Concussions Update, News (Grey-Bruce Highlanders AAA Minor Hockey Association)

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Sep 20, 2011 | dmoffatt | 2198 views
Concussions Update


MEDIA ALERT – Brain Expert: Kids Shouldn't Play Contact Sports

"We're going to be recommending that nobody under the age of 14 be involved in collision sports," said Dr. Robert Cantu, chairman of the Department of Surgery at Emerson Hospital and co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine. He also is co-director of the Neurologic Sports Injury Center at Brigham and Women’s Hospital. excerpt from


In a recent newspaper interview, Dr. Robert Cantu chairman of the Department of Surgery at Emerson Hospital and co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine stated that "We're going to be recommending that nobody under the age of 14 be involved in collision sports”.

His recommendation is evidence based and it is clear that testing has shown that teenagers who played contact sports often already showed signs of chronic traumatic encephalopathy, or CTE, a degenerative brain disease caused by multiple blows to the head.

CTE is a huge problem because people living with CTE have no way of knowing it. Diagnosis most often is possible only after death, when scientists are able to study a person’s brain tissue. Most important, Dr. Cantu draws a direct correlation between CTE and symptoms of personality changes, memory loss, depression, even dementia. Brain scans (post-mortem) show clear differences between healthy brain tissue and that of a patient with CTE.


Competitive ice hockey is characterized by high rates of speed and physical contact which increase the likelihood of collisions leading to injury.  Within the competitive or “representative levels” injuries to the head and neck often result in concussion and are a common occurrence in ice hockey.  In an update and revision to the Vienna Consensus recommendations on concussion in sport, McCrory and colleagues reported that head and neck injuries were the second most frequently reported hockey injury, typically resulting in mild traumatic brain injury (mTBI)/concussion.  Injuries to younger competitive level players, which may begin as early as nine years of age, are of particular concern when one considers that the brain has not yet developed fully and long lasting cognitive deficits are more likely to result from the head trauma.  Cantu re-stated this last point when he said “the young brains are more vulnerable, they're less myelinated [less insulation of neurons], the necks are weaker, the heads are bigger proportionately so the forces that accelerate the brain need not be as high to produce higher accelerations”.

Dr. Cantu has been saying this for years and nobody has been listening – he is very concerned with return to play post injury and would rather sit a player out than risk a second impact while the player’s brain has not fully recovered.  But nobody is changing their behaviours, there is no conscious or collective action to recognize the fragility of the brain in developing children and change behaviours to prevent injury.  Therefore the only way to prevent the problem is to suggest banning participation. 

Play it Cool offers an alternative to banning children from participation collision sports like ice hockey.  The main objectives of Play it Cool is to teach coaches how to teach the game safely and to reinforce the message to everyone associated with the game, including parents, coaches, on-ice officials, and players, that hits to the head in ice hockey are NOT part of the game! We also need to continuously stress to coaches, parents and players that getting injured is not part of the game! 

Ice hockey helmets work, in that they protect the head (skull) from focal injury (or a direct impact injury) In other words prevent a skull fracture!! 

In the US and Canada all helmets must be certified by either ASTM or CSA, and there is no helmet sold in Canada or USA that does not meet these standards. All helmets that are certified by CSA and ASTM do exactly what they are designed to do, under the most severe of tests. However, there is no guarantee that a helmet will prevent CTE nor prevent a concussion because of the characteristics of the impacts that cause a concussion, such as linear accelerations leading to focal traumatic brain injuries, as well as rotational accelerations leading to diffuse traumatic brain injuries resulting from head impacts.  Concussion is an injury that occurs as a result of FORCES (sheer forces and/or linear impacts) to the head that are transferred through the skull to the soft tissue of the brain.  As Cantu also stated, helmets offer protection to players in certain types of hits -- where the force is in a back and forth direction, like whiplash. However, even the best helmets can offer insufficient protection when the force causes the head to rotate, like in the majority of concussions.

The easiest way to prevent CTE and Concussion is to stop hitting players in the head or in a way that causes the head to “snap around.”

If a player wears a proper fitted helmet then they can reduce the sheer forces or linear impacts that are translated (transferred) to the brain if they do sustain any contact to the head (contacted by other player, making contact with the ice, making contact with objects like the puck, stick, net, or the boards).   By wearing a proper fitted CSA/ASTM helmet the player reduces the risk of incurring a concussion injury, and reducing the translation of impact through the skull when there is contact to the head. Not wearing a helmet increases the risk of sustaining such injury.

However, if taught to play the game without involving the head in contact/collision type activities (i.e. direct contact to the head from any cause), then not only can players develop skills, and strategies for success, but they can enjoy the game over their lifespan and participation will have less risk of adversely affecting their lives.  The best way to stay in the game for a long time is to play it safe! The following guidelines are designed to help you get the most out of your game.

Be the Best Skater You Can Be! - Having strong skating skills lets you:

*      Keep your balance when you make contact with someone else

*      Develop a strong core/body that lets you handle making contact in all situations

*      Improve your turning and pivoting skills

*      increase opportunities to play at higher levels of hockey

Head Up – Head on a Swivel!  - Keeping your head up allows you to:

*      See everyone and everything around you so you can avoid accidental contact

*      See where your teammates are so you can work with them and help them keep their heads on a swivel

*      See where your opponents are on the ice so you can apply strategies for success through effective positioning

Always From in Front, Not Above the Shoulders!  - Checking from in front with your hands and stick down shows:

*      Respect for your opponent

*      You know how dangerous checking from behind and to the head are

*      You understand the rules of the game and that these types of checks are bad penalties that can hurt you opponent and your team

Know the Danger Zones!  - Knowing the danger zones means you:

*      Understand the meaning of the term “the checking perimeter”, and are aware of the location of the checking perimeter

*      Know to keep your head up and head on a swivel when near the checking perimeter so that you can avoid collisions and injuries

Angle, Angle, Angle!  - Approaching the boards on an angle helps you:

*      Rub your opponent off the puck and stay with the play

*      Keep your head on a swivel making your field of view of much larger

*      Keep skating after you’ve retrieved the puck

Be Ready for Contact!  - Being prepared lets you:

*      Communicate with your teammates so everyone is ready when contact is coming

*      Be ready to initiate and receive contact by keeping your legs moving and your core strong

*      Keep your head up, and keep your head on a swivel in order to expect contact

Heads Up!  Don’t Duck!  - Smashing your face will prevent you from breaking your neck!

*      Getting your arms up when going into the boards lets you absorb the impact of hitting the boards

*      Getting your arms up when going into the boards lets you avoid going head first into the boards and helps you keep your chin up