Sports Medicine Research: In the Lab & In the Field: Recommendations of the National Football League Physician Society Task Force on the Use of Toradol® Ketorolac in the National Football League (Sports Med Res)
Monday, September 3, 2012

Recommendations of the National Football League Physician Society Task Force on the Use of Toradol® Ketorolac in the National Football League


Recommendations of the National Football League Physician Society Task Force on the Use of Toradol® Ketorolac in the National Football League

Matava M, Brater DC, Gritter N, Heyer R, Rollins D, Schlegel T, Toto R, and Yates A. Sports Health. 2012. 4(5):377-383.

The National Football League Physician Society Task Force on the Use of Toradol® Ketorolac in the National Football League has released its recommendations. “Ketorolac tromethamine is a non-steroidal anti-inflammatory drug that has potent analgesic and anti-inflammatory properties…Ketorolac injections have been used for several years in the National Football League, in both the oral and injectable forms, to treat musculoskeletal injuries and to prevent post-game soreness.” The document offers a nice review of various aspects related to ketorolac (e.g., mechanism of action, accepted indications, contraindications) and provides several recommendations.

4 comments:

Dustin Grooms said...

Does anyone have a concern that any agent that decreases pain perception given prior to athletic competition, and especially football and especially something as strong toradol could have the effect of masking concussion symptoms? I understand the statement says only those with a prior injury... But will that increase the risk of repetitive concussions in the same event since pain perception is decreased and the concussion may now go unreported due to no perception by the player?

Jeffrey Driban said...

Hi Dustin:
Thanks for the comment. I spoke with Ryan Tierney and Jane McDevitt who do concussion research at Temple University we seem to agree that an oral analgesic medication may mas some of the concussion symptoms (e.g., headaches) but is unlikely to hide other symptoms (e.g., dizziness, balance, memory problems). They suggested that using a multifaceted assessment approach should help minimize the chances of missing a concussion. They also noted that being aware of medication use is important when performing your evaluation. Any thoughts?

Dustin Grooms said...

Wow that was pretty fast Jeff!! Thanks for looking into this.

I do agree and I believe most sports medicine\athletic training programs are using a multifaceted approach involving multiple health care professionals and a variety of instruments. However, as a clinician if I don't see the hit or the player is displaying an obvious problem (dizziness, balance, memory etc) then the concussion already tends to go unreported by the player. So if we lecture our athletes on the importance of having every symptoms checked out, and then we possibly remove a primary symptom... I am concerned about a further increased risk of unreported concussions.

Also with all the recent media coverage on the concussion issue, especially regarding the NFL these seems to be an area the position statement overlooked? Especially with this idea of many "low" level impacts through out a game that add up, these are likely not to have immediate obvious symptoms and combined with a player receiving analgesic medication, may go missed for a long duration. Basically I am saying that the headache is commonly the gateway for player reporting and assessing for other symptoms.

I also wonder what the demographics look like for Toradol use.. Do players at higher risk for head injury tend to be the players receiving the treatment or is the spread pretty even among positions? Linebacker(many possible lesser impacts) vs. wide receiver (no impacts or single large ones-easier to single out for further evaluation) for instance...I am just conjecturing on this last idea.

Devra Bommarito, PT said...

Dustin,
Take a look at the Mulligan et al study (albeit it is small and has some limitations)but it does seem to correlate with your hypothesis.

I definitely think there is a distinct possibility that athletes develop neurocognitive and neurophysical deficits over the course of the season as a result of cumulative "sub concussive" hits. I have the BIODEX SD in my PT clinic and the the neurocognitive standard testing; I would be surprised if the local coaches would be supportive of allowing a study to be done at the high school level (toradol in use or not). I suspect they would not like the findings if we are correct.

Mulligan, I, Boland, M, Payette,J. J Orthop Sports Phys Ther. 2012;42(7):625-32. Epub 2013 Apr 24.

Post a Comment

When you submit a comment please click 'Subscribe by Email" (just below the comments) or "Subscribe to: Post Comments (Atom)" (at the bottom of this page) if you would like to receive a notification when another comment has been submitted to this post.

Please note that if you are using Safari and have problems submitting comments you may need to go to your preferences (privacy tab) and stop blocking third party cookies. Sorry for any inconvenience this may pose.