Cody Kusch and the Seafair Minor Hockey Association of Richmond, B.C., have heard the rebukes – baseline testing for children before they suffer a concussion is neither required nor reliable nor recommended. For Kusch, a vice-president of the association who was just 14 when his career as a player ended with a concussion and a fractured neck, those words are perturbing – "100 per cent."
But Seafair's baseline program has a noteworthy supporter: Harvard Medical School, where researchers are so keen to access the hockey association's data that the Ivy League institution is covering the cost of testing every player in the organization, from 10 and up, for the 2017-18 season. It's an indicator of how concussions remain a foremost issue in minor hockey and how the testing is considered a valuable tool by some yet openly dismissed by many in the hockey and medical communities.
Baseline testing involves athletes answering a series of questions and completing problem-solving exercises, with the results used as a benchmark when an athlete is suspected of having suffered a concussion. The national injury-prevention charity Parachute Canada issued a statement in August that said "current evidence does not support a significant added benefit of baseline testing in youth athletes … it is not necessary and not recommended at this time."
More: Read excerpts from Game Change, Ken Dryden's new book on hockey and head injuries
It's argued the tests are not always administered by licensed health-care professionals and can thus be misleading. It's also often said there isn't enough clinical proof that baseline testing is worth the effort or the cost, as some companies charge as much as $100 per test.
"The challenge with some of the baseline tests is that as kids grow and develop, the way they score on some of the tests will also change," says Dr. Kathryn Schneider, a researcher with the Sport Injury Prevention Research Centre in the University of Calgary's faculty of kinesiology. "There may be environments where a physician or a physiotherapist or a team therapist working on a regular basis with the team knows the athletes. … In some cases it may be a benefit, but that tends to be more the exception than the rule."
Kusch counters such talk by pointing out that Richmond-based Evolution Sport Therapy has been doing the tests for a mere $10 per child and that "[Harvard researchers] are fully in favour of it because they see our testing being way more consistent – because we have athletic therapists doing all the initial testing. We've done it over the past eight years using all the latest assessment tools. … We've seen a decrease in concussions. We get about 25 per year in our association of more than 400 players."
Kusch was seriously injured in a bantam game 30 years ago after being checked from behind into the boards. His doctor told him that in treating other patients who had suffered the same injury, he found that 99 of them had had their spine severed. Kusch's spine was pinched. He was called "a walking miracle" – but told he could never again play a contact sport.
Wanting to protect young players, he has helped Seafair become one of the more progressive minor hockey organizations in Canada. It was his collaboration with University of British Columbia psychiatrist William Panenka that led to Harvard's interest. (Panenka had done previous work with Harvard and knew Grant Iverson, a former UBC professor who had joined the U.S. school's department of physical medicine and rehabilitation.)
While skeptics have questioned the legitimacy of baseline testing on children and teenagers, the information compiled by Seafair was too rich to ignore. So, too, is the fact the NHL, NFL, NBA and Major League Baseball all have baseline testing as part of their concussion protocol.
"We're getting good data for the kids, for their doctors, for the other people who will care for them when they get a concussion," Panenka says. "All the sports organizations that can do [baseline testing] well will continue to do it."
Hockey Calgary ignited a national discussion five years ago when it tried to ban body checking in peewee as a way to reduce head injuries. What prompted the push was a study by the University of Calgary that showed Alberta peewees were three times more likely to be injured – and four times more likely to be concussed – than their counterparts in Quebec, where body checking at that level was not allowed.
A follow-up study released this year showed that since a body-checking ban was put in place across the country by Hockey Canada for the 2013-14 season, there has been a "50-per-cent relative reduction in injury rate and a 64-per-cent reduction in concussion rate" among peewee players in Alberta.
Teams and associations rely on Hockey Canada's concussion guidelines for recognition, rehabilitation and prevention, but they also set their own agendas. For example, in 2015, the Greater Toronto Hockey League – the country's largest minor hockey organization, with more than 40,000 players – voted to eliminate body checking at the minor bantam A level. The same year, Hockey Quebec banned body checking from the lowest levels in bantam and midget. Last season, Hockey Edmonton did the same, allowing only AA and AAA bantam players to throw hits at one another.
For its part, Hockey Calgary has banned body checking from bantam division 4 and lower as well as from midget division 5 and lower. And to remind people what to do if a player appears to have suffered a head injury, it has given 1,000 coaches a clipboard with the concussion protocols written on it for easy reference.
"I look at it that we are the ombudsmen [for player safety]," says Hockey Calgary's executive director, Kevin Kobelka. "Do we have the right [dividing] line? Is it division 3? We chose division 4. … We've taken a stand and we've actually seen that our [bantam registration] numbers haven't dropped. Our numbers have even grown a little from doing this."
Wouldn't it make more sense to reach a national consensus for all levels of minor hockey?
"Hockey Canada sets policy and regulations – at a minimum standard level," wrote Paul Carson, Hockey Canada's vice-president of hockey development, in an e-mail. "But it is important to keep in mind that it will be difficult to standardize beyond the minimum standard because there will always be adjustments made. To be fair, the standardized regulation is set at the peewee level."
The Saskatchewan Hockey Association (SHA) was the lone dissenter in 2013, voting against a body-checking ban. General manager Kelly McClintock insisted the SHA membership was strongly supportive of leaving body checking in the peewee game so kids could learn how to hit and take a hit before moving on to bantam and midget. That support remains, as does the question: Precisely how many kids are concussed during a season?
"The majority of concussions, I don't believe they're reported to Hockey Canada," McClintock says. "It means parents filling out an injury report to our office through to Hockey Canada so there's a tracking. I would say there really isn't a good measure of whether there are concussions."
Todd Jackson is the director of insurance and risk management at Hockey Canada and acknowledges that "concussion surveillance is one of the biggest challenges.
"We have a little bit of tracking through our insurance program but we don't hear until there's some after-care that needs to be taken."