Time to put legislative teeth into the concussion debate

Time to put legislative teeth into the concussion debate

'We are starting to make gains, especially with treatments for post-concussion syndrome,' says brain injury expert Charles Tator

By Dr. Charles H. Tator for CBC Sports
August 23, 2017

When I was a boy I was obsessed with sports: my heroes were Turk Broda, Syl Apps, Teeder Kennedy, Gordie Howe, Ted Lindsay, Johnny Bower, and Howie Meeker, to mention only a few.

I was a hockey fan, hockey player, and hockey obsessed. I skated to school, played pick-up hockey at West Prep elementary school in Toronto with the Delzotto brothers (from Tridel) who were as good as the NHLers, at least it seemed that way to me. I was good enough to make my high school hockey teams — the Forest Hill Falcon — both junior and senior teams.

Dr. Charles Tator, concussion specialist, has seen the devastation brain injuries have caused pro athletes. (CBC) Dr. Charles Tator, concussion specialist, has seen the devastation brain injuries have caused pro athletes. (CBC)

Putting on the team hockey sweater was a thrill! I was not a star, but I had a great time. I competed in the “2-mile Joe Lake swim” at Camp Arowhon in Algonquin Park when I was 13 and had one of the fastest times in camp history. Playing for the University of Toronto Meds hockey team was also great. So yes, sports were important to me growing up.

I benefited from the exercise, the camaraderie, the team spirit, and the lifelong friendships. That is why I recommend participation in sports for most kids, including collision sports, like hockey. Yes, I was also interested in sport safety when I was young.


I got my bronze medallion from the Royal Lifesaving Society as a teenager. My mother was safety obsessed, and it probably rubbed off. Later in my life, as a brain and spine surgeon specializing in trauma, sports took on a different light and became very important to me in a way that I had never previously imagined. 

I found myself playing on a different type of team doing battle with terrible enemies called brain injury and spinal cord injury. The fight was now to save an athlete’s life after a brain injury in football or skiing, or to try and restore movement to an athlete’s arms and legs after a broken neck in rugby, diving or hockey.

I learned first-hand that the sports I loved could put a player in a wheelchair for life. These sports-related encounters in the emergency department, ward or operating room were often terrible for the athlete, their families and for me because all my learned skills were often insufficient to put the pieces of the brain or spinal cord back together again.


It became clear to me that the only uniformly effective treatment for major injuries is prevention, and that successful prevention is a “team sport” that had to include the athletes themselves, their parents, coaches, teachers, referees and leagues.


Awareness of concussions

I collaborated with many sports organizations to prevent injuries in hockey, diving, swimming, football, soccer, skiing/boarding, motor sports, equestrian sports and others. I also attempted to recruit governments and professional athletes for the prevention team. “Smart Hockey with Mike Bossy” was a great kids’ video we made aimed at preventing broken necks in hockey. We created many special programs like the “Concussion Road Show” that travelled across the country, and I went to countless schools to tell kids how to protect themselves. The message was “play safer to play longer.”

Hockey great Mike Bossy was part of a video focused on preventing broken necks. (Bruce Bennett/Getty Images) Hockey great Mike Bossy was part of a video focused on preventing broken necks. (Bruce Bennett/Getty Images)

ThinkFirst Canada and its successor Parachute Canada were the injury prevention organizations for which I volunteered, and they made a huge impact on the country’s awareness of concussions. Indeed, it is very likely that Canada will soon adopt concussion legislation to put teeth into concussion education and management.

Do injury prevention efforts work? With broken necks, we changed the rules in hockey and told players about the risks of hitting from behind into the boards, and then with the registry we developed in 1981 we showed that there was a decline in the number of hockey players ending up in wheelchairs. The last Canadian Ice Hockey Spinal Injuries Registry report in 2016 covering the years 1943-2011, showed that in the peak years of 1990-92, there were 18 spinal injuries per year in hockey in Canada, whereas after the injury prevention programs, spinal injuries dropped to five per year in most years from 2001-10 (Clinical Journal of Sports Medicine, 2016). Yes, sports injury prevention works.

Looking back at 50 years of work, I think I have had a hand in preventing some injuries in sports and recreation. It is always easier to count the ones you did not save: the deaths and disabilities are there for everyone to see. 


In hockey, you can add up the number of saves a goalie makes. The “saves” of lives or injuries are much more difficult to count, although the spinal injury example shows that it can be done. Registries are expensive, but the total cost of the Canadian Ice Hockey Spinal Injuries Registry for the 35 years it has been in operation is a small fraction of the cost of looking after one 18-year hockey player who ends up in a wheelchair for life.


Legislation to prevent deaths

I was thrilled in 2015 when the Prime Minister of Canada wrote to the Ministers of Health and Sport and asked them to do something about improving the management of concussions in this country. To accomplish this Parachute Canada was appointed to “harmonize” the concussion guidelines for all sports so that the messaging to athletes and their families would be more uniform and more effective. I co-chair the committee that is working on this, and soon we will have Canadian Harmonized Concussion Guidelines for most sports.

Former Philadelphia Eagles safety Andre Waters’ suicide was chronicled in actor Will Smith’s movie Former Philadelphia Eagles safety Andre Waters’ suicide was chronicled in actor Will Smith’s movie "Concussion." (Gene Sweeney/ Getty Images)

I am also on “Rowan's Law Committee,” created by the Government of Ontario to develop better ways including legislation to prevent deaths from brain injuries like concussion in school-based and non-school based sports. Our view that concussions are a public health concern has been accepted. In 2010, I started the Canadian Concussion Centre and the Canadian Sports Concussion Project at the Toronto Western Hospital to do research on why some people do not recover from concussions, and to discover treatments for concussion.

Unfortunately, there are very few evidence-based treatments for concussion, but we are starting to make gains, especially with treatments for post-concussion syndrome which can be very disabling because of headaches, dizziness, anxiety, depression and many other symptoms.

My induction into Canada's Sports Hall of Fame this year was another thrill, and it was not because of my play for the Forest Hill Falcons or for the Joe Lake swim, but rather the citation said it was for my role in injury prevention.

At the recent Calgary Sports Hall event I was on the stage with the other inductees, including my sports heroes like Mike Weir, Lanny McDonald and Cindy Klassen.

Cassie Campbell-Pascall was the moderator and asked each inductee to tell the story of their most memorable sports achievement. I was last to speak, and heard the wonderful stories of all the other seven inductees which included Cindy’s story about her six Olympic medals, Mike’s Masters win, and Lanny’s Stanley Cup title.


After hearing their great and inspiring stories, I was very concerned about what I would say because I had no outstanding sports moments or achievements, except for one. I stated that my greatest sports achievement was tonight by being elected into Canada’s Sports Hall of Fame, and that I accepted the win on behalf of my sports injury prevention team across the country. It was my greatest sports achievement because in electing me, Canada’s Sports Hall became a member of my sports injury prevention team. With my induction, I joined the Hall’s team, and the Hall with all its great athletes joined my sports injury prevention team.

(Large photos by Getty Images/The Associated Press)

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