Can contact sports like hockey really cause brain disease in kids?

Ask a mom what she thinks about her kid playing contact sports like hockey or football and you're likely to see some worry on her face, because of the risk of concussion.

Perhaps you’ve read the recent media reports of scientific studies linking contact sports to a brain disease called CTE, or chronic traumatic encephalopathy. One such study published in January 2018 in the journal Brain found evidence of CTE in the brains of deceased athletes. Some media reports say that these results are evidence that repeated hits to the head can cause CTE, even in players who have never suffered a concussion.

This research follows soon after news of a study published in September 2017 in the Journal Translational Psychiatry. It found that kids who played tackle football before age 12 were more likely to have behavioural and cognitive problems later in life.

But what does all this mean? Is the news as bad as it sounds? According to some doctors, maybe not.

According to Gerard Gioia, Division Chief of Neuropsychology and the director of the Safe Concussion Outcome, Recovery & Education (SCORE) Program at Children's National Health System, these two studies don’t actually show the complete picture. “These are what we call ‘hypothesis generating’ research," he says. "They’re important studies. They give us a lot of good information. But they give us more questions than answers. They show us that we need to be doing more research in this area. But they don’t show a causal relationship [between].”

In addition, Gioia says the Translational Psychiatry study contained a selection bias, meaning that the brains used in the study do not represent the general population because they all came from athletes who had already suffered symptoms of CTE. The study participants were all adults, as well. So they played youth football decades ago, before current safety standards were put in place.

It's also worth nothing that a number of other studies showed no increased risk of brain disease among athletes who played contact sports as children. For instance, this 2017 study by the Mayo clinic found no increased risk for brain diseases among high school football players compared to swimmers and other non-contact athletes. And this 2017 study in the Journal of the American Medical Association found no increased risk for mental health problems among high school football players.

For whatever reason, these studies haven’t gotten nearly as much attention as the Brain and Translational Psychiatry articles. The result? Parents and policy makers are panicking.

What parents should know about concussions

According to the US Centers for Disease Control and Prevention (CDC), a concussion is a type of brain injury that’s caused by a blow to the head, neck or body. When your child suffers a concussion, his brain will literally bounce around, or even twist, inside his skull. This causes chemical changes in the brain and may damage brain cells.

Concussions in contact sports may be on the rise. A 2016 study in the journal Pediatrics examined ER visits to treat soccer-related injuries in children from 1990-2014. It found that soccer-related concussions increased by nearly 1,600 percent, from about 2 per 10,000 soccer players in 1990, to about 225 per 10,000 soccer players in 2014.

It is possible that this increase is a result of increased concussion awareness, rather than an actual increase in injuries. Michael Fox is a professional equipment manager for multiple youth and professional sports leagues in Philadelphia, including football, baseball, and lacrosse. He is also a former athletic trainer and coach, and currently provides first aid and injury evaluations for tournaments. He says that new concussion guidelines have encouraged coaches, players, and parents to report symptoms more often.

“I run triage for lacrosse tournaments," says Fox. "We used to have one, maybe two concussions in a weekend when we had over 140 games. Now, because of the new guidelines, because of the rules, we're sitting down 15 to 20 kids.”

Groups like the American Academy of Pediatrics (AAP) and CDC recommend that kids should immediately stop playing after a concussion, and that they shouldn’t return to play until they are cleared by a physician. All 50 states have “Return to Play” laws, and the province of Ontario recently passed concussion safety legislation called "Rowan's Law." The requirements of these laws vary, but they usually include mandatory bench times, required medical clearance and required concussion education for coaches, athletes, and parents.

Unfortunately, Fox says that the majority of concussions still go unreported—perhaps as many as 80 percent of them. This happens partly because a lot of kids don’t recognize their concussions symptoms. But it’s also because of a culture of toughness in some youth sports, where kids are encouraged to “just play through it.”

Should parents let their kids play contact sports?

This may all sound scary, but it doesn’t mean that contact sports are too dangerous for children. It does mean that parents need to investigate their children's sports leagues, get involved and ensure their kids are being kept safe.

Doctors are quick to point out that contact sports have many health benefits as well. And as long as your child is playing in a league that uses proper safety measures, the benefits tend to far outweigh the risks. Sarah Liska is a mother of four in Sykesville, Maryland. Two of her sons and one daughter have all played tackle football. She’s also had her kids in soccer, baseball, basketball and lacrosse. She admits that she was a little nervous when her son first asked to play football, but she feels much more comfortable with the sport now that she’s gotten involved and learned about her league’s safety measures.

“They teach ‘Heads Up’ tackling and that has saved a lot of injuries and improved the sport, I think,” says Liska. “And the helmet technology has actually transformed in the decade that Toby's been playing—it’s much safer now. So the more that they put new safety rules in place and the more that they come up with new helmet technology and the more they teach these kids how to hold their bodies to keep from making head to head contact, the better the sport will be.”

Fox says that it is imperative that parents educate themselves on their kids’ sports organizations’ culture and practices. “First and foremost, it goes back to education,” he says. “You’re a parent. Ask. Go to the meetings. What are they doing? What are their concussion protocols?”

It’s also important for parents to ensure that their kids have properly fitted helmets that meet current safety standards. Football players can get a safe helmet for about US$200-$250. That’s a lot for some families to afford, so many parents use hand-me-down helmets that their older children have outgrown, or purchase used helmets that are too old to be certified. But if the helmet doesn’t fit properly, or it doesn’t meet current safety standards, not only is it a waste of money, but it could put your child at risk for a serious brain injury.

So if your child plays football, hockey or lacrosse, research brands and styles of helmets. If your child’s team has an equipment manager, talk to that person about which helmets they recommend. If not, look for a specialty equipment store in your area, where an experienced sales person can help you choose the safest helmet. Additionally, the helmet manufacturer should have fitting instructions available online to ensure a perfect fit.

To learn more about concussions and kids, click here.

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