No Collision Sports For Kids Under 14

13 Sep

On this blog we have been presenting information that has led to me and others saying that intentional contact to the head of adolescents is not good for long-term health.  What has not happened until recently is a “big name” in the research/medical world suggest that collision sports are inherently dangerous enough to warrant us to re-think our practices.

At the end of August the American Academy of Pediatrics announced that kids should not be boxing for the risk associated with concussions (number one injury in boxing).  That was quickly shunned by the boxing world and even the prominent Dr. Robert Cantu said there could be a social impact that should be realized.  Dr. Cantu stopped short of admonishing the decision as well as supporting the decision (in the related article).  However, the announcement was not unexpected if you have been paying attention, more as more problems are being found with brain injury.

I have clearly stated that I will have no problem with my children playing collision sports, only when they are older and in high school.  I want nothing more than for my sons to play football (if they choose), but at what risk?  Sure “back in the day” kids were getting their “clocks cleaned”, then subsequently grabbing some “smelling salts” and returning to the game, heck I was one of those.  As they and me have aged things have changed, not just in research, but in my (most likely others) well-being and personality.  These issues were commonly associated with environmental or social changes; are we sure there wasn’t an underlying mechanical/chemical issue in the brain driving this problem that is a result from repetitive brain injuries?

Dr. Robert Cantu, believes this could be the case and has clearly stated, in an interview with the media reported here by WCVB, that contact sports should be avoided until later in life, age 14 to be specific;

“We’re going to be recommending that nobody under the age of 14 be involved in collision sports,” said Dr. Robert Cantu, chairman of the Department of Surgery at Emerson Hospital and co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine. He also is co-director of the Neurologic Sports Injury Center at Brigham and Women’s Hospital.

Dr. Cantu has been on the forefront of concussions since the 80’s when he developed some of the first return to play (RTP) protocols and grading systems.  He has not only led the way but has reassessed the information constantly and steered the medical and sports community with changes; removal of grading system and eliminating his RTP guidelines.

When Dr. Cantu speaks people listen or SHOULD be listening.  When I was at the New Jersey Concussion Summit I hung on every word he was saying and when he made the comment about collision sport and kids younger than high school (summarized by me in the live blog) it signaled this recent move;

Cantu – opinion; there is no need for anyone younger than high school level to subject to head trauma, i.e. collision sports.  There will be a modification to sports in future.  Take checking out of hockey, flag football at younger ages.  He realizes that it wont change today or be popular.

The statement from Dr. Cantu made in the media even caught the outspoken Matt Chaney off guard, “a bombshell for the issue of brain trauma in American football, Dr. Cantu just won my admiration (and) respect.”  Although it is one thing to make statements, it is just a first step as we will have to make uncomfortable changes with the support of bigger entities as Chaney finished his comment, “we’ll see if NFL heads like Goodell back him up.”

It is not just the NFL that will have to back this up, it is the COUNTLESS youth leagues in collision sports: American Football, Australian Rules Football, Rugby, Boxing/MMA, Rugby, Rodeo, Ice Hockey and Lacrosse.  For a more specific definition the American Academy of Pediatrics issued a policy statement in 2001 (updated in 2008) about sports classification;

Sports are categorized by their probability for collision or contact in Table 1. In “collision” sports (eg, boxing,ice hockey, football, and rodeo), athletes purposely hit or collide with each other or inanimate objects, including the ground, with great force. In “contact” sports (eg, basketball and soccer),athletes routinely make contact with each other or inanimate objects but usually with less force than in collision sports. Table 1 does not separate collision and contact sports, because there is no clear dividing line between them. In “limited-contact” sports(eg, softball and squash), contact with other athletes or inanimate objects is infrequent or inadvertent.

Some limited-contact sports (eg, downhill skiing and gymnastics) can be as dangerous as contact or collision sports. Even in non-contact sports, such as power lifting, serious injuries can occur. Overuse injuries are not related to contact or collision.For these reasons, the categorization of sports in Table 1 insufficiently reflects the relative risks of injury.1 The categorization, however, gives an idea of the comparative likelihood that participation in different sports will result in acute traumatic injuries resulting from blows to the body.

As Dr. Cantu opined and I have written these changes will not be popular, it is tearing at the fabric of sports, but he feels they are necessary changes.  The countless speaking engagements I have given when this question is asked I respond similar to what Dr. Cantu has said, but I can only control my kids and family.  It boils down to the possibility that the brain can only sustain a “certain” amount of total force before it starts to create great damage;

Testing has shown that teenagers who played contact sports often already showed signs of chronic traumatic encephalopathy, or CTE, a degenerative brain disease caused by multiple blows to the head.

“The young brains are more vulnerable, they’re less myelinated, the necks are weaker, the heads are bigger proportionately so the forces that accelerate the brain need not be as high to produce higher accelerations,” Cantu said.That means concussions can happen even with minor hits and cause more damage than the same injury to an older player.

“It’s not just concussions,” Cantu said. “In fact, we’ve had a number in our center who have had no recognized concussions at all, so it’s total brain trauma. We have millions of youngsters putting their heads into collision sports right now and we don’t really know how safe this is for them.”

It is going to be a “personal” decision made by those that control the consent for adolescents, the parents/guardians.  Before there was legislation for seat belts in cars, parents had to make the same decision for their children.  Perhaps we will find out the “silliness” of putting your child in a car seat or restraint will be similar to not allowing the kids play collision sports.  If you are unfamiliar with this analogy ask your parents (if you are older than 30) how you came home from the hospital – I bet a majority of you came home in the arms of your mom, while she sat in the front seat, without a seat belt on herself.

I am not advocating legislation to remove collision sports for the youth, if the demand is there it will continue to be present – some still drive without seat belts – I think everyone that has kids in sports, or soon will, should take a risk-assessment approach.  Dr. Cantu also explained this in the media;

“If one is ultimately going to be superior in a sport, it’s their genes that are going to determine that, plus their work ethic. It’s not going to be that they started the sport earlier.”

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9 Responses to “No Collision Sports For Kids Under 14”

  1. brokenbrilliant September 14, 2011 at 07:06 #

    Flag football before high school. No checking in hockey. Radical.

    But could it be… that this might actually develop the athleticism and “physical intelligence” of future high school players, rather than conditioning them to play through pain and take a hit with the best of ‘em?

    Taking the collision out of sports at a young age might be one of the best things that happens for our future athletes. And put the sportsmanship back in sports.

  2. Mark Langer (@gotbrain) September 14, 2011 at 15:17 #

    As an adult TBI survivor and a sports med doc, I agree with the premise here, but wonder where should we stop. What about rapid stop / start movements in basketball or reversing direction at speed in other games involving running? Then there is the issue of parents who gun it away from the traffic light only to hit the brakes hard to stop at the next one. Can we legislate away acceleration / deceleration injuries and the diffuse axonal injury they can cause? Should we wait until the frontal lobes are fully developed (age 20 according to one neuropsychologist I heard.)

    Life is inherently risky. I believe that we can have a greater effect by increasing the physical fitness, the coordination, and other potentially protective mechanisms. Limit sitting in frot of the TV too many hours, make sure ALL cyclists (kids and their parents) where helmets, and teach proper sports technique using the best protective gear.

    I wonder if anyone has looked at the numbers of brain injuries in “normal” life vs. organized athletics. I’d like to see the complete amelioration of TBI, but that’s not going to happen. Is setting an age 14 age limit going to help?

    • Dustin Fink September 14, 2011 at 16:13 #

      Mark,
      Very valid and good points… Is 14 going to help? I don’t know, no one knows. Heck Cantu in the 80’s came up with RTP guidelines that they thought would help, but they didn’t, and reevaluated and changed. Grading system has gone by the wayside. I get what you are saying, a fellow AT thinks that the risks associated with driving a car at 16 are somewhat the same, and he suggest we look into the mTBI/TBI rate of 16-20 y/o’s as well.

      I think at the very least it has sparked an awareness point, and “headline” to make the correct statments about the injury (which as we know is not the biggest issue) and the management of the concussion which is the biggest problem we are facing… If every concussion was treated in a manner that would allow for full healing (Omalu says 90 days, other say 30 minimum) then this would be a far less headline grabbing issue, and even to the point of being moot.

      I think the better question is; Is setting an age of 14 as a limit going to hurt?

  3. Geoff Schaadt (@gschaadt) September 16, 2011 at 08:21 #

    Whew – this is a tough one for me.

    Looking at this from the perspective of a hockey dad…

    By the time these kids are 14 years old, they are flying on skates. I don’t have the hard data, but I’m pretty sure they are moving significantly faster than any adult can run. And we’re going to introduce contact for the first time at that age? By then most of them will have been playing the game for almost 10 years – and playing with no conception that they have to be heads up looking for the hit. Playing for almost 10 years thinking they can race up the boards – with a nice 4 foot cushion between them and the boards – and nothing bad will happen.

    I can anticipate a lot of really ugly hits – hits with serious head injury implications – happening because you have created a rink full of boys who a) can fly on skates b) have no experience with giving or taking hits, and c) at 14, are dealing with the physical, mental, and emotional consequences of massive amounts of testosterone flowing through their systems that, for many of them, will also be a first time experience.

    My concern with taking the recommendations of any of these MD or medical association pronouncements is that they *tend* to approach these decisions in isolation. All they evaluate is the fact that there may be some downside for a few children if they have head contact. They tend not to look at big picture implications, i.e., what is the downside of introducing contact in a delayed context.

    Furthermore, I have had conversations with pediatricians who literally believe that no child – anyone under the age of 18 – should participate in contact sports. These physicians believe that any risk of head injury greater than 0% is unacceptable – and they are not afraid to push their agenda. I have had more than one physician tell me that football should be banned and hockey should only be played if checking is removed from the game.

    Wearing seatbelts or using child seats when riding in a car did not introduce other safety issues. It doesn’t reduce the ability of the driver to control the car or monitor the actions of other drivers – no downside. But, we know that young drivers are significantly more unsafe than older drivers – so why don’t we say that no one is allowed to drive at greater than 35mph until they are 25 years old? Then, after they have been driving only at low speeds for 9 years, we cut them loose. We will have a whole new driving cohort on the roads who have great confidence behind the wheel. But they have no conception of the differences between driving at 35 and driving at 70. I think this hypothetical experiment might result in some “unintended health consequences.” And the reaction by many public health experts would be that high speed driving should be limited until 30 years of age…

    It’s not a simple or straightforward issue.

    • Dustin Fink September 16, 2011 at 14:44 #

      Wow – Great comment and perspective…

      I completely get where you are coming from. However, because I like to continue the conversation what about these thoughts in regards to your comment (and feel free to blow them out of the water or laugh at them).

      – Its not that there will be NO CONTACT, it will just be that there will be no collisions. Contact will occur, and really should occur, correctly in most team sports. I get the analogy of skating up the ice without the thought of repercussions, but I would also tend to believe that that won’t exactly be the case. Take for example woman’s hockey, it is a “no checking” sport, yet there is always contact.
      – There will be some vicious and nasty hits as the hitting begins, but aren’t there already? Wouldn’t this mechanism possibly reduce the chances of this happening to younger athletes?
      – The no play until 18 is because of “informed consent”, those that urge that agenda feel that until you can consent yourself you should not be put in a position to where you can sustain brain injury, or any injury for that matter. A lot has been put on the age of 14, I still feel that is an arbitrary number, and that parents should do a risk assessment at any age with regards to concussions.

      I guess in conclusion there are still way to many people out there that have their head burrowed in the sand about concussions. If you pay attention to this blog and a lot of the more prominent medical professionals its not the injury of concussion that is the massive issue. THE PROBLEM IS THE MISMANAGEMENT OF THE CONCUSSION. Perhaps this recommendation, whether follow-up upon by the parents/kids will arise more awareness and thus help with the management of the injury.

  4. Geoff Schaadt (@gschaadt) September 18, 2011 at 22:18 #

    Dustin, I could not agree with you more, so let’s repeat that…

    The problem is the mismanagement of concussions.

    The number of parents who have no concept of the seriousness of these injuries is remarkable — and even more remarkable to me is the number of physicians who are woefully ignorant. This is rivalled only by the number of parents who have been filled with fear, uncertainty and doubt by a largely uninformed mass media and a vocal minority from the medical community.

    We need to find a way to create a reasonable middle ground. To find a way to approach these injuries with our eyes open to the inherent risk, while also accepting that there are a great many benefits that also come from participation in these sports.

    As to the “informed consent” movement, personally I find that approach to be compete rubbish. I’ll be thoroughly sexist and repeat the old phrase: boys will be boys. They are hard-wired to be aggressive, to take risk, to engage in rough-and-tumble play. Taking away “collision” sports isn’t going to eliminate that part of the juvenile male psyche. They’ll just move on to other high risk activities. Has anyone published statistics on the per exposure injury rate of skate boarding or mountain biking vs football or hockey? I can’t claim to be correct — but I have my suspicions…

    As to your comments regarding contact vs collisions, I can only speak from my experience up here in Ottawa, Ontario —

    – Most of the boys on my son’s team are starting their 7th year of organized hockey (10y/o’s), and legal hitting in the game is not introduced until next year. So, I can say without reservation that, yes, when they play the game they play with the expectation that no one is going to “hit” them. In fact, when contact does occur, it generally comes as quite a surprise and is almost always an accident. The officials here are quick to call “body contact” penalties. It may be different elsewhere, but around here the kids don’t have anything that you could call real contact until age 11 — and, yes, they carry the puck with complete impunity. These kids have zero concept of the *real* game of hockey yet.

    By the way, starting this season all levels of hockey in Ontario have a zero tolerance rule for head contact. Any head contact, even if it is accidental, is an automatic penalty. It will be interesting to watch the kids adjust. At a midget game last week (15-16 y/o’s) there was a young guy who gave an opponent a “face wash”. The boys were off-ice friends, both were wearing cages, and both were laughing. The ref gave him a double minor for intentional head contact!

  5. geswin November 28, 2012 at 01:20 #

    I would disagree on Non Contact Sports , Non Contact Sports are for weak people who rely on weakness ,but I do agree on sports from kids under 14 though I’ve never seen people play that’s way younger

  6. Pat March 28, 2013 at 07:49 #

    I found this article while looking for non-contact sports for my 15 year old daughter who has acute concussion symptoms 6 months after being punched repeatedly in the head plus neck and head injury from hitting the ice – during a non-contact BB rep hockey game.

    Our gifted, french immersion student has gone from 90’s to 40’s in school. She can’t even use a ruler in art class or walk on uneven ground without developing lasting, blinding headaches. Her doctor and neurologists warn successive concussions will be worse. She is devastated to give up hockey, soccer and lacrosse.

    I’m amazed where parents and coaches are willing to stick their heads so they can hang onto their beliefs that unnecessary aggression in sport is OK, especially for kids.

  7. Ray November 1, 2013 at 13:33 #

    Dr. Cantu,
    I presented my power point presentation version of my argumentative essay to my English 101 class. My argument was to ban all contact sports for children under the age 15. I did about a weeks worth of researching and found hundreds of articles, blogs, scholar/academic journals, and news reports. I stumbled upon your webpages and articles many a times. I used your voice in a couple of my power points (correct citations were used) and I believe it helped get my point or argument to hit home with some of the middle age moms and dads that were in the audience. I believe I won my argument academically. Personally, I feel I, not only educated students and parents on the sport-related concussion epidemic, but sparked a thought they did not have about brain injuries in sports and the seriousness of it; due to the few rebuttals I received. I want to thank you for all that you have done and wish you success on your crusade.
    I agree with taking steps to prevent head injuries in sports 100 percent, but after completing my research I wrote down a question: “What happens after 14?” As a retired amateur boxer, ex-football and soccer play, I am joyful and content that I stated my athleticism as a child of 6 or 7 years old. I gave up contact sports and soccer, witch I love and respect, when I was 25 years old because of injuries. I am 33 now and play baseball and flag football hear and there. Well… my question is, “If a child of 6 or 7 years old does not build up the tolerance to sustain the minor injuries he would in youth league sports, how would they be able to accept the punishment in a contact sport league of 14 and 15 year olds, wouldn’t the teen be even more vulnerable to concussions?”

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