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Medical experts would ban hitting until 15 or 16.Peter Power/The Globe and Mail

Concussion symptoms last significantly longer for student hockey players in earlier stages of puberty, according to a new U.S. study that warns younger players should be discouraged from "playing up" with older, more physically mature athletes.

The study, published last week in the Journal of Pediatrics, found teenage boys who were less physically developed took an average of 54 days to recover from a concussion. That was about three weeks or nearly 40-per-cent longer than the average recovery for those who were in more advanced stages of puberty.

Lead author Dr. Peter Kriz, of the department of orthopedics at Rhode Island Hospital, explains that talented young athletes are often encouraged to "play up," or to play at a higher level with older, more advanced players, to give them opportunity to develop skills. In some circumstances, 14-year-olds may be grouped with players aged 18 and under, he says.

"The potential injury risk, specifically with concussion, probably outweighs the benefits of developing skill," says Kriz, a sports-medicine physician affiliated with Brown University. "What we see is sometimes those really skilled, younger, undersized players accrue a few injuries, and then, unfortunately, they can't really sustain contact. They get symptomatic and in some cases they have to leave the sport."

The study examined data from 145 hockey players, both male and female, ages 13 to 18, who visited three sports-medicine clinics with concussions. Concussion symptoms included signs such as headache, dizziness, difficulty concentrating and disrupted sleep. The players were also asked about their puberty development, using a validated self-assessment rating scale that involved questions such as whether their voice had started deepening for boys, and whether they had begun to menstruate for girls.

Among the 101 male participants, those in the "early" puberty category reported concussion symptoms that lasted longer. Heavier male players were less likely to experience prolonged symptoms. Unexpectedly, among the 44 female participants, heavier players had a higher risk of longer-lasting symptoms, though the researchers noted this result "may have more statistical than clinical significance."

One of the limitations of the study was that roughly 44 per cent of the participants visited one of the three clinics within the first 10 days of their injury, Kriz says, noting the delay in seeing a clinic doctor may have affected the recovery times of the rest of the players. This delay, however, is common for patients seeking treatment at specialized clinics, he says.

Over all, the findings support growing concern that it may take longer for adolescent athletes to recover from concussions than adults.

Questions about whether to ban or delay the introduction of physical contact have been subject to much debate in youth hockey, as growing research points to the prevalence and health consequences of concussions in contact sports.

The American Academy of Pediatrics advises against bodychecking before the age of 15, and recommends youth hockey organizations expand their non-checking program. In their study, Kriz and his fellow researchers support this latter recommendation.

"I'm all for endorsing proper bodychecking technique, and kids need to learn that. That's a point of emphasis here, no question," Kriz says. But, he notes, they need to be learning with peers at the same relative age. "They shouldn't be learning how to bodycheck when they're playing in a game against someone three or four years older. That's probably going to be a set-up for failure and injury."

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