Navigating the Sidelines: Career-Ending Injuries in NCAA Athletics

The world of NCAA athletics is filled with dedication, passion, and the pursuit of excellence. However, the intense physical demands can sometimes lead to injuries that prematurely end an athlete's career. These career-ending injuries not only impact an athlete's physical well-being but also their mental and emotional state, their identity, and their future prospects. Understanding the multifaceted challenges faced by these athletes and the resources available to them is crucial.

The Impact of Severe Injuries on Health-Related Quality of Life (HRQOL)

Many athletes experience sport-related injuries during their careers that could compromise and reduce their future HRQOL. Severe injuries can have a major effect on an athlete's overall HRQOL. Health-related quality of life is often thought of as an individual's contentment with life and general feeling of personal wellbeing. Health-related quality of life includes several health components: the physical, psychosocial, and social aspects that are affected by the individual's experiences, expectations, beliefs, and perceptions.

A patient-centered approach to care requires collecting and accounting for patient input at every step of the patient care process. This approach is necessary because it accounts for the patient's perspectives and experiences, which helps in determining the overall wellbeing of the patient. However, measurement of HRQOL in sport-rehabilitation-related clinical practice and research is not yet routinely incorporated. Clinicians tend to examine the HRQOL in athletes only during their athletic careers but rarely follow up with them after they have returned to activity or after the athletic career is over.

Research Findings on Former Collegiate Athletes

A study was conducted focusing on former NCAA Division I, II, and III collegiate athletes. Participants consisted of a convenience sample of former NCAA Division I, II, and III athletes from existing databases. A total of 720 former collegiate athletes were originally contacted, and 202 individuals started the survey. Of these, 171 former collegiate athletes (69 men, 102 women; age = 29.7 ± 3.9 years, height = 171.5 ± 10.4 cm, mass = 76.4 ± 12.9 kg; Division I n = 83, Division II n = 32, and Division III n = 56) completed all aspects of the survey (response rate = 23.7%) and their data were used for analyses. To be eligible for participation, alumni must have competed in NCAA Division I, II, or III intercollegiate varsity athletics (baseball, basketball, bowling, boxing, cross-country, fencing, field hockey, football, golf, gymnastics, ice hockey, lacrosse, rifle, rowing, skiing, soccer, softball, swimming and diving, tennis, track and field, volleyball, water polo, or wrestling). Former athletes were excluded if they indicated participating only in organized club or intramural sports during their collegiate years or failed to complete the surveys.

The primary aim of the study was to assess the influence of previous severe injury on the HRQOL of former collegiate athletes. Athletes who endure a severe injury are often thought to experience physical and psychological effects on their health. These adverse effects could potentially decrease the athletes' HRQOL postathletic retirement. The findings, which were based on a diverse population of 171 former collegiate athletes that included both men and women, 19 sports, and 3 NCAA divisions, demonstrated that those who sustained a severe injury while participating in collegiate athletics had worse SF-36v2 subscale scores than those who did not sustain a severe injury. Of the 8 SF-36v2 subscales, physical functioning, role physical, bodily pain, and general health were different between groups. Also, former collegiate athletes who sustained a severe injury had worse PCS scores. Conversely, vitality, social functioning, role emotional, and MCS were not different between groups. It is possible that previous severe injuries decreased former collegiate athletes' HRQOL and may have had a greater effect on their physical health compared with their mental health.

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Clinical Implications and Future Research

A majority of the sample (60%) sustained a severe injury during collegiate athletics. The number of severe injuries sustained and associated worse HRQOL emphasize the need for access to health care resources for former high-level athletes after their collegiate careers. Findings warrant paying attention to the health of former collegiate athletes, particularly given that a majority of collegiate athletes never play professionally and that they play at all levels of the NCAA and not only Division I. Clinicians should consider using HRQOL measures during preparticipation examinations to capture deficits to help optimize patient-centered care and establish baseline measurements for use in care after injury. Developing our understanding of the effect of injury is important for several reasons. First, these severe injuries result from sport participation, which may lead to dropout from physical activity and subsequently to a variety of negative long-term health consequences (eg, cardiovascular disease, heart disease, cancer, obesity, adult-onset diabetes). Second, poorly managed musculoskeletal injuries sustained during collegiate athletics may lead to disabling long-term health problems that have become a national health care concern, such as osteoarthritis.

The Psychological Impact of Career-Ending Injuries

Dedicating your whole life to a sport, only to lose the ability to compete in it is akin to a loss. In many cases, losing a sport is akin to a loss of self. As one athlete shared, "When I was in high school, I kind of did just enough to get by with my grades. I didn’t really push myself in the classroom. I pushed myself in sports. My whole focus was this team, this running, this whole part of my life. And so when that was gone, I was, like, So what am I good at anymore?" The University of Utah study found that athletes return to their former self-concept within 9 to 15 months.

Lainey Stephenson's Experience

Wright State fifth-year senior women's volleyball student-athlete Lainey Stephenson suffered a ruptured Achilles during a match. As part of the NCAA's amplification of student-athlete voices during Mental Health Awareness Month, Stephenson shared a firsthand perspective on her injury and the value of a sports psychologist for student-athletes. "There's a ton of student-athletes like me who don't want to seek out help. I'm a perfectionist, and I beat myself into the ground if I don't think I'm performing at my highest level." Stephenson, who led the Horizon League with 10.66 assists per set this year and graduates with the second-most assists in Wright State program history and the ninth most in Horizon League history, earned her undergraduate degree in media studies and master's degree in physical education with a focus in sports management. She was preparing to start her career as an assistant coach and recruiting coordinator for a Division I women's volleyball program.

Stephenson recalls the moment of her injury: "Nothing could have prepared me for Oct. 29, 2022, a day forever imprinted in my mind… It was a routine serve. I ran across the net, preparing to set up a teammate, something that I've done a million times. I felt it and heard it immediately. I lay there on the cold gym floor, and I wasn't crying. I wasn't even in pain yet. As they carried me off to the training room, the tears came. It hit me that I was probably never going to play again."

The emotional toll was significant. "All the pain started to kick in on the seven-hour bus ride back to Dayton. I got maybe two hours of sleep when I got home. I tore it on a Saturday, met with a surgeon Monday and had surgery Tuesday. We had a big game against Northern Kentucky that night, battling for the right to host the conference tournament. It was the most stressful two and a half hours of my life, and I wasn't even playing. I had no control over it - so I was miserable. I'm from the area around Northern Kentucky, and I'm friends with a lot of those girls." Despite the injury, Stephenson earned Horizon League Setter of the Year for the second time in her career. "Thank God! I think mentally if I didn't get it, I would have been distraught."

The Importance of Mental Health Support

Stephenson emphasizes the importance of mental health support for student-athletes. "During COVID-19, I was having a little bit of a difficult time, and my coaches made me see our sports psychologist. Her name is Allison Newlin, and she helped me with performance anxiety, visualization and breathing." She adds, "It's important for student-athletes to have someone to talk to other than their teammates. Sometimes you need professional opinions and advice to get through a time. Nobody on my team could relate to my Achilles injury. It's a necessity for student-athletes to have access to a sports psychologist. It should be a requirement, and I know the Division I Student-Athlete Advisory Committee has been vocal. We really fought in the Horizon League for there to be at least one sports psychologist on each campus. I was shocked in 2020 when some schools didn't have one. We've lost too many student-athletes to mental health. No one should be afraid to ask for help. I didn't want to, but once I did, I was 30 times better. Playing better, feeling better and sleeping better."

Allison Newlin, the sports psychologist, provided crucial support. "During Senior Night, not even a week after the injury, Allison came up to me and gave me a rock. She told me, 'Remember how strong you are.' Allison had open hours in our athletic training room, and I would go in and talk to her there. She more wanted me to focus on my mental health and look outside of volleyball. My life had been consumed by the sport. She's great."

NCAA Policies and Procedures Regarding Career-Ending Injuries

When an athlete obtains a career-ending injury, individual universities decide whether or not to honor scholarships and medical care to the injured athletes. A research study investigated the policies, procedures, and enforcement procedures regarding athletes who obtain a career-ending injury as written in the athlete handbooks of 23 Division I NCAA university athletic departments. Findings revealed written policies used to guide the majority of the athletic departments’ handling of athletes with career-ending injuries were inconsistent and lacked specificity.

The Need for Clear and Consistent Policies

The inconsistency in policies highlights a significant issue within the NCAA. Athletes who dedicate their time and energy to their sport deserve clear and consistent support when faced with a career-ending injury. This includes ensuring that scholarships are honored and that necessary medical care is provided.

Navigating the Recruiting Process and Finding Balance

A rewarding college experience begins with an informed recruiting process. Remember that the recruiting process goes beyond athletics. To give you a framework for evaluating colleges, we’ve compiled the following list of questions. Be thoughtful as you go through it. Am I interested in a particular field of study?

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For Elizabeth “Liz” Harrison, the realization to seek balance came early in her athletic career. SportsRecruits Insights may be perfect for you. Want to talk to us on the phone?

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