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Becoming Sidelined: 6 Factors to Consider in Possible Sport Retirement Due to Brain Health Concerns

by Dr. Anthony Savino

Humans have a strong connection to competition and sport, with records dating back thousands of years.  As children, we play sports to expend energy, engage socially and learn fundamentals that prove useful as we move into adulthood such as determination, teamwork and humility.   Often times, sport also provides a safe outlet for frustration, anger, anxiety and other underlying psychological stressors. 

Lastly, we know that young people who play sports are more likely to be active when they are older and subsequently have a decreased risk of serious medical conditions including heart disease, diabetes and obesity.  

Some of us will go on to play sports in college, often creating an avenue to obtain an education at an institution which would not have otherwise been possible.  A minority will then make sport a career, while the majority will continue that lifelong passion in a multitude of other ways, using sport as a framework to maintain a healthy lifestyle. 

For all of these reasons and more, sport participation can have significant benefits on physical and mental health.  However, every athlete’s competitive career will come to an end at some point.  Athletes retire for various reasons including injury, life changes or loss of interest. Sometimes, the decision is even made for them as in a recommendation from a physician. Eventual retirement plans should be a consideration for every athlete, whether youth or professional, and as with any other significant change, preparation is key in order to mitigate any adverse effects.

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Specifically, the decision to recommend athlete retirement due to concerns for brain health is not one to be taken lightly.  Several factors must be considered, as the removal from sport itself may lead to its own issues down the line, especially if the decision is made for the athlete instead of by or with the athlete.  Most athletes, especially one-sport athletes or those playing at an elite level, identify themselves heavily with their sport.  For this reason, forced retirement can have a significant impact on their overall wellbeing. 

As outlined below, there are several factors to consider when discussing possible retirement from sport due to brain health concerns.  Each factor may not be the answer in and of itself, however when considered collectively they can provide an overall picture of brain health to assist in making this complicated decision.

6 Factors to Consider in Possible Sport Retirement Due to Brain Health Concerns

1.  Life and sport goals.

This is the most important factor to consider.  When looking at all of the other factors below, they must be put in perspective of the individual athlete’s goals.  A potential retirement conversation is very different with a contact sport athlete who plans to stop after senior year of high school versus one looking to go play college or professionally.  There are clearly different levels of acceptable risk. In addition, with the latter there are often other things to consider, including incentive.  If this is to be their career and main source of income going forward, then they may be more willing to accept the risk of future injury.  Even so, they need to understand the risks and benefits of continued participation in order to make an informed decision. 

2. Baseline neurological and psychological functioning.  

Every person’s brain is wired differently.   There are some concussed individuals who walk around from day to day with little to no symptoms at all.  Unfortunately on the other hand, there are those who have to deal frequently with symptoms, which may include headaches, anxiety, depression, poor sleep or learning/attention issues.  We know that these two groups respond differently to brain injuries, that some symptoms or conditions predict prolonged recovery after an injury and that these conditions can be worsened by injury.  As athletes consider starting or continuing to play contact sports, these conditions need to first be recognized, and then addressed as possible predictors of future issues.  If it is decided to go forward with participation, these need to be managed proactively and followed over time to optimize long-term brain health.

3. Recovery from concussion.

Concussion is a temporary injury, which resolves over time.  There are expected time frames for recovery depending primarily on age.  Literature suggests that youth and older athletes take longer to recover than high school and college aged athletes.  If symptoms persist beyond the expected recovery time, or take on a pattern atypical for concussion recovery, this is called post-concussion syndrome. 

When reviewing an athlete’s concussion history, which is paramount when discussing retirement due to concern for brain health, it is important not only to determine the certainty of each previous concussion diagnosis but also analyze how they recovered from each concussion. To this end, it is not necessarily the number of concussions that matters most, but how they recovered from each injury.  I would be less concerned about an athlete that has had 3 concussions, each of which recovered completely in the expected time frame, than an athlete with 1 concussion who took 6 months to return to baseline or never fully returned to baseline at all.  

How previous concussions were managed is also important.  We have now started to move away from the “rest is best” mentality, and are taking a more active approach to recovery.  This may muddy the water a little bit for those athletes with a history of prolonged recoveries in the past, as some if not all of the prolonged symptoms may have been due to the overly cautious management itself. 

4. Ease of injury or symptoms with sport participation

Is there concern that the athlete is getting concussed with less forceful impacts?  Again, this requires a detailed history and evaluation to determine the likelihood of injury versus symptoms for a separate reason.  If it is suspected that they are becoming injured more easily, regular sport participation may put them at an increased risk for injury, and would be a consideration for retirement.

Alternatively, we know that not all symptoms experienced during sport participation, or even from impacts, are due to concussion.  However, symptoms for any reason can affect our day-to-day lives and therefore this is also a consideration when recommending continuation of sport participation.  An athlete who has frequent headaches with sport participation, for example, needs to be properly evaluated and treated, so this does not lead to a chronic headache problem or significant quality of life disruption.  If it cannot be managed with proper treatment, and it is significantly affecting other aspects of that athlete’s life, this could be a consideration for retirement. 

5. Overall exposure

With the concern for long-term brain health now focused on cumulative head impacts over time, an athlete’s past and estimated future overall head impact exposure should be considered.  This should be put in the context of the athlete’s overall sport and life goals.  Again, the discussion with an athlete playing contact sports who has no plans to continue past high school is different from an athlete with plans to continue playing in college and beyond.  The risk for overall and high-velocity impacts is much higher in the latter, assuming the same sport, compared to the former and will help to shape the discussion.  

6. New or progressive issues

Similar to symptoms occurring during sport participation, evaluating for any new symptoms or conditions which have developed during sport participation and can be linked to sport is important.  These might include new headaches, poor sleep, mood issues or cognitive complaints.  For those older athletes who have been playing contact sports for many years, are there any issues which have progressively gotten worse throughout their career?  Again, it is important to be proactive.  It is much harder to assess these issues, and whether they are related to sport participation, years after they have started.  Just as with yearly sports physicals, regular neurological evaluations are paramount in promoting long-term brain health and providing a framework to follow athletes over time. The overall goal should be for every athlete to finish out their sport career on their own terms, and with the same healthy brain and body they had when they started.

As you can see, there are many factors to consider when discussing participation in contact sports.  These are detailed and lengthy conversations and should not be taken lightly.  Without a proper history and true understanding of the athlete’s goals and motivations, a recommendation for retirement may lead to serious physical or mental health issues.  It is important that the athlete be part of this process, no matter the decision, in order to avoid any unintended consequences.  At the end of the day, there is still very much unknown when talking about long-term brain health and contact sport participation.  That is why proper management and regular neurological follow-up is important for athletes moving forward while consideration of the factors above helps to put things in perspective and can help guide decision-making. 

Disclaimer: This article is for informational purposes only. Neither Sidelined USA nor its affiliates provide clinical or medical care of any kind via their relationship with Sidelined. At no time should a user have an expectation of clinical care or professional services offered or rendered.

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Dr. Anthony Savino

Neurologist and Director of Illinois Bone and Joint Sports Neurology Program

Neurological Consultant, Chicago Red Stars and Chicago Wolves

Team Pool Physician, US Ski and Snowboard Team

“ Participation in sport and competition is a natural part of being human. My goal is to provide education and guidance, so athletes may compete in the safest way possible, for as long as they want. Removing athletes from their sport is a big deal, and I am glad to be part of a program such as Sidelined USA that takes such a comprehensive approach to that discussion as well as provides resources during this difficult period of transition.”