Patriots head coach Bill Belichick, left, and linebacker Tedy Bruschi look on after linebacker Mike Vrabel was injured in the fourth quarter of a game against the Detroit Lions earlier this season.

The Providence Journal / Mary Murphy

The National Football League season ends next Sunday in Miami, 22 weeks after it began. .

Twenty-two weeks of jarring collisions and highlight-film hits. Twenty-two weeks of broken bones, concussions, pulled muscles, dehydration, cuts and illnesses. Twenty-two weeks of players pushing the limits of the human body in an attempt to stay on the field. Twenty-two weeks of training staffs helping them do that.

How do they do it? How do the players beat the pain and stay in good enough shape to perform over 22 grueling weeks, not to mention the month-and-a-half of training camp that precedes them?

“You sure don’t know what’s best for you as far as getting better,” said New England Patriots nose tackle Mike Wright. “So of course you’re going to listen to the training staff.

“They’re extremely helpful attending to everything, and you know they have it in their best interest for you getting back on the field. It’s just as important for them as it is for you . . . they’re not going to give you anything that has extreme side effects. As long as there are no side effects, it’s legal and the league approves it, it’s worth it.”

But the levels players go to might surprise the average fan.

According to a former NFL trainer, some players take Vicodin before games in anticipation of pain, and some also use it just to calm down. Other players use drugs similar to Ritalin, which is prescribed for people with attention deficit disorder, , because they think it helps them concentrate. . Players are continuously being hooked up to IVs in order to get the fluids and medications they need.

“There’s a lot of pressure to give players what they need, what they want, and to have them ready,” said Dr. Robert Shalvoy, an orthopedic surgeon in Providence who treats athletes. “That’s the bottom line.

“People say, ‘How does Brett Favre get hooked on Vicodin?’ [But how] many people in the NFL are going to say no to Brett Favre? The goal is, ‘Look, the guy has pain and needs to play in two days, figure it out.’ So there’s a lot of pressure to just get it done.

“Training staffs are under the same pressures as players. Trainers are always concerned with, ‘Is this the year they get somebody else?’ ”

The pain of it all

Former NFL linebacker Bryan Cox played for the Dolphins, Bears, Jets, Patriots and Saints during a 12-year career. Prior to his signing a one-year deal with New England in 2001, the Patriots did not allow Vicodin in the locker room.

Cox pushed for it. Finally, the Patriots relented. Now it’s a common drug, even though side effects include sedation. Vicodin – while a legal substance allowed by the NFL — is also addictive, both physically and emotionally.

Other, less addictive, substances are also used. Toradol is a non-steroidal, anti-inflammatory drug used to relieve moderate, acute pain. It is supposed to be used for a limited amount of time and is not recommended for long-term therapy. It’s like ibuprofen, only a lot stronger, and can be administered via injection.

“It has no mind-altering effects,” said Shalvoy. “It has none of the effects of Vicodin, alcohol or marijuana.”

Marijuana commonplace

Marijuana use is common among NFL players, and, judging by arrests for possession, it seems like the practice is widespread. (As is alcohol use, judging by high-profile DUI cases.) The most publicized case in recent history regarding marijuana use in the NFL involved former Miami Dolphins star running back Ricky Williams, who was suspended for the 2007 season after three times testing positive for the banned substances. He played last year in the Canadian Football League.

His claimed he used marijuana for relief of his anxiety disorder, and that his body didn’t react well to certain legal pain medications.

Some feel there’s an argument for the use of medicinal marijuana to help relieve pain.

“I can see why guys do it,” said one former NFL trainer. “It works. If it was legal, guys would probably smoke before games.”

But others disagree.

“It’s more of a relaxant than anything else, for people who have a need to de-stress,” said Shalvoy. “As far as pain control, it doesn’t have much of a use.”

Marijuana does have habit-forming components and also has a negative effect on the heart, just like cigarettes, Shalvoy added.

Players have little to say on the subject. The moral and legal issues outweigh all other considerations, and few players are willing to call publicly for increased use of a drug that is currently illegal.

“There’s an old argument that marijuana does nothing and it’s okay,” said Shalvoy. “It’s not a big stretch to realize that’s not true.”

Shalvoy recommends rest and a stringent lifestyle to combat health issues. But he realizes that the demanding schedule of an NFL team can work against it.

“Frankly, it’s easier to rely on medication to counter the affects of that,” said Shalvoy, “whether you’re using a stimulant or a relaxant.”

The NFL’s drug policy calls for up to 10 tests a month after one positive result. A second violation results in a fine equal to the player’s salary for four games and a third in a four-game suspension and a year’s suspension for a fourth violation.

In New England, violators are treated appropriately for their actions. In the past, players were forced to show up for drug testing as early as 5 a.m. During those exams, testing for masking agents are concentrated on more than the drugs.

Praise for training staff

The Patriots were a bruised and banged-up group for much of the 2006 season. Getting to the AFC Championship Game was quite an accomplishment and credit must go to the team’s training staff, which is not allowed to speak to the media.

The players in the locker room had nothing but kudos for the staff.

“Our training staff does an excellent job,” said linebacker Rosevelt Colvin. “They probably work the most hours of anybody besides the coaching staff. Their knowledge of injuries and rehab is definitely an asset and a plus for us as a team.”

Coach Bill Belichick, who never discusses injuries, praised his training staff prior to the start of the playoffs. “They do go unnoticed,” said linebacker Mike Vrabel. “We have a group in here that takes a lot of pride in helping players out. There are a lot of players in this locker room and there are a lot of different needs. They do a good job trying to facilitate everybody. Everything’s not going to be perfect; you’re not going to get everybody back in two days. They bust their [butts] like everyone else. On the flight they’ll be working the aisles like flight attendants, making sure that everybody’s got what they need — meds and treatments.”

It’s the side of football the public doesn’t see.

The Super Bowl is only a week away and when the Vince Lombardi Trophy has been raised and the celebrations are over, players will begin preparing for the 2007, whether that means rest, rehab or surgery.

It’s a process that will forever continue.

jmcdonald@projo.com