Sports Medicine Research: In the Lab & In the Field: “Playing Up” May Be Putting Young Athletes on the Bench For Longer Periods Following Concussion (Sports Med Res)
Wednesday, February 24, 2016

“Playing Up” May Be Putting Young Athletes on the Bench For Longer Periods Following Concussion

Physical Maturity and Concussion Symptom Duration among Adolescent Ice Hockey Players

Kriz PK, Stein C, Kent J, Ruggieri D, Dolan E, O’Brien M, Meehan WP. J Pediatr. 2015: ahead of print

Take Home Message: Among adolescent ice hockey players, early pubertal stage is associated with longer concussion recovery in males. Young players should be discouraged from “playing-up.”

Due to the cost and equipment restraints, many high schools lack age stratification in youth ice hockey leagues. Therefore, it is not uncommon for younger, less physically mature players to oppose more mature players that are faster and stronger. Currently, there has been little research investigating concussion injury risk due to level of physical maturity within these athletes. Therefore, the authors conducted a prospective study within 145 high school ice hockey players (101 boys and 44 girls) ages 13 to 18, seen at 3 outpatient concussion clinics (Rhode Island Hospital, Boston Children’s Hospital, and South Shore Hospital) to investigate the association between physical maturation and risk of prolonged concussion symptoms (more than 28 days). At an initial evaluation the authors collected demographic, anthropometric, and injury data. During initial and follow up appointments the authors used the Post Concussion Symptom Score (PCSS) and a computerized neurocognitive assessment to measure concussion sign and symptom severity and duration. The authors compared these assessments to baseline when available. Then, time to symptom resolution was measured from date of sign and symptom onset to the date the athlete self-reported no longer experiencing symptoms from his/her concussion. Athletes were grouped by pubertal development (early or late) using the Pubertal Development Scale, which involved 5 or 6 items about his/her physical growth (height, body hair, skin changes, facial hair, voice changes in males, and breast growth in girls). The average duration of concussion signs and symptoms was 45 days. Almost 50% had concussion symptoms for more than 28 days. Male players in the early pubertal category (45%) had longer symptom duration than those in the late pubertal category (55%). Additionally, weight, pubertal development score, and initial PCSS were each independently associated with prolonged symptom resolution time (28 or more days). Specifically, lighter weight, higher PCSS and early pubertal development scores were associated with increased odds of experiencing prolonged symptoms. Most of the girls were in the late pubertal category (87%). Additionally, most girls played in girl-only leagues (96%). Only, heavier weight had an increased probability of experiencing prolonged concussions within the girl cohort.

The authors determined that there is an increased risk for prolonged concussion signs and symptoms among the male adolescent ice hockey players. Both their weight and pubertal development scores were associated with longer concussion sign and symptom duration. This suggests that stratification by weight or physical maturity may be beneficial for youth ice hockey leagues. Physical maturity was not found to be problematic in the girl’s cohort; however, it may be important to confirm these results in a study with more women who are in the early pubertal category since this study only had 5 female players in the early pubertal category. Heavier weight was found to be associated with longer signs and symptoms; however, this may be statically significant and not clinically significant. It was also interesting to note that nearly 50% of this cohort suffered from prolonged concussion sign and symptom duration, and the mean time for full symptom recovery was 45 days. Compared to previous reports (football and soccer), where nearly all athletes recovered in 28 days these athletes on average suffered concussion signs and symptoms an extra 20 days. Further research should be done to determine if this increased recovery time is due to participating in youth ice hockey, the age of the population, or other risk factors. For now, medical professionals should educate athletes, parents, and coaches on the risk of playing with more mature players, especially when the athlete is not physically mature. Medical professionals can also use this study to help young ice hockey players understand how long they may be symptomatic after a concussion.

Questions for Discussion: How often do you see athletes “playing up?” Do you think there should be stratification to reduce risk of concussions?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:
Sport-related Concussions: Knowledge Translation among Minor Hockey Coaches


Kriz, P., Stein, C., Kent, J., Ruggieri, D., Dolan, E., O'Brien, M., & Meehan, W. (2016). Physical Maturity and Concussion Symptom Duration among Adolescent Ice Hockey Players The Journal of Pediatrics DOI: 10.1016/j.jpeds.2015.12.006

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