Evidence of meeting #5 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was going.
A video is available from Parliament.
7:25 p.m.
Ottawa—Vanier, Lib.
My impression was correct; you study mostly male brains.
Our committee is trying to see what could be done at the federal level. In your opinion, what could we, as legislators, do to improve things in this area?
7:25 p.m.
Chief Executive Officer, Concussion Legacy Foundation
I'll try to be as concrete as possible.
From a policy perspective, what's in Rowan's Law is very similar to what is in the laws that exist in every state in the U.S. If you're going to play sports, everybody needs to be educated on concussions. That means we require it for coaches, and we require it in many states for the athletes. In some places, we even require it for parents, because parents don't realize that the average concussion isn't going to be diagnosed at practice. Those symptoms may show up when the person gets home that night. If they don't know what to look for, they won't piece it together. Mandating education through sports organizations, I think, is absolutely appropriate to do.
In the U.S., in most states, we mandate that you have to be cleared by a medical professional to return to sports after a concussion. I've heard about the backups for going to doctors as a reason why people don't get medical clearance. Finding a way to fix that issue, whether you need more trained doctors, or whatever.... It's absolutely appropriate to say that you have to be treated by a medical professional and cleared before you can return to sports, because returning to sports too soon is often how lives get derailed.
On the research side, it's hard to mandate specific things, but certainly convening a group to potentially put together a research road map and investing that time in getting scientists together to say where the gaps are and how we close them....
I mention that second just because, when I look at this issue as a public health problem, it's going to take decades to develop treatments for this or new ways to diagnose it using biomarkers on the sideline. That's an investment of time and effort, but right now we can draw a line in the sand and stop a whole lot of these problems on the prevention side, whether it's preventing the impacts in the first place, preventing mismanaged concussions or preventing a child from hiding a concussion, because we educate them better.
In terms of changing the culture, I would add that, if you're going to do education for athletes, it can't just be asking athletes to self-report, because asking a 10-year-old to diagnose their own brain injury in the moment they have a brain injury is an insane plan.
One program we've put together, which we do up here as well, is called Team Up Speak Up, where the primary message we give to children is not that you need to look out for yourself—that's the message they have already received—but looking out for your teammates. Your teammate is probably not going to know they're concussed, so if you see something, it's your responsibility to speak up to a coach or to a parent and say, “I'm worried about them; check them out.”
Prevention-wise, I think looking into the idea that there should be minimum ages before it's open season on a child's head in sports is important. Again, I look at that like lead exposure. We have five-year-old kids in America, again, 40-pound kids putting on a four-pound helmet and running into each other, and we know they're getting hit in the head hundreds of times. We also know that, at the NFL level, we have guys walking away from the sport and turning down millions of dollars because they don't want to take that risk. The idea that we put kids at this risk when they don't understand what the long-term effects could be, because they're not old enough to understand what the long-term effects could be.... We usually don't assume they can predict this until they're 18.
When Eric mentioned checking at 15, to me that's an obvious one. When we brought checking down to young ages, we weren't thinking about the brain; we were thinking about preparing them for the money down the road. From a public health strategy, it's absurd that we encourage kids to run into each other.
Does anyone here play in any adult sports leagues? Are there any ice hockey players? Do any of the men here play in checking ice hockey leagues as adults? Of course not. We would never do that to ourselves. We're too smart for that. You know you need your brain down the road, so the idea that we'd put 13-year-olds in that situation without giving them an option to not check is cruel, I think.
7:30 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
You have about a minute and a bit.
7:30 p.m.
Ottawa—Vanier, Lib.
Is there anything else you'd like to share with us? Honestly, I think you have so much to offer that I would leave you with the floor if you have something like a takeaway that you think we really need to look at.
7:30 p.m.
Chief Executive Officer, Concussion Legacy Foundation
I would just reiterate that this is a big area. I sort of fell into this in my mid-twenties, and now I've spent 15 years trying to understand it. I just want you to have confidence that this is a solvable issue. You can come out of this with very concrete steps that will put all Canadian athletes and citizens in a better position, where we have a better respect for concussions and a better respect for their brain, and change the course of the future of sports so that we don't deal with these outcomes that we're unfortunately uncovering way too much through the brain bank or through other situations. We can succeed at this in a short period of time.
7:30 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you.
We are going to move over to the Conservatives. I understand you'll be splitting your time.
You have five minutes, Mr. Nuttall and Mrs. Falk.
7:30 p.m.
Barrie—Springwater—Oro-Medonte, CPC
Thank you so much.
I just want to pick up on exactly what Ms. Fortier was asking you.
Chris, I want to give you an example of where we are at in Ontario. There is no malice on my behalf about the other things that I'm going to talk about that are being taught to the hockey clubs.
A hockey mom who found out I was on this committee reached out to me. She is the assistant convenor of one of the local leagues. They've been required by law to have coaches have conversations with their teams regarding gender issues. I'm not saying that's a bad thing. Let me be very clear.
7:30 p.m.
Barrie—Springwater—Oro-Medonte, CPC
They've never been mandated to have conversations about concussions.
You sit there and you think, how is it we're going so far on this track, but we haven't even left the station on this one? Is that right?
7:30 p.m.
Barrie—Springwater—Oro-Medonte, CPC
It sounds like you have so much information and data. It would be nice.... You come and you are able to tell us about it. How much of it can you just throw on our desks and on the analysts' desks and say, “Here's the raw data. Here's the stuff. Please put it to work. Here are the 10 recommendations I make to every school I speak to in the U.S.” or whatever?
7:30 p.m.
Chief Executive Officer, Concussion Legacy Foundation
There aren't many opportunities to talk about federal changes. I would say there are a lot of recommendations.
I think that's an incredibly important point. In college, I remember being required to go to a gambling thing for sports. Every athlete had to go to a gambling issue, even though there was one case of people gambling on their own games in all of the United States.
I can promise you that if they're in a contact sport, 10% of those athletes are going to be diagnosed with a concussion over the next coming season. Probably 30% to 50% of those who have it are not going to say anything. The idea that you wouldn't mandate a concussion conversation but you'd mandate anything else is potentially bad, short-sighted policy.
I do think the idea of mandating.... You know, we're not born understanding our brain. Unless we actually sit there and talk about it, we're not going to appreciate it. I didn't realize until I was a couple of years into this work that we don't have pain nerves in our brain. That's why we don't feel anything. That's why we're so reckless with it. The feedback you get is that you have to interpret this mild headache as a brain injury, even though you get mild headaches from having the flu or other issues. You're right that we need to ask more of ourselves. We also have to understand the pitfalls that are coming.
I'll quickly give you one interesting study I just came across. A former colleague of ours, Christine Baugh, recently was able to survey four division 1 college football teams and found that their likelihood of reporting concussions diminished the more concussions they got. If you survey doctors, they'll tell you they start retirement conversations at three or four diagnosed concussions.
This survey found that they'd tell you about the first concussion. They'd tell you about the second one, and they might tell you about the third concussion. Fewer than half would tell you about the fourth concussion. Not a single athlete in this entire group had more than four diagnosed concussions, even though many of them admitted to having more than 15 concussions.
There are a whole lot of social aspects to this that we have to prepare people for. It is just very complex.
7:35 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
You have a minute and a half.
February 6th, 2019 / 7:35 p.m.
Conservative
Rosemarie Falk Conservative Battlefords—Lloydminster, SK
This has been a very interesting conversation for me. I was never raised in contact sports, nor was my husband. We have a daughter who's in gym—she's a little gymnast—where they fall all the time. It's not contact, but they're up on a bar that's six feet high. It's very interesting that she trains 12 months a year. There is no break, because when they break, even a summer break, they notice too much regression, which makes it more difficult to compete. That was an interesting takeaway that I had.
Also, I have a nephew. I don't know if it's like this here, but where I'm from, in western Canada, everybody's in hockey—every single person. My nephew is six years old. They put him in hockey for the first time when he was five years old, and he's a joke because he wasn't put in when he was two years old.
7:35 p.m.
Conservative
Rosemarie Falk Conservative Battlefords—Lloydminster, SK
How do we change this culture of putting our kids in such high-pressure sports at two years old?
7:35 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
You're going to have to hold on to that answer. Gather your thoughts, and we'll come back to the Conservatives.
We're moving over to the Liberals.
We have Mr. Fisher.
7:35 p.m.
Dartmouth—Cole Harbour, Lib.
Thanks very much, Mr. Chair.
Chris, you said we don't diagnose most concussions, and then you said there are professional NFL players walking away because the risk is too high. How many NFL players are not coming forward to say that they have potentially been concussed? At this level, they probably know when they're concussed, but it's millions and millions of dollars. You have pressure from agents, pressure from coaches and interior pressure to make a living as well. How many concussions are going undiagnosed because of players not coming forward?
7:35 p.m.
Dartmouth—Cole Harbour, Lib.
I can't imagine too many players walking away from the game in fear of getting a concussion. I'm not saying it doesn't happen, but probably more—
7:35 p.m.
Chief Executive Officer, Concussion Legacy Foundation
More are choosing to play through their injuries. They're making an informed choice, and you can't necessarily fault them for it, but, as soon as they walk away, players will be completely honest, and there are many quotes from athletes saying they got concussed all the time but they wouldn't say anything because if you get two concussions in one season in an NFL career, you're basically done, because they see you as a concussion case.