It seems a question not even worth asking.
Which sport is more dangerous when it comes to head injuries – full-contact male football or no-bodychecking female hockey?
The answer will certainly surprise Canadians.
According to the New York-based Women's Sports Foundation, a survey of American studies of high-school and college athletes suggests that "girls and women suffer from concussions at higher rates than boys and men in similar sports – often significantly higher."
"Across all sports in the study," the foundation reported, "the highest rate of concussion was reported not by male football players, but by female hockey players."
This reality struck home for Bu-Kahn (B-K) Lam, a cardiac surgeon at the University of Ottawa Heart Institute and Antoinette Corvo, a pediatric anesthesiologist at the Children's Hospital of Eastern Ontario. They were shocked earlier this winter when their 10-year-old daughter Francesca came down for breakfast and announced "Mommy … I'm not right."
They knew then it was serious.
The day before there had been an incident at practice, though most of the adults present said they had seen nothing. Francesca had been sent headfirst into the boards by a teammate after a simple drill. There had been tears and a headache and the parents had checked through the night, but in the morning the youngster said, "I look normal – but I don't feel normal."
Francesca was diagnosed with a concussion. By February, she was back to her normal self but she was no longer in competitive hockey.
The two doctors know only too well that injuries can happen. B-K Lam has played hockey all his life and is a minor-hockey coach. Francesca and younger brother Matteo, 8, are active and physically gifted. Francesca dreamed of one day playing for the McGill Martlets women's hockey team. Now, her parents have taken her out of the game she loves more than any other.
There was a hearing and an appeal and there are dozens of pages of documents, but this is not about who did what or who saw what when. The local organization met, heard everyone out and concluded that "no additional disciplinary measures should be taken against the offending player or the relevant team officials."
But the appeals committee did agree that the organization would be addressing three expectations laid out by Francesca's parents: mandatory education on hits to the head, a revised code of conduct and the creation of a discipline committee.
Drs. Lam and Corvo had hoped for much more. They wanted to see the creation of a quality data base on minor hockey concussions. They wanted hard, mandatory rules. "If they can do it for helmets," Dr. Corvo said, "they can do it for this." Most of all, they wanted more education.
"There was no learning on the spot to the player who hit Francesca," said Dr. Lam. "It was an opportunity lost."
If there is opportunity here, they are determined it not be lost. They worry that with all the talk about concussions – their possible effect raised yet again this month with the death of 35-year-old former NHLer Steve Montador – not enough attention is paid to minor-hockey head injuries and, in particular, to concussions suffered by young girls and women.
"We worry about the professionals, we worry about college players," said Dr. Corvo, "but what of the 10-year-olds like Francesca? Who is advocating for these people?"
The problem apparently exists across all sports. In a Washington Post commentary, Marjorie A. Snyder, senior director of research for the foundation, said the studies show that female softball players experience concussions at double the rate of male baseball players and that the injuries were also higher for basketball and soccer.
That young women in hockey are in danger of concussion isn't a surprise to Kristian Goulet, the pediatrician in charge of the concussion clinic at the Children's Hospital of Eastern Ontario. Dr. Goulet is himself a former junior and college player and has noted the number of female players getting injured.
The theories behind the preponderance of girls and young women suffering from concussion vary from weaker neck structure to less reluctance to report. Dr. Goulet says that, despite dealing with 3,000 cases, the injury remains a mystery. "Even as physicians we don't really know what a concussion is," he said.
"By the time you see me it's not even a concussion usually – it's a psychosomatic thing. What 'concussion' is to me is really a mental-health issue."
The medical treatment of the child is one matter, but the reaction of the parents is another. The child might fully recover but the parent has already decided that there will be no further such activity, which Dr. Goulet believes is a mistake.
"I like to tell people that concussions are like the ocean," he said. "You have to respect the ocean. You have to be aware of rip tides and undertows and the like – but you should not be terrified of it. You can still enjoy the ocean so long as you respect the dangers."
To him, education is the key. "You have to change the culture," he said. "People are starved for information and they want to do more.
"My hope is that the pendulum that has swung one way will return to the middle – with sport made as safe as you can make it for children."
The suggestion that there be a national database for reporting concussions strikes Dr. Goulet as difficult to do with reliable consistency. This opinion is shared by Hockey Canada, the Calgary-based organization that overseas all minor hockey in the country.
"The real challenge would be the accuracy and integrity of 'self-reporting,'" said Paul Carson, Hockey Canada vice-president of development.
Mr. Carson says there are mandatory safety education elements already in place. Within Hockey Canada's coach education requirements there is a Coach Stream program and a Respect in Sport Activity leader program. At coaches' clinics, the safety issue is again discussed at length. Various courses on the prevention and care of injuries are mandatory for all personnel. Hockey Canada even provides a concussion "app" for smartphones and tablets.
Some local branches, but not all, have made mandatory a Respect in Sport Parent Program that also deals with injuries and the proper protocol to follow before an injured child returns to play. When dealing with parents and players, Hockey Canada can only recommend, and has its own safety course with a section on concussion awareness that it hopes parents and players take. The organization also recommends that each team have a designated safety person to ensure that the best information is available and shared.
Hockey Canada would like nothing better than for more grassroots organizations to embrace as much information as possible on safety, though Mr. Carson cautions that "It takes more than mandatory positions on some of these items to change the behaviour" of some involved in minor hockey.
A sometimes-forgotten solution, Dr. Goulet would suggest, is simple common sense. "If someone takes a big hit and there is any indication at all of a possible concussion," he said, "you just pull them. Doesn't matter if it's a game or a practice."
"Something good has to come of this," said Dr. Corvo.
Francesca's father, Dr. Lam, says all coaches have an obligation. "If you're going to coach a team," he said, "coach because you want to be part of the organization and not just there for your son or daughter. If there's an issue, you should always err on the side of being safe."
As for his daughter, Francesca says that she will return to play house hockey next year, and might one day again try competitive.
"If it's safe," she said, "I would."