My older grandchildren play hockey and enjoy the game. With practice and lots of ice time, they are getting better and becoming strong players. It is a pleasure to watch their skills improve and see how the discipline of the sport has a positive effect on their lives. They wear all the appropriate protective equipment, and it often appears that, when dragging the hockey bags around arenas, they weigh less than their equipment. However, as an Opa who studies neuroscience, I worry about what damage this game can do to their brains.
Concussions in sports
Newspapers and scientific journals are full of reports of the brain damage suffered by professional and amateur athletes due to repeated hits to the head. Football in America is at the centre of multiple legal actions by retired players who report cognitive impairments. There are multiple post-mortem studies of professional athletes’ brains revealing neurodegenerative diseases. Particularly damaging are multiple concussions that occur when athletes go back to the field or rink too soon after a first concussion, without giving the brain adequate time to heal. Other sports with head contact, like soccer and rugby, have similar problems. And hockey, too – just think of Sidney Crosby’s concussion history.
The brain is an organ that is well protected from many types of damage. It has a blood-brain barrier that prevents dangers that get into the body and blood from affecting the brain itself. This barrier allows only the passage of substances that the brain needs, such as its fuel, glucose. The brain has the consistency of a stiff porridge. It is encased in a membrane called the meninges (which is like a soft, supportive bag) and floats in a bath of cerebral spinal fluid. All of this is in turn housed in a hard casing, the skull.
However, any protection has limits. In a concussion, when the head bounces hard, the brain hits the skull and its soft tissue can “bruise.” If you have a bruise on your skin, it discolours because blood capillaries rupture; the discoloration indicates how bad the bruise is. In contrast, there is no way to see bruising in the brain, making it hard to determine how severe the damage is and, perhaps more importantly, to know when full healing has occurred. If the brain is still healing, a second concussion has the potential to cause much more severe and long-lasting damage.
Decrease the risk
Assessing the severity of a concussion is an imprecise task. Coaches and sports officials often use a variety of behavioural signs: did the person lose consciousness? Are they disoriented? Do they have memory problems? Are there mobility difficulties? But these tests (as well as further clinical tests) are not perfect, leading to suggestions that with kids particularly we should err on the side of caution.
If concussions do occur or are suspected, recovery time away from further play should be long. Seek professional advice, as recovery time is so variable. Especially with children, incomplete recovery can have long-term adverse consequences, so caution is important. At my university we sometimes see students who have had a concussion – or worse, a series of concussions – who live with long-term impairments in cognitive skills. While rare, we have had a graduate student take a full year off from his studies to recover from concussions.
For me, it is difficult to say whether the dangers of these sports are outweighed by their positive aspects. I am pleased to learn of important changes, like no-checking rules in children’s hockey, which reduce the risks and should be encouraged. But is this enough? People die in car accidents, but that doesn’t stop us from driving. Are sports injuries similar: something that we try hard to avoid while continuing to play the sport? Or do we say, let’s drive a car but not a motorcycle. In other words, let’s avoid high-contact sports and pursue the skills, character building and other benefits of sport in sports with less likelihood of physical injury. Sports are a wonderful part of God’s good creation, but they are only a game. Participation in safer sports can be encouraged.
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