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Concussions and culture – how to reduce the number of traumatic brain injuries in youth ice hockey

Toronto, April 21, 2016

By Marc Dodsworth

Dr. Michael Cusimano
Dr. Michael Cusimano

A cultural shift is needed to reduce the number of traumatic brain injuries in youth ice hockey, said Dr. Michael Cusimano, a neurosurgeon and researcher at St. Michael’s Hospital.

“The culture of forceful contact with other players that we imbue in our professional sports is the main reason why we see such a high number of concussions in youth hockey,” Dr. Cusimano said Tuesday at the 2016 Visiting Professor in Injury Prevention Symposium held at Sick Kids Hospital.

Research by Dr. Cusimano found that hockey accounts for nearly half of all traumatic brain injuries that required emergency care among children and youth participating in organized sports. The study found that contact with other players was the predominant mechanism by which players sustained traumatic brain injuries.

In his speech Dr. Cusimano referenced a study published in the Journal of the American Medical Association that found that the risk of game-related injuries, including concussion, increased by three times among 11- to 12-year-old hockey players in leagues that permitted bodychecking compared to leagues that did not.

“When we allow bodychecking in hockey, there’s a behavioural change in the players that contributes to a culture of aggression in sport,” Dr. Cusimano said at the symposium organized by the University of Toronto Trauma Program and the Dr. Tom Pashby Sports Safety Fund. “We can enforce protective measures like wearing protective equipment such as pads and helmets but we must also look at rule changes and their enforcement to really change culture in a way people can understand.”

Several attempts have been made at the professional level to curtail the high number of traumatic brain injuries in ice hockey. The Ontario Hockey League enacted a rule against bodychecking in 2006 and the 2011-12 National Hockey League season saw the implementation of Rule 48, which imposed a two-minute minor penalty for targeted hits to the head from any direction.

However, this did not result in a reduction in concussion rates, as found in a study led by Dr. Cusimano.

“Either the rules need to be enforced more strictly and the consequences, more severe, or players are having difficulty adapting to the new rules,” said Dr. Cusimano, a scientist in St. Michael’s Li Ka Shing Knowledge Institute. “This is a cultural issue. If things don’t change at the professional level, younger players, who so often imitate the pros, will continue to be at high risk for traumatic brain injuries.”

Dr. Cusimano said that rule changes, when combined with educational programs, could be a promising strategy to reduce the number of concussions.

The Canadian Pediatric Society recommends that bodychecking be banned from competitive hockey leagues until the bantam level (13 to 14 years old).

“We need to consider if we really need bodychecking in the game and ask ourselves what purpose it serves,” said Dr. Cusimano.

“And fighting obviously has no place in the sport.”


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.