fessing up to head injury

Monday, May 26, 2014

One is 6’9”, weighs 220 pounds and plays forward for the Indiana Pacers. The other is 4’8”, weighs in at a whopping 80 pounds and plays for his local peewee hockey team. They both made news this week with their head injuries but it’s likely that the kid’s concussion story will quickly be lost and forgotten.

For Paul George, who was benched when he admitted to being briefly knocked out by a knee to the head, his later self-admission led to his missing a game as part of a concussion assessment. Even with the slow motion replay showing the blow, Mr. George continued to play only because the diagnosis of concussion is difficult to make if the player doesn’t fess up to symptoms. Afterwards, he was quoted as saying “…I probably should have kept that to myself.  It just made a mess…” There are times when pro athletes should be role models, but this is not one of those times.

And that brings us to the poorly timed press release on the Monday of the Memorial Day long weekend by the American Academy of Pediatrics that addresses the risk of concussion and injury in youth hockey due to body checking. For those who watch the NHL, part of the excitement of the game is the colliding of two skaters at 30 miles per hour as they go after a loose puck. The boards rattle and the game goes on as fellow players and fans cheer the action. But what happens when 11 year kids hit each other. The average sized player is barely taller than 4 ½ feet and weighs little more than a sack of potatoes, and the ability to absorb the force of a body check is not the same as that of older players. A Mayo Clinic study published the same Monday found that injuries are affected by age and gender…qu’elle surprise! For that reason the AAP issued guidelines to better protect the players:

  • Restricting body checking to boys no younger than 15 years of age who play at an elite level.
  • Coaches are asked to follow zero tolerance rules against any contact to the head
  • Rules preventing body contact from behind, into or near the boards should be reinforced

Unfortunately, the pediatricians are a little late to the game. In 2003, the Canadian Medical Association stood against organized minor hockey officials who had tried lower the body check age to 9 years old. Hockey Canada gradually raised that age to 11 and then to again to 15, but allowed body check experimentation in some provinces at a younger age. This led to research published in 2011 that found that the risk of concussion was three times higher in 11 year olds when body checking was allowed.

The researchers noted a few limitations to their study and the most important one was that they may have missed counting some concussions because the players or their family did not report the injury to their trainer, coach or doctor. Two explanations are possible. First, the kids did not appreciate the symptoms of concussion, which is very plausible. Concussions may be hard to diagnose with some complaints being especially vague like difficulty with concentration, sleep disturbance and change in personality. The second possibility is linked to Paul George. It might perhaps be true that Mr. George was unaware of his injury but players want to play and do not want to be removed from the game.

The potential for injury is always present in sport. Many are accidental, Dwayne Wade did not target Paul George’s head with his knee, but the rules of sport are meant to minimize those accidents and protect the player. While all sports recognize the risk of concussion and have rules that protect the head, the best treatment for head injury is prevention and the medical establishment should be front and center when setting policy. It was late with football and now it seems that the pediatricians are late with hockey.


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