I was struck by Marco van Basten’s story of playing with pain and the effects it had on him as a person, documented in his book and interview in The Observer with Donald McRae.
What did he say?
He remembers: “Whispering, I never reach the toilet before I get to 120. The door sills are the most challenging part because my ankle has to go over without touching them. Even the slightest touch makes them bite my lip to prevent a scream.”
“It was very difficult because I went from the highest level in football down to the lowest level of personal unhappiness.”
“After a lot of problems with operations I was limping. I couldn’t do anything without pain. I was really handicapped and the doctors couldn’t help me.”
“It was a very big fall and a really dark time.”
“It had gone from bad to worse. After many operations, and seeing doctors from all over the world, I had tried everything, but we couldn’t find the solution.”
“I first got injured in December 1986 and it didn’t get better. Johan (Cruyff) had a discussion with the doctor who said: ‘He has a problem but it’s not going to be worse. He can play.’ I had a feeling this is not good. I’m in so much pain. Johan said: ‘Listen we make a deal. You don’t play all the competitions and some training you can skip. But you have to play in Europe. No matter what happens, you have to play the final.’ That was the deal we made.
And now: “I don’t have any pain but I am limited. I can’t play tennis or football. But I can play squash and I am thankful. Looking back I was feeling it was a pity I couldn’t finish my career after winning more Champions League [titles]. I wanted to show more of myself. Some players have 18 years in football. But some players are injured before they start. When I thought like that I said: ‘If I compare with that I have been very lucky. At least I had 10 years of a beautiful experience that changed my life for ever.’”
It is positive that we are hearing from people in different sports talking about the challenges they face and what they have learned. Freddie Flintoff opened up about bulimia and Tyrone Mings talks about his experiences of injury and racism. Both will inspire and encourage.
So, what can we learn from what van Basten’s experiences?
Here are some takeaways, which are naturally interrelated. There will be others.
- Pain and injury are poorly related, which means that we need to examine and assess the person (not a player, a person) and their life to understand their experience, explain it to them and help them make the best choices. Pat Wall, one of the fathers of modern pain science, was talking and writing about this in the 70s. Wall said: ‘Pain is better classified as an awareness of a need-state than as a sensation.’
- A person-first approach is necessary. Actually, essential. To zoom in on the bit that hurts and ‘treat’ it may work for an acute injury, sometimes, if you are lucky. But you run the risk of missing something that could indicate the possibility of on-going sensitivity. These are people who play football, not footballers. There is more to them than that.
- Listen to the person and notice how they enact their pain.
- Go back in time to understand now: the past medical history is not just a list of complaints. Instead, it is the basis of what is happening now; how and why. Study what they say in detail.
- Give them space and time to talk about how it makes them feel and describe the impact upon their life and vice versa.
- Encourage empowerment from the outset so that the person feels control. They are the ones who get better.
- Creating the conditions for recovery and getting better sits withing their whole life, not just the inflamed area: thoughts, feelings, emotions, relationships, environment, sense of autonomy, self-esteem etc.
Football medicine has moved forward enormously, which is encouraging. I have been lecturing at QMUL on the Sports Medicine MSc for some years now. In that time, I have seen a significant positive transition in attitudes to pain.
One of the first lectures I gave was met with feedback from one student: ‘why do we have to know about pain?’.
I hope that I have inspired some different thinking since then.
I worked with some Premiership and EFL players who had not recovered as expected. The issues to be resolved went beyond the local tissues. They were receptive and recognised the need for a wider approach. It started with a rapport and connection.
I have run courses for football medical teams. There was definitely a thirst for understanding the perception of pain and looking at modern ways to treat the person.
However, pressures remain from the club, managers, coaches, owners, supporters, society, and of course themselves. A balance must be found within the game, but through the lens of person-first. This attitude is already here; we are seeing it. It must grow. There is much more to the person than being a football player.
The modern understanding of pain gives great hope and it will continue to evolve. The way we use this knowledge is equally important. One approach is Pain Coaching, which I have been pioneering over the past 10 years or so. Recently I spoke with Simon Austin of the Training Ground Guru. You can read his article here.
Fortunately, the conversations are evolving.
On we go. Making the game better by thinking about people and what they contribute to society via their feet, but mainly their hearts. Think Marcus Rashford and free school meals.
Then think about what they need to be well and to perform in their lives. To be heard, to be validated, to be valued as a human being, to be cared for, to be guided and encouraged. This we can do, as we can and must for anyone suffering pain.