Sport-​Related Concussions are a Public Health Issue

September 3/2014

U of T public health professor and primary care physician Ross Upshur says sport-related concussions are a public health issue and stronger action should be taken to prevent them in children and youth.

"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. Ross Upshur of the Dalla Lana School of Public Health and Dr. Paul Echlin of Elliott Sports Medicine Clinic, in a commentary titled "Sport-related minor traumatic brain injury: A public health ethical imperative to act." The commentary was published in the online socioeconomic publication of the American Association of Neurological Surgeons on September 3.

The World Health Organization classifies concussions 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.

Children participate in sports — including soccer, basketball, rugby, football and ice-hockey — from the ages of six 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, who is also the Scientific Director of the Bridgepoint Collaboratory for Research and Innovation.

Drs. Upshur and Echlin agree that the human and economic toll that this injury has 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? 

Drs. 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 like soccer, and enforcing significant suspensions to participants or supervising adults involved in games in which head injuries occur.