For the Sake of Wimbledon -- Rafael Nadal Will Play Injured

VIDEO: Thoughts from Dr. Walter Lowe of UTHealth/Memorial Hermann.
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Gone are days of secret locker room injections given on the sly to hurt athletes. Since injuring his heel earlier this week, tennis pro Rafael Nadal has made no attempt to hide the fact that he is numbing his injury so that he can keep playing through the Wimbledon semifinals, despite the risk of further injury.

"My foot is not fine, but we are in quarter finals of Wimbledon, so it is an emergency. I have to play," the Spanish tennis player said at a Wimbledon press conference Wednesday. "We decided to [anesthetize] a little bit the zone of the foot to play the rest of the tournament."

Nadal slipped and hurt his foot on the court during his match against Juan Martin del Potro Monday, but this has not stopped him from advancing to the Wimbledon semifinals.

"Basically, when he twisted his foot, he put stress on the peroneal tendon on the side of your leg. They're injecting lidocaine around the tendon to reduce the inflammation for each match so he doesn't feel the swelling," says Dr. Jennifer Solomon, an assistant attending physiatrist at New York's Hospital for Special Surgery, who also serves as a team physician for the United States Tennis Association.

Though traditional wisdom dictates that an athlete should not continue playing on this type of injury and risk doing further or permanent damage, anesthetizing the pain long enough to allow a player to finish the game, or in this case, tournament, has become a common, if sometimes clandestine, practice among some professional athletes.

"I'm surprised they're telling the public. It's frowned upon in sports medicine in general because you can get further injury when you're not aware of what's happening in the area. Pain is a protective sensation, and without it you might do more damage," says Dr. Lyle Micheli, director of the division of Sports Medicine at Children's Hospital in Boston.

Normally, one would use oral painkillers, lidocaine patches on the injury site and ice to get someone through a competition, he says. Because these methods allow a player to still sense the pain, they will know not to overdo it.

Nadal, however, says, that when he's undergoing treatment, he doesn't feel anything for five hours, which makes the chance for further injury higher, according to medical experts.

"The injection itself isn't a problem, but playing through an injury when he can't feel the pain at all, he risks restressing his tendon and [that can] lead to other problems, so you have to be careful," says Solomon. But for a professional athlete who receives excellent medical care, the risk is minimized.

"This is their career, their life," says Solomon. As sports medicine physicians, "we try to do everything we can to get them safely on the court, and it's done in a very controlled environment. It's just a short term solution. Afterward, he'll have to take time off to heal."

When dealing with professional level competition, some doctors, such as Dr. Sherwin Ho, a sports medicine specialist at the University of Chicago, are "pro-competition" physicians, meaning that as long as an athlete is aware of the risk and benefits of playing through the injury, then numbing it up is fine.

"Would I let my 16-year-old athlete do this? No. But this is Wimbledon. The reward is big, and the risk for permanent damage is pretty low, so I would let him do it," says Ho.

Playing Through the Pain When You're Not a Pro

For those of us who don't make our livelihood off our athletic abilities, playing through the pain is almost never a good idea, says Micheli.

"Unless you have a good diagnosis from a medical professional that says the injury is OK to play on, like, say, a low-grade tendonitis, you shouldn't be pushing through the pain," he says.

And Solomon agrees: "You wouldn't want to play through this injury if you're not a pro," she says. "You would need to ice it and get proper treatment from a doctor."

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