Medical Files

Getting Manny out of harm’s way

(First in a series)

We all felt bad about the loss of our boxing icon, Manny Pacquiao, when he fought the egotistical Floyd Mayweather last Sunday morning. We felt even worse when Manny announced after the fight that he was nursing a shoulder injury, which was diagnosed by MRI studies to be a “significant” tear of the tendon or ligament anchoring his shoulder muscles to the ball-and-socket shoulder joint that allow it to move in practically all directions.


Called a rotator cuff tear, this shoulder injury is relatively more common in athletes engaging in body-contact sports like boxing or football.

The shoulder rotator cuff (or rotator cup, as it is sometimes called) is supported by four tendons that give the shoulder stability and agility. Each tendon is attached to a separate muscle, making the shoulder move in different directions.

A significant tear

Manny got the injury during his training, almost four weeks before the fight; and his team erroneously expected it to heal completely and ready for rough action on fight night. If it was really a significant tear, four weeks was obviously a short period for it to heal, considering the wear-and-tear which 20 years of boxing had given it. With or without surgery, it definitely needed more time for healing with regular physical therapy to strengthen the shoulder muscles and reduce the risk of future


His shoulder doctor apparently advised Manny to have a shot (intramuscular or intravenous injection) of Toradol (ketorolac tromethamine) an hour or two before the fight but officials from the Nevada State Athletic Commission did not allow it. Personally, I think it was a judicious decision for Manny’s sake. He might have ended up with more trouble had he been given the painkiller shot.


Toradol is a nonsteroidal anti-inflammatory drug (NSAID) that relieves moderately severe pain and swelling caused by any injury. It is usually given after surgery. It works by blocking the production of prostaglandins, which are hormones produced by the body that cause pain and swelling, warning the body that a part of it is injured and has to be rested and allowed to heal. So the pain and swelling are actually natural compensatory mechanisms to warn the body to rest or stop using a part of it. It’s like a natural splint protecting an injured part of the body.

Toradol relieves the pain, but by doing so, it’s actually suppressing the body’s compensatory mechanism, which might make the person wrongly feel like the injured part has already healed. Normally, for skeletomuscular injuries like in Manny’s case, analgesics like Toradol are given just to make the patient pain-free, but never to allow the person to “abuse” the joint again or allow it to engage in similar activities that injured it in the first place.


If Manny had been given the Toradol shot, he might have been deceived by a false sense of assurance that his right shoulder joint was already in good shape because the pain had been masked. He would have used his feared right-left combinations as he would in normal circumstances, and that would have likely made the shoulder injury worse and probably irreparable already. That would have definitely spelled the end of his illustrious boxing career.

Common side effects

The second reason why, to me, it was a blessing that he was not given the Toradol shot was the fairly common side effects which the drug would have caused. Manny would have been in big trouble if he experienced any of these side effects, like headache, dizziness, drowsiness, upset stomach, severe nausea or vomiting, and diarrhea.

He might have been groggy and dazed inside the ring, and what a disaster it would have been. The merciless Mayweather would have pounced on him and might have inflicted serious harm. I shiver as I imagine what could have happened to Manny.

So, instead of thinking that the Nevada State Athletic Commission has shortchanged him on fight night by not allowing the Toradol shot, I think Manny should be grateful to them for getting him out of harm’s way.

Speaking of getting Manny out of harm’s way, should he fight again after recovering from his shoulder injury, or is it time to hang up his gloves?

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TAGS: column, health and wellness, Manny Pacquiao, Rafael Castillo, rotator cuff tear, shoulder injury
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