They carry as much news about injuries or ailments as goals scored or records broken. It's something every professional will have to deal with at some stage - but they don't all take it very well. And in terms of recovery, it's the mental attitude which can make all the difference.

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There are differences in the injuries associated with specific sports. A professional footballer is likely to suffer a more traumatic injury such as a damaged ankle or knee due to a heavy tackle or foul. Athletic injuries are usually more subtle, such as a strained muscle or tendon. Then there are extremes, with broken limbs or worse which are always a risk in events such as horseracing or downhill skiing.

Even with the diverse nature of injuries, the need for specialised sports medicine is consistent. For the past 10 years, physiotherapist Gerard Hartman has been earning a reputation as one of the best in the business, with the treatment of athletes at his sports injury clinic in Limerick. He sees certain trends in both the emotions and attitude of his patients.

"In terms of athletics, almost all the injuries are the result of chronic overuse," he says. "And I'd say 60 per cent of those are around the knee area. The problem is mainly due to the increase in training loads over the past decade as the competition calendar gets more and more cramped. Between Olympics, world championships and the like, there are a lot more events with a lot more money available and that means athletes take greater risks with training loads in order to capitalise on their talents."

As a former national triathlon champion whose own career was ended through injury, Hartman is well versed in the psychological implications associated with a sports injury - something he believes is lacking in a large section of the medical profession.

"It's very important that there is a clear understanding of the injury. If you can fully explain the cause and extent of the problem it can help their confidence, but a lot of people in the profession don't take that into account. You have to get involved and really convince the athlete that they can make it back if they just follow the treatment."

Hartman has also discovered a difference in reactions between male and female athletes.

"From my experience, on the emotional terms, it's the female athletes who nearly always take it extremely poorly. Male athletes seem to be a lot more realistic and if I tell them that it's going to take five weeks to get over this injury then they can take it fairly maturely. I don't know why, but the female athletes see it much more as a disaster and tend to get very upset. Still, no athlete wants to be told to take five weeks off. They want to be out for the least amount of time possible and so you have to deal with the emotional side of the athlete as well.

"For example, it's vital to get the athlete doing something, whether it's on the bike or in the pool, just to limit the emotional damage and keep them enthusiastic. It's a sort of psychological trick to get them active without stressing the injury."

Hartman has seen professional careers getting shorter all the time, and any athlete or player at the top of their game for more than five years is doing well. There has always been a fine line between success and failure in professional sport, and between those who make it to the top and those who quickly drop out. As the games become faster and the rewards higher, the problem of injuries will continue to play an increasing role in separating the two.