The Athlete's Dilemma

Data everywhere, and nowhere to hide. In the bad old days, you got injured, and you didn’t tell anyone.  You usually recovered.  Lived to play another day.  Until you couldn’t.  Today, you get injured; you could be monitored, measured, uploaded and reported to everyone.  You might not be allowed to play.  You are “protected”, maybe even blacklisted.  Which scenario is better?

Playing with pain, and playing through injuries, is clearly not a smart short- or long-term personal plan, unless your contract and livelihood depend on it.  In that case, the decisions balance short-term gain against long term injury.  For adults—and especially for pro athletes—these choices are faced daily.  No NFL or college football player ends the game feeling healthier than when the game started. Ice baths, massages, drugs, all ease the pain.  Relative youth provides natural healing, for a while.  The injuries are graded on a 1-10 scale, with 1 being barely noticeable and 10 being unplayable.  Once the injury is noticed by the trainer or reported, a waterfall of decisions is launched. These might include down time, rehab, surgery, even career threat assessment.  At the end of the day the player, trainer, and team doctor make the final call.  If minimal out of play time is incurred, a new clock starts once the athlete is returned to play.  

But what happens to high school and elementary school athletes?  And what if there was longitudinal data from the time the athlete started to play as a child, all the way up through their professional career? What if players had a lifetime athletic health record?

California is one of the few states that do not require athletic trainers for team sports, never mind team doctors.  So each injury to young athletes goes relatively unreported.  There is no cumulative documentation, no risk assessment, and no standardized guidance.

Half a million kids play soccer in the U.S. each year.  While heading the ball has been eliminated in under age 11 soccer. There is no data on the amount of repetitive head impacts with other players, or the ball, or even outright concussions, estimated to the 6th most common injury in youth athletics.

Given that there is a huge variation in the rate at which kids mature physically,  you often have well-developed chronologic 14 year olds playing with kids who are 14 years old chronologically, but age 11 developmentally.  The opportunity for injury is great, and the assessment of the long-term impacts of those injuries is poorly understood.  Three out of four kids drop out of youth soccer by 14, and only 1 in 10,000 go on to play in a top collegiate program. Since so few continue on, is the repetitive injury exposure worth it?  Would they or their parents like to know their “injury score” (if there was such a thing) along the way?  

Clearly, from a safety point of view, the answer is yes.  In this era of personal digitization it is dumbfounding our child athletes are subject to random quality control.

This may be ending. Several powerful efforts to enroll all athletes in standardized cloud-based injury reporting are underway.  And this is not just for athletes.  The goal is put sports doctors, trainers, physical therapists, and coaches on a single platform to share an athlete’s health record.

One such platform at the forefront of this movement is the Players Health app, a partner of US Club Soccer, and there are others. Monitoring programs are cheap when the entire team or league signs up.  All injuries are recorded, treatments given, and return to play documented.  A personal injury bio is retained by the athlete and parents, and only accessible to coaches or scouts given permission to see it.  

It’s a brilliant idea, but with one huge caveat:  Once it’s recorded, will colleges or coaches be required to review the data before offering the athlete a scholarship?  And is an injury in middle school in any way predictive of future performance?  

Since we now know that all things digital are or will be public, shall we just give in and expose ourselves to anyone who “needs” to know?  Will this radical transparency for youth athletes lead to healthier lives and more successful careers?  The dilemmas for the parent of the youth athlete today is “record and upload and possibly be denied”, or bury their injured heads (and bodies) in the sand.  The widespread presence of degenerative brain disease in NFL players should make the choice a no-brainer.