Welcome to where parents talk. My name is Lianne Castelino. Our guest today is a physiotherapist epidemiologist and professor in the Faculty of Kinesiology at the University of Calgary. She is a Canada Research Chair and chair of the sport Injury Prevention Research Center, also at the University of Calgary. Dr. Carolyn Emery is the principal investigator of a study published in the Canadian Medical Association Journal in June of 2022. The study examined the impact of body checking experience with the risk of concussion among hockey players between 15 and 17 years old. Dr. Emery is also a mother of two. And she joins us today from Kootenay. BC, thank you so much for making time.

Thanks for having me. Lianne.

I’d like to start by asking you first of all, what was the objective of this study? And why was it important to conduct?

Yeah, thanks for that. So it’s really important, when you look at significant policy changes and you sport that aim to reduce the rates of concussion and an injury, that there aren’t any other consequences of such a change that would be thought of as adverse consequences. So for example, there’s lots of conversation in the community of ice hockey, around the elimination of body checking, and certain age groups and certain levels of play, and potentially, the adverse effect that that could have or the unintended consequences that that could have for injury and concussion risks later on. So it was really important with the opportunity to look at five years of data and an older adolescent age group, so 15, to 17 year olds, or the under 18 age group, to understand the association between experience body checking and games, so number of years experience and risk of injury and concussion. And so in this particular study, we were actually able to demonstrate that delaying body checking to an older age, such as the 1314 year old age group, that there was not this unintended consequence of actually having higher rates of injury and concussion in an older age group. So we actually showed that those that had more body checking experience, were actually at a higher risk of injury and concussion.

That is really interesting. And I wonder if we could sort of unpack a little bit how you went about conducting this study?

Absolutely. So we have a validated injury surveillance program, where we collect information on exposure, so the number of hours of participation of players in games and practices, as well as injury, and concussion information. All of the kids who sustained a suspected concussion, as identified by a therapist that is working out in the community, would then be assessed by one of our study sport medicine physicians, so we can diagnose concussion. And so we’re able to collect the information around their exposure to risk, their injuries, and concussions, as well as other risk factors for injury. And when we can control for all of those things, we can ask very specific questions about certain risk factors. And in this case, the focus being on experienced body checking, and the risk of injury and concussion.

So let me ask you what if anything surprised you about these findings, as somebody who has been on the frontlines of this kind of research as a relates to injury prevention among youth for a long time? What, if anything, struck you?

Well, I think what was really striking is that even when you control for the level of play of participation, the division that they’re in, as well as their previous injury history and concussion history, that actually the, the magnitude of the effect was really significant. So we’re looking at a greater than two fold, increase risk of concussion and injury and those players that had three or more years of body checking experience, even when we control for those other factors. So it was really I think the magnitude of that increased risk that was surprising and particularly in light of so many people in the community, believing that actually lower A number of years of experience might actually have a negative effect and might have actually increased the risk of injury and concussion. So I think that, that it was really about the magnitude of the finding. That was, that was a bit of a surprise to me.

So let me ask you this, you had mentioned that the study looked at five years of data. There are more than 70,000 kids between 15 and 17 years old, playing hockey and registered as hockey players in Canada. What would be your message to parents based on the findings of this study and everything else that we know about concussions and sort of injury prevention, as it relates to hockey, what would be your message to parents in terms of what they should be mindful of as a key takeaway resulting from this study?

Well, I think that it’s really important to realize, and particularly in this organization, we look at Hockey Canada, they really care about their players, they have a focus on safety, they have a focus on keeping kids in the game. And so they continue to want to work with researchers and and groups such as a sport Injury Prevention Research Center, to make sure that they are making the right choices for their membership, and particularly for kids. So I think that just the fact that, you know, hockey, Canada and provincial organizations are working very hard to make sure that they’re making evidence informed decisions for their players. And, and so to be patient, if you have a child who’s 11, or 12, and you’re anxious for them to be in a body checking league. And before they before they turn 13, there’s lots of opportunities within training programs within practices to develop the skills of body checking, prior to being introduced to body checking in games. So I think that says, particularly with, with parents who have kids who are very talented, it can sometimes, you know, require patience, because you’re, you know, your child will have opportunities to really develop their skills across across all components of the game, and really be ready when body checking is introduced, and an older age group and in more elite levels of play.

So along those very lines, Dr. Emery, what do you say to parents and others who say, you know, what, body checking is just part of a contact sport, how to take a hit, how to receive a hit that just is par for the course? And, you know, we should just go on with that in mind, like, what would you say to them in terms of maybe trying to shift or influence their thinking, based on the the findings of this study?

Well, I think that as parents, and I was a parent of two hockey players and coached and certainly we like to see our kids succeed. And, and certainly, there’s lots of opportunities for kids to be involved in programs all year round, in ice hockey now, and, and I think that, you know, really, one of the key messages is, the most important thing is that, you know, your child has the opportunity to participate in sport, and that your child will continue to be able to participate in sport, throughout their lifetime. And, and I think that that’s more important than really thinking about perhaps the very, very small percentage of kids that are going to go on to be and we just came out of Stanley Cup playoffs, and, you know, it’s really a small number of kids who are going to first of all, survive. And when I say survive, be survivors, they’re there, they are able to avoid significant injury, or career ending injury at a young age, and they make it to that level, that’s a small number, more importantly, is that those kids continue to love the sport when they’re well into their adulthood. And, and I think that that’s, that’s a really important factor to be thinking about. And, and really, what we can do as parents is, is really to support our players to, to be successful to be on the ice to do the right thing, if we think they may have sustained a concussion, not be pushing to get them back on the ice quickly. But to make sure that actually, if there’s a suspected concussion that they don’t go back to play, that they seek medical advice, and that they are able to go through an appropriate return to play strategy, so that they can keep playing the game and they’re not at an increased risk of a recurrent concussion and long term consequences of concussion that can occur. And so I think so those are some of the pieces as a parent that are really really critical to consider with our kids who are participating in high risk, concussions sport?

Absolutely, certainly very important messages for parents to keep in mind. And, you know, a lot of people just get sucked into, you know, my kid’s going to be the next Sidney Crosby or whatever it is. And sometimes it’s hard to sort of harness that and stand back and look at the bigger picture. You had mentioned earlier on about the importance of research, such as this study, in helping shape policy potentially, from a policymaking perspective. What do you hope that the results and findings of this particular study will lead to and yield down the road?

Yeah, that’s a great question. The and I think that a lot of people in the community felt that, you know, the discussion was over, we demonstrated this fourfold greater risk of concussion and leaks of kids who are 11 and 12. In terms of an increased risk of concussion, and I think that, you know, the the right decision was made. But I also think it’s continues to be incredibly important to continue to ask the questions as to what impact that decision has made in subsequent years. So while we have now in many jurisdictions, kids who are in non elite levels of play, and we’re talking still 70% of kids who are playing in ice hockey, who I would say, are the non elite levels of play ages 13 to 17, that are not exposed to body checking in games and 30%. That are, and that’s not across all provinces. But I think that we continue to inform decisions at provincial and regional levels. And we continue to reassure the community, that this was the right choice to make around body checking policy, based on the evidence. And and the other, you know, other other guests side note would be to say that, we have some evidence actually just published in another paper this week, by one of our PhD students, Ash kolstad, he was interested in offensive performance, so did a lot of video analysis, and actually demonstrates that that delay of body checking to older age groups doesn’t have a negative impact on performance. In fact, we may be seeing, you know, more completed passes, and, and, and changes offensively around performance that are very positive for this for the game and for skill development. And so asking those questions that are important to the sport community is really critical. And and considering the evidence and policy and going forward as it continues to be important.

So on that note, how far away do you think that we are from removing body checking entirely from minor or youth hockey in this country?

Well, I don’t think that that will ever happen. I think that, you know, we’re never going to see a Stanley Cup or, you know, a high level of the international game without body checking as a component of the game. So therefore, it is important that, that kids that are in that elite group, as they reach the appropriate ages, to be introduced to body checking, not just in games, or not just sorry, in training and practices, but also that they have that experience in games as they get towards the elite level of the game. I think that even when you watch, you know, when when we’re watching the playoffs, I would say that, you know, body checking may feature a little bit less You see, I mean, the skill, the skills that you see now, compared to 10 years ago. I mean, it’s it’s incredible to watch and the very young, young players on the ice and, and I think that, you know, there’s other focus areas for development that are really critical to the game. And it’s, it’s about the right time, and right level of play for which body checking should be potentially introduced. And I think we’re having the same conversations and tackle football and in rugby, around the tackle, what’s the appropriate age and experience to which we can we can minimize the risk of concussions and injuries in a sport that is a collision sport.

So on that note, is there a tipping point in your estimation with respect to the number of concussions and sort of preventable injuries that are occurring through these various sports? We’re focusing on hockey Right now with respect to this particular study, but is there a tipping point that needs to be reached? In terms of the number of injuries that are sustained before there is real consideration given to removing contact at this at these younger levels?

Yeah, I think it’s a really great question. And because I would say that in concussions are unique, and they’re individual and in sport medicine world, very often people say if you’ve seen one concussion, you’ve seen one concussion, they are, they are very unique and different. And and so it’s back to even the in on an individual level, how many concussions is too many? Right. So and I think that is an individual decision to be made between a child a physician, in this country, and an apparent around around that, that decision at an individual level, I think, at a league level, that actually we’ve come a long way. And, and we continue to, in the sport of hockey, develop the skill, so if body checking in, in, in practices where actually, the rates of concussion are quite low, even when body checking is introduced, so So I think that we can develop the players that will have potential to play up at that high level of the game. And, and so I think that, you know, we continue to do the work that will help to inform the best decisions for kids and offer them more opportunities to play at a competitive level, where there is not body checking in the game. And I think that, you know, ultimately, most of these kids are going to go on to play and in adults, recreational leaves. And so if that’s what we’re preparing them for, we really want them to have fun in the game.

Absolutely. Now, the sport Injury Prevention Research Center at the University of Calgary, an organization that you’re affiliated with, is supported by the International Olympic Committee, and the center is striving for a 25% decrease in injuries across youth sport and recreational activities. By 2025. I’m curious, where are you along that timeline?

Yeah, that’s a great question. And some of my colleagues would say it was a lofty goal, but we’ve done it before. And I think we could say that in Alberta, we’ve, we’ve seen a 20% reduction by 2020, across multiple sports and the studies that we’re working on in school sports and community sports. So certainly, I would say it’s always good to keep the bar high. And I think we’ve shown again and again, that we’re reaching that bar in many different sports and in schools with different strategies around policy laws, and rules of the game around training programs, such as neuromuscular training, warm up programs and team sports and in schools, as well as equipment recommendations and equipment strategy. So across multiple targets for prevention, I think we’ve shown we’ve had a huge impact. And we continue to ensure that the optimal education and protocols for concussion management are available in all contexts of sport for youth, because we also want to make sure that we continue to prevent the high risk of recurrent concussion, or a second concussion or third concussion, as well as the longer term consequences in some kids who endure symptoms for months.

Certainly an incredibly important study in important findings, as well Dr. Carolyn Emery, who is a Canada Research Chair and chair of the sport Injury Research Prevention Center at the University of Calgary. Thank you so much for your time and your perspective today.

Thanks so much for having me, Lianne.