Macrocosm: Athletes Are Risking Their Health and Even Their Lives for Our Entertainment, What Can Be Done About It?

Stanislaw Pytel

*Insert your favorite sport here* has become unwatchable. How many times have you heard this hot take? Usually it comes in response to the different safety measures put in place to protect athletes. The NBA has gotten better at giving out fouls, but many fans argue it has compromised the integrity of ‘the game’. NFL players who illegally or flagrantly tackle opposing players can be suspended. A rule many fans believe is too harsh and should be replaced with a simple fine. Soccer players are labeled “soft” when they overreact to injuries, even painful ones. 

Athletes are the backbone of the sports industry. We buy their jerseys, hang up pictures of them on our walls, watch them every single week, and idolize them. We also share in their heartbreak when they suffer a serious injury. So why do we hate the rules put in place to protect them? Many will argue that sports injuries are an occupational hazard athletes need to come to terms with. “They’re simply part of the game”, but do they really have to be?

ACL Tears

ACL, the three letters no athlete wants to hear. Unfortunately for them, the ACL tear is one of the most common sports injuries. The American Orthopedic Society for Sports Medicine estimates that just in the United States, between 100,000 and 200,000 ACL injuries occur annually. The anterior cruciate ligament, or ACL, is a band of tissue that connects the thigh bone to the shine bone. Think of it as a stretched rope, when it snaps, the knee stops functioning properly.

Only 20% of ACL tears are contact injuries, the other 80% occur when an athlete is cutting, pivoting, sidestepping, slowing down, or landing awkwardly from a jump. That is why they are more common in sports like soccer, basketball, volleyball, and skiing. Women have it worse; female athletes are two to nine times more likely to sustain an ACL tear than their male counterparts as women tend to have smaller and looser ACLs.

ACL injuries are notorious for their lasting effects. 79% of athletes who undergo ACL reconstruction develop osteoarthritis, 20% suffer re-injury within 2 years, and only 65% return to their pre-injury levels of knee function within the same time. Legendary career killers, ACL injuries have led to the downfall or early retirement of countless athletes.

It isn't all bad. Because most ACL tears are non-contact injuries, they can be avoided with some work. Many ACL prevention programs have been developed over the years. When one is implemented, it can prevent between 50 and 80% of injuries. Prevention exercises are typically performed several times a week for about 20 to 30 mins. Sounds easy enough, especially for athletes whose entire job consists mostly of training.

Although most athletes wouldn’t hesitate to participate in an ACL prevention program, the real issue is that they aren’t widely implemented. Athletes tend to train on their own during the off-season and the training that occurs during the regular and post-seasons is more focused on developing skills. It is up to the different sports teams and clubs, the ones who ironically suffer most when players are injured, to prevent ACL injuries. Making ACL prevention programs universal, would be a great place to start.

Heart Conditions

In 2017, professional soccer player Abdelhak Nouri experienced a cardiac arrhythmia attack during a pre-season friendly match between his team, Ajax, and competitors, SV Werder Bremen. As a result, Nouri suffered permanent brain damage and his career, and the possibility of a normal life, are effectively over. He was only 20-years-old at the time.  

The human heart wasn’t built to endure hours of intense exercise. Athletes are able to overcome this by developing what is appropriately called “athlete’s heart”. Essentially, demanding exercise triggers physiological changes to the heart causing it to grow in size and develop thicker muscle walls. On its own, athlete's heart is a completely normal and safe phenomenon, but it can sometimes mask a serious disease, hypertrophic cardiomyopathy (HCM)

HCM is a genetic condition that causes the heart to develop thick and stiff muscles. Sound familiar? It is also the leading cause of sudden death in young athletes. HCM makes pumping blood difficult, possibly leading to sudden cardiac arrest or arrhythmia. For athletes with HCM, the changes associated with athlete’s heart can be lethal.

Major sports leagues already know about this. Most have instituted mandatory cardiac screenings for athletes to detect genetic and acquired cardiac conditions. Paramedics or personnel trained in CPR and AED use are usually on standby. Still, many cases slip through the cracks.

In 2018, Zeke Upshaw collapsed during the final minute of a G League game between the Grand Rapids Drive and the Long Island Nets. A defibrillator wasn’t used, not by the team doctors or paramedics at the scene. Despite CPR, which wasn’t started until 7 minutes, and far too long, after his collapse, Upshaw’s heart remained in cardiac arrest for almost 50 minutes. He died two days later. Upshaw had undergone three separate heart screenings in the 16 months leading up to his death; he passed them all. In Nouri’s case, Ajax later admitted that the medical treatment he received on the field was “inadequate” and may have contributed to his brain damage.  

Upshaw and Nouri are outliers among outliers. These precautions have been successful at preventing fatalities on multiple occasions. Clearly, the process just needs to be refined and better enforced. For athletes with HCM, there is some hope. At the 2020 European Society of Cardiology Congress, researchers revealed that they had developed a pharmacotherapy, mavacamten, for HCM. Mavacamten inhibits myosin, an essential protein that happens to be mutated in patients with HCM. The drug is expected to apply for FDA approval in early 2021.

Mental Health

As fans, we tend to commend athletes for overcoming the physical burdens of sports. We can clearly see all of blood, sweat, and tears poured into every game or match. What isn’t obvious, is the mental toll it takes. A true invisible struggle.

 Professional athletes are expected to be perfect both on and off the court or field. A type of pressure that would cause even the strongest mind to develop a few cracks. It’s no wonder that 35% of elite athletes suffer from a mental health crisis. Injury, performance failure, overtraining, online abuse or harassment, personal issues, impaired sleep, and lack of a support network are contributing factors. Even when athletes transition out of a sport, they are faced with challenges if their retirement is unplanned or they struggle to establish an identity outside of sports.

Statistics on mental health symptoms and disorders in elite athletes are scarce. It is believed that 35% of elite athletes have anxiety/depression, 19% misuse alcohol, up to 19% of males and 45% of females have an eating disorder, and 7% have a gambling addiction. These are all just estimates. In reality, not enough data exists to paint a clear picture of the prevalence of these mental health disorders, and many others, in athletes.

Support initiatives for athletes have focused primarily on raising awareness and encouraging help-seeking behaviors. An unquestionably good thing but not necessarily the best approach. To create effective detection and intervention networks, which are currently nonexistent, more data must be collected from current and former athletes.  

This is easier said than done because when they do speak up. When they are candid about their struggles. Honest about their experiences. Athletes face harsh criticism. On a 2018 episode of Saturday Night Live, Kevin Love was mocked by comedian, Pete Davidson, for opening up about a panic attack. Davidson, who has faced his own mental health struggles, didn’t believe that Love had the right to complain since his issues weren’t (subjectively) as severe as Davidson’s. Although Davidson was only joking, for the most part, what he said echoes how many people feel. Athletes are better off than the rest of us, so they shouldn’t have anything to feel bad or complain about. This is simply not true.

Thankfully, research study participants are completely anonymous to the general public. Urging athletes to participate in them is a far more productive support initiative. Sports leagues and mental health professionals can’t begin to give athletes the best care for their mental health needs until they understand what those needs are.

Rules of Engagement

By law, athletes who play team sports are considered employees. Yet the Occupational Safety and Health Administration, the federal agency responsible for maintaining safe work conditions for all employees, can’t do anything for them. Professional sports leagues have players’ unions but athletes don't understand their own safety needs. The rules and regulations fans hate are currently the only way to protect them.

 Athletes are risking their health, and sometimes even their lives, for our entertainment. In an ideal world, we would be able to ensure their safety without drastically altering the sports they play. Potential sports injuries can be prevented in a lot of cases but the correct rules, regulations, and programs must be established first. It is clear that more needs to be done, but without support from fans, that can’t happen. Maybe, just maybe, these regulations aren’t changing the game, they’re making it better for everyone involved.