All the ways sports risk your patient’s health—and how to initiate patient conversations (without alienating them)
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Sports participation has well-established benefits for physical health, mental health, and social development. So the conversation isn’t simply about the risk of one issue, concussion. It’s about balancing risk of concussion with other meaningful benefits.
—Caitlyn Mooney, MD, sports medicine physician
Contact sports are a beloved pastime, but many patients don’t realize they can come with both short- and long-term health implications.
Emerging data suggest blood–brain barrier dysfunction may persist years after exposure to contact sports, with recent research suggesting that even years after a patient’s prime, the blood-brain barrier can remain “leaky,”[] raising new questions about how clinicians counsel current and former athletes.
In the United States, at least 2 million adolescents and young people play contact sports. These can include American football, ice hockey, lacrosse, soccer, and rugby.[] Among the risks in these sports are orthopedic injury, concussion, and traumatic brain injury. Repeated head trauma can increase the risk of chronic traumatic encephalopathy.[]
What this means in practice
Ask about remote history of contact sports in patients with unexplained cognitive, mood, or neurologic complaints
Recognize that absence of recent concussion ≠ absence of risk
Consider cumulative exposure when counseling adolescents and parents—not just single injuries
Set expectations that long-term effects may evolve even after athletes stop playing
“All contact sports have a risk of head trauma, some of which will result in concussion. The most significant risk is participating in contact sports while recovering from concussion. In high school and college athletes, the typical recovery is 2-3 weeks. A small percentage of patients will have a prolonged recovery lasting for more than 30 days,” Steven Erickson, MD, Chief of Primary Care Sports Medicine at Banner Health, tells MDLinx.
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Dr. Erickson says it is important for physicians to properly explain the risks involved to their patients, while providing instructions for what to do should a concussion or head trauma occur. “Patients who sustain head trauma followed by neurologic symptoms including headache, dizziness, cognitive difficulty, and visual complaints should not participate until evaluated by a provider experienced in the treatment of sports-related concussion.”
What this means in practice
No same-day return to play for any athlete with suspected concussion
Emphasize strict medical clearance before resuming contact sports
Counsel on modifiable risk reduction:
Neck strengthening
Proper tackling/heading technique
Avoiding head-first contact
Flag patients at risk for prolonged recovery (>30 days) and monitor more closely
Reinforce that premature return increases risk of repeat injury and delayed recovery
Just as importantly, Dr. Erickson says physicians can remind their patients that there are steps that can be taken to minimize some of the risk, particularly for concussion.
Don't discourage activity
“Contact sports have an inherent risk of injury, including concussion. Neck strengthening exercises can decrease the risk of concussion. Using proper technique—including not using the head as a weapon—can decrease risk of concussion. If you sustain a concussion, do not participate in contact sports until cleared by a sports medicine specialist with experience in the treatment of sports-related concussion.”
But despite the risks from contact sports, experts say patients don’t necessarily need to give up contact sports altogether.
“It’s important to put this into context: concussions can occur in almost any activity, including non–contact sports and everyday life,” says Caitlyn Mooney, MD, a sports medicine physician at Vanderbilt University.
“Sports participation has well-established benefits for physical health, mental health, and social development. So the conversation isn’t simply about the risk of one issue, concussion. It’s about balancing risk of concussion with other meaningful benefits. For many individuals, removing access to sports may reduce overall physical activity, which has its own long-term health consequences,” Dr. Mooney says.