Many athletes push themselves beyond their limits and sacrifice short-term well-being and long-term health for a chance at victory. Elite sport shapes a certain type of character: mentally and physically tough, and unrelenting in the pursuit of the marginal gains that separate champions from the second best. The difficult question, especially for elite sports, is, "How do managers, coaches, athletes, and members of the health team find the balance between protecting the athlete's health and pursuing athletic greatness?" In this Viewpoint, we offer 4 perspectives on the roles and responsibilities of sports physical therapists: (1) the care of, and ethical obligations to, the elite athlete, (2) decision making that is in the athlete's best interest, (3) building a working relationship with the athlete, and (4) supporting athletes who face end-of-career decisions. .