There are no magic pills. Grant Hill looks at his injured ankle every once in a while and wishes there were, wishes he could take something to stop the aches and fuse his joints back to the way they used to be.
"You can take a pill to help the pain, but usually, it's just covering something up, the injury is still there," says Hill, who instead will sit and watch as the NBA playoffs get underway without him this weekend. He has accepted his fate, for the most part anyway, but that doesn't mean he hasn't seen other players get desperate at this time of year. Pills, injections, the herbal remedy that someone's cousin once recommended -- there are guys who will try anything to compete.
"Sometimes as athletes, to get to the level we are at, you have to go to extremes, and I see guys doing that sometimes with medication," Hill says. "The normal dosage of a painkiller is two, so they take four. And the playoffs are when guys push themselves the most."
Over the next few months, coaches will reach into their cookie jar of cliches to talk about "gut checks" and "laying it all on the line." Injuries will often be seen as excuses, especially once a playoff series gets down to its final critical games, and players will start grasping at whatever team trainers provide. Yet as the dangers of painkillers have become ever more apparent, some players are having an increasingly hard time balancing their short-term desires with their long-term health. And as the postseason looms, many aren't even sure where to turn for advice.
Shaquille O'Neal, who has been fighting knee and toe injuries for several seasons, has agonized over what to take and when. He runs down the list of pills Lakers physicians have given him at different times -- Naprosyn, Orudis, Indocin, even plain old Advil. They have made him feel better, stronger, able to jump more freely.
"They've also made me find blood in places you don't want to know about," he says, and so in February, O'Neal said he would no longer take the pills, at least not the Indocin.
The pain returned, however, and O'Neal was forced to miss three of Los Angeles' games, including a matchup against Yao Ming and the Houston Rockets. Talk radio buzzed, with callers wondering whether O'Neal's $24 million contract had a boo-boo clause. Kobe Bryant said he understood O'Neal's decision but also subtly noted that he was playing despite pain in his own knee. Coach Phil Jackson joked that perhaps O'Neal had a case of "Ming-itis."
A few weeks later, O'Neal talked about starting up the Indocin again. A few weeks after that, he swore off the pills completely. That kind of indecision is common, former Orlando Magic forward Horace Grant says, especially when athletes find themselves unable to perform the way they are used to.
"Painkillers were a big part of my life a couple of years ago," says Grant, 37, who is now out of the game completely. "You play hard, you get a lot of bumps and bruises, and so to get back out there, you take some more. From the time I was about 34 or 35, I needed painkillers just to go out there and try to do what I could do.
"But after a while, you start to accept that your best days are behind you. You stop looking to the training room to fix you, because you know you can get addicted to them, like [Green Bay Packers quarterback] Brett Favre did. Or like in Alonzo Mourning's case, you can take them for too long."
Question of Risks
Like any drug, the medicines NBA players take for pain come with risks. Even Tylenol has been found to cause liver damage when taken inappropriately; at a recent Food and Drug Administration hearing, its maker acknowledged that more than 100 people overdose on drugs like Tylenol each year. The stronger the painkiller, the more potential danger lurks, as some prescription drugs have been more closely linked with kidney and liver ailments, and others, such as Vicodin, carry a risk of addiction.
There is disagreement in the medical community, however, over just how high the risks are. Some doctors feel they are minimal; others feel they are more related to the genetic makeup of the person taking the drugs than to the drugs themselves.
"Non-steroidal anti-inflammatory drugs are used by a lot of people without adverse effects," says William Briggs, a professor of nephrology at Johns Hopkins University. "But like anything else, it's common sense. You want to use them in certain amounts. You want to make sure the person isn't dehydrated, which would make them more vulnerable to filtration problems in the kidney."
Making the picture even fuzzier, Briggs says, is that even when problems do flare, there is no concrete way to tell whether anti-inflammatories are responsible. This uncertainty has left many athletes confused over the highly publicized cases of Mourning, whose kidney problems have stymied his career, and former San Antonio Spurs forward Sean Elliott, who required a kidney transplant. Both have acknowledged using anti-inflammatories over the years, but neither has been able to definitively link their illnesses to painkiller use, leaving coaches such as the Heat's Pat Riley skeptical the drugs were a factor at all.
Nonetheless, Riley says he has warned his players to be cautious. He has also given up painkillers himself, even though injuries from his playing days still creep up on him.
"Of course, back then, you'd take them all the time," says Riley, who played in the late '60s and early '70s, when players had much more access to all kinds of drugs, from pain medicines to amphetamines.
These days, teams say they monitor what their doctors are prescribing more closely, and coaches, many of whom are former players, give little drug-talks of their own. Yet with the financial stakes in the NBA now so high, some in the medical community worry that when playoff time rolls around, warnings about the risks of painkillers can be scant.
It can be hard to be objective, after all, when swallowing a little medicine can translate into millions of dollars of postseason revenue.
"The pay is so much with athletes today, and there's so much on the line," says Doug McKeag, director of the Indiana University Center of Sports Medicine. "Ethics can sort of go out the window when the employer is paying that much money. The employer expects certain things to occur.
"Don't forget that the players represent a commodity to them, and when the commodity is injured, the idea is to get the commodity back as soon as possible."
NBA deputy commissioner Russ Granik acknowledged the conflict of interest some teams have when it comes to looking after the long-term health of their players.
"That's an age-old issue in the area of team doctors," he says. "The way we've tried to handle it is to tell players they always have the right to seek their own medical opinion, separate from the team. And players in our league often do."
At Any Cost
What happens, though, when the players are just as desperate for that magic pill as the teams they play for? When then-Philadelphia center Matt Geiger struggled through the playoffs with a leg injury two years ago, he was regularly booed by the Sixers fans for a perceived lack of toughness. His teammates were more understanding, but as Philadelphia advanced, the need for Geiger's services became more and more glaring.
By the NBA Finals, Geiger was determined to play.
"You've heard of guys getting addicted to [painkillers] and stuff, but because it's the Finals, I decided that I'll risk possible serious injury just because it's do-or-die, it's a once-in-a-lifetime experience," Geiger said at the time. Tears in his quadriceps muscle were making it hard for him to even walk up a flight of stairs, and Geiger tried not to take the medication on the series' off days, to avoid potential side effects. Still, on game days, he went back to the pills, saying, "I kind of made my mind up that I was going to do whatever it took to get out there."
Former NBA forward Purvis Short remembers feeling the same way himself when he was a player. Now, as the director of player programs for the NBA Players Association, he tries to give his charges as much information as possible about the medications they might be taking. In response to increased player concern, the NBAPA has even stepped up its seminars on painkillers and supplements over the past year, and players have a help line they can call if they have questions about certain medications they've been given.
Still, Short and other former players acknowledge that at certain times of the year, it can be hard for athletes to see the long-term risks through the glare of a championship trophy. Geiger may be out of the league now, but over the next two months, plenty of other players will step into the training room, looking for a little something to help them get through the night.
"You don't get to the highest levels of any physical competition unless you are just so driven that pain literally means nothing to you," Bill Walton says. "The top players just grind up their bodies until there is nothing left. I know I did. And still, I would have given anything to play just one more day."