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Neurosurgeon argues against hockey bodychecks: increased risk of brain injury

A mountain of evidence exists to show that bodychecking in hockey has detrimental effects, says a neurosurgeon who has compiled new statistics on kids’ hockey injuries.

Young players were more than 10 times as likely to suffer a brain injury after Hockey Canada allowed body contact for the Atom age group in the 1998-1999 season, says the study published Tuesday by the journal Open Medicine.

Dr. Michael Cusimano of St. Michael’s Hospital in Toronto and colleagues looked at data for 8,552 boys ages six to 17 who went to one of five hospital emergency departments in Ontario for hockey-related injuries over 10 seasons, before and after bodychecking rules were relaxed. The hospitals had all collected information as members of the Canadian Hospitals Injury Reporting and Prevention Program.

The researchers found that more than half of the injuries were related to bodychecking.

“And we found that certain groups were more vulnerable,” Cusimano said in an interview.

“The group that had bodychecking first introduced, that is, the Atom group, they had the highest odds of sustaining a bodychecking related injury compared to the other groups.

“If we looked at the different types of injuries that occurred especially at that age group, that the odds ratio for a brain injury was 10 times after the rule change, as compared to before.”

The Atom division was 10- and 11-year-olds in 1998-99, but the ages for the division changed to nine and 10 in 2002-03. The Hockey Canada website says the rule for bodychecking is now PeeWee and above — ages 11 and 12.

Cusimano said it’s time to ask questions about the role of kids’ hockey, and whether it is to create National Hockey League players, or it’s for kids who won’t go on to play major league hockey.

“If the goal is to create NHL players, we know that the chance of getting into the NHL is about one in 4,000 kids, so are we designing hockey for the one in 4,000 kids, or are we designing hockey for the other 3,999 other kids?” he asked.

Options that don’t expose kids to risks of injury are needed for children who want to play at a high level of skill, he said. These kids and teens would then have all the benefits of hockey, including fun, teamwork and physical fitness.

Paul Carson, vice-president of hockey development at Hockey Canada, said the study numbers are interesting and worth noting, but he observed that they cover the period 1994 to 2004.

A lot of good programs have been put in place since then, he said, including checking clinics at the branch level, as well as checking resources and concussion seminars.

“I think all research is important, and Hockey Canada certainly values the contributions of the research in the medical communities,” he said in an interview from Calgary.

“It provides us with the type of information that we need to review, and we need to be very much a part of paying attention to, in terms of creating a safe environment for participants.”

Cusimano said recent concussions sustained by Pittsburgh star Sidney Crosby and Montreal Canadiens forward Max Pacioretty have put the spotlight on the issue once again.

Crosby is one of the best players in the world and knows how to give and take a bodycheck, he noted.

“If it can happen to him, it can happen to anybody and all of a sudden there’s a name to that silent face of brain injury, of the thousands of kids who sustain brain injury every year,” Cusimano said.

“I think we have to ask groups that are involved in hockey, like Hockey Canada, like the NHL, is when are they going to take a leadership position that reduces the risk to children and youth?”

Carson said it brings to the forefront, particularly for minor league parents and participants, the need to pay attention to concussions — “for example, that we don’t just shrug off a blow to the head as a bump, and possibly a mild concussion, but that we recognize it as a potential injury, and we need to deal with it properly.”

Theresa Dostaler, who runs the website Hockey Mom in Canada, says she’s interested in knowing what can be done within body contact hockey to reduce injuries.

“I don’t disagree with the authors’ claims that it’s not a good thing to start body contact early, like in Atom. I’m happy to see it held off till PeeWee,” she said from her home in Madoc, Ont.

“But I’m not sure that you can remove body contact from hockey entirely. So if that’s the case, then how do we make it safer for players?”

Her two sons, ages six and eight, play hockey, and she also has a three-year-old daughter.

Dostaler was on her way out the door to see a game between the Ottawa Senators and Pittsburgh Penguins; ironically, she was only able to get the tickets because the injured Crosby wasn’t playing.

The NHL could go further to ensure players aren’t subjected to hits to the head or checked if they don’t have the puck, she said.

“At lower levels, I think it’s about proper coaching and the coaches sending out the right messages, and I also think there’s a role for proper equipment.”