This article appears in the Nov. 28, 2011, "One Day, One Game" issue of ESPN The Magazine.
IT'S BEEN A WEEKLY -- and sometimes daily -- headline in Dallas: Tony Romo Gets Pain-Killing Injection. Ever since he fractured a rib during a Week 2 win over the 49ers, Romo's pregame shots have been news, mostly because he plays QB for America's Team and partly because he's a reality show waiting to happen. But the story also speaks to a larger issue: how much medicinal help banged-up NFL players often need to get back onto the field -- and the uncertain risks they're willing to take to do so.
By midseason, the pregame training room of every NFL team looks like a flu clinic. Players line up to get injected with a 1.5 inch, 22-gauge needle filled with Ketorolac tromethamine -- Toradol -- the NFL's most commonly used quick fix for what ails players. Romo has never revealed whether, in addition to the Kevlar vest he wore for almost two months, he was taking Toradol or Marcaine, a numbing shot, or both. "Your first day in the league is the last day you'll ever be 100 percent healthy," says Eagles center Jamaal Jackson, an eight-year vet who suffered a torn ACL in 2009 and a torn triceps in 2010. He's no stranger to a game-day shot to help deal with the pain. "That's part of football," he says. "You take every legal advantage possible."
Toradol is a highly potent, nonsteroidal anti-inflammatory (NSAID). Since being approved by the FDA in 1989, the drug has primarily been used in operating rooms to relieve pain associated with outpatient surgery. It is a non-narcotic and not physically addictive. Over the past decade, though, Toradol has taken up secondary residence in NFL locker rooms. The drug, which is basically beefed-up Motrin, comes in pill form. But NFL players typically get injected with a 60 mg shot because it acts faster.
Tony Romo Swallows Four Motrin isn't news. It's the injection part that raises some eyebrows among fans. NFL players simply shrug. "Toradol is a wonder drug," says former All-Pro safety Darren Sharper, who retired last year after 14 NFL seasons. "You get a shot in the butt, and within 10 minutes nothing hurts. And that feeling lasts the entire day."
During the 2003 season, Titans receiver Drew Bennett was struggling with a bad hamstring when he first tried a pregame Toradol injection -- the shot some teammates called the Lifeline. "I couldn't come close to opening up and running full speed," Bennett says. "I took a Toradol shot, and 15 minutes later I felt no pain." Bennett, who retired in 2009 due to chronic knee issues, says he received a weekly injection for the rest of his career.
In Pittsburgh, the Steelers call an injection of Toradol the T shot. Safety Ryan Clark, who's started every game this season despite tearing tendons in both of his biceps and a middle finger, says the drug doesn't do much for his pain, but he takes his pregame shot as a matter of ritual. "If the doctors told me I couldn't get it, I'd be fine," says Clark, who estimates that half of the Steelers roster gets a T shot every week.
A generation ago, cortisone was the NFL's wonder drug. Today, we know cortisone can lead to tissue damage, bone degeneration and ultimately bone death. Not much is known about Toradol's long-term risks yet, but the drug is banned in several European countries because of concerns about potential gastrointestinal issues such as ulcers and surgical bleeding. Dr. Lawrence Brown, who oversees the NFL's drug program, says that the league educates players on the risks associated with all prescription medications and that each Toradol injection is carefully done by team doctors. "They make scientifically founded decisions based on the patient in front of them," he says.
While the long-term effects are unknown, some physicians worry about the short-term problems players ignore. Although Toradol is technically not a numbing agent, many players say they feel diminished sensations when it's in their system. That presents a problem because pain is the brain's way of sending the body a message. In the case of NFL players, that message is: Don't play. Dr. Arthur Bartolozzi, a University of Pennsylvania orthopedist who served as the Eagles team physician from 1995 to 2002, wonders, "You have to be very careful with it -- do drugs like Toradol enable players to play, or do they cause further injury?"
The drug could always do both. "It does mask pain," says Bucs cornerback Ronde Barber. "But that's the price you pay when you play through injuries."
Barber would know: The five-time Pro Bowler has started 191 straight games, more than any other player in the league. Although he's not a regular Toradol user, he estimates he's been injected 25 times during his 15-year career. He says it's helped him cope with the immense pressure to suit up no matter what. "We're a commodity," Barber says. "We're useful only when we're on the field."
And that should be news to no one.