To Tackle or Not: That is the Question


Rugby Sports Med panel (L to R): Drs. Kerr, Gerber, Viljoen, Cantu, Akhavan, Mjaanes, Landry

There is an ever-increasing debate on both sides of the Atlantic regarding contact and collision sports for youth.  In particular, the issue of tackling (whether in rugby or American football) is in the cross-hairs of many.  I’ve written about this recently after Dr. Bennet Omalu, the subject of the movie ‘Concussion’ and the pathologist who first described CTE in an American professional football player, wrote an op-ed piece in the New York Times arguing that contact football should be banned in those under age 18 [‘Don’t Let Kids Play Football’].

My impetus for this blog post is two-fold: 1) I am currently attending a rugby sports medicine conference, where the issue of tackling and brain injury is a ‘hot topic’ for discussion; 2) the issue of tackling in youth rugby has exploded after recent events in the UK.

USA Rugby sports medicine hosts a conference each year around this time, and this year there was a panel of experts who entertained the question: when should youth athletes take up contact/collision sports?  There was a variance of opinion and a recognition that more research needs to be done to give an informed answer to this question.

In the background, occurring in the ‘real world,’ this same question was being debated in the media and social media after a group approached the UK government asking for a ban on tackling in youth rugby. The Sport Collision Injury Collective (@sportcic on Twitter) circulated a petition signed by 70 academics asking that touch rugby only be taught to schoolboys in the UK [“Our message is simple: Prevent injury, remove contact.  Replace contact with touch in school rugby.”]

The media response has been vigorous:  check out these stories from the BBC and the Guardian.  Opinions have come from players, parents and coaches as well as physicians  [the Royal College of Paediatrics and Child Health wrote a response to this proposal ] and sports scientists.

This is an important and healthy debate, one where I find most if not all stakeholders have the health and welfare of our youth foremost in mind as we try to gather more information and make decisions now, the ramifications of which may not be seen for years to come.

And so, I thought I would use this blog as one more platform where concerned folks could weigh in on their opinion of this question. Take the poll below,* ** follow the links above, and engage in the discussion which is taking place in the media.

*There have been many ages proposed for initiation of contact in youth sports, ranging from age 10 to 18.  For the purposes of the poll, I have tried to give a variety of options, though I recognize the choices are not exhaustive.

**I have intentionally given poll takers the option for a limited number of answers, recognizing that there is room for many more (e.g. ‘we need more information’, ‘yes, allow contact, but we need to reduce the amount kids get’, ‘football and rugby are different, and my answers would be different for each sport’ etc.)

Shedding light on the dark

It’s January and winter has at last arrived in North America. It officially started several weeks ago, but it took a while to really get going.  After a balmy December (for most of the country, anyway), the first month of 2016 has given us, as expected, single digit temperatures and snow:  the Minnesota vs. Seattle playoff game earlier this month was the third coldest NFL game in history. This month is also giving us the shortest days of our year north of the equator.

ACSP 2016

ACSP meeting coming up — Come to Surfers’ Paradise if you can!

[sidebar and shout out to our colleagues in the Australasian College of Sports Physicians (ACSP)–I am so looking forward to the warmth and long, sunny days of Surfers’ Paradise, in a mere 4 weeks!!!]

But the days are lengthening, and the sun will get stronger each day, of course. And metaphorically, at least, I can find light in this darkness by sitting down with this month’s edition of CJSM.  You can, too.

Yes, ‘shedding light in the dark,’ that’s the image I hold as I enjoy this privilege of being one of a group of editors managing one of sports medicine’s premier journals.  The on-going process of scientific investigation continues to expose the dark corners of our knowledge base, and journals like ours–disseminating this knowledge via print, internet, and other media vehicles–help practicing sports medicine clinicians bring the latest evidence-based research to the sidelines, training rooms and clinics.

In truth, I recently wrote about being ‘in the dark’ (literally and figuratively) as I watched the movie ‘Concussion’ and reflected on how much we still lack in our understanding of this clinical entity, in almost all aspects:  diagnosis, management, treatment, prognosis.  I am reading now with pleasure three pieces of original research about concussion just in our January issue, bringing their light to bear on the issue:

And as I have begun to prepare my talk for the upcoming ACSP conference (“School sports and youth injury: the promise and the peril”), I find myself leaning heavily on research published in CJSM. To wit: Read more of this post



Transitions: November in the USA.

Really?  Can it be that November is here?

I just covered my last high school football game of the fall, a loss in the playoffs. A season which began in the heat and humidity of August [with its attendant muscle cramps and concerns of exertional heat illness & exercise-associated hyponatremia] is now over, and injuries sustained on wrestling mats and in basketball gymnasia are beginning to show up in my clinic.  Before you know it, the skiiers and snowboarders will be filling out the waiting room.

November also brings with it the publication of our last CJSM of 2015, and it is a good one.  We have profiled two offerings in particular, both of which currently are freely available on line:  original research looking at potential limitations of American Heart Association recommendations for pre-participation cardiac screening in youth athletes; and a provocative editorial [and just right for the change of seasons] arguing for adult autonomy in deciding whether or not to wear helmets when skiing.

Both subjects are among the more controversial in sports medicine.  Whether or not to consider pre-participation screening with ECG when taking care of our younger athletes–well, that’s a question whose answer can vary depending on what side of the Atlantic one is on, or what part of the United States you may live in.  It’s a question whose answers may lie in much of the research we publish in our journal, with luminaries such as Jonathan Drezner and William Roberts weighing in.

Whenever we publish research or commentary on the question of mandatory personal protective equipment, I sometimes feel as if we have entered the ‘blood sport’ arena of sports medicine.  This issue’s editorial  on the ‘Ethics of Head Protection While Skiing’ has already generated some buzz on our twitter feed. Two years ago, we published the Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the Mandatory Use of Bicycle Helmets, and our social media feeds erupted.  I have never seen so much discussion on the blog site.

There is much more to be read carefully in this November 2015 issue.  A very interesting piece of original research, from one of our more prolific authors (Dr. Irfan Asif), looks at the potential psychological stressors of undergoing pre-participation cardiovascular screening.  As a pediatric sports medicine specialist, I’ll be reading with great interest a study on the potential prognostic implications of post-injury amnesia in pediatric and adolescent concussed athletes–lead author Johna Register-Mihalik continues to make major contributions to our understanding of that injury in that population.

So, enjoy this issue.  And brace yourself–2016 is on its way.  It will be here before you know it!

Alphabet Soup: Concussion Assessment in Youth

alphabet soup 1

Chicken soup: good for the soul….good for concussion? Photo: strawberryblues Wikimedia

SCAT2, SCAT3, Child-SCAT 3, SAC, BESS…….as those of us in sports medicine know, concussion assessments have become an alphabet soup!

Our July 2015 edition of CJSM contains an interesting study looking at baseline SCAT2 assessments of healthy youth student-athletes; it also included some preliminary evidence for the use of the Child-SCAT3 in children younger than 13.

The 4th International Consensus Statement on Concussion in Sport introduced the SCAT3 and Child-SCAT3 instruments.  The Child-SCAT3, in particular, was a significant advancement as there had been no pre-existing instrument for pediatric concussion assessments prior to the 2012 Zurich conference.  If you have not ever looked the Child-SCAT3 over, take the chance now by going to the freely available consensus statement–the Child-SCAT3 PDF is readily downloadable.  Among the differences between the SCAT3 and Child-SCAT3:  a different set of Maddocks questions (is it before or after lunch?); days of the week (as opposed to months of the year) in reverse order; a parent- as well as a self-assessment of symptoms (and the self-assessment is written in more age appropriate language).

Throughout the year, but especially at this time of year (late summer–football has begun) we do assessments like this for the large number of kids we see with concussions or suspected concussions.   Read more of this post

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