Subcommittee on Sports-Related Concussions in Canada Committee on April 3rd, 2019

[The Chair, Liberal, Peter Fonseca]

Welcome, everyone.

This is the subcommittee on sport concussions. Pursuant to the motion adopted by the Standing Committee on Health on Thursday, October 4, 2018, the subcommittee is resuming its study of sports-related concussions in Canada.

We have two panels of witnesses here tonight.

First, we welcome Commissioner Ambrosie and his counsel, Mr. Shamie. Commissioner Ambrosie is going to provide an opening statement.

Commissioner, I believe this is your second year at the helm of the CFL. I know that you're pursuing a coast-to-coast-to-coast league. We wish you well with that. Many of us are fans, and we're excited to hear from you today.

This committee, and I speak for all members, is looking to grow sport in Canada. What parents and communities are asking is that they would like to see our arenas, sports fields and all areas of play to be safe for the participants—from the amateur level, the little leagues, all the way up to the majors such as the CFL.

It's great that you are here with us today.

The members are going to have an opportunity to ask you questions. You'll have an opportunity now to make a statement. We look forward to hearing your answers.

The floor is yours, Commissioner.

[Randy Ambrosie, Commissioner, Canadian Football League]

Thank you very much, Mr. Chair.

Good evening. Thank you to all of you for your public service. Thank you for your focus on sport and thank you for this opportunity.

In preparation for today, I read some comments from you, Mr. Chair, suggesting that commissioners should want to “grow the grassroots of their sports and have parents feel their kids are playing in safe environments all the way through.” I couldn't agree more, and I think you will see that reflected in my comments.

I want to say three things today. First, I am going to tell you just some of the steps the CFL has taken to prevent, detect, diagnose, assess and treat concussions in particular, and promote player health and safety in general. Second, I am going to challenge you—and through you, challenge the government—to expand your focus beyond concussions alone to overall mental health. We very much want to work with you on that. Finally, I am going to ask you to really broaden your horizons and work with us to address what I see as a crisis, which is declining participation rates in football and the corresponding effect on the physical, mental and emotional well-being of our youth. I fear we are scaring kids away from sport, and our game in particular, when we should be doing all we can to encourage them to participate.

Let me say from the outset that player health and safety is a top priority for the Canadian Football League. Mr. Chairman, this is not just a motherhood statement from me. Our focus on health and safety is not just an academic exercise for me. I played for nine years in the CFL as an offensive lineman, on top of my years in university and amateur football. I see our players in the CFL not just as employees, but as peers, even if our careers have been separated by a decade or two. I see them as partners in building a bigger, stronger and better CFL. No athletes anywhere in the world do as much work in the community as ours do on issues such as opposing bullying, promoting nutrition and combatting attitudes that lead to violence against women. I think the world of our players and I want them to be safe.

Allow me to mention just a few of the steps we have taken to make our game safer. We have lengthened our season by a week to give each team three bye weeks a year without a game, instead of two. We have eliminated contact in practices during the regular season and playoffs, which is one of the factors that has led to a 35% decrease in injuries in practice. We have added an injury spotter to our command centre, which monitors every play of every game from our Toronto headquarters, looking to identify an injury or player in distress that may not have been detected on the field or from the sideline. We put in place a comprehensive concussion protocol, which is updated annually in keeping with the best practices around the world, and which is managed exclusively by our medical staff and which, of course, removes a player from play if he has any symptoms of a concussion. It does not allow him to return to play until he is symptom free. We have introduced mandatory baseline testing at the start of every CFL season, so we can compare the brain health of our athletes, particularly if they have suffered a concussion or are recovering from one. We have put in place mandatory education on concussions for all of our players and officials, as well as information on the signs and symptoms of concussions, which are posted in every CFL locker room. We have introduced the use of player safety videos throughout the season that reinforce the need to eliminate dangerous and reckless play.

We co-hosted an international conference on collision sports from all around the world to share best practices and align on data collection and research. We participated in research projects that have, for example, examined active rehabilitation techniques for concussion recovery, measuring athletes' willingness to report concussions, and an assessment of the King-Devick test for diagnosing concussions. We have constantly updated our rules to put an emphasis on player safety. It is now illegal, for instance, to hit a quarterback from the knees down or from the shoulders up.

We work closely with our world-class medical personnel. We meet with them and learn from their counterparts in sports around the globe, and engage in ongoing education and training for our equipment manager and athletic therapists.

We are particularly proud of the fact that we have partnered with Football Canada to deliver a safe contact program. It has now trained and certified 13,000 amateur football coaches from across Canada in how to teach the safest blocking and tackling techniques.

Football Canada is also working to ensure that kids engage in full contact at appropriate ages. By January 2022, it plans to mandate that no 12-person tackle football can be played by anyone under the age of 12. Already, it is prescribed that there should be no tackle football played by anyone under the age of eight.

While we enthusiastically support tackle football for older age groups, we are putting a huge emphasis on flag football for young girls and boys. This year, the CFL and our member clubs invested more than $4 million in amateur football, much of it devoted to flag and touch football, as well as tackle football.

We want our youth to play the game and to play the game the right way—safely. When it comes to concussions and player safety in general, we do not pretend to have all the answers. We are always looking to do more and learn more. We work with our own doctors and other leading experts from around the world, but our commitment is clear.

I do, however, have two concerns that keep nagging at me.

The first is this. This singular focus on concussions, while addressing a valid concern, doesn't go nearly far enough. We keep focusing on one tree, albeit an important one, instead of the forest.

I personally believe we have to do much more to make the overall mental health of young people an important focus, and not just athletes but all young people. One in five teens experiences mental health challenges. Suicide is the second leading cause of death in this age group. However, we remain far more advanced in treating sprained knees than we do troubled minds.

This isn't a sports problem; it is a societal one. I believe sports can set an example by taking the mental health of our athletes as seriously as their physical condition.

Also, maybe if we can learn more about helping athletes handle the stresses of a season or a career, we can unlock better ways to help youth deal with the pressures of growing up, athletes with the pressures of juggling work and family, or our seniors with the pressures of growing older.

I would like the CFL to be the first professional sports league anywhere to start each season with a mental health assessment of our players as well as physical exams, not for evaluating an athlete but for diagnosis and treatment.

This can be an important element of concussion treatment, because there is growing scientific evidence that there is a link between concussion recovery and a patient's overall mental health, particularly depression and learning disabilities. The more we understand an athlete's mental health profile, the better we can understand his or her recovery from concussion.

This would be an expensive undertaking. The CFL is a Canadian institution. It is a major brand. It has a storied history. If we work to expand our international football footprint, as part of a strategy I call “CFL 2.0”, we have a bright future. However, unlike other leagues, we do not participate in the windfalls generated by giant U.S. markets like New York and California, and we are not rolling in dough. Therefore, we look to you and to government to help work with us.

We would very much welcome an opportunity to partner with the federal government on this. We could start with a smaller pilot project. It could even be a model not only for sport but for employers everywhere.

Finally, I am worried that the ongoing and often singular focus on concussions, magnified by the media and amplified by Hollywood itself, carries with it an unintended but tragic consequence. Too many kids are not playing sports. This is certainly true in football, where participation rates are steadily declining.

A study on sport participation done by the federal government in 2010 estimated 170,000 youth played football. Research for the CFL conducted in 2015 pegged that number at 136,000. Today, Football Canada estimates the total to be about 100,000, a 40% decline from a decade ago.

I respect all sports, but I can tell you that football has had a transformational effect on my life, and it has had that effect on millions of lives.

The game is incredibly inclusive. A football team needs athletes of all sizes and shapes and with all sorts of skill sets. Boys and girls can play touch football or flag football, as well as tackle football, or even just toss the football around with their friends. Football preaches discipline, teamwork and hard work. It teaches lessons, creates friendships and produces opportunities that literally last a lifetime.

Too many kids are missing out on that because they are missing out on football, and the singular focus on concussions is one of the reasons why. It has disproportionately affected football, when the fact is that other sports have higher rates of concussion.

Also, it has created a climate of fear instead of what we want, and what I am certain you want too, which is a society that encourages physical activity and participation in sport at the same time as it ensures that sport itself fosters a culture of health and safety.

Encouraging kids to be physically active and to choose sport, including the sport of football, has to be an urgent priority. The Government of Canada reports that obesity rates amongst children and youth in Canada have nearly tripled in the last 30 years. Diabetes has become one of the most chronic diseases amongst children and youth. A report from Children First Canada and the O'Brien Institute for Public Health found that, amongst youth, the number of hospitalizations related to mental health has increased 66% in the last year. The Toronto Star reported last year that 5,800 Canadian children and youth have committed suicide in the last 13 years, some of them as young as eight years old.

Isn't it obvious that some of those overweight kids, some of those kids who develop diabetes and some of those mentally ill kids would be healthier if they were physically active, if they had a welcoming place to play, a team to be part of and a sport to call their own? Is it possible that some of those kids who took their own lives might still be with us if they'd had a teammate to talk to, a coach to count on or a game or a road trip to look forward to?

Please understand what I'm saying. I want your report to call for more action on concussions, for more work, more research and more funding. Of course, we would welcome all three, but let's at least match that effort and funding with programs and dollars designed to encourage kids to play sports, including football. Let's invest in making certain that sport, including football, is possible and accessible in under-resourced and remote communities.

We have taken the Grey Cup to the Far North, to remote aboriginal communities, and we have conducted flag football clinics there. These were the three things we heard most: “We can't believe you're here; we can't thank you enough; we need you to come back.” Please help kids in every community, rich and poor, around the corner and in remote corners of our country, enjoy the benefits of sport in general and football in particular.

With all due respect, support for football in this country is underwhelming and disappointing. Years ago, the federal government adopted a funding model that favoured Olympic sports and international competitions. The result is that our homegrown game, Canadian football, which is part of our history, our heritage and our culture, is too often underfunded, understaffed and really underappreciated. At times, it can feel like it's under attack. Volunteers in every corner of our country do their very best, but it's a losing battle, and our kids are losing out.

In conclusion, Mr. Chair, please, we welcome meaningful recommendations on concussions. Those are very important. But we also ask that you and your colleagues in Parliament look beyond concussions alone to the mental health of not only our athletes but all youth. Please engage the CFL in that work. We want to lead the way with you, and please—this is so crucial—look at what our children and our youth are going through today, and don't make the mistake of scaring them away from sport and away from football. Encourage them to get off the couch and off the screen and out of the house. Do all you can to encourage them to play. Our kids will be healthier for it, our country will be stronger for it and our future will be brighter because of your work.

Thank you. I look forward to a conversation with you.

[The Chair, Liberal, Peter Fonseca]

Thank you, Commissioner. Thank you for your passion and your commitment to tackling concussion as well as the bigger picture of mental health.

We are going to move now into questions from our members and your answers.

Members, we may shortly hear the bells ringing. I want to ask for unanimous consent to stay here until a few minutes before we need to get up to the chamber to vote.

[Some hon. members]

Agreed.

[The Chair, Liberal, Peter Fonseca]

I see unanimous consent. Great. We are going to start with questions from the Liberal side.

Madam Fortier, you will commence. You have seven minutes.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Thank you, Mr. Chair.

Thank you to the witnesses for their presentations.

I know it's important to talk about the mental health of athletes, sports participants and young people. That said, since our subcommittee's mandate is to study sports-related concussions, it would be useful to hear you talk about that.

Do you do any research on concussions sustained by athletes in the CFL? If so, could you describe what exactly you're studying and how you approach the issue?

[Randy Ambrosie]

Yes, in fact, we are involved in a number of research efforts. While we don't have a self-contained research facility within the Canadian Football League, we are working with groups around the world of sport and engaging in research on concussions specifically.

Last year, for example, we co-hosted a conference on concussion sports that brought some of the leading experts in sports from around the world together to talk about the best practices in concussion protocols and to talk about some of the research that's going on to help us all gain a better and deeper understanding. We're constantly looking to partner in the world of concussion research and brain health research, and we try to do everything possible that we can be involved in with respect of concussion and brain health.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Has the research you've done or the stories you've heard given you ideas on how to change the culture and the way the game is played in order to protect athletes from concussions? If so, can you give us some examples?

[Randy Ambrosie]

It is a great question. I am so proud and honoured to say that the game has already changed more than you could possibly appreciate.

I'm an athlete who played in the 1980s and early 1990s, and I can tell you that this version of the game is very different. It's safer. When I first started playing football in Winnipeg, the techniques that we were taught were effectively “my nose to your nose”, so it was essentially teaching effectively a collision between the athletes who faced one another. Today, the techniques they're teaching children and ultimately that we're teaching the athletes at the professional level are far different.

The game used to be played vertically, where the combatants went at one another almost in a direct pursuit of one another. Today, the game is played horizontally, which is to say, if you watch offensive linemen, who I am one of, you'll note that on almost all plays, their first step is sideways. They're trying to gain ground. The game today has a very different fundamental dynamic than it had back when I played. The game, in my view, has never been safer in its history. We continue to look for ways to improve and evolve the game, but really, it is a combination of the way the game is taught and played, and the culture of the game is also changing.

I would submit to all of you that we are living in the echo of the two most violent decades in sport, the 1970s and 1980s. Back then, if you turned your TVs on in the evening, the highlights in sports were almost always the biggest collisions and the toughest fights. That's what we watched for. During those two eras, I think athletes were engaged in a very combative sport that was more focused on the physical combativeness than the version today. We've refocused on the beauty of their athleticism, the big catches and the big plays.

In fact, in my first season as commissioner, we called it the year of the catch, which was evidence of our own desire to reframe the narrative and the conversation around our sport, not so much for its pure physical toughness but for the beauty and the skill these athletes have.

The game has not just changed physically. I could take you through.... If we could come into the centre of this circle, I could show you just how differently the techniques are taught today than they were in my era, but the more important thing is that the culture is changing. Players are learning to take care of one another. There's a greater emphasis on respecting the fact that your competitor is an athlete who is, in our sport, making a living playing the game and needs to be respected. That's why we've been very tough on our discipline.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

I gather that you want to continue making the game of football safer. Although changes have already been made, my guess is there is still some work to do. Can you give us an example or two of how you're currently working on that front?

[Randy Ambrosie]

Again, thank you. That's a great question.

We just completed an exercise in reviewing what we call our rules committee process for the upcoming season. One of the changes we're making is to install an even greater penalty for making head-to-head contact with a quarterback. We're going to make that a greater point of emphasis and very punitive to the team that is engaged in that behaviour. We are going to further engage our command centre and our injury spotter to have them play a greater role in the officiating of our games. Our on-field officials will now be able to call up to the command centre and ask them for guidance and assistance in respect of what has happened on the field. Before the season begins, we're going to engage to talk to our teams and our coaches and ask them to emphasize just how severe the penalties will be for play that is dangerous and that disrespects the athletes who are wearing the other uniform.

In fact, the entire rules committee process was really centred around health and safety. How do we make the game safer? How do we play the game more safely? As much as I can tell you the game is different today than the game I played, there's always going to be work to be done. There's always going to be the next improvement to make. I think that's one of the great qualities of the human species; we're always reaching for the next improvement, and football is part of that endeavour.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Thank you very much.

[The Chair, Liberal, Peter Fonseca]

We are now going to move over to the Conservatives.

Dr. Kitchen, you have seven minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Mr. Ambrosie and Mr. Shamie, thank you very much for being here. I greatly appreciate it.

I truly believe that Canadian football is the best football in the world. I also believe the Canadian Football League is the best football league in the world. I appreciate that. It's a great game, and we need to get that out to Canadians.

I'm happy to hear you talk about youth and sport and trying to expand that down to our youth such that we continue to focus on them being active and educating them on the safety that's out there.

In your presentation that you talked about pre-season assessments and you talked about baseline testing for your athletes. I commend you for doing that. I think that will go a long way as we further research this important issue.

The Canadian Olympic and Paralympic Sport Institute Network also came out with a report recently that talked about baseline testing for athletes per se, especially in contact sports, etc.

What are your thoughts on that sort of baseline testing, not only for professional athletes but for our athletes as they develop from youth, from the playground up to that professional level?

[Randy Ambrosie]

We're hoping and encouraging that our best practices at the professional sport level will be adopted at the amateur sport level, but that's expensive. It's one of the reasons we're asking all of you, and asking the government, to reinstate better funding for the game of football. We are a very underfunded sport today. If you look at the overall Sports Canada funding, we are well down the list. This is one of Canada's great games, yet we struggle for funding. I visit with amateur football coaches and amateur football leaders from across the country, and they all say the same thing: They're starving for resources.

Part of the answer is to set a good example that these baseline tests are important. It's an important part of understanding where an athlete is so that in the event of an injury, they can better assess their recovery. In order to do that and in order to have that trickle-down effect, we're going to have to have the government help us with funding.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I infer from that that you believe if these leagues could afford to do that, it would be worthwhile doing so they would have that baseline as they watch their athletes play.

[Randy Ambrosie]

Absolutely.

Again, I think of professional sports as a place where best practices are encouraged and developed and those best practices are shared. In fact, that has been a theme of these past two years. Stephen Shamie and I, as well as our colleagues and our board of governors, say frequently that there's room in the CFL tent for everyone. We are a community that wants to bring the rest of the football community, and frankly all Canadians, into our world and share with them the things that we know and that we're learning.

We're working hard right now with university sports and junior sports all to share what we're learning and what we know. The only thing missing with respect to being able to do that more effectively is to make sure we have the financial resources and support to do it.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

That leads me into my next question, about the King-Devick assessment, which you mentioned in your report.

For those of you who don't know, it's a two-minute, quick assessment. It's a very high-sensitivity and high-specificity test, but it also comes with a cost.

When you're talking about that, there is the issue of cost. As we move forward, how do we further educate our trainers, our sideline coaches, and so on, on these aspects, on this one in particular, because there is a cost to it? You have an annual cost to use it.

[Randy Ambrosie]

Yes. The answer is that group, and as we think about the health and safety of our players, everyone is part of it. If you looked at a team, you would note that our equipment staff, trainers, athletic therapists and doctors are part of an ecosystem to help keep our players safe. Creating the resources for them to share all that they're learning and all that they know with their counterparts in amateur sport could be an important feature in making the game safer for the amateur athlete. We're happy to do that.

If you could only know, and Dr. Kitchen, I know you know and love the CFL, but if I could somehow try to share and convey with all of you just how amazing these people are that I get to work with every day, that Steve and I get to go to work with, these are some of the greatest Canadians in this country. They love not just the game of football, but they love the country, and they are willing to share. Our owners, our team leaders, our coaches and our presidents of the teams all want to share what they know and what we do with the world of sport. Our players are amongst the most selfless and most giving athletes in the world and will go anywhere you ask them to, to share the knowledge that we have and the great messages we have in our game.

We can do so much more with your help.

[The Chair, Liberal, Peter Fonseca]

You have about one minute.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Okay, thank you. I still have more time. I thought I was done. I'll very quickly ask another question.

In our last committee meeting, Mr. Gordon Stringer was here. His daughter Rowan tragically passed away from a head injury. In Ontario, we have Rowan's law.

I will paraphrase something he said when he was talking about education. I believe that aspect of it is education, education, education, educating right down to our youth not only in high school, but in elementary school where they're playing flag football, and so on, which means having that sport health attitude to teach our kids to be stronger and healthier.

Would you agree with that and would you support that?

[The Chair, Liberal, Peter Fonseca]

You have 30 seconds.

[Randy Ambrosie]

Yes, absolutely. As I said, the culture change we've been undergoing needs to be shared, teaching athletes to respect one another, to see each other not just as competitors, but essentially as allies in the game. Anywhere we can share the message of how the game should be played and respect for each other as athletes and sharing that right through the food chain is important.

Again I would emphasize that our players, athletes, coaches, presidents and administrative staff all want to do more to help the amateur sport community.

[The Chair, Liberal, Peter Fonseca]

We're going to move to Ms. Hardcastle, from the NDP.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Thank you very much, Mr. Chair.

Thank you, Mr. Ambrosie, for setting out your statement and your stance for us here.

I wonder if you can help us understand a bit better the situation with the CFL. Why has the CFL failed to acknowledge, or refrained from acknowledging, the link between concussions and brain disease?