The long term physical and psychological consequences of playing professional football
Playing professional football is a high risk occupation. Injury rates among professional footballers are higher than those commonly found in other industries. Several Scandinavian studies have begun to document the long-term physical health problems, such as osteoarthritis (OA), that can beset ex-professional footballers. However, the experiences of ex-professional footballers playing and living in the United Kingdom (UK) have not received similar academic attention. Furthermore, no studies have investigated the impact that OA has on the quality of life of former players anywhere in the world. This thesis aimed to rectify a widespread and serious health problem among a cohort that has largely been neglected to date. In Phase I, 284 ex-professional footballers responded to a postal survey which aimed to establish the prevalence of injury and OA. In Phase II, 12 semi-structured interviews were conducted with ex-professional footballers from Phase I who had developed OA. The aim was to gain an in-depth understanding of how the condition impacted on their lives and how they coped. In Phase II, 101 ex-professional footballers, who were not involved in Phases I and II, responded to a cross-sectional postal survey, which investigated the relationships between pain, pain coping and psychological distress within the context of a stress and coping model. Career injury and surgery were common among respondents in Phase I and nearly half (49%) had subsequently developed OA in at least one joint. Pain was the most common problem for all respondents irrespective of OA diagnosis. Lack of mobility and work disability were other problems reported by respondents. Interviewees in Phase II described how they were encouraged to 'play hurt' during their career and to accept, minimise or ignore the threat of pain, injury and OA. It was some of these attributes which enabled respondents to 'live hurt' in the presence of chronic pain and disability in later life. In Phase II it was shown that psychological distress was not a serious problem for many respondents. However, several coping strategies (denial, emotional venting and upward comparison) were positively associated with pain and psychological distress, particularly for those participants in greater pain. Although OA and chronic pain are prevalent among ex-professional footballers in the UK, its impact upon psychological distress was not as great as reported in some other studies of persons which chronic disease and pain. Increased psychological distress was linked to greater pain and the use of several coping strategies (e.g. denial, emotional venting and upward comparison). However, given the cross-sectional design, it remains to be clarified whether coping predicts psychological distress or whether an increase in psychological distress precipitates more coping. Suggestions are proposed for a psychosocial intervention which would have an impact on pain coping and psychological distress among ex-professional footballers.