Feature on the use of cortisone in football, The Times, August 2003
Every footballer knows there is a price to pay. At worst, the next tackle could be the last. A whole career of tackles, twists and turns habitually adds up to an affliction described in the civilian after-life as dodgy - usually a knee or ankle. Ex-professionals view these as industrial injuries. They rub at the soreness, free the locked joint, get on with it.
In recent years, players of a certain age have begun to suffer debilitating conditions that they are less phlegmatic about. Fill a room with footballers from the Seventies and Eighties and they are noticeably different than most other middle-aged men. They look older. Some will limp or shift their weight awkwardly. Arthritic joints are nursed with elasticated bandages - more than half of all ex-players contract arthritis before they are 40. In short, our former heroes are whacked out and they don't believe it's due solely to the wear and tear of their former occupation.
Their playing careers coincided with the introduction of a proverbial 'wonderdrug' - cortisone, a pain-suppressing steroid. An injection into the seat of a muscle-based injury had an almost miraculous effect. The player was soon off the treatment table, the stiffness and soreness gone, scampering around the pitch scoring goals, winning matches. "Before, you'd not be able to stretch or even run properly," said Jim Steele, the former Southampton and Scotland defender. "Afterwards you'd not feel a twinge."
Steele, at 53, still has the healthy radiance of a sportsman. He has arthritis in his wrist but otherwise he would appear to have been one of the lucky ones. Far from it. Steele has paid a debt to cortisone higher than most of his contemporaries. He believes it has made him sterile and this has been a significant factor in the breakdown of two marriages. "Both of my ex-wives wanted children and it made it very difficult when we couldn't have any," he said.
His infertility was discovered in 1979 while he was playing in the United States. "The specialist asked me if I'd ever taken drugs or been on hormones. I told him I hadn't, then remembered the cortisone injections I'd had. He said straight away that they'd caused it. He had no doubts."
Three years before, Steele suffered a serious groin strain that required a break from playing of at least six weeks to heal properly. At the time, Southampton were embroiled in a relegation battle and couldn't afford to be without one of their most consistent players. Over the course of about six months, the club doctor routinely gave him two doses of cortisone a week. The current recommended maximum dosage is no more than three or four injections per year. The procedure became so commonplace that the doctor would sometimes answer the phone while the needle was still inserted in the groin, asking Steele to, 'finish the job off.'
Afterwards, Steele would suffer acute discomfort - known as 'cortisone flare' - when the substance crystallised in his muscle. Once this subsided, usually a day later, he was free of pain and able to play. The soreness would return after the match, often of greater intensity because the injury was aggravated while the pain had been masked.
The effectiveness of cortisone meant its use became endemic in football. Gordon Taylor, chief executive of the PFA and a player from the same era, remembers it 'given out like cups of tea.' It was also an unpleasant treatment. "The syringe was like something you'd use on a horse. It certainly brought tears to your eyes," said Taylor.
Cortisone was not intended for use in the treatment of sports injuries. It became available in the Fifties to reduce inflammation around the joints of people suffering severe arthritis. It has no curative qualities but simply replicates the action of the adrenal glands, albeit on a massively exaggerated basis. Like many treatments, it is the subject of debate within the medical profession but there is unanimous agreement that sustained use has grave side effects. An eight per cent reduction in bone mass was noted in cortisone-users after just four months and doctors report that bones and joint tissue on long-term users becomes, 'like Swiss Cheese'.
The PFA is well aware of the hundreds of players stricken by arthritis and other conditions possibly related to cortisone. Despite this pressing anecdotal evidence, Taylor is doubtful about securing legal redress. "There is the question of who is to blame. Is it the clubs, the FA, the doctors, the drug companies, or possibly the cortisone manufacturers? A long time has elapsed and medical records will be difficult to obtain."
Ex-footballers also have to prove that they are affected in greater numbers than other men of a similar age and that the cortisone is to blame, and not the rigours of the sport. The enormous cost of funding a legal case and the uncertainty of the outcome makes it unlikely that the PFA will pursue the matter through the courts. Instead, it is putting resources into warning current footballers of the dangers of cortisone, so they can make what is commonly known as an informed choice on whether to consent to an injection.
Cortisone is still used in the game, though it is seldom referred to by name. The chemical amalgam is much the same but the injections are now 'pain-relievers' or 'something to reduce the swelling.' Taylor believes regular testing of players and extensive medical check-ups will highlight cases of over-use.
Jim Steele is of a different generation. These safeguards were not in place when he played. There was no concept of informed choices; they trusted doctors and their clubs explicitly. Most of all they wanted to play and to win. He is disappointed. "The PFA is absolutely loaded. You'd think they'd be able to do something about it." He has formed a rough alliance with a group of ex-players but is reluctant to devote time to a concerted campaign. A year ago he took over the tenancy of a large pub in the Cotswolds and has settled down with a new partner. He is happy serving morning coffee to tourists and chatting with the locals in the evening, often about football. He doesn't want to dwell on the past too much or succumb to bitterness. He long ago accepted that he will not have children. "There's enough rug-rats in here to keep me going," he jokes, pointing to the slowly filling lounge.