The old adage “the bigger they are, the harder they fall” should be modified to “the bigger they are, the harder they hit” when referring to younger adolescent males playing collision sports.
Children grow at different rates. By the time boys are 15 years old, they typically weigh between 90 lbs and 175 lbs and stand between 5 ft. and 6 ft. tall (see growth chart from the Centers for Disease Control at the end of this article).
When 15 year old children play collision sports like ice hockey or tackle football, those differences translate into a wide disparity of injury rates—particularly regarding concussions, an injury that can have a life time effect.
According to a newly released study in the Journal of Pediatrics, when it comes to suffering from concussion, adolescents competing against more physically mature males run a risk of taking nearly 40% longer to recover—54.5 days as opposed to 33.4 days.
Concussion is the most common injury among young male players. The Journal of Pediatrics and USA Hockey Today magazine rates concussion as representing more than 15% of injuries among 9 to 16 year-olds and 25% of injuries among high school players.
The study, which was led by Dr Peter Kriz and co-authored by Cynthia Stein, M.D., Janet Kent, M.D., Danielle Ruggieri, BA, Emilie Dolan, BS, Michael O’Brien, M.D., and William P. Mewhan, III, M.D., enrolled 101 boys between the ages of 9 years to 18 years who had been diagnosed with concussions from playing ice hockey.
The boys were followed at three regional medical centers—Rhode Island Hospital/Hasbro Children’s Hospital, Boston Children’s Hospital, and South Shore Hospital in Weymouth, Massachusetts.
Between September 1, 2012 and March 31, 2015, the children’s symptoms were measured according to the Pubertal Development Scale (PDS). The PDS is a self-assessing rating that for males tracks five areas of growth: height, body hair, facial hair, skin changes, and voice changes. Post-injury studies were done on the young athletes including computerized neurocognitive testing (ImPACT), other neurologic examinations, and a standardized Post-Concussive Symptom Scale.
Typical symptoms of concussion include temporary loss of consciousness upon impact, headache, confusion, dizziness, slurred speech, nausea, vomiting, and fatigue. The study concluded that boys who fall in the early pubertal stage for the PDS were most at risk for prolonged concussion.
Lead investigator Kriz, who is now assistant team physician at Brown University (fellowship at Rhode Island Hospital/Hasbro Hospital), medical advisor to a number of Providence-area schools and the Providence Bruins professional hockey team, argues that the study results are too conclusive to ignore.
The disparity in children’s maturity rates is creating an un-sustainable risk of concussion injury for smaller players. Should there be a size limit for hockey or football players? Should school districts create new teams of more like-sized players?
Based on this study, Kriz recommends that school districts make rules and participation standards to prevent less mature boys from playing against larger players. Having them compete in leagues grouped by relative age, and discouraging more skilled players from ‘playing up, ’ might be one answer.
Unfortunately, such suggestions, as Kriz tells OTW, are not practical. “Ice time, transportation, and rink costs are expensive. Adding a junior varsity or freshman team for the sake of injury reduction and player development would likely be cost-prohibitive, ” since most public schools typically lack funds for more developmentally appropriate teams.
Since 1994, The American Academy of Pediatrics (AAP) has defined collision sports such as ice hockey, football, boxing, and rodeo, as sports where athletes purposefully hit or collide with other players or inanimate objects such as the ground, equipment, or walls. Contact sports such as soccer and basketball run the risk as well, but with usually less force and intention.
Speaking with Richard Salit of The Providence Journal, Kriz says “there’s been a lot of focus on football and concussion. But it’s important to remember there are other collision sports.” Boy’s ice hockey has a concussive incidence second only to junior and high school football.
The unique aspects of ice hockey such as the head-to-toe equipment worn may offer a false sense of security. Although they do provide protection, they still cannot prevent injury. And the fact most schools don’t, or cannot, offer a variety of teams makes it more imperative that younger players are protected. When it comes to ‘butting heads’ against older, more physically developed players in collision sports, equal physical development and the standard ‘bigger is better, ’ may be true. It’s certainly safer.
NOTE: Forty-four adolescent female ice hockey players were also included in the study, with quite different results in that the heavier girls experienced longer recovery periods from concussion than their peers. However, more trials and participation is needed before results can be collected and analyzed and considered conclusive.
