Every Sunday night, millions of Americans grab their favorite snacks, team jerseys, and sit down to watch country music star Carrie Underwood introduce the week’s Sunday Night Football game on NBC. It’s the culmination of a day-long party in which fans across the country watch young men compete at the highest level of what many have called “America’s game.” In many ways, things have never been better for the league and its players. In 2017, the National Football League generated $8.16 billion in revenue. In 2018, over 15 million fans watched an NFL game on television. The average player’s salary is $2.1 million, and athletes receive benefits, access, and fame that few individuals will ever experience. So why, when things seem to be going so well, are so many calling it quits?
Just weeks before the NFL celebrated the start of its 100th season, superstar quarterback and 2018-19 Comeback Player of the Year, Andrew Luck of the Indianapolis Colts, announced his retirement. In doing so, Luck joined the ranks of All-Pro tight end New England Patriots player, Rob Gronkowski, future hall of fame wide receiver, Calvin Johnson, and a growing list of others who decided to leave the game at or before the age of 30.
“It’s really the equation of pain versus pleasure,” says Brian J. Sennett, MD, Penn Medicine’s chief of Sports Medicine. “If the scale tips towards the side of making money and having fun, the player is fine, but if it moves towards pain and they’ve had enough, that player will retire.” Sennett also notes that, given the astronomical salaries players earn, their ability to retire early is much greater now than in past decades. For example, in 1970, the average NFL salary was $23,000 (roughly $115,000 today), but in 2019, with greater collective bargaining power, the NFL Players Association has secured minimal annual pay for active roster rookies at $480,000. So in the past, a player may have had to subject their bodies to more punishment longer to reach financial stability, today, players can listen to their bodies earlier because they have the financial wherewithal to do so.
And those injuries add up. A number of studies have examined the injuries most commonly associated with football, and their respective recovery processes and long-term health implications. While new information around the long-term effects of head injuries have led to improved technology in helmets, a 2018 study published by the National Institutes of Health found that the most common upper body injuries to quarterbacks aren’t concussions, but shoulder injuries, of which Andrew Luck suffered two of during his NFL career. For wide receivers and running backs, it’s the lower body injuries that add up, with the most common injuries sites being found at the ankle and knee. This highlights Sennett’s point that, “it’s not the athlete, it’s how they’re used. If receivers just run down the field, they’re less likely to take a hard hit than if they run a crossing route up the middle.”
Following these injuries, players are likely to engage in rigorous physical therapy. This is where players who have dealt with a history of recurring injuries may begin to consider retirement. “There’s a question of how long players will have to work through the rehabilitation process,” Sennett says. “It’s not the actual action of going to rehab. What they do in practice is far more difficult. It’s the uncertainty of how long it might take or if it’s even possible to be 100 percent healthy after certain injuries.”
Indeed, returning from injury isn’t as simple as undergoing surgery and participating in physical therapy. Research has found that 29.5% of athletes who suffered an ACL tear experienced another tear within two years of returning to the field. For other types of injuries like an Achilles tear, it may be impossible to ever completely bounce back. This can be particularly true in players like lineman who have a higher body mass index or players who are older. This uncertainty, or the fear of reinjuring can help guide an athlete towards a decision on the future of their career.
Sennett also suspects the media has some level of influence. “When you get people constantly asking the question of whether or not Carson Wentz is ‘injury prone’ on the radio, those players get frustrated. I’d be shocked if Wentz isn’t absolutely tired of answering questions about his health.”
But what about blows to the head? An issue that has haunted football and the modern NFL is CTE, short for “chronic traumatic encephalopathy.” The issue first rose to prominence in 2005, following a paper detailing the abnormalities presented in the brain of a deceased football player. While this is certainly a concern among players, Sennett is hesitant to connect this with the decision to retire early. “In the long term, I think it does play a role, but when a football player suddenly decides to retire, I think there are more pressing concerns related to overall physical wear and tear,” Sennett says.
Ultimately, Sennett believes fans will see more and more superstar players retiring early. This is in stark contrast to the “iron man” legacies of players like quarterbacks Brett Favre and Eli Manning, whose consecutive start streaks of 297 and 210 games respectively, place them in an elite club that is unlikely to grow as more players look to protect their wellbeing and future earnings.
“Maybe it’s already unheard of, but I do think it will be rarer to see someone play for 20 years in the future. It was an old mentality of just playing through injury. As most people are aware, Brett Favre did have significant problems with pain medicine. Eventually he wasn’t able to deal with that pain anymore,” Sennett says.
With the first week (and accompanying injuries) of the 2019-20 season of the National Football League in the books, it appears that these questions will play a larger role than ever in the United States’ most popular sport. As Sennett quips, “There’s a reason people say that ‘NFL’ actually stands for ‘Not for Long.’”