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Back to School: preventing concussions on the playing field

Sport-related concussions are a public health issue, says Dr. Ross Upshur

Rules should be changed to eliminate all purposeful and intentional head contact in sports such as soccer, says Dr. Ross Upshur

As kids head back to school, hoping to make this year's sports teams, U of T public health professor and family doctor Ross Upshur is calling for stronger action to prevent sports-related concussion in children and youth.

The World Health Organization classifies concussion suffered in sport or recreational activities by children and adolescents as a minor traumatic brain injury (mTBI). The yearly incidence of sports- and recreation-related mTBIs in the United States is estimated between 1.6 and 3.8 million, many of which remain undiagnosed or do not result in doctor or hospital visits.
"Our children should have the right to play at all levels of skill in an environment without fear of brain injury from intentional ‘win at all costs’ violence, or unrecognized repetitive trauma," say Dr. Upshur of the Dalla Lana School of Public Health and Dr. Paul Echlin of Elliott Sports Medicine Clinic.
The researchers co-authored a commentary titled "Sport-related minor traumatic brain injury: A public health ethical imperative to act" that was published in the online socioeconomic publication of the American Association of Neurological Surgeons on September 3.
Children participate in sports – including soccer, basketball, rugby, football and ice hockey – from the ages of 6 through 16, their formative physical and social development periods. Studies show elevated risks of psychological distress, suicidality, utilization of prescription medication for depression and anxiety and other negative social and mental health outcomes associated with mTBI.

“The question that is most obvious concerning these findings is: knowing that players average 240 impacts per season, why would a parent knowingly allow this?” asks Upshur (pictured at right), who is also the scientific director of the Bridgepoint Collaboratory for Research and Innovation.

Upshur and Echlin agree that the human and economic toll of this injury is reflected in the less documented incidence of mental illness, associated physical illnesses, as well as loss of academic and occupational productivity among those individuals that sustain this “invisible injury.” 

So how can the sporting environment change so that children develop their social and physical skills through participation in athletics? 

Upshur and Echlin recommend dramatic rule changes from the recreational to the elite competitive level, including game and rule structure changes to eliminate all purposeful and intentional head contact. They also suggest eliminating the use of the head in games such as soccer, and enforcing significant suspensions to participants or supervising adults involved in games in which head injuries occur.

Nicole Bodnar is a writer with the Dalla Lana School of Public Health at the University of Toronto.