Keeping Your Head in the Game

Concussions in Youth Sports

When Gordan Marshall was bundled to the ground during an especially physical basketball game, a concussion was the least of his worries. It was his ankle that seemed off. A 130-pound-tall lanky basketball player, Marshall was focused on making a big contribution for his team in his freshman year with his varsity team, “The way I play is very physical, so I’m not afraid to get dirty or get knocked around,” he said. Marshall picked himself up from the court like normal, finished the entire game, and went home thinking nothing was wrong.


Later on that night his head started to hurt. He was having trouble focusing and he noticed that his eyes were being bothered by the light. His parents insisted that he should get a concussion test done and Marshall reluctantly agreed. “Honestly I didn’t really feel it was necessary. At the time, I just thought that I had a severe headache,” he said. While doing a standard concussion test at the doctors, it was clear that it was more than just a severe headache. The doctor informed Marshall that during his fall he snapped his head back, giving him whiplash, which had caused a concussion, which was his third concussion suffered while playing sports.


He then spent the rest of the night in sleep mode, spending all his time locked away in his room with the lights off and hardly any noise. He also missed four weeks of school, relying on his classmates and teachers to provide him with updates. Slowly he eased back into school, starting by attending one class a day but he found it hard to keep focus, “I was finding it very hard to keep up. Like I wasn’t able to look up because the bright lights were really hurting my eyes, I was scared I was going to have to drop out or something,” he said. His team doctor also warned him that this may be the end of his sporting career and that suffering another concussion could end his sports career for good. “This was awful for me because love basketball and I was scared I was going to be forced to quit the game,” he said.


A concussion is classified as a traumatic brain injury that affects brain function, effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Dr. Vincenzo Bastile is a neurologist at Sunnybrook Hospital and he has spent a vast majority of his career researching the brain. “Concussions are a very unique injury because there are so many instances that can cause a concussion and in many cases, there are no external signs of head trauma,” he said.


Bastile also adds that while the skull protects the brain against penetrating trauma, it does not absorb all the impact of a violent force. “The brain is cushioned inside the skull by surrounding cerebrospinal fluid, despite this, an abrupt blow to the head or even a rapid deceleration can cause the brain to contact the inner side of the skull,” said Bastille.


This is why concussion safety and protocol is so important when it comes to sports.


For most children, teenagers and adults, sports take up a huge part of their time. According to a study done by the Canadian Youth Sports Report, 84% of Canadian youth between the age of 3-17 participate in sports of some kind and 60% do it on an organized basis. For many kids who participate in high contact sports like football, soccer, hockey and rugby, concussions are always a worry. In a study done by Boston University, the largest of its kind, it was revealed that after examining the brains of 202 deceased football players, scientists found CTE- chronic traumatic encephalopathy, a neurological disease caused by brain trauma- in 87% of the brains. It was also revealed that young athletes who had only played high-school football showed signs of the disease, which effects result in changes in behavior, mood and cognitive function.


The dangers of concussions have always been known but with new studies coming out every year highlighting the cause, parents are starting to worry even more about their children’s safety in sports. With this in mind, there have been attempts from various sports leagues across Canada and the world, to help protect the players. Recently, Ontario accepted a report conducted from the Rowan’s Law Advisory Committee, which focused on the next steps for concussion safety, focuses on safe participation in sport through surveillance, prevention, detection, management and awareness. The report will also allow Ontario to work alongside sports leaders, in an attempt to make sports safer for everyone. The Rowan’s Law Committee was established after the tragic death of 17 year-old-Ottawa native Rowan Stringer, who died as a result of a concussion she suffered while playing. The committee is chaired by Dr. Dan Cass and it started a broader study of the concussion landscape in Ontario, providing advice to the government on how to improve head safety across Ontario’s sport system.

In Ontario, 22% of students reported being knocked out or admitted to hospital due to a head injury in their lifetime. In Canada, among children and youth who visit an emergency department for a sports-related head injury, 39% were diagnosed with concussions, while a further 24 were possible concussions. Recently, Manitoba also introduced the “Concussion in Youth Sport Act” which ensures better training and identification by coaches. Efforts have been made by the country to help protect players and youth sports leagues have followed suit.

During the 2015 summer outdoor season, the Toronto Soccer Association(TSA) used Danish EIR soccer balls in a trial run involving under 13 girls. The EIR balls are specifically designed to lesson injuries suffered while playing soccer. The trial covered 425 girls playing for 25 club teams in 206 league and cup games over a four-month outdoor season. The trial was deemed very successful with a post-season survey revealing that all the U13 G coaches and players reported no concussion, ankle or knee injuries while using the ball. It has been reported through studies that girls playing soccer suffer more concussion, ankle and knee injuries than boys and the U13 age group was chosen for this trial because it marks the year where competitive soccer players transition from a youth size #4 ball to the larger and heavier full sized adult #5.

While players loved the new ball, highlighting how the ball made multiple aspects of the game easier, coaches had more concerns. They noted that when played on an artificial turf, the ball bounced higher. Coaches also highlighted that when competing in tournaments outside of the TSA, the balls used during a game are the regular adult size 5 ball. While this trial was deemed successful, it’s clear that more work needs to be done in order to make this a viable option in the future.

Along with the trial, TSA announced a partnership with the Holland Bloorview Kids Rehabilitation Hospital in an attempt to improve the safety of youth soccer through education and concussion management strategies. The partnership has resulted in the creation of a new, comprehensive concussion policy for the TSA’s 24,000 competitive and recreational youth soccer players, parents and coaches. The policy includes protocol, procedures, documentation and formalized training programs, specifically designed for youth soccer players to increase their safety during the game and off-the-field. Under the new policy, any player with a suspected concussion is immediately removed from play and referred to a physician for diagnosis. If the player receives a concussion diagnosis, they will follow a gradual return to soccer protocol to ensure they recover safely and receive medical clearance by a physician before rejoining the game.

“The new concussion policy ensures that we, as medical professionals and everyone in the sports community, look after the health and safety of youth who participate in sports,” said Dr. Nick Reed, a clinician scientist and co-director of Holland Bloorview’s concussion centre. He also said that, “The policy provides important education on what a concussion is and riection for what to do if you have one.” The policy puts soccer players, parents, trainers, coaches and also the soccer community on the same page to best support kids and youth.

While these initiatives are great and are great strides with regards to concussion safety, Jacques Koning, the vice president of TSA worries that there is no definitive way to prevent concussions. “Unfortunately, injuries and concussions can occur in sports and in soccer, it is more complicated than concussions suffered while heading the ball, most concussions actually happen from contact involving players falling and hitting their heads on the ground,” he said.

While it is true, it is nearly impossible to prevent concussions in sports, the focus now is on concussion management and how we can spot concussions and treat them. This was evident this past October when a high-school coach decided to forfeit a football game.

Impacts During a Soccer Game

During a soccer game there are countless examples of physical contact during the game. Here is a short video highlighting these moments:

Impacts During a Soccer Game.

Hits During a Hockey Game

Hockey is a very physical sport. It is also has some of the highest concussion rates in sports. Here is a link to a video that shows what goes on in a typical youth hockey game:

Hockey Hits

Sports Clinics

Sports Clinics are essential to helping athletes recover from injuries, including concussions. Here is an interview done with Jeff Whelan who works at a sports clinic

Interview with Sports Clinic.

Concussion Story

Being Concussed

A high-school student’s story about his experiences with concussions

The scene was in New Brunswick, with the L’Odyssee Olympians trailing the Tantramar Titans 35-0. During the game four Olympiens players received body injuries, four declared concussions and four others displayed concussion symptoms. This was enough for coach Marcel Metti to pull the plug on the game during halftime.

The decision was a result of Metti’s personal conscience but also the school district’s new concussion protocol, which states that any player who receives a blow to the head must be cleared by a doctor before they can play again.

The injuries occurred during this game resulted in an investigation conducted by the New Brunswick Interscholastic Athletic Association, to deem whether the plays during the game were legal. After reviewing the game tape, they concluded that the game was played within the rules of the game and there were no safety concerns.

This came to a shock for many parents who had sons on the football team but it also reiterates the fact that concussion prevention is nearly impossible as it is unclear what can trigger a concussion but what can be done is concussion management, which has seen great strides.

The Canadian Institute for Health Information reports that in Ontario and Alberta, 94% of emergency department visits for sports related injuries in 2014-2015 were concussion related. The data also showed that this was a 45% increase in emergency room visits among 10-17 year olds over a five-year period.

These high numbers and also the study conducted by Boston University has quickly changed the narrative on concussions and how they are treated. When receiving an injury during a sports game, most players will be told to “suck it up” and to get back in there, and for a long time that was the nature of sports.

“Back in the day, players never came off injured. You would have to literally be dead in order for you to warrant being taken off the field but that’s just how it was. That was the culture but luckily, we’ve gotten a little bit smarter and have realized that this is not safe for anyone,” said Brian Weir, a house-league hockey coach.

For too long this was the culture of sports, and athletes had to suck up the pain and continue to play, which is something that Marshall highlights. “You never want to go off because then you’re seen as weak or a wimp and that’s not what any athletes wants to hear, they want to prove they are tough and sometimes it’s against our better judgment,” said Marshall.

Marshall has since recovered from his concussion and has slowly integrated himself back into basketball but he notes that it was a difficult transition. “Because this was such a major concussion, the worst of my career, I found it hard to play the game the same way. I noticed I was taking it easy on the court and I wasn’t going as hard as I normally would,” said Marshall.

This is a common theme for not only athletes, but people in general who have suffered concussions. After suffering from concussions, there can be long lasting effects and people can have a hard time adjusting to this. This is why all the initiatives being done with concussion safety is so important. “The main goal is to treat concussions now in order to prevent further damage later on in life. As we know with the studies done with NFL players, a lot of them had brain damage that young men shouldn’t have, so with this knowledge we are now focusing on youth and making sure that they don’t have these long-lasting damages,” said Basile.

Concussions will probably never be eliminated from sport, but what we can do now is to turn the attention to how treating concussions and how we can help people recover from them and get back to their everyday lives.

I’m just thankful that as of right now, everything is fine and I haven’t had any other post-concussion symptoms. I can definitely say that my life was changed by this injury as I got a glimpse at what my life could be like in the future if I continued brushing concussions off,” said Marshall

Sports Clinics in Toronto

Brain Injury Emergencey Department Visits in Alberta and Canada in 2015

Hit by Ball