Disqualified and Discarded: The Emotional and Institutional Fallout of Career-Ending Injuries in College Sport

Abstract

This study examines how medically disqualified NCAA Division I student-athletes experience the abrupt end of their athletic careers and how those experiences reflect broader cultural and psychological dynamics within college sport. Utilizing an interpretive phenomenology analysis, we explore if the experiences of National Collegiate Athletic Association (NCAA) Division I student-athletes, who become medically disqualified, can be conceptualized by researchers through the stages of the Kübler-Ross model addressing grief responses. Unlike the prior research criticizing the application of the model to injured athletes, we found ample support for the possible applicability of each emotional stage; however, our study findings also reveal that the staged transitions do not necessarily follow in sequential order, as suggested by Kübler-Ross. Thus, the model applies as a general framework of grief from loss, but not as a fixed set of grieving processes for elite student-athletes who become medically disqualified. We conclude with implications for NCAA policy, athlete mental health services, and the cultivation of exit cultures that prioritize human well-being over athletic productivity.

1. Introduction

Elite college athletes, such as the U.S. classified National Collegiate Athletic Association (NCAA) Division I student-athletes who are the focus of this study, are often conditioned since their childhood to have focused athletic identities. Existing literature is replete with evidence of student-athletes who begin to neglect non-sport-related activities, such as school, hobbies, or other friends in favor of being athletes (Ballesteros et al. 2023; Kegelaers et al. 2024; Madrigal and Robbins 2020; Mathews et al. 2021; Yukhymenko-Lescroart 2024). NCAA Division I institutions often cultivate high-performance cultures, which often have the effect of prioritizing athletic achievement over holistic student development (Gaston-Gayles 2024). These environments embed student-athletes within highly structured routines, exclusive facilities, and social networks that reinforce a singular athletic identity. Institutional reward systems, such as scholarship renewals, playing time, and public recognition, are frequently tethered to athletic performance. That effect amplifies the stakes of injury and fosters dependency on the sport for validation and identity. Moreover, NCAA institutional members do not consistently offer intentional structures to prepare athletes for involuntary career exits, which would offer supports when student-athletes are suddenly removed from team environments. This absence of transitional scaffolding exacerbates the psychological impact of career-ending injuries and may deepen the sense of abandonment or disposability felt by medically disqualified student-athletes (MDSAs).

The degree to which elite student-athletes identify as athletes only can intensify the existential identity crises that such college students face when they experience terminated athletic careers and their athletic identity and status are lost, particularly when that termination is unanticipated and involuntary (Ballesteros et al. 2023; Chun et al. 2023; Ferrara et al. 2024; Jewett et al. 2019; Kegelaers et al. 2024; Mathews et al. 2021), such as in the case of medical disqualification due to injury or illness. To explore the mental and physical investment taken by student-athletes, this study seeks to critically examine the institutional neglect of medically disqualified student-athletes. Indeed, this topic continues the ongoing debates about the culture of risk in college sport and the inadequacy of support structures.

1.1. Involuntary Exit and Identity Foreclosure

An athlete’s world can be upended when they suddenly face a serious or traumatic injury or illness that disrupts or ends their athletic career (Ballesteros et al. 2023; Kegelaers et al. 2024; Ogilvie and Howe 1986; Rohrs-Cordes and Paule-Koba 2018; Walker et al. 2007). Research has shown that injured athletes experience a significant range of emotions, including confusion, anger, anxiety, frustration, impatience, and stress (Brewer 2007; Brewer 1994; Kegelaers et al. 2024; Madrigal and Robbins 2020; Manthey and Smith 2023; Roberts et al. 2023), as well as an extensive range of psychological challenges, including: trauma, alcohol or drug use, eating disorders, identity loss, behavioral disengagement, depression, and suicide ideation (Brewer 2007; Grove et al. 1997; NCAA Sport Science Institute 2016; Rao et al. 2015).

Involuntary exit from competitive sport due to injury is one of the most disruptive events an athlete can experience, often producing profound psychological, social, and identity-related consequences (Chun et al. 2023; Ferrara et al. 2024; Roberts et al. 2023). For NCAA Division I student-athletes, whose personal and institutional environments often prioritize athletic performance over holistic development, the termination of a sport career—particularly through medical disqualification—can generate trauma akin to grief or even loss of self (Ogilvie and Howe 1986; Jewett et al. 2019). Although injury in sport has long been a subject of sport psychology, more recent work emphasizes the need to understand athlete injury through broader sociocultural and institutional lenses, including the culture of risk, athletic identity foreclosure, and the stigmatization of mental health (Ferrara et al. 2024; Tabet et al. 2021).

Research has focused on identifying the antecedents that trigger mental health risk for student-athletes. Among the most studied triggers are low self-esteem (Rao and Hong 2016), injuries (Rao and Hong 2016; Rohrs-Cordes and Paule-Koba 2018), athletic identity loss (Ballesteros et al. 2023; Roberts et al. 2023), and failing performance expectations (Barnard 2016; Manthey and Smith 2023). It is common for students to have difficulty in handling the stigma associated with mental illness (Trela 2008; Tabet et al. 2021), and student-athletes are less likely to seek mental health services compared to their non-student-athlete peers (Barnard 2016; Chen et al. 2010; Gee 2010; Roberts et al. 2023). Fear of being negatively labeled often prevents student-athletes from seeking mental health services (Roberts et al. 2023), and counselors frequently report having a difficult time convincing student-athletes to make use of mental health services (Watson and Kissinger 2007; Chow et al. 2020). Student-athletes often feel counselors outside of the athletic department will not understand their unique struggles and needs (Watson and Kissinger 2007; Roberts et al. 2023). Instead, the research has reported that student-athletes often confide in the athletic trainers and academic advisors they see on regular basis, and with whom they have formed an established relationship (Barnard 2016; Cosh and Tully 2015; Roberts et al. 2023; Watson and Kissinger 2007). Certainly, some athletic personnel feel an obligation to assist MDSA’s transition from sport (Kiefer et al. 2023).

Many athletes relate stories of their sudden loss of athletic identity that likens the experience to a death (Jewett et al. 2019; Manthey and Smith 2023). Previous research (e.g., Manthey and Smith 2023; Ogilvie and Howe 1986; Roberts et al. 2023; van der Poel and Nel 2011) found that collegiate athletes reported feelings that paralleled the Kübler-Ross (1969) model of death and dying, upon their involuntary and unanticipated exit from athletics. According to Kübler-Ross (1969), grief responses to death and dying follow a predictable pattern, beginning with denial, then proceeding to anger, bargaining, depression, and finally acceptance.

1.2. Negotiating Environment and Emotional Toll

According to Wolff and Lester (1989), this parallel process begins with the athlete denying that their sport days are over. They may refuse to acknowledge the severity of their injury and seek additional medical opinions in search of a better prognosis (Harris 2003). A perceived lack of empathy and support can cause the athlete to isolate themselves from others (Jewett et al. 2019; van der Poel and Nel 2011). Further, the research reports that anger emerges and is directed at everyone or anyone in their life, including themselves, friends, family, teammates, medical and coaching staff, and even a deity as a super force (Harris 2003; van der Poel and Nel 2011; Wolff and Lester 1989). The athlete moves beyond denial and anger through bargaining, which can be religious in focus or manifest as the former athlete attempting to negotiate a failed return to the sport (van der Poel and Nel 2011; Wolff and Lester 1989; Kegelaers et al. 2024). In addition, depression and anxiety sink-in when recovery plateaus and the athlete realizes that one’s sporting career has reached its conclusion. Eventually, they accept their loss and consider new career opportunities they might find satisfying (Roberts et al. 2023; van der Poel and Nel 2011; Wolff and Lester 1989). This acceptance can be bolstered by a strong support network, coping mechanisms, and an ability to ask for help when needed (Harris 2003).

Brewer (1994) scrutinized the idea that injured athletes progress through this predictable pattern of stages, arguing that it has not withstood empirical analysis. Instead, Brewer (1994) found that reactions vary among injured athletes, depending on their personal characteristics, and may not follow a common sequence. Asif et al. (2015) and Udry et al. (1997) found no evidence that injured student-athletes went through a bargaining phase, while Kastenbaum (1986) found they may oscillate between stages. Nonetheless, the literature reports consistently the effect of a grieving process (Kegelaers et al. 2024; Manthey and Smith 2023)

1.3. Mental Health Stigma and Social Barriers

Despite growing awareness of mental health in athletics, substantial stigma persists, especially for athletes who are expected to exhibit strength and resilience at all times (Barnard 2016; Bissett and Tamminen 2020; Tabet et al. 2021). Student-athletes often avoid mental health services out of fear that they will be perceived as weak or unreliable (Yoon and Petrie 2023). Additionally, many do not view campus mental health providers as attuned to the unique pressures of athletic life (Ballesteros et al. 2023; Cosh and Tully 2015). Research suggests that athletes are more likely to seek support from athletic trainers and advisors, rather than counselors, because of their pre-existing relationships and perceived empathy (Milliet et al. 2025). For instance, Milliet et al. (2025) examined the role athletic trainers (AT) play in supporting athlete mental health, particularly during crises such as the suicide of a student-athlete. This study revealed that ATs often fill the void of counselors and emotional coaches during periods of profound personal grief and concern for the well-being of other athletes. Significantly, the study also highlights the necessity for institutional mechanisms and policies that not only provide resources for athletes, but this article also considers the preparation and postvention strategies to support ATs in their dual role as caregivers and individuals affected by such tragedies.

1.4. Institutional Support and Systemic Failure During Transition

In response to persistent stigma and student-athlete mental health concerns, NCAA Division I athletic departments have increasingly considered the use of Mental Performance Consultants (MPCs). While there are variations among the categories of mental health professionals, a subset category are credentialed professionals, who are trained and certified to support both the mental health and performance-related demands of student-athletes (Jones et al. 2022). The approach addresses, in many cases, the bridge between sport culture and psychological care. According to Jones et al. (2022) and Menaker et al. (2023), athletic departments that employ CMPCs report more integrated support systems, which may reduce stigma by embedding emotional wellness into athletic training environments. However, just under 26% of Division I athletic departments offer mental performance and/or mental health services (Jones et al. 2022).

Nonetheless, when medical disqualification occurs, athletes face involuntary exit and unexpected outcomes when dealing with the university. Many MDSAs often face bureaucratic ambiguity and a lack of institutional preparation for life after sport. Framed around the involuntary exit or forced sport retirement, research reveals that the transition out of athletics is rarely scaffolded by comprehensive exit planning or structured psychosocial support (Chow et al. 2020; Kiefer et al. 2023; Roberts et al. 2023). Many institutions lack coordinated protocols for supporting MDSAs, and as a result, these student-athletes have reported experiencing isolation, academic disengagement, and mental health decline (Roberts et al. 2023; Rohrs-Cordes and Paule-Koba 2018). This omission in the institutional structure and processes is especially troubling given the NCAA’s ethical obligation to care for athletes whose injuries are directly tied to their institutional athletic commitments.

Studies have documented the limited and inconsistent support available to athletes undergoing transition out of sport, especially those who are medically disqualified (Kiefer et al. 2023; Roberts et al. 2023; Rohrs-Cordes and Paule-Koba 2018). Research has uncovered that NCAA institutions often lack standardized exit protocols or transition services tailored to the psychological and identity needs of MDSAs. Even when support is available, it may be underutilized due to the mental health stigma or lack of proactive outreach, which were mentioned earlier.

The NCAA’s Mental Health Best Practices acknowledges the importance of “holistic wellness,” but there are realistic barriers. Namely, implementation at the institutional level remains highly variable (NCAA Sport Science Institute 2016). Affected athletes often experience limited supports following disqualification. By contrast, athletic programs have readily in-place supports for athletes facing other life crises (e.g., family issues, academic struggles) in which permanent medical disqualification are not at issue. In other words, the research suggests potential feelings of abandonment and disposability of athletes once they no longer serve competitive functions.

2. Materials and Methods

Informed by the Kübler-Ross Model of death and dying, this study examines how medically disqualified NCAA Division I student-athletes experience the abrupt end of their athletic careers and how those experiences reflect broader cultural and psychological dynamics within college sport. This study investigates how the experience of medical disqualification affects the choices, emotions, and psychological conditions of medically disqualified NCAA Division I student-athletes during the transition period. With that honed-in study population, we utilize an interpretive phenomenology analytical approach (IPA) (Smith 1996), employing interviews with a small, homogeneous sample of MDSAs to understand their lived experiences. Smith (1996) asserted that “the aim of IPA is to explore the participant’s view of the world and to adopt, as far as is possible, an ‘insider’s perspective’ … of the phenomenon under study” (Smith 1996, p. 264).

The interview protocol, which we used to prompt responses from the MDSA in this study, was intentionally structured to generate participants’ lived experiences in a manner consistent with both the Kübler-Ross model of grief and the methodological tenets of Interpretive Phenomenological Analysis. The protocol began with demographic and athletic background questions to establish the personal and contextual grounding of each participant, which aligns with IPA’s idiographic focus. The core of the interview explored athletic identity and psychological responses to medical disqualification, with prompts intentionally aligned to the Kübler-Ross stages of denial, anger, bargaining, depression, and acceptance. Our intent was to structure the inquiry around the comprehensive coverage of emotional reactions. However, rather than directly asking participants to identify with specific stages, the interview used open-ended questions such as “Tell me about the emotions you experienced since being medically disqualified” and “Describe your initial thoughts and emotions.” This approach allowed participants to naturally articulate their lived experiences in their own words. Also, this line of questioning presented minimal risk of participants omitting key phases or simply parroting the framework. At the same time, our protocol respected the emergent, interpretive nature of IPA. We also posed additional questions on social support along with academic/social life changes. We recognized that these questions would further contextualize the meaning-making process because we used those questions to invite participants to reflect on how institutional and interpersonal relationships shaped their transition. Throughout, prompts such as “Tell me more about…” and “Can you elaborate…” supported the double hermeneutic process of IPA. In particular, these types of questions encouraged MDSAs in this study to ponder more about the whole experience and it allow us, as the researchers and instruments of the study, to interpret how participants made sense of their disrupted identities and post-sport retirement processing.

In other words, we guided the study through Kübler-Ross’s (1969) five-stage model of grief. The model shaped the development of the interview protocol and guided initial areas of thematic inquiry, particularly with regard to understanding emotional transitions following medical disqualification. Rather than imposing the model rigidly, it served as a heuristic framework to explore how grief-like responses may manifest in this unique athletic context. Building off that grief framework, we examined the experiences of MDSAs through an IPA approach that aided our understanding of each participant’s experience while exploring the contextual features of the phenomenon of being medically disqualified from their sport. IPA is more suitable than a more broadly phenomenological approach, as phenomenology initially highlights participants’ experiences based on what is said throughout the interview, whereas our interpretive phenomenological approach allows the researchers to explore if participant experiences can be conceptualized through stages of Kübler-Ross Model of Death and Dying. As Walker et al. (2007) noted, for two decades, “almost without exception,” Kübler-Ross (1969) was the dominant interpretive paradigm in sports psychology for conceptualizing the emotional recovery process of injured athletes (p. 175). Although the stages are consistently observed in recovering athletes in the extant literature, the sequencing and trajectory of those emotions has proven less consistent and less reliably experienced (Walker et al. 2007).

A criterion sampling strategy was selected (Denzin et al. 2023) for this qualitative study, since participants were alike in that they: (a) were current students at NCAA Division I institutions; (b) had a medical condition that precluded continued involvement in their sport; (c) were medically disqualified within the prior five years; (d) had remaining athletic eligibility; and (e) remained under the supervision of their university’s athletic administrator until graduation. Among theoretical approaches, IPA may be uniquely suited to investigate the lived experiences of MDSAs, as phenomenological analyses are rooted in the health sciences. As Smith (1996) noted, by “conducting semi-structured interviews, one may be able to obtain a richer account of how the person is thinking about, and dealing with, complex health-related questions. And utilizing a criterion sampling strategy improves the trustworthiness of our analysis” (see also, Denzin et al. 2023).

Identification of prospective participants occurred through: (a) inquiries with staff and administrators who work with student-athletes at NCAA Division I institutions; (b) inquiries with student-athletes; and (c) correspondence with the National Association of Academic and Student-Athlete Development Professionals (N4A) listserv. Fifteen remote interviews (through a web-based call) were conducted with MDSAs fitting the study criteria. Nine participants were male and six were female, all aged 20–23; seven MDSAs were Black, seven were White, and one was biracial. Eight participants were former football players, with the other seven consisted of swimmers, wrestlers, or basketball, soccer, lacrosse, tennis, or volleyball players.

Two rounds of 60-to-90 min interviews were conducted, recorded, and transcribed by the research team. Transcription, followed by data analysis, started immediately after the first and subsequent interview(s), followed by a two-cycle coding process (Saldaña 2014). Initially, as noted, the first author engaged in deductive coding informed by Kübler-Ross’s (1969) stage-based model of grief, which served as a sensitizing lens to explore potential emotional trajectories. However, in alignment with IPA’s emphasis on emergent, participant-centered themes, the research team determined that continued use of a prestructured framework risked imposing theoretical assumptions onto participants’ lived experiences. Consistent with that approach, the researchers set aside the deductive codes and re-examined the transcripts. As a fresh start, the team used a fully inductive, phenomenological strategy. Both authors independently re-coded the data. We used a line-by-line analysis to identify salient phrases, emotional expressions, temporal markers, and metaphors used by participants to describe their evolving identities and responses to disqualification. The process adopted the IPA idiographic commitment by staying grounded in the individual experiences of each participant before searching for patterns across cases.

To enhance credibility and interpretive rigor, the researchers engaged in multiple rounds of collaborative analysis. In particular, we focused on resolving seemingly discrepant and emotionally layered narratives. This round included re-reading full transcripts, identifying sequential patterns of emotional shifts, and analyzing “what-if” statements and ambivalent reflections that surfaced during interviews. Our meaning-making, as associated with the interpretive analysis, was treated as both dynamic and recursive, not linear. Final themes emerged through iterative discussion, where both researchers negotiated interpretive convergence without forcing consensus. We prioritized resonance and conceptual depth over categorical agreement. In this way, the analysis remained true to IPA’s focus on double hermeneutics whereby we, as the researchers, could make sense of how participants experienced that sense of their loss, transition, and reconstruction of self.

3. Results

Figure 1 presents the distribution of the participants exhibiting each stage of grief demonstrated (Kübler-Ross 1969). All five stages of grief were found. Forty percent (40%) of MDSAs experienced some form of denial, and 53% experienced anger. Ninety-three percent (93%) of MDSAs experienced symptoms of depression, while 67% reached the acceptance stage. Only five participants (33%) reported bargaining behavior. The next section illustrates the five stages of grief as told by the participants. Consistent with prior research, these stages were not necessarily found in order (Walker et al. 2007).

3.1. Denial: “I Didn’t Want to Truly Take It in.”

Injuries are an inevitable part of sports. In many cases, athletes are encouraged to play through the pain and continue to compete. For some, it is only when they receive a diagnosis or are medically disqualified that they begin to realize playing through the pain is no longer an option. In other cases, athletes may sense the end of their careers before receiving the life-altering medical disqualification. Either way, the transition period is psychologically complex and often begins with denial. The symptoms of denial are: (a) refusal to accept the severity of the injury; (b) inability to believe their sporting career is over; (c) seeking additional opinions in the hopes of receiving a better prognosis; and/or (d) withdrawal from others if perceived as non-supportive.

For Randy, the symptoms of denial set in before he received his prognosis for his knee injury:

Maybe I may have to get another procedure done, more time to rehab…. I know this can’t be the end of the road for me. I know I still got a lot of knowledge in me as far as playing. I just got to stay healthy.

• Isaiah was clearly in denial even after signing the papers. He stated, “It was not real…. Football wasn’t over.”

The fourth sign of denial, withdrawal from others, though perceived as non-supportive to recovery, was clear in this study. Tonney found the effort to convince her coaches and teammates that she was in pain taxing. As Connie said:

People checked in on me like, “How are your knees feeling?” At the end of the day, they didn’t know or even have a clue how my knees were feeling. I would always sugar-coat it just because they couldn’t see it, and so if I made it sound what it actually was, would they even believe me? I just tried to stay to myself in that sense because of the view no one would understand.

• Time and again, participants in the study recalled non-supportive roles that others played in the recovery process, at times amounting to denial on behalf of—and much to the detriment of—injured athletes. Loretta’s parents were in denial about her depression:

They didn’t know I was there until I called them from the [inpatient mental health] facility because last time I was depressed, they downplayed it. They told me I was just sad, and I’ll get over it and all that stuff. My dad doesn’t even believe in—I don’t even think he believes in suicidal thoughts. He thinks it’s—I told him, “You literally told me one time that it’s dumb, so I’m not understanding why you’re so confused that I didn’t tell you I’m in the hospital now because you don’t care.” That made me very upset, honestly.

For still other athletes, friends, parents, former teammates, and coaches each took turns denying the severity of injuries, even when the athletes themselves had come to terms. As Connie stated:

For me, it was more of a convincing game. I got to the point where I was like, “I’m done convincing people,” just because I was wasting my energy and my efforts at that point. Then at that point, people started to see on their own, because it got to the point that I couldn’t do certain things for a prolonged period of time…. It took maybe some more actions like people seeing me in the training room every single day, or people hearing about all the procedures that I went through for them to really understand, which still sucked because they couldn’t understand that I wouldn’t just be making up the situation.

3.2. Anger: “I Wanna Punch People on the Face.”

Participants in Kübler-Ross’ study expressed anger at their lack of control, feeling they could no longer live their normal lives. In this stage, anger emerges and could be directed at anyone in the participants’ lives, including themselves, friends, family, teammates, and medical or coaching staff—or even God.

Adrian was medically disqualified due to a rare illness caused by food poisoning that left him with arthritis and ligament issues in his foot. Given the rarity of the condition and his arduous journey to recovery, Adrian not only asked, “why me?”, he became irate when recalling his reaction to the condition during that time:

I do get super-upset about it…. I just say that I wanna punch people on the face when they ask me about it, because you know right now it makes me angry. I wanna, actually wanna punch anybody in the face. It’s just that at that moment in time, that’s how I feel when they talk to me about it, you know.

• Similarly, Sterling lacked a target for his anger: “I was pissed…. It made me feel angry knowing that I was able to do something and just take a bunch of steps back and not forward…. I didn’t know who to take it out on my anger.”

Like Adrian and Sterling, some athletes were outwardly angry about their situations, and others expressed anger accompanied by other emotions. One reaction was crying. Jimmie shared his experience when he realized his sporting days were over: “I cried, punched things. It was just a period of anger and sadness.”

Some athletes in this study appeared to trace their anger to resentment of their peers—believing that they should be the ones competing or practicing. For example, Connie said, “I was still a little bitter because I should also be out there.” Isaiah was “jealous of [the] guys practicing.” Non-participation was recalled as a surreal place, when anger about their injury or medical disqualification made it difficult to cheer on team members. As Jada stated, “I loved cheering on the team, but [when] it got to my event, and I had to go into the locker room because watching them swim my race and imagining that’s where I could have been.” It was tough to watch “her race” because it left Jada imagining where her own performance may have taken her.

3.3. Bargaining: “If I Had a Time Machine.”

Bargaining can be characterized by regret or denial, manifested frequently in the form of regrets, when participants discussed times when they bargained with God or themselves, questioning if they would have had a better outcome if they had done something different (Kübler-Ross 1969). “Oh, I always think about that,” said Adrian. “If I had a time machine, oh my gosh. It would be absolutely incredible for what I could do, but I can’t so….” In the case of MDSAs, this stage may include trying to negotiate a failed return to playing their sport.

Alicia said, “I wish I would have known that that was the last game I was going to play in. Maybe I would have done something different, tried something new.” Randy’s situation was a bit different, as he was told by another student-athlete that being medically disqualified applied only to his current institution. Randy considered transferring to another institution. He said, “I don’t care if it’s DI, DII, or JUCO. I just want to play ball.” Randy decided to stay at his current institution once he realized the severity of his injury. Sterling shared disbelief when his neurologist told him he would no longer be able to wrestle: “I didn’t believe them. I was like, ‘Whatever. You can say what you want. I’m still going to try’…. The frustration came out when I tried to wrestle and had a seizure.”

Some participants could point to a specific moment of realization, which came as the culmination of their attempts to negotiate a return to competition. As Jada said:

That mentality of deciding, ‘Okay, I’m done.’ I’ve never been able to do that. I’m very competitive. I’m very strong-willed so having the doctor say—I would ignore the signs. If I had another broken collarbone, I would ignore it and just say, ‘Oh, it’s just leftover pain from the last one,’ but the doctor had to tell me …: ‘If you keep swimming, there will be issues down the line. You need to stop that.’ It clicked. I needed someone to tell me or else I would just make up excuses for everything.

3.4. Depression: “Is Lonely an Emotion?”

Depression sets in once the participant realizes their recovery has plateaued and their athletic career has come to an end. This stage may be characterized by sadness, lack of motivation, withdrawal, questioning what the point is, and even suicide or suicide ideation. Many participants expressed a lack of motivation once their sporting days were over. Academic grades went down, communication with family and friends became almost non-existent, and they lacked the desire to go places. In fact, many participants in this study directly mentioned they experienced depression during their transition. Speaking on the lack of motivation, Michael said, “My grades slipped quite a bit. I couldn’t focus. I didn’t want to go to class. I think I skipped a lot of my classes. I just had … no motivation.”

Helplessness was another common theme, as the isolation and loneliness set in. A few participants isolated themselves from their families, teammates, and coaches once they were medically disqualified. They wanted to be by themselves for days and not communicate with anyone or to talk about their injury, disqualification from their sport, or plans for the future. As Randy said, “That whole day, I just stayed to myself. I went back to my room, locked the door, cut the lights off and started crying.” Mazie also spoke of this troubling period:

During that time, I would be very distant from people or I would be quieter. If I had to go to class on campus, I would go to class and immediately go back to my apartment. No social interactions. I didn’t say anything to my former teammates because I just distanced myself. I just felt so angry and hurt that I didn’t want to talk to anybody. The only person I was really talking to then was my mom and my therapist.

Mazie’s persistent class attendance and ongoing communication with her mom and therapist were more than many athletes could manage, including Randy, who simply wanted to be alone to grieve in the darkness. Still others interacted with the world with reduced frequency. For example, Connie asked “is lonely an emotion?” as she spoke of this stage of her post-injury life:

I also felt lonely because I was sitting on the side-line by myself while everyone else was performing. I was sitting at home at night thinking about performing, et cetera. It got very lonely, and I also shut people out or I didn’t talk about it really when people would ask me about it. I would just give them short answers because it made me uncomfortable because I didn’t come to terms with it right away because to me it was like, ‘Oh, this is temporary or something.’

Connie experienced a depression stage concurrent with her ongoing denial about the finality of the decision to medically disqualify. Regardless, some MDSAs actively isolated themselves and pushed others away while they were depressed, which made the recovery process still more difficult. As Devin stated, “Kind of pushing your friends away and isolating yourself. Not—maybe not purposely, but just out of like, ‘Oh, they don’t wanna be around me ‘cause I can’t play football.’”

As their non-participation continued, these former athletes began to miss playing sports and their camaraderie with teammates. They related stories of playing their sport for many years and enjoying their bond with teammates and expressed some sadness at no longer being part of the team. Devin said, “For a long time you just feel like you’re left out because you can’t do the things that other people can do. So it’s tough.” MDSA’s discussed how difficult it was to be left out, especially when some of them were already dealing with issues related to identity and isolation. As they related their stories, the athletes emphasized how they had spent their entire lives competing, and how difficult it was to accept that it was no longer possible. Like Devin, Tonney spoke of this feeling of missing out: “I would say just random thoughts that come to me, like missing the team or missing the feeling of being out on the field with everyone, playing with everyone.”

Other athletes connected their fears about the future to their depression. They discussed the uncertainties that come with sustaining a life-changing injury, which led some athletes to a very dark place, where they were unsure of what would happen next. For many, their sport was their life, and they could not see another reality without it. Connie mentioned this feeling:

I was sad because I didn’t know where life was headed. I didn’t know where I was supposed to go from there. I was sitting in that gym every single day watching everyone else live out the dreams that I wanted to accomplish.

• While depressed, some athletes said they spent a lot of time watching their teammates perform, while others like Randy spent their time watching themselves via game film. He said, “I didn’t want to play Madden no more because I missed it so much…. I just pull up my old tapes from high school, look at my cleats and just sit there with them.”

Depression was the most prevalent symptomatic stage for MDSAs in this study. Many told stories of suffering from a lack of motivation after losing their athletic identity. Those feelings led to isolation and loneliness in addition to submersion in reflective states and memories. For others in this study, even recalling the more difficult moments of their recovery process brought some of those same emotions to the surface. Some participants, such as Reginald, declined to elaborate:

It was just a difficult time. I [don’t] necessarily care for speaking [about the dark times] that much. You start to realize who’s there for you, who’s not. Put it that way…. No [further comment] about the dark times, about dark times.

3.5. Acceptance: “This Is What I Go Through. This Is Who I Am.”

Athletes in this study eventually embraced and accepted their post-injury lives, although they admitted that it was a tough process to move on. Some athletes spoke of being happier after their medical disqualifications. Mazie spoke of the importance of happiness: “Me growing as a person is really me focusing on what makes me happy. What makes me happy? Finally putting my well-being at the forefront instead of trying to please everybody else so much.” Loretta spoke of the blessing that came with her recovery process: “A blessing in disguise for me because the person that I’ve become since I’ve stopped playing tennis is just so much different and so much better.” Athletes like Mazie and Loretta highlighted the value of being happy with who they were as people and focusing on the positives. Devin also shared this sentiment: “Just being satisfied with who you are…. That you can’t rely on someone else or something else to make you happy, or make you feel fulfilled.”

Athletes at this stage testified to reaching a point where they were able to secure happiness, knowing that things would work out. Many athletes related stories of discovering other passions that fulfilled those needs and made them feel valued. Mazie spoke of this growth process: “Growing is just learning more about me and basically investing more in myself really, trying to just get out and enjoy things that you didn’t have a chance to enjoy before because you had a full schedule.”

For many, this later stage was a period of exploration and the expansion of their environment. Connie recalled a point when she told herself:

‘Okay, volleyball is only one aspect of this world sports and only one aspect in this world. There’s so much more to not only take in but to give and to get myself to.’ I feel like it was, like I said before, a reality check that I needed. I have more to get to this world than my performance on the volleyball court.

Michael said, “I expanded my horizons beyond football, I found other passions [cooking and musical theater]. Being a part of the [football coaching] program has really expanded outside of it and my friend circle.”

For others like Sterling, acceptance meant that education became a priority: “I focus a lot more on my education.” Jeremiah said, “It was a choice that I made…. I wasn’t mad, I wasn’t sad. I’ve been good, honestly, just focusing on school.” Jada spoke of the necessary role the injury played in her life, redirecting her path:

I needed to have that injury to stop me from swimming because there was nothing else that would stop me. It happened so I could get that opportunity and have a chance to have the future I want…. After I got the vet job my grades started going back up again and I started to feel myself again…. It was after [swimming] when I realized it wasn’t just here or there that I was missing things [family trips and job opportunities] but it was an entirely different life that I was missing where I could work full-time and travel and really live. It felt good once I realized it.

• Although the injury itself was not a positive experience, Jada described the aftermath as a period of joy because she was able to indulge in parts of life that had been missing due to her sporting responsibilities. Jada said she was able to place more value on her career progression and family time, both of which she considered essential. Ultimately, student-athletes in this study testified to a need for closure and an acceptance stage, in order to move on. For some, acceptance seemed to lead quickly to brighter days. As Reginald said, “I spoke to my dad about everything for the last time in 2018; that helped me out a lot. From then on, I was in tunnel vision to move forward.” Tonney described the passage of time as beneficial:

It’s just the change is weird, hard to explain. I guess accepting my life without soccer was weird, but as time goes on, definitely I’m more accepting and welcoming of what’s next for me, and it’s getting more and more exciting without soccer.

Indeed, many participants moved far beyond mere acceptance of their new life roles: they experienced a significant degree of liberation when the demands of their athletic careers had lessened. Religion and spirituality played a significant role in several of the MDSA narratives. Four participants referred to what happened as a “blessing” or “a blessing in disguise.” Reginald, who was side-lined with shoulder injuries, called being medically discharged a blessing in disguise because, “[his] body just couldn’t take it to be honest;” Loretta said that leaving tennis was a blessing because “the person that I’ve become since I’ve stopped playing tennis is just so much different and so much better.”

3.6. Conclusion: “Imagine a Loved One Dying”

Consistently, the experiences among the student-athletes captured a series of emotions from loss to acceptance with the latter drawing into new exploration. For instance, as Darvin reflected, “It goes back to a saying that football is my first love. What you and people want to imagine [is] a loved one dying…. It’s that kind of feeling in my heart.” Nonetheless, he rebounded, refocused on his academics, and found himself in a live beyond sports.

4. Discussion

Building off previous research (e.g., Chow et al. 2020; Grove et al. 1997; Manthey and Smith 2023; Ogilvie and Howe 1986; Roberts et al. 2023; van der Poel and Nel 2011), this study uncovered very similar outcomes of how NCAA Division I medically disqualified student-athletes (MDSAs) experience the end of their competitive sports careers. However, this study further unpacks the understanding of the lived experience of NCAA Division 1 MDSAs. The findings highlight the profound emotional, psychological, and identity-related disruption that follows an involuntary, medically driven exit from sport. Although previous research has addressed retirement and athletic identity foreclosure (e.g., Jewett et al. 2019; Kiefer et al. 2023), our findings contribute to the extant literature by capturing the suddenness and institutional void that characterizes the MDSA experiences. Unlike planned retirement, MDSAs encounter unanticipated separation that often lacks structured institutional support, which amplifies its psychological toll. Our analysis emphasizes that MDSAs experience something more than a career transition. MDSAs experience a significant disenfranchised loss that is largely unrecognized by the very systems that once celebrated the athlete’s identity.

Moreover, this study questions the neatly aligned perception of the Kübler-Ross (1969) model within the context of MDSA grief processing. Although prior literature has suggested that athletes’ psychological responses may parallel the Kübler-Ross (1969) model of grief, this study only affirms the existence of each event, but not as a staged, sequential experience. That is, while the stages of denial, anger, depression, and acceptance were widely observed, they did not follow the predictable pattern or universal sequence that others reported. Instead, participants cycled through emotions in ways shaped by their personal narratives, institutional responses, and available support systems (Asif et al. 2015). These findings support Walker et al.’s (2007) critique of the model’s linearity and further demonstrate the value of treating Kübler-Ross as a flexible heuristic rather than a prescriptive model. However, Walker et al.’s (2007) study examined athletes who recovered and returned to the sport, not MDSAs who were unable to return.

Instances of “denial” in the present study are illustrative of the variable and recursive nature of the stages in the MDSA recovery process. The pervasiveness of social and institutional denial, not only internal to the athletes themselves but also among peers, coaches, and family members were also present in the data. This degree of denial echoes Chun et al.’s (2023) recent synthesis of athlete identity work, which calls attention to how external expectations and social roles can impede identity reconstruction following sport exits. Further, college athletes may sense the end of their careers well before receiving the official notification. And the transition period is psychologically complex, often beginning with denial but frequently experienced in concert with a range of emotional turmoil and feelings of defeat. The symptoms of denial are: (a) refusal to accept the severity of the injury; (b) inability to believe their sporting career is over; (c) seeking additional opinions in the hopes of receiving a better prognosis; and/or (d) withdrawal from others who would be perceived as non-supportive. Yet, our participants described a more insidious form of denial, whereby coaches, peers, and even athletic department protocols minimized or ignored the emotional impact of disqualification. This lack of acknowledgment led these former student-athletes to question the validity of their own grief and inhibited help-seeking. By identifying this institutionally mediated silence, our findings suggest that denial, for this context, extends beyond a personal coping mechanism to address. In particular, the absence of meaningful recognition and support from administrative and procedural responses as well as more caring interpersonal responses from the athletic program signals some concern. The responses tended to manifest actions such as the immediate removal of the student-athlete from sport activities including team meetings, lack of follow-up from coaching staff, and the omission of any formal transition planning. The MDSA is then left to manage the identity loss and emotional distress in isolation. Also, the institutional silence was exhibited by the socially reinforced response from various persons from coaches to other players, in some instance, and these behaviors may reflect embedded consequences of the Division I athletic culture.

Although the present study offers insights that are consistent with most of the prevailing literature (Chow et al. 2020; Harris 2003; Roberts et al. 2023; Wolff and Lester 1989), this study reported that withdrawal from others was a frequently reported phenomenon. Adding to the literature, the participants in this study illuminated effects from social isolation. Most frequently, these effects appeared symptomatic of denial, concurring with the athletes’ general sense of lacking support. Closely tied to lack of support was the idea that others in the MDSA’s lives were more firmly in denial than the athletes themselves. For example, Isaiah recounted a memorable contrast between coaching attitudes to their players. As Isaiah’s narrative implied, for MDSAs to bargain from a position of power or leverage, they would undergo some plausible deniability of their career’s end. Denial would seem to be a pre-condition for any degree of “bargaining.” Another possible reason for the scarcity of MDSA testimonials for “bargaining”—both among our participants and in the wider literature—might be that such negotiations often take the form of internal dialogs, occurring early in the injury-recognition process—and frequently concurrent with some degree of “denial.”

There is ample evidence supporting the possible applicability of each emotional stage outlined by Kübler-Ross (1969) among the NCAA Division I MDSA population sampled here. As Walker et al. (2007) cautioned, however, sports psychologists and practitioners should use caution before taking the Kübler-Ross model in toto when it comes to MDSAs, as their trajectories and the instances of those stages appear to be highly variable unlike prior research suggesting linear staged effects (Harris 2003). Perhaps the most heartening evidence to emerge from this study of MDSAs is the degree to which our participants had not only accepted but fully embraced their new, non-student-athlete roles and identities. Even when their new roles bore traces of their previous identities—such as the participants who work in coaching/training—these former student-athletes were frequently filled with gratitude for both their playing experiences and their post-injury growth/learning. As Michael said, “I’m in a much better place, I’m happy, healthy, really living the best life I can live right now. Just going from the deep, dark valley thirteen months ago…. It’s definitely a blessing.” This is consistent with prior research suggesting that injured athletes may thrive as the result of stress or trauma (Galli and Reel 2012). These findings of new identities suggest that emotional toll, while traumatic, may have positive prospects if the exit experiences are designed with more intentionality with key supports, structured experiences, and exploratory activities.

Though many participants eventually reached a stage of acceptance and personal growth, these outcomes were not inevitable. For some, spiritual or religious beliefs played a role in reframing their situation as a “blessing in disguise.” At the same time, for some other MDSAs, they credited therapy, creative outlets, or new career and academic passions to drive their attention from the significant loss. These experiences echo Galli and Reel’s (2012) concept of stress-related growth and demonstrate that thriving post-injury is possible, but these experiences remain contingent on time, context, and support.

First, universities should expand access to mental health services tailored specifically to student-athletes. As Yoon and Petrie (2023) emphasize, athletes are more likely to seek help from familiar figures within their athletic environment rather than from external providers or others not directly associated with their focus as athletes. To address this gap, campus counseling centers could collaborate with athletic departments to place culturally competent mental health professionals and counselors with experience in sport. Ideally, these counselors would be trained in trauma-sensitive care, grief-informed therapy, and the unique stressors tied to career-ending injuries.

Despite increasing awareness of the importance of mental health among student-athletes, stigma remains a significant barrier for injured collegiate athletes, especially MDSAs who need, and sometimes actively seek, psychological support. Indeed, as noted earlier in this paper, college athletic departments have increasingly recognized this gap of addressing student-athletes’ mental health. In some cases, programs have responded by hiring mental performance professionals with specialized training. In particular, Division 1 athletic programs may consider employing or contracting with Certified Mental Performance Consultants (CMPCs) to better address the transition that MDSAs experience from student-athlete to just a student. These professionals, who are certified through the Association for Applied Sport Psychology, have the proper training to help former college athletes manage the psychological challenges related to injury and transitions out of sport (Jones et al. 2022).

The inclusion of CMPCs or Licensed Sport Psychology Professionals (LSPPs) is one strategic measure to support student-athletes’ psychological transitions. These professionals can help athletes redefine their identities, enhance coping strategies, and improve emotional regulation during periods of acute stress or post-sport adjustment (Jones et al. 2022; Menaker et al. 2023). Their presence is particularly impactful in helping athletes reconstruct meaning following identity loss and in fostering resilience through structured mental performance programs integrated within athletic departments. Expanding the visibility and normalization of such services could mitigate stigma and promote a culture that values mental as well as physical recovery. More specifically, these professionals can help athletes redefine their identities, enhance coping strategies, and improve emotional regulation during periods of acute stress or post-sport adjustment. Their presence is particularly impactful in helping athletes reconstruct meaning following identity loss and in fostering resilience through structured mental performance programs integrated within athletic departments. Also, the visibility and normalization of such services could mitigate stigma and promote a culture that values mental as well as physical recovery.

Second, beyond formal counseling, universities should draw on the “team” from the athletics office such as athletic trainers, academic advisors, and coaches. These individuals may serve as front-line mental health allies. Many athletes in this study turned to trainers during emotional crises. This reliance illustrates the trust embedded in those daily relationships. Universities could provide these staff with foundational mental health training, clear referral protocols, and access to their own support resources. As Milliet et al. (2025) note, athletic trainers often absorb athletes’ emotional distress without institutional recognition or support. Therefore, universities should also acknowledge and resource their relational labor that may be called upon in these instances.

Third, to ensure continuity of care, NCAA institutions should implement structured transition programming for MDSAs (Ferrara et al. 2024). Unlike those who retire by choice, MDSAs often experience abrupt exits without closure. With that context in mind, universities should offer guided exit planning, reflective exercises, career development, and peer mentorship to help athletes reframe their identities beyond sport akin to other separation activities such as employee layoffs. Similarly, as Chun et al. (2023) suggest, identity work should be not incidental encounters, but instead, the identity impacts of MDSAs requires intentional environments and design supports to help the MDSA through this experience and lead to personal growth.

Finally, consistent with research by Chow et al. (2020), Ferrara et al. (2024), and Gaston-Gayles (2024) in which mediating activities may lessen the impact, the NCAA and member universities should adopt policies that treat medical disqualification as a matter of institutional responsibility. These policies should include mandating minimum standards for post-disqualification support, providing coach training on emotional injury response, and conducting regular audits of transition services. Universities must also redefine student-athlete value in ways that extend beyond performance. This value proposition means affirmation of diverse student identities throughout the athletic career and recognition that the end of athletic participation does not mark the end of institutional care.

5. Conclusions

This study explored the emotional, psychological, and institutional fallout experiences of NCAA Division I medically disqualified student-athletes (MDSAs). Through the involuntary exit, the data reveal that MDSAs’ transition out of competitive sport often mirrors grief-like responses as similarly conceptualized by the Kübler-Ross model. Yet, our findings complicate a linear interpretation of those stages contrary to work such as Harris (2003). They illustrate that denial, anger, depression, and even acceptance can surface cyclically, coexist, or be shaped by sociocultural and institutional dynamics. The abrupt and involuntary nature of medical disqualification intensifies the emotional toll, particularly for student-athletes with a deeply entrenched athletic identity. Our participants frequently experienced social withdrawal, loss of purpose, and profound institutional silence. These effects highlight how college sport cultures normalize pain, stigmatize vulnerability, and offer inconsistent support during athletic exit.

The insights generated here call for more than empathetic understanding of MDSAs. The findings demand a structural transformation within universities and the NCAA. Universities must reimagine athlete care. It should extend beyond physical recovery and active eligibility, offer culturally responsive mental health services, provide trauma-informed transition programming, and support exit planning that affirms student-athletes’ value beyond the sport. Athletic departments should also recognize and support the relational labor of athletic trainers and staff who often serve as informal first responders to athletes in emotional crisis. More broadly, the NCAA must move toward policies that mandate post-disqualification protocols and hold institutions accountable for the well-being of all student-athletes, including those who can no longer contribute to performance outcomes.