Sport Ethics: Leave it All on the Field

It's a movie cliche but also a real life cliche, in fact, it is more than a cliche, leave it all on the field possesses a moral imperative for individuals and teams  committed to a common goal. It is not an exhortation that can be called upon often, but it does possess a power and urgency that committed athletes and professionals will respond to under strong conditions. It remains an important if ominous moral resource.

Last week the women's volleyball team at UW came from behind 0-2 and won the match 3-2. Twice they were down and facing match point in the last game, but came back. When they won most collapsed too tired to move and some too exhausted even to cry with joy. The players simply kept drawing on "more." They kept pulling up strength and skill they did not know they had. Jim McLaughlin their coach summed up the experience, “To tap out emotionally like that, people just don’t know what it takes. They were so tired, so exhausted. That’s when you grow as a player, as a person. That’s when you learn what you’ve got.”

In movies and real life, this call to dig deep comes up under dire conditions where the stakes are high and immediate. Often the leader urges this not just when stakes are high and immediate, but the end game is in sight and people are tottering, exhausted and struggling to stay focused and competent. Sometimes it is spoken of in terms of great goals or future states, but my favorite movie line emphasized the absolute importance for successful athletes and professional to be totally present to their task in the moment. At the end of Varsity Blues the quarterback Jonathon Moxon and his teammates run off their  hallowed coach Kilmer to save a teammate from taking  painkillers. Moxon gathers them around and says, "Before this game started, Kilmer said "48 minutes for the next 48 years of your life". I say "fuck that". All right? Fuck that. Let's go out there, and we play the next 24 minutes for the next 24 minutes, and we leave it all out on the field."

Leaving it all on the field makes moral sense when the stakes are high, the urgency is great and normal endurance and performance levels probably will not achieve the goal. It invokes both a strong team loyalty ethic as well as an inner dialogue for each person with him or herself. 

This is an imperative sentence as well as an evaluative position.

When an athlete plays, whether for the whole game or as a two minute substitute, leaving it all on the field demands that the person give his or her best possible performance for as long as he or she is in the game.

This aspect of sport buttresses the imperative to be present to the moment, the sport and the opponents. It means that the player exists fully in that present moment offering up every bit of cognitive, emotional and physical talent and skill they possess. The athlete will give maximum performance while they are on the field. It does not matter if it is one special teams' play or 45 minutes of an overtime basketball game.

Leaving it all on the field first involves a person’s relationships to him or herself and to his or her field. Almost always when this imperative is called out, it requires the person to recall focus, energy and skill that they have spent years working to perfect. Its importance began early with the individual's time and effort to master and practice their expertise. It plays out early and durably during practice that refines the perceptual and attention tools, builds up the body memory and the physical and emotional endurance. Without this training, preparation, pattern recognition and experience, most individuals will not be able to adjust their energy level and maintain or draw upon resilience under immense stress.

If a person or player had not devoted the time to acquire this mastery, there would be little to call upon to leave on the field.

The second dialogue involves a moment of self-evaluation where the person asks him or herself—am I giving all that I can without destroying myself?  After the fact it involves the almost impossible question—could I have given more?

The other side of this question involves did I ever quit? No one who quits or gives up in a competition ever leaves it all on the field. In fact such quitting violates the most profound promise athletes make to themselves and their teammates--to be present with their full mind, body, and skill set during the competition. This extends to drawing upon their entire self to the fullest extent. Even  when losing or down or hitting a wall, they promise to challenge oneself and one’s team members to draw deeper and leave it all on the field.

In the end the challenge to leave it all on the field reduces not to “no excuses” but to NO REGRETS.

To crawl or stumble off the field or course, we have given all--our hearts, our bodies, our minds and above all our loyalty to each other--to achieve the goals the group set. 

This is where the contagion impact of teams and the fact that people possess different reservoirs of will and emotional talent matter. It also points to why good teams and organizations need several focal points of leadership and coherence. Teams, especially in contact sports, can get beaten down. They fall behind and start to splinter. Teammates need  the contagious confidence, drive or  pull of teammates who still possess robust endurance who can exhort, model and get in the face or encourage them when they are tempted to fold. Others may be tottering, but if a peer can model full energy and call up focus and reserves, others can try to dig deep and respond with similar discipline and focus, even if they do not immediately possess it.

Now the duration of the game and one’s performance will affect what this means. Most sports are not marathons but lumpy with moments of relative downtime followed by moments of intense and full effort required. The net sports and reset sports like volleyball, tennis or football exemplify this. But in that sprint mode, the athlete gives every once of attentive energy and skill they possess. This mastery lies in calibrating how much an athlete can give on each play while still possessing the reserves to continue to call forth that level of energy and attention.

Exerting maximum effort takes a special kind of discipline because it involves immense physical and emotional exertion on the part of the athlete. This calling forth and the electro-chemical aspects of it can negate the cognitive aspects of pattern recognition and execution required. Too unbalanced and emotional/physical burst of strength and endurance can draw down needed nutrients and vital attention from the brain and memory. Athletes need this reservoir to give form and effectiveness to strength when it is needed. Cognitive effort can be as depleting as physical effort during intense competition, and cognitive modeling and steely focus can be as important as physical endurance and courage.

Every athlete and every coach playing to leave it all on the field needs to regulate this balance given the length of the game. If done well by the end of regulation elite athletes will literally be exhausted mentally and physically. This accounts for the anti-climatic nature of so many overtime games where the players have so little left, and it takes amazing discipline and untapped reserves. Players are literally consuming their own muscle and mind to stay focused and effective in overtime situations. 

The length of season and number of games impacts a players and team’s ability to utilize this approach. In a football season or college Olympic sport season such as soccer, volleyball or lacrosse, the small number of games gives greater scope to the leave it all on the field since players have more time to recover between game or game sets.

At the opposite end of football season where every game is a “big game," baseball and to a lesser extent basketball—especially in its professional manifestation—have so many games, that no player can leave it all on the field each game and have the time to recover or renew. Baseball provides many opportunities within the game itself to renew physically and emotionally even as it requires relentless and intense attention and spurts of focused force and physical effort.

During games or seasons players “hit the wall.” Individuals reach a state of being where he or she believes they cannot draw upon any more skill, emotion, physical stamina or capacity. Literally they are stuck. At times they may “grind it out” to get through these periods, or they may “coast” or just get “benched.”

At certain points athletes may be so ground down or exhausted that all they possess is automatic pilot. They can barely think a coherent thought; their body screams, aches and burns; they find it hard to hear or process yelling coaches or fellow players. But the elite players continue on the field. 

Here all the practice, preparation, neural memory development, endless repetition with oneself and others prove their worth. Men and women play on, not as zombies, but as trained, exhausted professionals for whom skill carries only one aspect of their professionalism. The capacity to attend when exhausted, to focus when diffused, to act when confused, all emerge from the trained mind and memory of professional mastery.

This manifests itself in exhausted doctors in emergency rooms, FEMA workers and emergency workers in under duress working, not as zombies, but as trained ingrained professional expertise.

Carried to its unending extreme, this approach has a dark side. It can lead people to drive themselves into injury or psychological and emotional damage. It can lead to mistakes when people have gone beyond the ability of internalized pattern recognition and professional memory to carry on. A person can hurt themselves or their team by trying to leave it all on the field and in fact reaching the point where they no longer recognize they have nothing more to leave. Players in such condition or on automatic pilot given their exhaustion are more susceptible to fakes or errors.

Long seasons, long games slowly eat away at performance and erode emotional reserves, wear and tear physical skill and talent and can lead to sloppiness and wandering focus. Some games just will not seem as important and the sheer grind of a season wears down all three components required by elite athletic performance.

Ultimately no person can play this way every day. The sports and professions with downtime permit renewal and recovery. But the long sports with endless seasons or endless emergencies engender a different rhythm of performance and resilience. They can sap the reserves of players and teams.

But in the end, when necessary  elite athletes and professional possess the capacity in themselves and together with the team to "leave it all on the field."

Sports Ethics: The Fragility of Athletes

Just a normal jump tangle going for a rebound in a hard fought close game. A Texas A&M player  Derrick Roland went up, lost the rebound to Washington's Quincy Pondexter. Pondexter and the game raced down the floor, but Roland came down wrong. Pondexter recounted, "I heard a loud slap, like his hand hit the floot, but that was the bone break. It's one of the nastiest things I've ever seen in my life."

I watched the game and along with the  Texas A&M bench could hear the break. Two breaks. The bone stuck out of his leg. Doctors and trainors rushed to his side. The 10,000 boisterous fans fell silent for ten minutes. Roland was rushed to Harbourview trauma center where he had major surgery. The moment silenced the crowd and reminded us all of how fragile and dangerous athletic competition can be.

This weekend the magnificent running back at South Carolina Marcus Lattimore was bursting through the line when two  Tennessee players tackled him with perfectly legal and tough hits . His body twisted and his leg twisted in inhuman ways until it flopped out in an unnatural angle. Tennessee players walked out to stand with him and honor him in his injury. Now he lies in a hospital with his season and possibly his career over. I could go on adding on the innumerable athletes in sport after sport whom have seen their game an careers snatched away by one misstep.

One fall. One slip. One tear. One break.One hit. Every athlete lives with the possibility of his or her sports life ending in a micro-second. Everything they have worked for and valued in themselves can be taken away without a moment's notice, usually by accident or chance.

This hovering fragility lies deep inside the minds of every athlete. It infuses the drive for athletic excellence and performance.

Every athlete is incredibly vulnerable to physical injury. The excellence of athletics builds upon the health of the body. All the character and commitment and mastery depend a sound body. Injuries can come from contact with another athlete or from a mistake or bad luck in execution or a mistake in practice; it lurks everywhere. One wrong cut, an ACL blows; one trip, an ankle goes; one wrong swing, a shoulder locks; one missed twist, a knee tears, a shoulder shreds. One greatness of athletic accomplishment lies in how humans can take this frail but resilient mortal coil and transform it into admirable feats of mastery and discipline. How they can overcome physical limitations and pain to achieve these goals.

This physical foundation can collapse in a mini-second. Every elite athlete has struggled through the pain and despair of injury. All athletes are aware of their own physical mortality, even as it means little to them. To a young athlete in superb shape, immortality seems more the norm than mortality, but it shadows them all.

This vulnerability can tear away the dream, path or livelihood in a second. This ever present vulnerability creates a peculiar fragility that generates a compelling  urgency to compete in game time. All  athletes live with the endless  shadow of injury and bodily expiration date hang over them. 

Most athletes ignore it; can't even acknowledge it. When they face injury, they grapple with it, rehab and overcome it. They learn to view their bodies as allies but also dimensions to be mastered, cared for and feared. If they are good they read the bodies well and carefully. But bodies can betray them. Time betrays bodies, but life, accident, one false move or awful collision and bodies can fail.

The quickness with which it can all disappear raises the intensity of the experience of play. The sheer joy of playing, the satisfaction of mastery, the cordial fun of hanging with team and friends, all reinforce and make athletics worth while. They provide motive, reward and renewal for athletes.

This extreme vulnerability infuses the games with the sense of urgency and intensity. Most athletes know that they live on borrowed time. Their own bodies and skills will break down soon enough. Their own skills will fade or be surpassed by the unrelenting competition of each new generation of younger athletes pushing them to get better and pushing to replace them. All this should remind athletes of the gift and privilege of competing.

The fragility of injury just amplifies this urgency and intensity. Few of us perform jobs whose very structure can take the job away from us. Few of us face the unrelenting competition and demands of each day or performance. Dancers and very high risk workers know the same tradeoff and intensity. Athletes who don't get this, fail to develop or flourish. Athletes who do get it can flame out or like a firefighter or dancer learns to meld performance and intensity and just "do my job."

This explains the hunger and drive of athletes as well as the strained morality of players who seek to play through pain or hide their injuries to get to the field, to compete. For some it may be about money in the rarified pro ranks, but for the vast vast majority, intense play challenges themselves, their bodies, their skills and time. Time and injury shadow every moment saturating athletic action with potential depth and energy. This makes the game worth playing.

Athletes are humans and know they possess  limited tim. They want to draw every ounce of satisfaction from the time they have. They want to play and compete. An injury can also lead to a journey of painful recovery, rehabilitation and hopefully self discovery. When an athlete's achievement is stripped from them with injury, they are challenged to discover the depth of their humanity, not just their identity as an athlete.

Athletes live at an edge of loss and accomplishment that makes competing an embodiment of the existential moment of existence. The very exhilaration of that edge, that danger helps them endure the risk for the reward of play.

Then again, all life is vulnerable and saturated with the possibility of loss. As is often the case, sports simply etches large and clear the reality that underlies all our lives.

"Shutting Down" Stephen Strasburg is Ethically Right

Why are sports commentators and players so upset over Stephen Strasburg? The Washington Nationals long ago decided to limit the total innings of their prized pitcher Steven Strasburg. Strasburg, who is one year out from a Tommy John surgery, will end his first year of pitching after180 pitches. Now he has ended it even earlier after a three inning stint where the psychological costs of being the center of a firestorm finally got to his concentration.

Even locked in a pennant race, the Nationals’ GM Mike Rizzo decided to protect Strasbug’s healing and avoid arm fatigue that has derailed the career of many fine pitchers. The decision has unleashed a firestorm of criticism for “shutting down” Strasburg. The criticisms come from an old school mythical view of sports and ignores the science and economics of what the Nationals are doing. We should be proud of a team that is putting a player’s welfare before winning at all costs. In a world where coaches risk the health of players to eek out a win, we should celebrate the courage of this action, it is the right thing to do.

Baseball pitching is one of the most notoriously inhuman actions performed in sports. 50 percent of major league starters will end up on the long term disabled list in the normal course of their career. We have ample empirical evidence of the costs of over pitching. We know managers like Billy Martin who road pitchers to championships only to have them ruined for the rest of their careers.  Jason Stark who has been the most reasonable commentator on Strasburg from the beginning has it pretty much right on the pros and cons of the decision to limit pitches one year out from surgery.

The Nationals consulted with a large number of medical personnel and have gotten almost universal respect from the medical and training community for their brave decision. The medical community has been trying to introduce a much stronger emphasis upon pitch count and sophisticated accounting for years, and the Nationals’ decision represents the high water mark of this attempt. This becomes increasingly important given the unique inhuman nature of pitching and the size and strength of modern pitchers who easily average 94-98 miles per hour.

The decision resonates with me because managers, coaches and general managers have traditionally been willing to risk careers of individuals to win championships. Too many incidents exist of players pushed by peer pressure, coaches or collaborating trainers and doctors to play when they should not. I’ve talked to doctors who ultimately left professional service because of the pressures they felt upon their medical judgment. Yet Rizzo very flatly stated, “We want to do what’s best for Stephen in the long run.”

In a world where athletes are treated as disposable commodities deployed to win at all costs, we should celebrate this decision, not vilify it.

I want to emphasize the players want to take this risk too. Most of the pressure to play through pain and risk comes from the internal drive of players to compete as well as the powerful almost ecstatic feeling of dominating performance when you are on. Players also feel strong obligations not to let fellow teammates down. When Manteo Mitchell finished running the first leg of the Olympic 800 meter hurdles on a broken leg, he knew the leg broke but kept running. As he put it, “You don’t want to let anyone down.”

The senior leadership of the Nationals is trying to set aside this type of pressure and romanticizing of pain. They have two strong justifications:

1.     1)          The team wants to protect the pitcher’s health. They already know that he can be injured and oversaw a model rehab. The decision flows from the desire to protect his long-term ability and lower the risk of career ending injury. The team has no certainty but has done its best to think about the dangers and stresses to a young strong power pitcher in his first year of recovery from ulnar collateral damage.


2.    2)             Economically the Nationals have made one of the major investments in the history of pitching in signing Strasburg (Thank you Scott Boros). The team has built carefully for the long run as witnessed by how they carefully husbanded another injured star pitcher Jordan Zimmerman as well as picking up veteran catcher Kurt Suzuki to work with them. The Nationals have every reason to want their economic investment to pay long-term dividends.

Strasburg is not 37 like Chris Carpenter for St. Louis last year. Carpenter went on a roll and and gladly risked what remained of his career to win a World Series. Nor is he Orel Hershiser in 1988 having one of the great seasons of modern baseball who showed no signs of stress or strain on the way to a World Series win and in the middle of 5 250 inning years. At 32 he blew out his arm and never had the same career. Strasberg is 23 and already severely injured. The Nationals do not have certainty but they know the heightened risk and have examples like the almost great career of Kerry Wood.

Ethics has a principle called the precautionary principle where individuals and institutions should prefer the outcome that generally avoids the maximum amount of damage. As the probabilities of the damage rises, the imperative of the principle rises. Yes the  Nationals are acting on probabilities. The have amassed and studied good information supported by an emerging science among doctors about how to protect and nurture the arms of modern power pitchers. They might be overly cautious but they are not wrong; they are much more humane, thoughtful and statistically sensitive. They are acting on the precautionary principle.  This is how teams should think of athletes, not as interchangeable parts.

Left to his own Strasberg would make the Achilles Choice I often write about. He is upset and angry about this decision. He would risk his long-term success to win all the glory of the World Series. We do not know he would win, but he would risk it. The Nationals will be competing for years, but this year looks special and he would do it. So would the Greek Chorus of fans and commentators and self styled old school players attacking the Nationals.

The attacks on Mike  Rizzo and the Nationals are many and varied but they all reduce to one narrative—athletes play to win. Athletes risk physical injury and that is their job. So let him take the risk and gain the glory.

Behind the critique lies the facile and wrong claim by the smaller, weaker, and slower ex-veterans that somehow this “shut down” (versus pitch control) indicts the coddled and pampered modern athletes compared to the tough guys of old. You see the same resentful logic among football veterans who attack efforts to minimize head trauma in football. To them, this decision defiles virtues of courage and overcoming adversity that gives sports narratives so much appeal in the USA.

These images evoke a bloodied Rams’ linebacker Jack Youngblood playing the Super Bowl on a broken leg. It conjures Kerri Strug with a torn ankle vaulting the US to Olympic gold in 1996. Strasburg’s “shut down” shatters this tale of courage and triumph.

I mean Strasburg is not even injured yet!!! They are taking him out before he is injured, and that makes no sense to the narrative of sport, to fans desperate for a victory or to players invested in their own self-image of warriors and gladiators.

The reality is different. Those unique heroic moments can occur because physiologically and psychologically athletes and humans can muster immense physical resources and surmount pain for short periods. High stakes, huge stress and strong loyalty amplify this power. We see acts of superhuman bravery and physicality during accidents, disasters and exceptional moments.

Most athletes and humans, however, do not achieve through pain. Their performance degrades, and the longer they stay in the worse they become and their teammates suffer for it. Injury and hurt degrades performance, and serious injuries can destroy careers in a nanosecond. Unless masked by painkillers or adrenaline, pain undermines performance quickly and radically. The realities in the broken lives and foreshortened careers-pitchers who lose their speed and delivery and end as journeyman because they were mismanaged and overused during their early careers.

The Nationals know the reality; they see through the myths we collectively embrace which are confirmed just often enough to reinforce its influence.

The average fan gets the moral and practical side of the decision to shut down Strasburg. They approved the decision by a 4-1 majority. They understand the fairness and risk with far more clarity about the issue than the commentators and ex-jocks. They know how teams usually exploit and toss off players to win.

The Nationals are right; this is ethical progress, not failure.

Sports Ethics: Play Through Pain

“Pain is your friend.”  “Pain lets you know you are still alive.” “Pain is good.” So Master Chief yells at the beleaguered SEAL recruits in a great movie G.I. Jane.

This lesson, so central to military life, pervades the moral culture of athletic competition. Every athlete trying to be a warrior, and here athletics draws heavily from millennial old origins as preparation for life combat, must learn to fight through pain and to seek goals despite  hurt and obstacles. Playing through pain is a central moral tenet of sports. It exemplifies three virtues critical to athletic success: self-mastery; courage; sacrifice.

It does not matter the moment we tune into sports, but pain splays through the games and the wounded fall before us with startling regularity. If we were not so inured to the carnage, we would be appalled by our callousness. This last month twenty five and counting baseball starters are out for at least three months. Seven Boston Red Sox outfielders alone are on the disabilities list. The first week of NFL pro to-practice saw at least three players end their seasons before even doning pads.  Derek Rose writhed on the floor with an ACL and the Chicago Bulls saw their playoff hopes collapse. The great Junior Seau committed suicide, too much pain. The NFL continues to try to bring to justice the players who deliberately attempted to end the effective careers of other league players through injuring them, not just pain. And this is only one month! 

All this endless pain in sports and life means we should not forget master chief’s lessons.. Pain is our friend, because pain signals to the athlete that his or her body has stressed beyond the point where it can continue to function at full efficiency and still be healthy. Pain signals deeper injury, inflammation, nerve overload, neurotransmitters warning and adrenalin flooded emergencies. The body floods itself with chemicals to deal with pain; some seek to quiet the pain, others to kick up the level  of awareness or body performance for a short time to get through the pain. Sometimes the body narrows the focus of the mind and eyes to prepare for and overcome the danger that body announces.

The ability of an athlete to be aware of and monitor their pain is important. In every sport every athlete lives with attrition of physical skill and strength over a season. They realize there are times when as an athlete they need to play with the pain because it is bearable and will not detract form their performance level. There are moments when they need to demonstrate courage to their teammates and encourage them to also play with a reasonable level of pain out of loyalty to each other; the contagion of a leader, if he or she can do it, so can I.

Last year Washington State University started a redshirt freshman quarterback Connor Halliday against Utah. It was his first start after a stunningly successful first game the week before. He played on cloud nine full of energy and adrenal protection. During the game he took some hard hits and suffered contusions and injuries, nothing that seemed out of the ordinary for the normal pain and injury that football inflicts upon its players. Yet later that day he ended up int he emergency room with a lacerated liver. The WSU doctors had run all the regular and protocol based tests when he was injured and nothing came up. This type of injury remains internal and not immediately evident; its pain should have alerted the quarterback of the severity. But like so many young athletes in the thrall of competition and loyalty and cortisol induced protection from pain, Halliday did not recognize the signals or refused the listen to them; he was going to play come hell or hi water.  To understand the culture of sport and athletes, it is important to listen to what his coach said after complimenting him for  "unbelievably courageous outing." "He hung in there and took hits and threw the ball under duress and pain. I'm very proud of his toughness and grit."

Yet even bearable pain may be a reason to leave the field. First, as in the case of the young quarterback, it may be the tip of an extensive set of damages not yet fully unfolded. It may be the warning signal that the body is pushing limits and catastrophic failure is shortly to occur. Playing on may intensify injuries or magnify the range of the loss. Secondly, even a bearable injury can detract from performance. It may be that a player hurts her or his team by staying on the field as an act of courage or self-mastery. Yet this important point is often missed and when Jay Cutler left the field of play for this reason the NFL's professional football semi-finals, he was vilified.

Pain serves a survival function and as an early warning system to people about the need to protect and attend to their body. It alerts athletes that worse is on the way if they keep pressing against the signals of the body. The young quarterback could have destroyed his life.

Pain manifests as a real physiological phenomena exhibited by neural and chemical responses. But pain is also experienced subjectively, and many persons have different responses to the same physical impact; they read their body differently. Individuals can be trained to deal with higher levels of pain, physical or mental, over time. Dealing with high levels of pain can be learned, and levels of pain that would paralyze a person at the beginning of training can be tolerated and functioned through later.

People experience pain subjectively, and the classic medical scales ask patients to rate pain 1-10. In real life, people might talk of mild or unbearable. It might be stabbing or throbbing or intermittent. It might explode or linger and thrum. The scaling and different manifestations make diagnosing and living with pain an art, not a science.

Sometimes the pain recedes because the pain initially signaled a level of muscle, vascular or pulmonary performance that the sport required pushing past. Pushing past meant experiencing the braying complaints of lungs, muscles and mind as the athlete learns to develop higher levels of endurance, strength or odd skills that require unique vascular and muscle specializations. The capacity of the body to function without hurting itself grows with practice and strength.

At other times the pain simply reflects bodily disorder and breakdown. The picture of Curt Schilling with blood flowing from a bone sticking through his foot as he pitches the Red Sox to a World Series win exemplifies the play through pain mystique and myth and imperative of sports. Jack Youngblood finishing a football game with a broken leg also ranks in the pantheon.

The key to remember is that  playing through pain has serious short and long term costs. First, pain distracts the athlete. It takes indirect concentration and focus to keep the pain at bay, and this distracts from utter complete presence to the task at hand. Second, the pain diminishes actual physical performance and limits physical actions. When a player is injured, they can often keep playing with adrenalin and team loyalty and support holding them together. But once on the sideline the adrenaline falls, the contagious strength of a huddle falters and the full measure of pain explodes and debilitates the player. The next time they go out, the deterioration of performance becomes obvious.

Finally, pain’s early warning nature signals later cost. Players who keep playing through the pain like a torn meniscus just tear the meniscus apart until they play bone on bone. Players with a ripped muscle continue to fray the muscle or micro-fracture grows into a greater break in the bone. Players compensate on the field and in compensating put excessive stress on other unprepared bones and muscle and end up multiplying injuries. The longer the player plays through the pain, the longer the healing and the greater the possibility of more injury and hence even longer healing. In my world of college athletes, the most common medical reason for waivers after major immediate injuries like ACL or broken bones involves players coming back too early, not giving their injury or body time to fully heal.

It makes perfect sense to play through certain types of pain. The accumulated aches, pains, strains, twists and bruises of a season nag at performance and harass a player’s focus. Good athletes know their own bodies well. They usually know when their body has reached its limits. Good athletes, like good professionals, learn to master these physical pains. They also learn to master and play through the mental pains that arise from daily life that ensnare daily suffering or worries about family or child or finances or breakups or friends. Playing through these pains mirrors a primary moral requirement of life.

The legendary status of playing through pain deserves its moral status. To do this humans manifest honor, strength of will, loyalty to goal and team. These are admirable traits and deserve praise. So modern athletes will “power through.”

But we have learned that more often than not playing through the pain of major injuries or threatening injuries makes no sense for athlete or team either in short run or long run. This is especially true for younger athletes who do not have the fine grained sense of their bodies or a well developed sense of self-preservation. This is why college and high school athletics must have independent and empowered doctors on the field to stop the athletes and stop the coaches when they prefer to risk the Achilles Choice that I have often discussed  to seek glory and victory.

The sacrifice of playing through pain makes little moral sense for young or college athletes. Players and doctors know this, even if coaches regularly forget it.

Achilles' Choice--Athletics and Injury I & II

In the Iliad Achilles, the greatest of all Greek heroes, makes a choice offered by the gods--a long, quiet, productive life as King or a brief and glorious life as a warrior. Achilles chose a brief and glorious life. His song would be sung; his life remembered.

Modern athletes are offered the same choice, but the ethics of the choice is far more problematic. Athletes in most sports run a much higher risk of serious injury than a "normal" life. Worse, they risk long-term debilitation as their knees, ankles, hips, backs and necks give out in their thirties and forties. For many, old age strikes in early middle age.

The dangers of athletic endeavor come from the fundamental physicality of sport. Athletic achievement relies upon the body, upon the trained, disciplined and intent guided bodily action. The marvelous human body can be driven to incredible feats, and this is one of the glories of sports and athletic accomplishment. The human body, however, remains a mortal coil, a magnificent but brittle and fragile entity.

Athletics involves the disciplined application of force and constant practice and focus. The force reverberates back on the body. This occurs in violent sports like football but force reacts upon the body in "noncontact" sports like tennis, volleyball  or rowing. The impact of athletic actions accumulate through trauma and repetition. The trauma involves injury beyond normal force applied to the body. This covers collision and impact in football or soccer or distress inflicted upon an arm and elbow of a volleyball or tennis swing. The trauma can ripple through back, legs and torso in gymnastics or swimming. Endless and relentless repetition in practice and competition steel the body against the pain of the trauma but also compound the impact over years of action.

Injury signals the body to stop and heal itself. Pain is the body speaking to itself to warn of danger to the body's integrity. All humans learn to read and in some ways master pain. We could not survive without that capacity. But a trained athlete learns early, very early, that succeeding in athletics incurs levels hurt and pain entwined with the achievement and joy of playing and succeeding.

Immediate severe trauma to the body in some ways is the safest. It stops the body from performing and forces the athlete to stop. It even forces the coach to take the player out because the pain and injury limit the player's effectiveness. Leaving aside team doctors or trainers who will sometimes "shoot up" a player to dull the pain and enable them to play when the body tells them no, the true injury forces stopping and healing. Sometimes it ends a career, sometimes it demands months of rehabilitation to recover and return to the sport. Many athletes--amateur, elite, professional--have lived through multiple damage and injuries that accumulate. They learn to play with pain, not through pain. Often they come back from the injury to play more.

Athletics is a young person's domain. A few pros may make it to late thirties, but most end their careers long before that. The danger of injury seems far away to a twenty year old. It does not even exist for 6 year olds and seems irrelevant to 13 year olds.  Given the ages athletics starts for children, we rely upon parents and coaches to protect players from this trauma and make decisions to protect their health.

Young athletes know they are immortal. They play for the joy the game and of competing, satisfaction at experience of body and achievement, and pleasing their parents, coaches or teammates. They take risks, few sane adults would take, and consider them normal. They come back from injuries and broken bones and ACLs and hernias and hamstrings and concussions and keep playing.

Young athletes are resilient physically and emotionally. They can heal and come back; they often choose to. The immediate and large injuries are clear to them, but none of them sees or understands the long term and nagging injuries that will accompany them for the rest of their lives.  Parents understand but humans are not well designed cognitively to act upon such long term low probability outcomes. These probabilities do not play well with adults when facing the joy and longing of kids to play as well as parents own complicated relation to their children's athletic achievement.

We shouldn't ban children from playing sports. We shouldn't will ban all sports; the logic of trauma and repetition dog all athletic accomplishment. Athletes sort themselves over time as many drop out of competitive athletics or find play at levels appropriate to them. As they stay in the competitive track, the risks of long term impacts arise, but most of them seem manageable and the pay offs for the young athlete feel real and immediate.

We all live with choices with hidden long term costs we cannot envision even if we "know" they exist. Adults often make choices to pursue dangerous activities a person excels at or loves or both. But the defense fails when athletes are young; we rely upon adults--parents, guardians, coaches, doctors to protect and defend the athlete's future. The dilemma arises when the young athlete wants to play, even if the wanting is infused with parental pressure or desire to please authority figures or be with teammates.

The glory and joy of athletics lures young athletes; only parents and coaches stand between them and the accumulating costs of trauma and repetition.

In the Odyssey, Odysseus travels to Hades and meets the shades of great Greek heroes. In his encounter with Achilles, we hear Achilles' verdict on his own decision to choose a brief life of glory over a long life on earth. "I'd rather slave on earth for another man....than rule down here over all the breathless dead (Fitzgerald translation)." At what point does overcoming pain and injury become a journey to Hades for athletes?

People forget that Achilles died ignominiously shot by the coward Paris from behind. Pain and injury accompanies the physical demands and risks of success at sports. Overcoming them and competing and achieving reflects human spirit and courage. We praise an celebrate overcoming adversity in all aspects of life.

At one level playing sports involves a risk tradeoff  similar to other areas of life. People make decisions to devote energy to an activity because of satisfaction, achievement and goals. They give up other activities; they may fail and their efforts bear no fruit. They may succeed up to a point, and then give it up or pursue other activities. In many other areas of life the probabilities of succeeding at least at a professional level are much higher and the opportunities much greater. This accounts for the huge fall off in athletic participation as people grow older. But in America, college educations can be won with sports achievement and for a very few elect, they might have brief careers as professional players, but most of even the best will be finished by the age of 27.

The numbers of people actually affected by sports trauma narrows to a very very small band of people by the time most of them are 18 and to a miniscule by the time they are 23. Fewer than 400 play professional basketball; in the entire history of baseball there have been fewer than 17,000 players. But the way to get there is littered with injuries and cumulative traumas from repetition. An epidemic of knee injuries plagues youth soccer and basketball especially for young women. The body of a twenty-five year-old gymnist evinces the wear and tear of a 40 year old. Many high school and club players have struggled with pain, injury and damage. Most elite college athletes deal with some significant damage. We just don't know the long-term cumulative impact for most of these sports; linear clarity of impact upon their later health is not always clear. Doctors, however,  know enough to be able to warn athletes of the long-term impact of arthritis or debilitating injuries or repeated attempts to come back from injuries. At this point the role of doctors and parents becomes critical to ensure decisions to continue on are informed and made rather than simply taken for granted.

Unfortunately what modern sport gives athletes is glory, if they are good enough, and a long life full of debilitating injury. A recent NFL study suggests that football players who have suffered number of concussions potentially have a much higher chance of suffering early dementia. This data  meshes with compelling studies by the U. S. military of the cumulative impact of IED explosions on soldiers in Iraq. Proposed rules of engagement limit exposures to three and prohibit soldiers from returning to combat. Football and other sports have not reached such conclusions.

The cumulative impact on cognitive functioning differs in a profound way from the cumulative impact upon bodies. Individuals can adapt to physical injury and limits. Most people maintain their own character intact as they grapple with physical injury. But brain trauma from cumulative impacts erode the core personality and cognitive functions. The way the brain works changes, personality changes, people become shadows of themselves, they arrive at Achilles fate.

But athletes, especially young athletes, did not make a bargain with gods. They play for love, joy and accomplishment. They play for the experience of being with other  athletes. They play for their parents and coaches. A few play for dreams of being a professional. At some point, they grow into adults and make their own bargain with the game and their fate. But as youth, they depend upon others to protect them from the shades and shadow world that could await them. The more we learn, the more we need to be alert to protect the young athletes from the permanent injury to their soul that can await them.

What does it mean for people like me who enjoy and admire athletes and athletic competition? What does it mean to pay money and enjoy athletic contests that can be slowly sapping not just the body but the mind of the players? I have not been able to watch boxing for years. Over 28 percent of boxers suffer serious cognitive disability. I can remember the beauty and glory of Mohammed Ali. I recoil with physical and spiritual dismay when I see what his sport has done to his body and mind. We will not outlaw football; we will not find technical solutions to the mounting hidden epidemic. I honestly do not know how to react to this knowledge. How can I revel in the next explosive hit or block, knowing that each hit, each smash contributes to the loss of a mind?

Modern athletic glory is fleeting. Modern athletes are fungible marketing commodities. Even the greatest gain their momentary glory and their treasure, but they gain not eternal glory but a long life after the glory, a life of slow loss and suffering. This may be a deal for adults, but not for children.