Lesson

Eligibility to play

After completing the PCMA, the team physician must make a recommendation regarding the athlete’s ability to participate in a high-performance programme. This is not always an easy decision. 26,27

In contrast to musculoskeletal complaints, where risk can often be mitigated (and the main potential problems are injury recurrence or pain), the risks associated with cardiovascular abnormalities are more significant and are not capable of being reduced in a similar way. If an underlying cardiovascular abnormality is identified, the athlete is usually advised not to participate in football because the intensity cannot be easily controlled.

After his cardiac arrest it was decided that Fabrice Muamba should not return to competitive football. ‘Eligibility’ decisions are often quite contentious.

In general, athletes should be encouraged to make decisions about their own lives. When others interfere in our lives, it can be patronising and overbearing. Such interference is often justified on the grounds that others, in this case, healthcare professionals, possess better, or more knowledge about an individual’s best interests than the individual concerned. This is quite a contentious issue and requires careful thought and consideration. Also, the justified interest of organising institutions – like FIFA and the confederations – to conduct matches without discrediting health events warrants consideration. 28

The Bethesda Guidelines provide evidence-based recommendations about sporting participation for athletes with a wide range of different cardiac conditions. They are an excellent resource when faced with a contentious decision about returning to sport.