Sports Medicine Research: In the Lab & In the Field: Are We Doing Enough to Plan for How Injuries Affect Players Later in Life? (Sports Med Res)
Monday, November 12, 2012

Are We Doing Enough to Plan for How Injuries Affect Players Later in Life?

Life after the game – Injury profile of past elite Australian football players

King T., Rosenberg M,, Braham R., Feruson R., Dawson B. Journal of Science and Medicine in Sport. 2012; ahead of print.

Australian football players are exposed to extreme physical demands, which cause disproportionately high number of injuries compared to other sports. Due to the magnitude of the physical and psychological strains most Australian Football League players have an average career of 4.7 years inevitably meaning a player pursues a second career, and there has been little research on how their football career affects the players later in life. Therefore, the authors investigated the long-term health (mental and physical) of past Australian Football League players and the effect of prior injuries on their currently lifestyle. Five hundred and ninety-two past Australian Football League players completed a health and well-being survey (37% response rate). The survey included questions about playing career, current mental and physical health, education and employment history, and demographic information on the specific serious injuries and concussions they sustained during their career.   Many of the players reported they had at least 1 serious injury (i.e., required hospitalization and/or surgery; 77%) and at least 1 concussion (73%). The retired players most commonly reported serious injuries at the knee (57%), ankle/foot (33%), and shoulder (31%). The authors found that the most common classification of those injuries were strains and sprains, both of which occurred on average 4 times throughout the career of players who reported a history of serious injuries. Sixty-four percent of the players reported that their previous injuries affected their daily life. In addition, 60% of players who reported serious injuries required on-going treatment. Half of the players reported they have arthritis. Players with a history of lower extremity injuries (82%) were more likely to be negatively impacted than those with a history of upper extremity injuries (55%). Players that reported 1 to 5 injuries typically played in fewer games (on average 77 games) than players that reported over 11 injuries (on average 120 games). Additionally, players receiving at least 1 concussion played in more games (on average 106 games) than those with no reported concussion history (on average 72 games).

Many retired Australian Football League players reported at least 1 serious injury during their career and many are still receiving treatment. The survey did not include questions about rehabilitation or time it took for their injuries to heal as well as medication use, which has been a problem in retired National Football League players (NFL; American football). This study reaffirms that athletes in high impact sports are at greater risk for negative long-term health outcomes, where the risk of this increases with lower extremity injuries compared to upper extremity injuries. Research conducted within the NFL supports the notion that some athletes may be in for long-term health issues. In sports medicine, we should be concerned not just with injury prevention but also preventing the long-term adverse health outcomes associated with injuries. Therefore, it is important for sports medicine clinicians to better understand what long-term health issues athletes have, what athletes are at risk for these, and then what we can do to amend that risk (patient education, treatment). In an environment, where the players and coaches are often concerned about the here and now we must take action and raise our voice about finding ways to reduce these long-term health issues. If we don't then we cannot really take claim to be experts in prevention and we are failing our patients. Do you believe if this study was replicated in the United States with rugby, football, or ice hockey athletes we would find similar findings?

Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeffrey Driban

Related Posts:

King T, Rosenberg M, Braham R, Ferguson R, & Dawson B (2012). Life after the game - Injury profile of past elite Australian Football players. Journal of Science and Medicine in Sport PMID: 23058879

13 comments:

Aaron said...

I believe this study hits on a very important issue that will only be more mainstream with media uptake. Recent events involving former NFL athletes and concussions are extremely alarming and will help bring awareness to the issue. I absolutely believe that it should be the responsibility of institutions or professional clubs to track and document former athletes and their quality of life. A survey regarding quality of life, lingering injuries, and mental health issues can be distributed electronically to former athletes every several years.
Currently I do not believe there is enough data or research available to discuss what the institution should do if an issue has occurred. If data is collected that shows a correlation between athletics, injuries, and future health complications then said institutions or clubs might require action. That’s when things get tricky regarding insurance and liability, but for now more data is required.

Jane McDevitt said...

Aaron,
I believe sending electronic surveys to the athletes every "x" amount of years is a great idea. It would be in the best interest of the athletes as well as the athletic club or association. I am not sure if anyone is doing this currently. It does take a lot of man power to keep all of the forms confidential, follow up on the athletes to get a good enough survey return, input all the data onto a spread sheet, and then they need a statistician (which should not be hard to find in sports) to crunch the numbers. The point you brought up about insurance and liability may be one of the reasons the clubs and associations do not do this follow up regarding quality of life, and lingering mental and health issues. They may believe this would open up a line of law suits. For now, we will need more research to bring more attention to this issue, and hopefully get the cooperation of the clubs and associations to take a more active role.

Zahida Mitha said...

I think that we would have similar findings in the United States. I think Jane makes a great point about not being able to claim that we are experts in prevention if we do not even know what the long-term outcomes are. I agree with Aaron and think that a survey would be a great way to determine these outcomes. Insurance and liability are issues for these clubs and associations, but I think knowing long-term consequences and catching them sooner rather than later could potentially prevent lawsuits in the long run.

Jane McDevitt said...

Zahida,

I think your point on if we use the surveys for finding out what the long term problems would be beneficial. This information will help not only in preventing health problems because we can provide better prevention care, but I believe as well that it will prevent lawsuits in the long run as well. We will need more research like this to push the associations and clubs to see the pros in doing long term survey research.

Nate said...

I agree that this study could be replicated in other collision sports in the USA. Whether it's news stories on CTE found in former NFL players or deaths in NHL enforcers I think there is a shift towards media attention on how injuries affect the athletes for the rest of their lives. I also agree that with electronic medical records becoming more and more common place we need to utilize this as a tool for tracking our athletes not only during their time in athletics but also after they have retired. When we have this information we will be able to better inform the athletes of the long term risk of their sport so I believe overall this will decrease any lawsuits that may result because all parties will be better educated.

William T. said...

I think that if this study was done in the US I think there would be an increased report of concussions as well as games played with concussions especially with football. I agree that more research is needed in order to shed more light on possible solutions for this issue; I think for concussions specifically we need to find a common or standard form of evaluation even with software. I was reading the other day that Michael Vick is still being held out because he didn’t pass his “ImPACT” exam; I am curious as to how many professional teams use that as opposed to CRI as used at my university. Either way, I think going along with what Nate mentioned electronic medical records need be more prominent, complied consistently and observed for trends during and following athletes careers. Obviously there isn’t any quick fix or anything going to be developed over night but if we start doing the little things and approaching the situation systematically now we will set ourselves up to potentially find answers that we are looking for sooner.

Jane McDevitt said...

William,

It would be interesting to know the protocols and the differences among professional sports and their treatment protocol for concussions. One huge problems is that there is not a standardized protocol pertaining to how you treat a concussion. There was a review by Broglio et al. (http://www.bakerneuropsychology.com/files/Sports_Concussion_Article_1.pdf), and the main finding was that doing several concussion tests increased sensitivity of diagnosing a concussion. Even a neurocognitive exam alone was not sensitive enough on its own to diagnose a concussion. I am not firmiliar with CRI. I have heard of Headminder and I work with ImPACT myself so I dont know how different they are. However, I agree along with electronic medical records and a more standardized way of treating concussions it will be easier to follow trends and adjust to better treat the athletes.

Chip W. said...

I agree with the aforementioned comments about this needing to be done in the US. Certainly with the media sensationalizing the concussion issue and the NCAA's legislation regarding athlete and coach education, concussions are being diagnosed and documented more frequently. In undergrad, our senior athletic training class held a mandatory session for athletes on concussion education, and a good portion of it focused on long-term effects of concussions. We included and E:60 video about an athlete living with the after-effects of second impact syndrome(http://sports.espn.go.com/espn/e60/news/story?id=5162747). I felt that it stuck with the athletes, and some of them even came up to me after to discuss how their ideas of concussions had changed from seeing that. A lot of times for high-level athletes, making them understand that there's life after sports may guide them towards proper reporting of injuries, whether it's concussions or something else.

Jane McDevitt said...

Chip,

I think the use of video can give a strong depiction of the worse outcomes and put that fear that concussions are brain injuries and not something to let roll of your shoulder. This video certainly does it but it is a little dated. They use "trainer, " and they do not follow the updated protocols or return to play standards that is in place.

I think if they use a video and show the athletes what happens as far as return to play in addition to this video when they continue to play with a concussion or do not follow return to play protocol it can be educational as well as have that picture that will stick with them and change their minds about concussions.

Brittany Cavacloglou said...

I believe looking into the long term effects is very important. Especially with young athletes today that are so into just playing the game no matter what it takes. We should educate athletes about the severe risk factors that come along with contact sports. In your opinion, what is the best way to get this message across to athlete's about the severe risk factors that come along with contact sports?

Jenna Robinson said...

I think injuries and whether the consequences being long term or not is a big risk athletes have to take when getting involved in contact sports such as football. Concussions are no secret but I think some athletes don't take recovery as serious as they should. I think prevention programs and simple education tactics will go a long way in helping younger athletes today be more careful and consider their future instead of just the game. The surveys are a great idea and giving them often will show more research as to how to go about sending the message to contact sport athletes especially.

Alex Ruxton said...

I found this article very interesting because it is very relevant in today's athletics. Many former NFL athletes have been diagnosed with CTE which could possibly be from sustaining brain injuries during their professional careers. I think you are correct by saying we are failing our patients if we are not preventing long-term health issues. I think athletes should have some type of insurance policy to protect them from long-term health issues if they can prove their issue stems from their professional career.

Brandon Green said...

The timing of this article fits in perfectly with today's issues in professional sports. There are several retired professional athletes that have received treatment for previous injuries received during their careers. The one that comes to mind is a retired NFL player who committed suicide. His name Junior Seau, and he was known throughout the San Diego community as a giving person, and he showed no signs of depression and was not receiving treatment for any mental illness. They contributed his early death to repetitive lesions in the brain most likely received while playing football. There should be protocols to ensure that retired athletes are able to live a full life after sports.

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