Body Checking In Youth Hockey Causes More Brain Injuries

Youth hockey players in the Atom division of Hockey Canada are more than 10 times likely to suffer a brain injury since bodychecking was first allowed among the 9 and 10-year-olds, says a study led by St. Michael's Hospital neurosurgeon Dr. Michael Cusimano.

The findings, published online in the journal Open Medicine, add to the growing evidence that bodychecking holds greater risk than benefit for youth and support widespread calls to ban the practice.

According to the researchers, led by Cusimano, director of the Injury Prevention Research Centre at St. Michael's Hospital in Toronto, the odds of visiting an emergency department due to a brain injury from bodychecking increased significantly among all minor hockey players after Hockey Canada relaxed bodychecking rules in the 1998/1999 season. At that time, the organization allowed, for the first time, body contact among 9 and 10 year-olds in the Atom division.

The team examined the records of 8,552 male youth 6-17 years-old who attended one of five emergency departments in Ontario for hockey related injuries that occurred before and after the rule change. Researchers found more than half of hockey-related injuries were a result of bodychecking. What's more, the risk of a head or neck injury, including concussions, increased across all minor hockey divisions.
"Our work confirmed the fact that body checking is the most common cause of injury in hockey. While proponents argue lowering the age for bodychecking helps players learn how to properly bodycheck and reduces injuries at older ages, our study clearly showed the opposite ― the risk of all injuries and especially, brain injuries, increases with exposure to bodychecking," Cusimano said. "While all age groups showed increases in injuries, the youngest were the most vulnerable and that bodychecking puts youth unnecessarily at the risk of the long-term effects of brain injuries, such as cognitive and social-behavioural problems."

For some time, researchers like Dr. Cusimano have called on organizations like the NHL to take more leadership in reducing the incidence of brain injuries. In recent weeks, pressure has mounted on the NHL after Pittsburgh Penquins captain Sidney Crosby and Montreal Canadiens' Max Pacioretty suffered serious concussions that sidelined both players.

"Ice hockey is a sport with great potential to increase the health of individuals but practices that increase the risk for the vast majority of players must be minimized," Cusimano adds. "It is now very clear that there is no benefit to any one or any group to continue to allow bodychecking. Hockey organizers, sponsors, the media, coaches, trainers, and players and parents must come together to advocate for multifaceted approaches that include changes to the rules to reduce the risk of injury."

Source: St. Michael's Hospital and Michael D Cusimano, Nathan A Taback, Steven R McFaull, Ryan Hodgins, Tsegaye M Bekele, Nada Elfeki; Canadian Research Team in Traumatic Brain Injury and Violence. Effect of bodychecking on rate of injuries among minor hockey players. Open Medicine, Vol 5, No 1 (2011)

See also: New Return-To-Play Guidelines For Sports Concussions and Youth Sports Concussions Double In Last Ten Years

Youth Sports Concussions Double In Last Ten Years

A new study from Hasbro Children's Hospital finds visits to emergency departments for concussions that occurred during organized team sports have increased dramatically over a 10-year period, and appear to be highest in ice hockey and football. The number of sports-related concussions is highest in high school-aged athletes, but the number in younger athletes is significant and rising. The study is published in the September 2010 issue of Pediatrics and is now available online ahead of print.

In a review of national databases of emergency department (ED) visits, there were 502,000 visits to EDs for concussions in children aged 8 to 19 years in the period from 2001 through 2005; of those 65 percent were in the 14- to 19-year old age group while 35 percent were in the 8- to 13-year-old age group. Approximately half of all the ED visits for concussions were sports-related, and an estimated 95,000 of those visits were for concussions that occurred from one of the top five organized team sports: football, basketball, baseball, soccer and ice hockey.

The researchers also note that in the period from 2001 through 2005, approximately four in 1,000 children aged 8 to 13 and six in 1,000 aged 14 to 19 had an ED visit for a sport-related concussion.
Lisa Bakhos, MD, is a recently graduated fellow who was practicing at Hasbro Children's Hospital at the time she led the study. Bakhos says, "Our data show that older children have an overall greater estimated number of ED visits for sport-related concussion compared to younger children. Younger children, however, represent a considerable portion of sport-related concussions, approximately 40 percent."

The researchers found that ED visits for organized team sport-related concussions doubled over the time period depicted and increased by over 200 percent in the 14- to 19-year old age group, while overall participation decreased by 13 percent in the same time period. Bakhos comments, "What was striking in our study is that the number of sport-related concussions has increased significantly over a 10-year period despite an overall decline in participation. Experts have hypothesized that this may be due to an increasing number of available sports activities, increasing competitiveness in youth sports, and increasing intensity of practice and play times. However, the increasing numbers may also be secondary to increased awareness and reporting."

James Linakis, MD, PhD, is a pediatric emergency medicine physician with Hasbro Children's Hospital and its Injury Prevention Center and is the senior author on the paper. He comments, "Our assessment highlights the need for further research and injury prevention strategies into sport-related concussion. This is especially true for the young athlete, with prevailing expert opinion suggesting that concussion in this age group can produce more severe neurologic after-effects, such as prolonged cognitive disturbances, disturbed skill acquisition, and other long-term effects."

Despite the apparent increase in concussions in youth athletes, there are no comprehensive return-to-play guidelines for young athletes. The researchers also note that there are no evidence-based management guidelines for the treatment of these injuries, while there is agreement that young children cannot be managed in the same way as older adolescents.

Linakis, who is also a physician with University Emergency Medicine Foundation and an associate professor at The Warren Alpert Medical School of Brown University, says, "Children need not only physical, but cognitive rest, and a slow-graded return to play and school after such injuries. As a result of this study, it is clear that we need more conservative guidelines for the management of younger children who suffer concussions." Return-to-play assessments might include such strategies as neuropsychological testing, functional MRI, visual tracking technology and balance dysfunction tracking.

Bakhos concludes, "What this research tells us is that we need additional studies to provide guidance in management, prevention strategies and education for practitioners, coaches and athletes."


Source: Lifespan and Bakhos, Linakis, Lockhart, Myers, Linakis. Emergency Department Visits for Concussion in Young Child Athletes. Pediatrics, 8/30/2010 DOI: 10.1542/peds.2009-3101

See also: Body Checking Not The Main Cause Of Youth Hockey Injuries and Science Fair Project Leads To New Sports Concussion Test

Body Checking Not The Main Cause Of Youth Hockey Injuries

Hockey fans likely would assume that body-checking -- intentionally slamming an opponent against the boards -- causes the most injuries in youth ice hockey. But they would be wrong.  Findings from a new study, the largest and most comprehensive analysis to date of young hockey players, show that 66 percent of overall injuries were caused by accidentally hitting the boards or goal posts, colliding with teammates or being hit by a puck.

Only 34 percent of the injuries were caused by checking. Moreover, the accidental injuries were more severe than those from body checks.

These results, which appeared in June issue of the British Journal of Sports Medicine, were a surprise to many, including the researchers at the University at Buffalo who conducted the five-year study.

"There is an image of body checking as a form of violence that is condoned by the game of hockey," says Barry Willer, PhD, UB professor of psychiatry and rehabilitation sciences and senior author on the study.  "However, this study found that body checking did not account for a large proportion of injuries. Perhaps as important, body checking did not lead to a rise in intentional injuries."


The youth ice hockey program in Burlington, Ontario, Canada was the base of the study. The researchers compared injury rates overall for the three levels of competition: "house leagues," where there is no body checking; "select," in which checking is allowed at age 11 and older; and "representative," for the most skilled players, which allows checking in all divisions at age nine and above.
 
They also examined injury rates as level of competition and players' age increased, and how injury rates varied in games versus practices. The data covered 3,000 boys ages four to 18 for a total of 13,292 player years. Only injuries that kept a player off the ice for at least 24 hours were included.
Their analysis of the data shows that there were three times more accidental injuries than body-checking injuries in the house leagues -- 92 versus 30. Willer says accidents at this level of competition primarily are caused by players watching the puck instead of what's in front of them, of not playing "heads-up," which coaches try to instill at all levels.

The "select" level tallied the least injuries (28) with more than half intentional, as players first experience checking. In the most experienced league, however, 59 percent of the 96 injuries were unintentional, but the number of intentional injuries (39) was the highest of all the categories, as competition level increases.

As the researchers predicted, as the level of competition and players' age increases, so did injuries. "Game injuries were much more frequent among the highly skilled players on rep teams," says Willer. Rates during practice were low across all age groups and divisions.  Willer notes that this study doesn't answer two important questions: at what age should body checking be allowed in youth hockey, or should it be allowed at all?

"The study does suggest," says Willer, "that, regardless of whether young players are allowed to body check, unintentional contact with the board, the ice or other players are important sources of serious unintended injury. To avoid these accidents, hockey coaches must teach players to keep their heads up, rather than looking down at the puck."

Sources: University at Buffalo and Darling et al. Intentional versus unintentional contact as a mechanism of injury in youth ice hockey. British Journal of Sports Medicine, 2010

See also: Science Fair Project Leads To New Sports Concussion Test and Lifting The Fog Of Sports Concussions