Becoming Sidelined: Common and Uncommon Factors
Guest writer and athletic trainer Jordan Anderson weighs in on the many different causes which may necessitate an athlete's premature discontinuation of his/her sport.
There are many different scenarios an athlete can experience which may lead to being permanently sidelined from their sport. As athletic trainers, we often find ourselves as the first responders to many of these injuries or situations. Most people associate being sidelined with a catastrophic injury that happens in an instant. However, several times we are forced to have a conversation regarding long term dysfunction and quality of life with our athletes and in most cases their parents as well. While many athletes of any age are often focused on short and medium length goals such as: winning a game, having a good practice, having a winning season, or winning a state championship, they are often short-sighted and have difficulty with the bigger picture. This is where the forgotten and overlooked sidelined athletes come into play. Chronic injury, chronic pain, chronic dysfunction, mental health, debilitating illnesses, emotional health, family dynamics, amongst others can also force an athlete to become sidelined. Athletes often need to be brought in for a conversation of long term health and quality of life before they may consider ending their athletic careers at any age. As many athletes find their identity tied to their athletic careers it is difficult to begin this hard conversation. Working together with physicians, physical therapists, athletic trainers, and parents is essential to help the athlete understand what the long term effects of continuing in their sport may be.
Sometimes the diagnosis may not be of a catastrophic career-ending injury, but rather a chronic or cumulative injury. Concussions have been at the forefront of this recent trend. I hear a lot of athletes and parents discuss a “cut-off” where after a certain number of concussion their careers must be over for their long term health. As a graduate assistant athletic trainer for a division I FCS football team, I have been present for this conversation with athletes. While most of these athletes are usually in a state where they do not feel like they can continue, they often struggle with the concept of life after football and how an injury that is not visible can cause this situation. It is important to point out that in the most recent Berlin Concussion Consensus statement, there is no “magic number” of concussions before an athlete is removed for good. Each concussion must be dealt with individually and every nuance is taken into consideration by the treating physician before making a career-ending decision.
Chronic or cumulative injuries can also lead to the end of a playing career. Often times the sport type is the culprit but body anatomy and individual physiology can factor in as well. Many times athletes will sustain multiple injuries to the same joint or structure because of the demands placed on them by a chosen sport. Our first recommendation is usually to reduce the amount of the activity in order to try and curb the load placed on these structures while also working on rehabilitation and trying to hone in on where the dysfunction is coming from. However, it is not always enough and sometimes the conversation needs to be had about the long term effects of repeated injury to certain joints and how it will change their life as an adult or after their sport. In these cases, sometimes a change in sport type can be the solution. This can be difficult for an athlete to grasp as these types of injuries are often able to be overcome with time, in the short-term. Once the long-term effects become apparent, physicians will often steer the conversation towards ending the athlete's career in the particular sport or athletic participation as a whole.
Illness or pathological factors have also been put in the spotlight recently as well. With these conditions, the goal is to prevent the scenario of a catastrophic situation. Many sudden athlete deaths are caused by underlying cardiac conditions. While typical EKG’s cannot always detect these, they along with other diagnostic testing have helped us to understand and identify any potential risk. Other conditions such as auto-immune diseases, connective tissue disorders (Marfans syndrome), and metabolic diseases can cause the end of playing careers. Many athletes find these to be easier to understand because they are out of their control and usually cannot be overcome with time or rehab. However, understanding does not always precede ease of transition out of sport. These situations may be rare but are just as difficult to accept for an athlete who identifies with their sport. The other unique aspect to these diagnoses is that they often lead to the changes that need to be made in daily life as well.
Psychological conditions and family dynamics are often very complicated and multi-faceted. While sports are often seen as an escape and coping mechanism for these, sometimes, they can also be the cause. Parental pressure and expectations can bear a heavy weight on athletes and can eventually cause athletes to lose their desire to participate. Sometimes, psychological concerns can develop from sports or from the inability to perform. Athletics can also cause a lot of stress and pressure deriving from the athlete themselves which can lead to ailments such as depression, anxiety, eating disorders, drug use, self-harm, and other concerns. Conversations with psychiatrists, therapists, family physicians, etc. are essential in identifying these concerns and how to help an athlete mitigate these conditions. On occasion a potential solution may be to remove the stressor, in some cases that can be athletics.
While each of the diagnoses present their own unique set of circumstances, it is important to keep the ultimate goal in mind. The ultimate goal is to provide safety, security, and maintain a good quality of life in the long-term. The short-term effects of the loss of athletic careers can be difficult and sometimes devastating. Attempting to offer solace in the long term health and happiness of an athlete is essential. It is also important for fellow-athletes, parents, health care professionals, coaches, etc to recognize that there are several reasons that an athlete may have to be sidelined. Each of these reasons presents its own path to being sidelined; while the paths may vary, the results can often be the same. Recognizing this fact is an important first step all people involved with a sidelined athlete can take to help ease the transition out of sport.
Jordan Anderson, MS, ATC
New Trier Township H.S.
Vice-President, Illinois Athletic Trainers Association