Youth hockey’s concussion woes keep growing

Dr. Laura Purcell is a bit head weary.

No wonder. It’s been an incredibly busy day for her in her practice as a pediatric sports medicine physician at McMaster University.

Purcell was the author of the recent Canadian Paediatric Society position paper on the treatment of children and adolescents with sports-related concussions. It urged that kids suffering from head injuries be taken to a doctor as soon as possible.

She’s getting her wish. On this particular day, she’s seen 11 children with concussions — including nine hockey players.

“I’m feeling a bit concussed myself right now,” said Purcell.

She’s not alone. To her chagrin, the treatment of concussions is definitely a growth industry.

According to the Centers for Disease Control and Prevention, the number of annual emergency department visits for traumatic brain injuries related to sports and recreation increased 62 per cent from 2001 to 2009 among people under 19 years old. The highest rates were among males aged 10-19.

The numbers collected by the Hockey Development Centre for Ontario show a similar alarming trend. Concussions were recorded as a related injury in 203 reports filed in the 2000-2001 season. The number of concussion recorded in the 2009-2010 report were 346.

John Mancuso, risk manager for the Richmond Hill Hockey Association and a longtime coach, is well aware of the rise.

“In the last 10 years, concussions have almost doubled and its scary,” said Mancuso. “It really worries me when something doubles over 10 years. I just worry about what’s going to happen in another five or six years. Is it going to get better? Is it going to get worse? … My worry is they escalate and in another 10 years we would have doubled them again.”

The jury’s out on the effectiveness of the new rules on head hitting instituted this season by Hockey Canada. For every parent or coach who thinks they are working, there seem to be another two who remain unconvinced.

“I’m sympathetic to the referees,” said Cam Kilgour, a high school teacher who coaches at Riverdale Collegiate and has a son in the GTHL. “These are split-second decisions. They are doing the best they can. But I still think what we need is a shift in the culture of the game.

“It will be an effort that includes parents, coaches, hockey associations, the media, everyone. I think some of the coaches who grew up in the Don Cherry School play the physical game, try to intimidate. That style of play has to change because the consequences are profound.”

Peter Kourtis, GTHL manager of hockey operations, said most of the complaints he’s gotten this year are about calls being too severe.

“I can go to a rink now and I can tell that kids understand it has to be controlled body contact. I’ve seen an improvement,” Kourtis said. “Maybe we ignored it for awhile, but now we’re catching up.”

Like many, Purcell attributes part of the increase to heightened awareness — sparked by the recent concussion problems of NHL star Sidney Crosby. Another part is she believes kids are more willing to own up to the injury. Then there’s the explosion of kids participating in organized sports and the fact many play sports like hockey year-round, plus they’re bigger and stronger than ever and playing at a higher level.

Still, Purcell believes the numbers are grossly under-estimated as they are based on emergency visits.

Larry Romagnuolo, general manager of the West Mall Lighting peewee AA team, subscribes to that theory.

“Whatever percentage of concussions you hear in the GTHL, I can tell you it’s probably three times that amount,” said Romagnuolo. “Not everyone gets massive headaches or throws up and gets all the natural symptoms. They might feel groggy for a few hours and then they feel fine and they’re out there playing again when they should be sitting out.

“Look at the NHL players. If the NHL players are sitting out for a month for a concussion, what makes parents think their kid can come out and play two weeks later?”

But a parent who had a son playing for Romagnuolo’s team this season found their own safety practices wanting.

Hugh Thompson said his 12-year-old son Ethan suffered a concussion in early October and was allowed to return to action with the Lightning without producing a doctor’s note, as required under GTHL rules. Romagnuolo said they thought it was a spleen injury.

But after the Star asked Romagnuolo about the matter this week, Thompson said he received a call from the general manager saying a note would be required before Ethan could return from his second concussion.

The Thompsons have decided to put their son in non-contact hockey, a choice many families are starting to make. Many are concerned about exposing a developing brain to repeated trauma.

Purcell said she’s had similar conversations with five or six families in the past week. One of the things she sometimes suggests if there’s been multiple concussions is taking the child out of hockey for the season to let their brain fully recover.

“I’m finding that more and more parents and athletes are actually okay with that, which is very reassuring and very refreshing,” she said. “There are some parents where the sport is the important thing and if the kid wants to play, they’ll let them play.”

But Dr. Mike Evans cautions against people making judgments. He’s an avid hockey player, as is his wife Sue, also a doctor, and their two sons and a daughter. In his family practice, he’s had to deal with the issue of whether a young patient should keep playing hockey.

“I think the image for a lot of this stuff is that the parents are driving it,” said Evans. “I’ve been through it a couple of times with families and it’s very hard for the parents because it’s the kids who are so wanting to play and it’s hard to pull them from that.

“It’s a big part of their identity. I think there’s a lot of judgment that goes on and these things are a lot more complicated than you think. It’s hard for someone who doesn’t live in that world to understand it.”

Purcell knows where she stands on the matter. Asked point-blank whether she’d let her kids play hockey, she doesn’t blanch.

“This is completely personal. I think hockey’s just too rough a game. The checking and the contact, I don’t think needs to be part of the game. I think it just puts kids at a huge risk of an injury. And the way that they set up the teams by age rather than physical stature, you have a wide variety of size for any given age. … I just don’t think it’s worth it.”

With files from Michael Woods

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Youth hockey’s concussion woes keep growing