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Reducing lifelong disability from sports injuries in children

See related research article by Emery and colleagues at http://www.cmaj.ca/cgi/doi/10.1503/cmaj.101540

Canadians admire their professional athletes, especially
if they overcome adversity and continue to play while
injured. These athletes are often role models for children
and youth. However, imitating professional athletes by
playing while injured comes with serious health and economic
consequences. We should ask ourselves whether such
practices on the hockey rink, soccer field or ski hill are worth
the risk of long-term disability.

First, as parents, let us dispense with the fantasy that our children
will become the next Sidney Crosby, David Beckham or
Nancy Greene. Only about 500 Canadians play in the National
Hockey League.1 Given our population of 32.5 million, that
means only 16 of every 1 million Can adians play professional
hockey at the top level.1 Similarly small proportions will achieve
professional or Olympic success in other sports.

Second, let us consider the health and economic consequences.
The annual incidence of catastrophic injury related
to sports or recreation is 6.9 per 100 000 participants, and a
substantial proportion of those injured are athletes less than
21 years old.2 Each year, nearly 500 Ontarians are admitted
to hospital because of a hockey-related injury, with thousands
more seeking acute medical care.3 Children aged 11–
12 years who play in hockey leagues that allow bodychecking
have more than a threefold increased risk of concussion
or other injury.4 In youth hockey, concussions are underreported
by team players and personnel: a maximum of 24.3
concussions per 1000 player game hours was estimated from
a survey of non-elite male youth hockey players, as compared
with a maximum of 0.61 per 1000 based on official
injury reports.5 Repeated concussions can cause long-term
disabilities that prevent return to play and have a lasting
impact on the ability to function and enjoy life.6 The economic
consequences of these injuries include the direct costs
of care and indirect costs resulting from loss of future productivity,
which are often much higher than direct costs
when young people are involved.

Allowing a child or youth to return to the same game after
an injury risks permanent damage, and it may even be career
limiting for elite players hoping to be future professional or
Olympic athletes. Injuries heal better and faster if they are
protected from further insults during recovery. With concussions,
preventing further trauma is crucial.

As a society, we hope to prepare young people for life
events, including how to persevere through difficulties. However,
we should not confuse excellence and bravery with behaviour
that needlessly and unwisely causes long-term harm.

Whose responsibility is it to reduce lifelong disability from
sports injuries in children and youth? Certainly not professional
athletes. Their livelihoods depend on taking risks. Similarly,
sports commentators and the media have a vested interest
in celebrating risk- taking behaviours and physical contact in
sport because audiences love the spectacle.

What about parents? Even though protective instincts and
bonds between parents and children are strong, so too are
hopes and dreams. Some parents contribute to the problem by
living vicariously through their children, seriously overestimating
chances of elite amateur or professional success, and
exhibiting unrestrained enthusiasm sometimes bordering on
rage. Simply educating parents will probably not work.

Reducing lifelong disability from sports injuries in children
and youth demands a public health solution similar to that used
to combat smoking and drunk driving. A coordinated, multifaceted
approach involving awareness, education and rule changes
is required. Unnecessary risk taking and violent physical contact
in sport need to be “de-normalized” through education and
awareness campaigns. Getting sports organizations to change
the rules is another solution. Parents who understand the problem
and want their children to play with less risk can champion
the cause. Former professional athletes whose careers were
ended by major injuries can also help. The medical profession
can contribute by providing evidence on what works in primary
and secondary prevention of injury and by developing guidelines
for practitioners and coaches on mandatory recovery times
before allowing players to return to play. Finally, tracking rates
and long-term consequences of sports injuries will be essential.

Children and youth can still be pushed to succeed in sports,
but with fewer risks and less physical contact. The goal is not
to change the behaviour and practices of professional and
Olympic athletes. Rather, it is to keep our young players
healthy to enjoy the rest of their lives. Unnecessary lifelong
disability will not help anyone, least of all a minor who cannot
fully appreciate the consequences of serious injury. Let’s be
careful not to excel at causing long-term harm rather than true
sporting achievements.

Alun D. Ackery MD MSc, Allan S. Detsky MD PhD; with the editorial ad –
visory team: Paul C. Hébert MD MHSc, Matthew B. Stanbrook MD PhD,
Ken Flegel MDCM MSc, Noni E. MacDonald MD MSc

For references, see Appendix 1, available at http://www.cmaj.ca/cgi /content /full
/cmaj.110634/DCI

Competing interests: None declared by Alun Ackery or Allan Detsky. See
http://www.cmaj.ca/misc/cmaj_staff.dtl for editorial advisory team statements.

Affiliations: See http://www.cmaj.ca/misc/cmaj_staff.dtl for editorial advisory
team statements. Alun Ackery is with the Division of Emergency Medicine,
Department of Medicine, University of Toronto, Toronto, Ont.; and Allan
Detsky is with the Departments of Health Policy, Management and Evaluation,
and Medicine, University of Toronto, and the Department of Medicine,
Mount Sinai Hospital and University Health Network, Toronto, Ont.

Correspondence to: CMAJ editor, pubs@cmaj.ca
CMAJ 2011. DOI:10.1503/cmaj.110634

Dean
M.Ed (Coaching)
Ch.P.C. (Chartered Professional Coach)
Game Intelligence Training
"Great education depends on great teaching."