Protecting children playing hockey, soccer, football, basketball and baseball from serious brain injuries could take simple solutions like padding goal posts and enforcing existing rules, a Canadian study suggests.

Researchers used data from 12,799 kids aged five to 19 who went to emergency departments across the country over nearly 20 years for brain injuries and categorized them by players' ages, sports and how the injury was sustained — being struck by a player, an object such as net or ball, or playing surface.

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Player-to-player contact and hitting from behind were the main causes of brain injuries in hockey. (Scott Takushi/Pioneer Press/Associated Press)

In Thursday's issue of the journal PLOS One, they said hockey accounted for 44 per cent of all injuries and almost 70 per cent of them occurred in children over age 10 from player-to-player contact or being hit into the boards.

"One surprising finding was despite having a rule in hockey for the last 20 odd years about hitting from behind, the hitting from behind is still a common mechanism," said Dr. Michael Cusimano of the neurosurgery division at St. Michael's Hospital in Toronto, where he treats people with brain injuries like concussion and studies prevention.

The findings included:

  • Hockey: Checking into the boards caused the greatest proportion of brain injuries.
  • Soccer: 19 per cent of youth who suffered brain injuries got them on the pitch, with most in the 10-to-14 or 15-to-19 age group. In those age groups, high kicks to the head or head-on-head collisions were the most common reason. For children five to nine, striking a surface or a goal post was the most likely source of the head injury. It's for these youngest players that the researchers suggested using moveable goal posts that are padded.
  • Baseball: Baseball accounted for 15.3 per cent of brain injuries. Most of them occurred in children under the age of 14, with 45 per cent in children under nine. Ball and bat injuries were common, mainly because teammates stood too close to the batter or bat and weren't supervised by an adult.
  • Football and rugby: Accounted for 12.9 per cent and 5.6 per cent of injuries, respectively, mainly caused by tackling.
  • Basketball : 11.6 per of injuries, mostly caused by elbowing, which increased as players got older and more competitive. Younger players tended to strike fixed structures like posts.

Overall, injuries tended to happen in the afternoon and evening with more players heading to emergency during the fall and winter.

For 2010-2011, the Canadian Fitness and Lifestyle Research Institute said soccer was the most common sport played, at 38 per cent for those aged five to 17; followed by hockey or ringette at 23 per cent; swimming, 17 per cent; basketball, 15 per cent and baseball, 10 per cent.

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Children playing baseball need to learn about keeping a safety zone around the batter. (Mike Kittrell/Press-Register/Associated Press)

For both hockey and soccer, the most popular sports, Cusimano suggested greater enforcement of rules against hits to the head and high kicks are needed, with incentives and disincentives for leagues, officials, players and parents to get the message and change behaviour.

Laura Calce, a physical education teacher at Birch Cliff Public School in Toronto, agreed and makes safety and skills training key parts of her lesson plans.

"I do think that we encourage kids to play at such a level of intensity that I think they confuse intensity with aggression," said Calce, who has two sons who play hockey. One had a concussion.

The research was funded by the Canadian Institutes of Health Research and the Ontario Neurotrauma Foundation.