Sport’s darker side

Around the world, boys and girls dream about becoming professional athletes, earning a living doing something that they love and having the opportunity to achieve fame and fortune. But most will have to find other ways to make a living and few will ever grow up to earn a living as a professional sportsman or woman.

I was one of those boys who dreamed of playing in front of a sellout crowd at Anfield stadium, but at 24, more than half way through my medical training, Liverpool Football Club still hadn’t phoned. I was heading to the east coast of the United States to spend three months working with a sports orthopaedic surgeon who was a team doctor for a famous National Basketball Association team. As anyone who loves sport can imagine I was excited about the opportunity to work with and meet some famous professional athletes.

During my elective I met most of the team and many other sports stars and celebrities, from tennis players to wrestlers. Coming from the United Kingdom, I had no idea who many of these US athletes were, never mind what they did. But I still felt in awe of them and envious that they have the chance to do what millions of people only dream about.

The doctor I was working with also worked closely with the NBA and the National Football Association players’ unions, and did medical checks for injured former professional players who have had to retire. He carried out full physical examinations and investigations to assess fitness and the injuries they may have sustained as a result of playing their particular sport. If the injuries were sufficiently disabling the former players were entitled to compensation from the governing bodies of the NFL and NBA in the form of a disability pension and medical insurance. My initial reaction was why?

Show me the money

Most of the patients I saw played American football. Almost all of these players earned in excess of $1m (£520 000; €650 000) a season at the peak of their career and many were famous in their heyday. Why did they need more money?

American football, known in the US simply as football, is a totally different game from the soccer played in the rest of the world. It is a competitive team sport known for mixing strategy with intense physical play. Players must wear special protective equipment, such as a padded plastic helmet and pads on their shoulders, hips, and knees. These protective pads were introduced decades ago and have progressively improved to minimise lasting injury to players. An unintended consequence of all the safety equipment is that it has resulted in increasing levels of violence in the game. Players may now hurl themselves at one another at high speeds without considering the risk of injury. So the injuries that result tend to be severe and often season or career ending and sometimes fatal.

My first patient changed my somewhat media distorted views. Injuries sustained by football players are often permanent. Many of the patients I met lived with constant pain, sometimes severe, that will last for the rest of their lives. Many patients needed surgery, even multiple operations, for injuries experienced years before. Some of the men could not even stand up straight without excruciating back pain. I saw many knee x rays that could have been taken from a 70 year old.

Sometimes the consequences were far worse. Catastrophic football injuries are defined as injuries that result in death, brain or spinal cord injury, or cranial or spinal fracture. From 1931 to 2007, the National Center for Catastrophic Sport Injury Research reported 1002 direct and 674 indirect deaths from participation in all organised football in the US.¹ American football accounts for the most direct catastrophic injuries of any sport reported to the centre.²

Retired NFL players receive health insurance for the first five years after their playing career and then are on their own, when insurance is often unaffordable, very different from the National Health Service in the UK, which is free at the point of care. Unlike the English soccer player, an American footballer’s career lasts on average three and half seasons. A relatively short period of time on high wages, and most players do not expect their career to end abruptly because of injury and do not plan financially.

Counting the cost

I talked to former players about their crippling injuries and having to live with the constant pain, and almost without exception the players expressed little regret about their choice of career. One of the former players took about six minutes to cover 40 metres—a distance he used to run in less than five seconds as an athlete. Unable to straighten his lower back and his knees, he said that the thrill of playing football was worth the price of a lifetime of subsequent pain.

This is the dark side of sport that rarely gets mentioned in the tabloid press or makes headline news. I was left with a different view of these athletes and a respect for their lack of regret that, despite the prospect of living the rest of their life in pain, they still felt lucky to have achieved what for millions of people remains an unattainable dream.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

1. Mueller FO, Diehl JL. Annual survey of football injury research. Chapel Hill, NC: National Center for Catastrophic Sport Injury Research, 2007.
2. National Center for Catastrophic Sport Injury Research. Twentieth annual report: fall 1982–spring 2000. Chapel Hill, NC: NCNSIR, 2005.

      

 Printable version     Download PDF   E-mail this to a friend   Respond to this article