Category Archives: General
A study led by a Hasbro Children’s Hospital sports medicine physician found that male student ice hockey players in earlier pubertal stages had a significantly increased risk of prolonged symptoms from concussion compared with advanced pubertal and postpubescent players.
Research by Peter Kriz, M.D., found that less physically mature players took on average 54 days – 21 days or nearly 40 percent longer – to recover compared to more physically mature players. Kriz said the findings further highlight the need for student athletes in collision sports to compete with similar-aged players and that there is risk in having younger, more talented athletes “play up” on varsity teams.
“Unlike other contact-collision scholastic sports with a high incidence of concussion, high school ice hockey lacks stratification by age grouping, largely because of prohibitive costs associated with equipment, transportation and ice time incurred with fielding varsity, junior varsity and freshman teams,” said Kriz. “Consequently, it’s not uncommon at the varsity level for younger, less physically mature players to oppose older players with increased strength, power and speed.”
The study, currently published online in The Journal of Pediatrics, assessed disparities in age, size, and physical maturity level among concussed adolescent ice hockey players 13 to18 years of age, and was performed at Hasbro Children’s Hospital, Boston Children’s Hospital, and South Shore Hospital, in Weymouth, Massachusetts. Additionally, the study also found that lighter weight among males and heavier weight among females increased the probability of experiencing prolonged concussion.
Concussion has been reported to be the most common youth ice hockey injury, representing more than 15 percent of all injuries in nine to 16-year-old players and nearly 25 percent of injuries among male high school players.
The study’s results challenge recent opinion, which has suggested that collision sport participation be postponed until freshman year or 14 years of age. “Sixty-five percent of freshman male ice hockey players in our study were in early stages of pubertal development and none were postpubertal,” said Kriz.
The findings also support concerns within the youth athletic community that adolescents might have longer recoveries from concussions than adults.
“Our findings have important implications for policy decisions related to grouping for high school ice hockey players,” explained Kriz. “While economic considerations often dictate whether a school fields ice hockey teams other than varsity, we support, at the very least, the establishment of junior varsity ice hockey by state interscholastic leagues for the purposes of player development and improved safety for undersized, peripubertal male players.”
Additionally, policies pertaining to high school football and boys’ lacrosse — two other collision sports which commonly permit underclassmen to “play up” on varsity teams — may ultimately be impacted by these findings, as lighter, less physically mature players may be at risk of prolonged concussion symptoms.
Kriz recommends that, until further studies determine valid physical maturity indicators, arbitrary age and grade cutoffs should not be used to determine when adolescent athletes are ready to participate in collision sports.
“Until such studies are available, collision-sport high school athletes should play in leagues grouped by relative age,” said Kriz. “Highly-skilled, peripubertal collision sport athletes should also be discouraged from ‘playing up’ at the varsity level with post-pubertal competitors three to four years their senior.”
In accordance with recommendations from the American Academy of Pediatrics, Kriz encourages youth hockey organizations to provide the option of non-checking divisions for players who remain in earlier stages of pubertal development, players who are undersized, players who have significant concussion histories precluding them from participating in collision sport participation or for players 13 years old or younger seeking safer alternatives to body checking leagues.
This study was funded in part by the National Federation of State High School Associations Foundation and the Rhode Island Foundation.
(Editor’s Note: What follows is an execrpt from an exclusive article written by Richard Robeson and Nancy M. P. King for the February issue of Concussion Litigation Reporter. The authors are professors from Wake Forest University)
In January 2014, Judge Anita B. Brody rejected1 the terms of a class action settlement between the National Football League (NFL) and a litigation class consisting of former NFL players with concussion-related health issues and the descendants and heirs of deceased players whose deaths were related to concussions — mild traumatic brain injury (MTBI) — sustained during their playing careers. Although the amount of the settlement was agreed to by both plaintiffs’ attorneys and attorneys for the NFL, Judge Brody expressed concern that its $765 million cap would be inadequate to the medical and financial needs of not only the more than 5, 000 former players who filed suit but also some 18, 000 former players who would be eligible over the settlement’s 65-year term.2 Judge Brody therefore ordered the cap to be lifted and the settlement renegotiated. Some current players also expressed dissatisfaction with the settlement, with one player pointing out that $765 million divided by the League’s 32 teams was equivalent to one-third of the average one-year salary per team.3 Another player called it “hush money,”4 because one of the conditions of the agreement was that the NFL would not admit to any wrongdoing regarding its handling of concussions or its own concussion research.5
The renegotiated settlement approved in April 2015 by Judge Brody is now worth $1 billion;6 and over the last several years the NFL has drastically altered how it handles possible concussions7 and Return-to-Participation.8 Even so, the settlement’s exclusions9 — not least among them being that no one who retired after July 7, 2014 can benefit — have been the cause of yet more recrimination and appeal. Some plaintiffs are especially dissatisfied that chronic traumatic encephalopathy (CTE), a degenerative brain disease that is associated with repeated concussions (recurrent MTBI), is a diagnosis that is expressly not covered by the settlement.10 This latter exclusion is the essential cause of the appeal, a ruling upon which is anticipated early this year. These putative shortcomings have significant implications for current players, including how the matter of informed consent may be regarded. … (To read more, subsccribe here.)
ImPACT Applications, Inc., developer of the ImPACT® test and ImPACT Concussion Management Model, has announced a partnership with New York Schools Insurance Reciprocal (NYSIR), provider of property and casualty insurance programs for New York State public schools and Boards of Cooperative Educational Services (BOCES), to introduce “a comprehensive” Head Injury Prevention Program.
The Head Injury Prevention Program is designed to help subscriber school districts manage student athlete injuries and train faculty and staff to recognize, respond to and prevent school-sports-related concussions. NYSIR’s program utilizes ImPACT for neurocognitive baseline and post-injury concussion testing and to educate athletic directors, trainers, coaches, physical education instructors and school nurses on concussion management.
ImPACT testing and training is currently being phased in by NYSIR and by the end of February, NYSIR plans to have the Head Injury Prevention Program in every subscriber school district—over 350 New York public school districts altogether. School sports covered by NYSIR’s agreement with ImPACT will include football, basketball, diving, hockey, lacrosse, soccer, baseball, softball, cheerleading, field hockey, wrestling and alpine skiing.
“For 26 years,” notes NYSIR President Carleen Millsaps, “we have been a leading insurer of New York’s public schools. The ImPACT-NYSIR partnership is a giant leap forward in our endeavors to continually provide programs and services that protect our subscribers’ student athletes, and a positive step in the education of school officials and staff about the risks of sports related head injuries.”
“ImPACT is honored to partner with NYSIR in its Head Injury Protection Program,” says Michael Wahlster, Chief Executive Officer of ImPACT Applications. “The organization is leading a national trend where innovative insurers recognize the important role they can play in helping subscribers implement an end-to-end concussion management program.”