This article is the third in a series on Athlete Physical Transition. See here for the previous one on Strength & Conditioning.
Injuries are a part of sport. Athletes get injured, no matter what their sport or level of competition. Injuries can stay with an athlete throughout their career and they don’t all of a sudden disappear the moment they retire. Some injuries may impact the rest of an athlete’s life.
Consequently, what can athletes do to help prepare for the medical support they may require in retirement? What questions can they ask? Who can they ask for help and advice? What information will help them make better choices around seeking help?
Additionally, how can sporting organisations provide support to their retiring athletes and can they be doing it better than they currently are? Who within the sporting organisations are best positioned to provide advice and support?
We’ll get to those in just a moment.
When I was 18, I was playing just my third competitive senior rugby union match since leaving school. I was enjoying myself and playing some of the best rugby I had played or ever played after that date. It was late into the game and my team was cruising to victory and continuing our undefeated start to the year. I had even been approached to join a professional team’s academy. Everything was going well.
It was then, that I got caught in an extremely awkward position and had the full weight of two men, much larger than me, come down on top of me, with my right ankle taking the full load. I subsequently snapped my talus in half and dislocated my subtalar joint. In layman’s terms, I had completely busted my ankle and done a pretty good job at it too! The injury was so ‘unique,’ that the surgeon had kept my x-rays and medical report to present at a conference he was attending. Even to this day, when I tell doctors and other medical professionals about my injury, they are completely shocked and invariably ask, “How the hell did you do that?”
Of course, an injury like this was pretty devastating for an aspiring 18-year-old. I clearly remember seeing the surgeon for the first time. He was pretty worried, with genuine concerns that the bone could die, even after surgery, as it had very poor blood supply. This meant the potential of walking with a limp for the rest of my life. Forget about playing rugby or sport ever again.
Thankfully, I was very fortunate.
Two surgeries later and 12 months of rehab, I was, thankfully, pretty much back to normal. The catch though, was that the surgeon, physio and sports doctors who all treated me warned that I would definitely need ongoing management and will almost certainly require surgeries later in life and suffer from posttraumatic arthritis.
On top of this, I went on to have two knee operations and have unrepaired ligaments still in my knee. It got to the point, where one doctor told me something, which has stuck with me ever since….”You want to be able to pick up your kids and play with them, so perhaps you need to consider if you want to keep playing.” Additionally, he told me it was pretty much 100% guaranteed I would need a knee replacement at some point.
All pretty confronting stuff to have had to digest by your early 20s.
Pain is inevitable; suffering is optional
I have been pretty good at managing myself over the years since, but the fact is, I pretty much have some level of constant pain in my knees or ankle. Where I was really lucky, was that each of the practitioners I dealt with, were excellent in telling me what needed to be done, referring me to the best specialists they knew and basically supported me as much as they could in helping me to manage each phase of my rehabilitation and injury management.
I know, I know, enough with the sob story, but the fact is, those injuries will impact me in some way for the rest of my life. But my story is certainly not unique, and many athletes, with much longer, more intense careers, at a much higher and more elite level than mine, will have chronic injuries that will affect them well into retirement. Impacts are not just physical either, they can be financial, mental and emotional.
A more recent and high-profile example is former WNBA star, Lauren Jackson. Lauren spoke of having to take sleeping pills simply to sleep at night, as the pain from her sporting injuries was keeping her up at night. Countless knee operations had forced her into retirement and will be something that she has to deal with for many years to come.
Medical Support as an Athlete
Many elite athletes, often through the sporting organisations they belong to, will have access to a number of medical professionals during their career. Physios, sports doctors, surgeons, psychologists, nutritionists, to name a few. Athletes do not have to worry about hospital waiting times to get scans or operations. However, this plethora of medical expertise is, more than likely, not available to an athlete once they retire. They might have a year or two, where the sporting organisation agrees to continue support, particularly if there has been a career-ending injury, but this support is certainly not indefinite.
Retired athletes are responsible for sourcing their own practitioners and cover any ongoing medical cost for themselves. This can range from ongoing physiotherapy for niggles and injury management, to serious (and expensive) operations, such as joint replacements.
So how does an athlete get the medical support that he/she needs in retirement?
Referrals and Recommendations
When an athlete retires, the best person to talk to regarding their ongoing medical support and requirements is the sports doctor or physio that has been treating them during their career. Whilst many athletes may have had several practitioners who have treated them during their career, the most recent will be the best. Tapping into the knowledge and the networks of their medical support team, an athlete will be able to plan ahead.
Medical practitioners will undoubtedly have trusted networks of their own, of which athletes can ask for referrals and recommendations, who they will be able to access of their own accord. Whilst the practitioners within the sporting organisation may not be able to help them anymore, they may know someone who can – and can even provide them with all the information they need to be able to treat an athlete effectively going forward. A small thing for the practitioner to do, with a hugely effective result. At the same time that they are having the conversation, an athlete should ask for their medical history, or at least ensure it is available to anyone who may need it in the future. This will help save time and money by not having any new medical practitioner start from scratch.
Through my work at The Final Whistle, we recently presented to a number of medical and health care professionals, all with a background in high performance sport, on the physical challenges athletes may face in retirement and how they may be able to help. One really interesting point that came from a number of those present, is that the treatment table often became a place where athletes expressed genuine concerns and worries they had. Their vulnerabilities were highlighted. It was almost an informal counselling session.
They went on to say that some athletes spent as much time with them as they did with their team mates or coaches. As a result, not only did they know the athlete’s body better than the athlete themselves, many of these practitioners knew the athletes better than anyone else within the sporting organisation. It puts them in a position where they are very well-equipped to help guide the athlete on the support they may need. Whether that is the best knee surgeon, psychologist or physiotherapist, the practitioners are often a trusted resource for the athlete, with the athlete potentially more willing to listen to their advice and recommendations compared to others around them.
Sports Organisation Assistance at Minimal Cost
Revisiting feedback we received during our recent presentation, many of the practitioners spoke of them being the ones that often delivered bad news to athletes that, due to injury, their career was over. A fairly tough and emotional task. From here it was discussed that to help improve the outcome for both athletes and themselves, they could then work together to ensure that athletes are looked after properly moving forward.
Support could range from referral to a suitable psychologist to help with the emotional aspects, to providing ongoing treatment themselves, perhaps at a discounted rate, or referring them to practitioners that could do the same if they weren’t able to. Just small considerations such as these, in which the practitioners we spoke to agreed, meant that both the athlete and practitioner would be left knowing they are going to receive the support they need.
Sporting organisations, perhaps, could do better in helping support this too. Speaking to a recently retired rugby union player, he mentioned that there was basically next to nothing in regards to support upon retiring to help understand what may be required going forward medically, no real advice on detraining, referrals to practitioners they could speak to or the best way to manage their medical requirements. Whilst he did admit if he asked for help, the team doctor would definitely be happy to chat, it certainly wasn’t a requirement on their part. It is worth noting, that this athlete did not retire due to injury, but by choice, after a long and successful career.
Similar to having an induction when starting out, sporting organisations could provide a transition workshop or exit interview, where topics such as an understanding of ongoing medical support and possible options are covered to help athletes feel more comfortable and understand their requirements and obligations. This could cover athletes retiring for any reason, including because of injury, of their own accord, or even being delisted. Even just a simple checklist is enough.
One initiative I recently came across in the USA, looks to provide medical support for NFL players up to 15 years into retirement. The Tulane Institute of Sports Medicine, in partnership with The Trust (Powered by the NFLPA), provide comprehensive health assessments. Once assessments are completed, the medical partners and practitioners who administered the assessment ‘will provide the former player with recommendations containing a plan of action the former player can follow to ensure continuity of care at home.’ A fantastic initiative and one which could look to be replicated and developed for other sports and organisations around the world.
Many athletes may have been responsible for paying their own health insurance during their careers. However, in retirement, an additional benefit of these conversations will help the athlete choose the most cost-effective and appropriate health insurance, ensuring they do not spend money unnecessarily on insurance they don’t need, but at the same time ensure they are covered for the things they do. This has the added impact of helping an athlete manage their finances in retirement, which can be an additional consideration for many athletes. Although, this is perhaps more a duty for an athlete’s financial planner or manager.
The elephant in the room here, which has received significant attention recently, and rightly so, is that of concussion in sport, concussion management and both the short and long term effects of concussion. A topic in its own right and beyond the scope of this article, one which we will explore in detail at a later point.
More Information, Better decisions
Like anything in life, the greater the understanding an athlete has of their medical and injury history, the more this will help them make more informed decisions about managing their bodies in life after sport and thus give you peace of mind. However, I accept that this is not an easy process, as every athlete is different, with each person going to have different medical needs after retirement.
But here are some points on how to achieve this:
What are you potentially going to require to help manage any chronic injuries eg. equipment and tailored rehabilitation programs.
Who are the best specialists to be referred to when it comes to certain injuries? Having options here is wise.
Who are the best practitioners to call on if needed to assist with detraining?
By answering these questions well before retirement, athletes will be in a much stronger position to ensure those chronic and niggling injuries are managed properly and don’t affect their quality of life after sport.