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Brandon Roy and Athlete Transition: The Most Important Issue in Sports Medicine

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Last month, former Portland Trailblazers first round draft pick, rookie of the year, and NBA all-star Brandon Roy underwent his seventh knee surgery. This week he'll return to practice with the Minnesota Timberwolves. Fingers crossed that all goes well. Roy's is a tragic and all-too-familiar saga in competitive sports. Young talent, flashes of brilliance, all dashed too soon by uncooperative body parts.

Yet in a candid interview with The Oregonian, Roy told us the problem wasn't really his knees. His medical retirement a year ago was a pragmatic decision, driven by obvious physical limitations, and the business side of basketball. His comeback this season with Minnesota, however, was an emotional one. Without the game, he didn't know who he was. He didn't know how to move forward. He couldn't live with wondering "what if?" Roy struggled, in a word, with transition. Despite his extraordinary talent and terribly unlucky knees, in this way Brandon Roy is very typical.

Every year, 21 percent of NBA players retire from basketball, completing an average 4.8 year pro career. Likewise 18 percent of major leaguers, 29 percent of the NFL, 18 percent of the NHL and a quarter of college athletes (assuming a four-year career) exit elite sports annually. All face their own transitions.

Retirement for elite athletes brings profound life adjustments and health challenges. For many, the biggest issue is identity -- self-image and valuation. They have to learn to value themselves as human beings outside of their personal and public identity in sports, and hear the message that others value them too. They have to replace default social communities that they had through sports. They have to be ok with the world ceasing to worship them as idols.

Accustomed to highly specialized training, retired athletes struggle to find healthy, lifelong exercise and diet patterns, and to understand how these patterns differ from competitive training. Even with ample financial resources, many struggle to find quality health care. Without an athletic trainer and sports medicine staff responsible for coordination and delivery of care, instead -- like most of us -- they must become their own health advocates. The challenges are diverse and formidable. Prominent, tragic failings are all-too-common. Athlete transition is an interdependent, whole-person health issue -- the most important issue in sports medicine today.

Not that you'd know it. Despite widespread concern about athletes' health, the conversation is narrowly focused on specific problems. The whole world's currently amidst a panic over concussion, which -- in the highest risk sports -- affects 6-10 percent of athletes a year. Before that, it was anterior cruciate ligament injury (<5 percent). No one questions the importance of these injuries, but the longer we play whac-a-mole with individual health conditions, the more we prolong the inevitable conclusion that proactively addressing health for the whole person is the only real solution. Transition is the place to start, because -- unlike any specific injury -- at some point every athlete is affected.

Unfortunately, research, media attention, and interventions targeted at transition are few and far between. In most cases, "transition" programs effectively mean financial and career education. That won't get the job done. A more comprehensive approach is required to effectively serve athletes' overall well-being.

The University of Southern California built a systematic program to educate student-athletes on lifetime, whole-person health, the influence of their sports experience, and proactive strategies to optimize near-term performance and long-term well-being. A culminating workshop for seniors addressed challenges of transition, bringing together comprehensive resources and experts to provide specific guidance. Over three years, 96 percent of attendees reported greater awareness of transition challenges, 94 percent found the specific recommendations helpful and 96 percent recommended it to future graduates.

All-American swimmer Amanda Smith attended the workshop last spring. "A lot of athletes are in denial about their careers ending, but I think the more you know, the better you'll be. I truly believe this is a program that all athletes need to hear." Volleyball player Allison Hillgren -- who attended as a student in 2010, and returned this year as a panelist -- adds, "It was challenging to go through the process of self discovery as a young adult in my early 20s. I can only imagine what it would be like for someone who continued to play professionally, and has a spouse and children to support while going through a personal and social transformation."

Imagine being a three-time NBA all-star.

And so I join many in wishing Brandon Roy the best, in and outside of basketball. Let's hope his story inspires leaders in collegiate and professional sports to pursue new approaches to athletes' health that seriously address transition. Doing so not only places them on the right side of emerging ethical and legal challenges, but also sows seeds for later success. Investing in athletes and engendering their trust creates a more nurturing environment for the future; a future where performance and health are recognized as compatible goals, and those understanding this principle enjoy a competitive advantage.

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