BOB CASEY'S DIARY:Taking anti-inflammatories or painkillers prior to a game is a regular occurrence but players must guard against an overreliance on medication

I READ WITH concern a piece with the recently retired English and Lions scrumhalf Harry Ellis about how he became dependant on anti-inflammatory tablets as he fought to save his career.

There are two reasons why a professional rugby player will end up taking these tablets. We engage in the ultimate gladiatorial sport, in this part of the world anyway, so it is inevitable that we are going to get banged up. We need something to cope with the pain and ease our swelling limbs or joints.

The other reason in the placebo effect.

To go out and do what we do you have to be mentally right. Or maybe that should be mentally wrong? Either way, taking anti-inflammatories or painkillers leading up to a game is a way of convincing yourself you can go full throttle. This is a dangerous reason to be consuming them and Harry Ellis is the living proof.

It is normal to see a doctor walking around a dressing room handing them out to those who really need them, although our doc would also provide you with a stomach protector tablet as well. Otherwise, these things can rip up your guts.

Ellis was getting his knee drained regularly so he felt the need to double up his dosage. I have made a similar mistake using the rationale that I am a big lad so I need to take more. In fact, when you over-medicate the tablets become ineffective. Your tolerance also builds up to the tablets so when you try to go back to the correct amount they have little or no impact.

All of a sudden you have only one of the two reasons for consuming the tablets. The placebo effect. You can become too reliant on them. Then you are in serious trouble.

It is not all about pills though. Pain management is a crucial part of every rugby player’s life. Our bodies are the tools of our trade. As you say goodbye to your early twenties it becomes increasingly rare that you feel 100 per cent pain free entering any game.

It becomes about managing the inevitable stiffness and swelling of joints and knocks. That could mean off-feet conditioning as opposed to a pitch session. Hit the pool, the rowing machine or an upper body circuit session (similar to the Cross Fit craze that is sweeping Dublin at the moment).

I would even sub in a young lock for a few moves to ensure I don’t exacerbate a niggly injury.

We got these “game ready” devices that the Dallas Cowboys have fitted into their jet plane. They can be attached to all areas of the body, providing compression and icing of joints all at once.

With all this in mind, I found it hugely unprofessional to hear Lee Byrne reported back to training with the Ospreys a full week after the autumn internationals with a broken thumb. The club even felt compelled to take the unusual steps of releasing a statement criticising their star fullback for failing to attend two medical appointments. I sense a financial penalty might be coming Mr Byrne’s way in the not too distant future.

There is a simple logic: If diagnosed immediately and constantly monitored you can be back on the pitch quicker.

Injury management is very much within the player’s control. Lord knows, in comparison to the regular Joe on the street, we are well looked after.

London Irish use the same private clinic as Chelsea FC. I am a regular visitor to Britain’s top knee specialist, Andy Williams. I have access to him or the clinic within 24 hours of sustaining any type of injury. If I need an operation I can be under the knife within three days if not sooner.

I take it for granted but when I retire I’ll probably need to work within the VHI parameters back in Ireland as I know for certain that I will need more work done on my troublesome joints post-rugby.

Managing a rugby injury is easy street compared to our American cousins. The majority of our pro contracts are based primarily on a retainer, with added bonuses, but in the NFL most of their salary is performance related. Hence those boys are forced to play hurt to get paid.

The old attitude that pain is a weakness is still prevalent but it only works against the team. If a lame defender is identified, the opposition will attack him, creating a hole in the defence. The really good teams sniff this out immediately. If you are injured you need to get off the pitch immediately.

Another example is our South African prop Faan Rautenbach dropping a 35-kilo weight on his finger last season. Fran said nothing until a few days later when the pain hadn’t subsided and he was forced to get it checked out. He had a broken finger.

The rugby physio becomes a hugely important person as we enter our thirties. I regularly bow at the altar of Dec Lynch.

Dec deals with players who operate on different pain thresholds every day. Say Delon Armitage (aka Didier Drogba due to the amount of times he goes down) lands on his table, Dec may not be too worried but if Chris Hala’ufia dips his big frame through the door he might dial 999, presuming a limb is probably hanging off.

Chris genuinely doesn’t seem to feel pain.

Dec has many of us operating on something called “Load Control”. I’ve heard that Paul McGrath used to just play matches at the back end of his career as his arthritic knees were so bad.

As you get older training becomes more about simulating the system to ensure you are prepared for games, without aggravating troublesome joints. It is a tightrope but the use of GPS has made it more controllable.

You can see from the data and heart rate of players how close they are coming to the exertion levels they would reach in games.

All this is a battle between the medical and coaching departments. The really successful organisations have an understanding coach and a strong-minded physio who is not afraid to stand up to the coach when a player needs to be looked after.

Otherwise, the injury will reoccur.

It is all about balance.

I imagine Munster and Ireland will be closely monitoring the load control of Paul O’Connell and several other senior players with a view to getting them to the World Cup next year in the best shape possible.