Why, when we know risk of injury, do we keep on playing sports?
Every day I hear something like this: "Doc, how soon can I get back to playing soccer?"
This can be a question from somebody with significant cartilage damage, torn ligaments and arthritis at the age 30, after having had six operations for both knees. For this person, returning to soccer means a chance of further bodily injury. Not to mention brain damage.
In soccer, there's the added risk of injury when heading the ball. A 16-ounce soccer ball traveling at up to 50 miles per hour smacks the head deliberately and repeatedly. How often? In a range of 32 to 5,400 times per player, per season, according to a study of amateur soccer players by Lipton et al Radiology . The brain changes detected by MRI were not subtle, nor would you expect them to be.
Why is it that the fun and satisfaction of participating in sports overwhelms our recognition that they could significantly destroy our body, be it the knee or the brain? The answer, I believe, is that as athletes we just can't comprehend the impact of the damage. We don't understand that sports injuries build up and lead to arthritis, or that repetitive brain trauma gradually reduces our cognitive power. Either that, or we choose to ignore it, we feel invincible. Simply put, the fun outweighs our belief in the risk and, even if we acknowledge the risk, in many cases, we think it is worth it.
As an orthopedic surgeon, an athlete, a former soccer player, a skier and a dad, I have multiple dilemmas. I work hard at developing the best methods for repairing my patients' injured joints and at developing new tools so that their injuries do not lead to arthritis later in their life. A goal of sports medicine is to get players back to sport as soon as possible, however, I know that our tools are limited -- the science is just developing to replace meniscus, cartilage and ligaments in ways that prevent arthritis. The tools for assessing brain injury are even more primitive and there are no treatments at all for the subtle and not-so-subtle brain injuries.
Am I wrong to help these sports warriors back to the fray? Although I warn them that further impact on their repaired cartilage is likely to shorten their active lifestyles and I tell them that arthritis ruins more lives than cancer kills people, is that enough? And what about our kids? Is encouraging them to play soccer and football simply crazy?
My answer, and I look forward to hearing yours, is that there is a little craziness to it all. And so we must teach our kids and our patients to do dangerous things safely, to measure the risks, and take the newest knowledge and apply it to the best safety gear and methods, and then encourage them to go fully enjoy the thrill of sports and learn the wonderful lessons that only team sports can teach. The alternatives are not palatable.
At the same time as I am enabling these activities, I must commit myself, and inspire others, to research, develop and test novel ways to protect the athlete and repair the damage once done. It seems reasonable that in the 21st century we should be able to repair, regenerate and replace injured tissues, which, while it won't make athletes indestructible, will certainly cut the risk of long term damage. That is my mission and my obligation.
1. Lipton ML, Kim N, Zimmerman ME, et al. 2013. Soccer heading is associated with white matter microstructural and cognitive abnormalities. Radiology 268(3):850-7.