The Sport Information Resource Centre
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The Sport Information Resource Centre

Highlights


“You have a concussion.” These are words that no athlete wants to hear. What exactly does it mean? Perhaps a full stop to sport-related activities. Or, no longer being able to practise, train or compete. Maybe uncertainty around recovery times or a return to play, and questions about future risks and implications.

In recent years, the conversation around concussion and its short-term and long-term effects has become a larger part of the sport injury prevention landscape (Davis et al., 2020; McCrory et al., 2017). In a departure from historical associations, the dialogue about brain injuries is no longer limited to high-risk, impact sports. Sport-related concussion and brain trauma is now in the forefront of the modern sporting world, with high-profile cases in professional leagues, players’ class-action litigations, and emerging concerns about potential risks for neurodegenerative disease (for example, chronic traumatic encephalopathy).

For many sport organizations, this heightened focus on concussion has meant increasing efforts to develop and implement preventative strategies, which can help protect participants from suffering concussions in their sport. Athletic careers can be paused or permanently ended because of concussion injuries and related consequences (Bergeron et al., 2015; Sedney et al., 2011). Therefore, it’s important to improve all sport stakeholders’ knowledge about concussion signs, symptoms and management strategies. That applies to participants, families, coaches, trainers and other sport personnel (Tator, 2012).

But beyond educating stakeholders, what other steps can sport organizations take to reduce the risk of concussion across all levels of sport and recreation? Similar to other types of sport injuries, it’s important to first understand the burden of injury that athletes face, and focus on evidence-informed injury prevention strategies. Such strategies combine the best research practice with real-world practice and expertise (Pike et al., 2015).

How should sport organizations continue to address this issue and focus their efforts on developing interventions for concussion injury prevention in their respective sports? Ineffective strategies often continue to be practised at great expense to existing resources (Pike et al., 2015), without successfully protecting athletes from concussion risks. With limited resources available, it’s critical that sport organizations invest in strategies that are most likely to effectively reduce the risk for injuries. Taking an evidence-informed approach to injury prevention is vital to planning and implementing interventions targeted at reducing concussion in sport.

In this article, we describe the processes that have informed Volleyball Canada’s approach to concussion prevention research, how we’ve used data to inform our concussion prevention strategy, and what we’ve learned along the way.

The E’s of sport injury prevention

Parachute, a Canadian national charity dedicated to injury prevention, highlights “The Three E’s of Injury Prevention” in The Canadian Injury Prevention Resource. The E’s (education, enforcement and engineering) were first developed for industrial safety. They’re frameworks that can help guide the development of community-based, injury prevention programs and initiatives.

Signs of a concussion - headache - dizziness - ringing in the ears - memory loss - nausea - light sensitivity - drowsiness - depression We all have a responsibility in recognizing a possible concussion following a hit to the head or body. If you're experiencing even one of these symptoms, stop playing, sit out and find help. http://ontario.ca/concussions Source: Rowan's Law, the  Government of Ontario

Other injury prevention and public health researchers have expanded upon these key concepts with 2 additional E’s to consider (epidemiology and evaluation) when taking evidence-informed strategies to injury prevention interventions (Pike et al., 2015; Tator, 2012).

A “sequence of prevention” model for injury research

Cover of Canadian Injury Prevention ResourceIn 1992, Van Mechelen et al. described a “sequence of prevention” model for injury research, which others have built and expanded upon to guide modern public health initiatives for injury prevention (Pike et al., 2015). Grounded in this sequence of prevention model, the Canadian Injury Prevention Resource outlines 5 functional elements to successfully help prevent injuries:

Step 5 is often overlooked. However, it’s extremely important in figuring out whether an intervention has been successful in reducing injury risk. This frequently means revisiting Step 1 to re-identify the extent of the injury (Tator, 2012, Van Mechelen, 1992). This evaluation process is, ideally, an ongoing component of the initial Step 1 process rather than a separate step altogether.

It’s also important to note that these 5 steps don’t have to be completed in order. Since sport organizations often have limited resources, they may need to adapt to real-world circumstances to make efficient use of their time and efforts. To do so, sport organizations should focus on developing strategies and interventions that are both targeted and sportspecific for reducing the risk of concussion (Pike et al., 2015; Tator, 2012).

Concussion prevention research with Volleyball Canada

Although concussions happen in volleyball, there’s been little evidence-based research informing prevention strategies in this sport. Using the sequence of prevention model, Volleyball Canada set out to understand injury rates (Step 1) and identify specific risk factors and injury mechanisms (Step 2) for concussion among its youth club athletes (aged 14 to 19).

Club athletes compete provincially and nationally, with the season beginning in the fall, and ending each May with Volleyball Canada’s National Championships. With the help of researchers from the Sport Injury Prevention Research Centre (SIPRC) at the University of Calgary, a survey on Canadian youth volleyball athletes, from 2016 to 2018, helped identify rates of concussion, risk factors and injury mechanisms (Meeuwisse et al., 2017). Additionally, the 2018 Volleyball Canada National Championships brought together 9500 athletes and 2000 coaches from all age classes, to one location, presenting us with a unique opportunity to gather extensive epidemiological data on concussion injuries and risk factors.

The SIPRC study’s results showed that most concussions in youth volleyball were caused because of ball-to-head contacts (57%) and the majority (62%) of these occurred during practice or warm-ups. This meant that a large proportion of concussions were from non-competitive, controlled environments, which could be specifically targeted for intervention (Meeuwisse et al., 2017). Using this information, Volleyball Canada developed measures (Step 3) to minimize the risk of ball-to-head contact during these controllable environments (specifically, pre-game warm-up routines).

Overhead views of 2 volleyball courts, before and after Volleyball Canada's  2018 rule change. On the left, players used to run onto the receiving side of the courts to retrieve their balls. On the right, the receiving side of the court is now out of bounds and players must retrieve their balls from the sidelines.

For example, during the standard hitting warm-up routine, a player would attack a ball over the net and immediately run under the net to retrieve the ball. This created a high-risk situation since it was more than likely that this athlete would be struck in the head by the next ball being hit by a teammate. To reduce the incidence of concussions during warm-up, Volleyball Canada introduced a new rule in 2018, which disallowed athletes from running under the net and over to the opposite side of the court to retrieve their ball during the standard hitting warm-up routine (Step 4).

Most provincial sport organizations adopted this new “Warm-up Protocol” rule for their 2019 competitive club season. Volleyball Canada enforced it at its national championships.

To tackle Step 5, Volleyball Canada has been actively conducting new studies to evaluate how effective this hitting warm-up rule change has been on reducing concussion rates. The COVID-19 pandemic and lack of competition since 2019 has delayed data collection and analyses. However, initial results suggest that the odds of reporting a concussion during the pre-game hitting warm-up routine remain unchanged since implementing the 2018 rule change.

In re-evaluating the risk of concussion sustained during warm-ups, interestingly, youth volleyball athletes have reported more concussions occurring during the unstructured portion of the pre-game team warm-up. This usually involves players using a ball to rally one-on-one with a partner, or more commonly known in volleyball as “pepper.” This highlights the importance of collecting data and re-evaluating the effectiveness of injury prevention interventions, as new information can continue to fill the knowledge gaps in concussion injury risks and inform future strategies.

Lessons learned and next steps

Though the process is ongoing, Volleyball Canada remains committed to using data and evidence-informed approaches to develop strategies for reducing concussion risks. However, this process is often difficult and resource-intensive for sport organizations. For example, competing priorities, possible resistance to change or new methods, or simply a lack of time, capacity or expertise, are all challenges that face sport organizations when investing in an evidence-informed approach to injury prevention (Pike et al., 2015).

What were some of the important lessons Volleyball Canada learned from its concussion prevention strategies to date?

1. Get creative and innovate

The gathering of quality epidemiological data is both time-consuming and difficult, especially at a national level. As this describes Step 1 of the 5-step process, investing in the resources to help understand the entire scope of the problem, can be a daunting first step.

Consistent data collection allows for assessment of historical trends, or retrospective analysis of the effects that other equipment, rule or policy changes may have on concussion rates (whether the changes are intentional or not)!

Therefore, it’s ideal to collect this type of epidemiological data as part of the membership or event registration process. Starting in fall 2021, Volleyball Canada’s new virtual registration systemwill give the organization another way to potentially help facilitate future information-gathering processes.

2. Build partnerships

With limited resources for research initiatives, partnering with external research or community groups can increase a sport organization’s capacity to conduct concussion injury prevention work. Developing initiatives with these partners, such as universities and hospitals, can help sport organizations gain access to trained staff capable of taking on some of the research burden.

These external groups may even have similar mandates as the sport organization’s injury prevention goals. For example, the University of Calgary SIPRC focuses on working with community partners to reduce the risk of injury in sport and recreation, with a particular emphasis on preventing youth injuries.

3. Engage in ongoing evaluation

By gaining sport-specific knowledge about how concussions occur and where the highest risks exist will guide and direct the development of specific interventions and strategies. Learning that concussions primarily occurred from ball-to-head contact within controlled environments helped Volleyball Canada adopt rule changes to reduce the risk of exposure to that mechanism.

However, equally important is the ongoing re-evaluation process, which continues to provide data on the effectiveness of this rule change. Interventions may or may not work, or may take some time to deliver tangible results. Without this re-evaluation process, sport organizations can’t know whether an intervention has been effective or successful in reducing the risks for concussion injury.

It’s important to consider incorporating this re-evaluation process right from the start of Step 1. That way the continual evidence-based approach can be supported by the initial efforts and infrastructure of setting up data collection and information-gathering measures.

Conclusion

“Although we have come a long way in understanding concussions in volleyball, there is still much more to do. We are still working diligently on the establishment of an effective and efficient surveillance system. Once we get to that in place, developing and assessing interventions strategies will be the easy part.”

Kerry Macdonald, Director of Sport Science, Medicine and Innovation at Volleyball Canada

Understanding the extent of the problem and identifying the factors that create concussion injury risk is key to implementing effective prevention strategies. For sport organizations, these strategies should be targeted and sport-specific, because every sport may have unique injury mechanisms that contribute to concussion risk. Alongside existing educational and technological strategies, an evidence-informed approach is the most effective way of developing further preventative measures that protect athletes and reduce the burden of concussion injury.


Highlights


In May 2021, the Sport Information Resource Centre (SIRC) announced the launch of its Community Activation Grants. This program supports sport organizations in developing and disseminating concussion and Safe Sport resources in Canadian communities.

The launch was set against the backdrop of the Government of Canada’s commitment to reactivate local sport organizations, after the COVID‑19 pandemic’s devastating financial, social and health-related effects.  In its 2021 federal budget, the government allocated $80 million over 2 years to support local sport organizations.

One issue that’s been at the forefront for sport organizations during the pandemic has been ensuring a Safe Sport environment as participants return to play. With the Safe Sport movement growing rapidly at the national and provincial levels, the Community Activation Grants are aimed at further growing the movement in local sport communities.

Successful applicants each received a grant of up to $5,000 and access to SIRC’s evidence-based resources. With SIRC’s support, grant recipients are championing resources that promote concussion awareness and safety in sport at a time when Canadians are returning to play.

We spoke with 6 grant recipients about the importance of Safe Sport and concussion awareness for their organizations, and about the initiatives their grants helped them build. Learn more about how Pickleball Hamilton, Soccability Canada, Freestyle BC, the Edmonton North Zone Soccer Association, the Castaway Wanderers Rugby Football Club and the Ottawa Sport Council are activating Safe Sport in their communities. They also share how you can jumpstart Safe Sport and concussion awareness in your community.

Spotlight 1: Pickleball Hamilton

Pickleball is a relatively new and rapidly growing sport with Pickleball Canada only having been incorporated within the last 10 years.

In 2020, a Pickleball Hamilton member fell while playing pickleball. While undergoing testing to diagnose a suspected concussion, an MRI revealed an undetected cancerous tumour that could have been life threatening. But it wasn’t just the tumour that came as a surprise. As a non-contact sport, concussions aren’t typically top of mind for pickleball players.

“This incident heightened our club’s awareness of concussion in the sport, but also revealed a knowledge gap among members and the wider pickleball community that needs to be filled,” says Matt Cunningham, Director of the Pickleball Hamilton Association.

That’s why receiving this grant and its timing was so important for Pickleball Hamilton.

“Thanks to the grant, we’re embarking upon a concussion prevention and awareness campaign that’ll both inform and protect our members,” he says.

The grant is supporting the creation of 6 short videos, each demonstrating real, on-court errors that could lead to concussions and about how to prevent them. Pickleball Hamilton already completed 2  of the videos, demonstrating how to safely retrieve a lob when playing singles and how to retrieve one when playing doubles.

“These videos are being talked about within our membership. That’s an early success that wouldn’t have been realized without the Community Activation Grant,” says Cunningham.

The videos will also complement concussion awareness posters to be displayed prominently at courts in the Hamilton area.

Using SIRC’s concussion resources, Pickleball Hamilton is working on its concussion policy and protocols. As a newer racquet sport with work to be done on concussion awareness and education, it’s leading the way at the community level.

Spotlight 2: Soccability Canada

Like Pickleball Hamilton, receiving the Community Activation Grant was a big first step for Soccability Canada. Spanning the country, Soccability provides accessible soccer programs for children and youth with disabilities. Officially incorporated as a not-for-profit organization in November 2020, Soccability is excited to use the grant to launch its concussion policies and initiatives.

“Receiving the grant was especially meaningful because of the recognition it provides to the organization, to Para sport and to Para sport concussion research,” says Matt Greenwood, Soccability Canada’s Program Director.

He discussed the lag in concussion research and policy for Para sport. Until recently, the International Concussion in Sport (CIS) consensus papers lacked the research necessary to address the needs of children and youth with disabilities. For this reason, and to ensure appropriate concussion treatment is provided to Para athletes, a multidisciplinary team of experts created the concussion in Para sport (CIPS) group.

Learn more about concussion in Para sport and the first position statement of the CIPS group in a SIRCuit article led by CIPS member Dr. James Kissick.

The grant provides Soccability with a starting point to consult and gain access to CIPS research experts. Greenwood was particularly enthusiastic about putting new Para sport concussion research into practice through the development of new protocols, educational videos and infographics. These resources will target several different stakeholders in the Soccability community.

“Soccability athletes are often accompanied by companions, which means that concussion initiatives targeting not just the athletes and coaches, but also parents, guardians, family members and companions are also important,” says Greenwood.

Soccability is currently in the design and development phase of many of its concussion and Safe Sport initiatives. Greenwood is excited to have their programs back up and running and is confident that the grant help spread awareness of concussion in their organization. Along with access to SIRC’s resources and new research, the grant is a major asset to growing Soccability and concussion education not only within the organization, but within Para sport more broadly.

Spotlight 3: Freestyle BC

Action shot of a freestyle ski athlete doing a trick in the air.Freestyle BC offers freestyle skiing programs in British Columbia, ranging from a fundamentals program that is designed for skiers as young as 6 years of age to high performance programs that support the best freestyle skiers in Canada to their flagship GirlStylerz program. Given the nature of the sport, freestyle skiing comes with risks that may lead to head injuries and concussions.

According to Executive Director Josh Dueck, Freestyle BC’s goal is to “create a barrier-free environment for all athletes to feel safe, welcome and included.” The funds from the grant are allowing Freestyle BC to continue its path to this goal and enhance their existing suite of services and resources.

Specifically, the grant has given the organization the capacity to work with experts of concussion, biomechanics, and mental health. In turn, Freestyle BC has refined its resources for athletes, coaches, and parents and guardians. The grant also supported access to experts in web design and communication who’ve helped Freestyle BC share this information in the most effective way with all members.

“We’re working on 5 critical resources for our community to draw upon to ensure our vision is achieved. No pillar in our commitment to Safe Sport stands alone, and each pillar needs to be guided and supported by experts,” says Dueck.

Once the materials for each of the pillars are in place, he says the plan is to “take full advantage of a captive audience at the annual general meeting in September.” They’ll summarize what’s available and expected as they shift Freestyle BC’s culture toward that of Safe Sport.

Overall, the grant has provided Freestyle BC with a launching pad to activate its concussion and Safe Sport initiatives. The funding has also helped to ensure that member clubs are in the best position to deliver safe, meaningful, and inclusive programs in the upcoming winter.

Spotlight 4: Edmonton North Zone Soccer Association

As part of the Edmonton Minor Soccer Association (EMSA), the Edmonton North Zone Soccer Association (EMSA North) is working toward achieving the national standards for Safe Sport outlined by Canada Soccer. Like most sport organizations, the pandemic halted EMSA North’s programs, requiring the organization to rethink how it operates.

“As we moved to re-opening, we really did a focused shift to try and provide a safe return and much of that includes education, particularly starting at the coaching level,” says Kylee Webster, Executive Director of EMSA North.

To support a safe return to play, the association is working with its governing body to obtain club licensing.

“Club licensing means we meet the National Standards of Quality for soccer, and we’re able to deliver a carefully thought-out program with highly trained volunteers,” says Webster.

The grant supports the licensing, which will focus on coach education. In particular, the grant will fund courses on concussion awareness, respect in sport, and making ethical decisions. It will also pay for the training of more than 150 coaches in the association.

“We’re focusing on coach training at this time because we feel this is the quickest stream to assist our association in a safe return to sport,” says Webster. “Coaches are on the field with players. They communicate directly with parents. That knowledge transfer is paramount to fostering a safe program.”

The association is buying course keys and will distribute them to cover the expenses for non-trained head coaches to further their education. In the meantime, EMSA North is using its social media platforms and newsletters to publish awareness posts, answer questions and provide information to coaches.

“Great resources have already been provided to [us] from SIRC concerning information and promotion of Safe Sport. We have and we will continue to use as many of these resources as possible to promote coach education and player education,” she says.

Spotlight 5: Castaway Wanderers Rugby Football Club

Concussion education and awareness are typically top priority in sports like rugby, where contact isn’t just inevitable, but a main element of the game. For this reason, clubs like the Castaway Wanderers (CW) in Victoria, British Columbia, are developing and promoting concussion and Safe Sport initiatives.

But after a lengthy stint away from the game because of COVID‑19, athletes must be reintroduced to effective techniques for preventing injuries during contact. This is a new challenge for sports like rugby.

“The ability to help athletes return to play in a safe manner is paramount for what we’re trying to do,” says David Hill, CW’s Mini Rugby Program Coordinator. “I think when you’ve players that haven’t had [any contact] for 15 months, if not more, it’s going to be challenging.”

While concussion initiatives have always been a part of CW Rugby, the SIRC grant will fund a new, post-pandemic era of return-to-contact campaigns. One such campaign is what Hill calls the “3 Ts.”

The first T is for “Tell.” Concussion symptoms may be more easily hidden than other injuries. So, athletes might keep quiet about a head injury if, for example, they fear they’ll be removed from play. That’s why spreading awareness about the importance of speaking up and encouraging athletes to tell someone is the first step.

“If you’re not telling at least your coach that you suspect a head injury, then you’re putting not only yourself at risk, but maybe some others at risk,” says Hill.

The second T is for “Teach.” For this component, CW focuses on how they’ll teach return to contact. This includes purchasing equipment, such as tackle bags, to teach contact technique while limiting human-to-human contact, according to Hill. CW Rugby also plans to host a Safe Sport and return to contact professional development session with coaches before the fall season starts.

The third T is for “Track.” Knowing players’ concussion history is important for decision-making. However, currently, there’s no system in place at CW Rugby for tracking this information. Some funds from the grant will be put toward a tracking system.

“It’s important from a club perspective that we set up something, so we know who’s sustained concussions over a period of time and so that we’re better informed,” says Hill.

Spotlight 6: Ottawa Sport Council

The Ottawa Sport Council (OSC) supports more than 750 community sport organizations in Ottawa. Through education, advocacy, and philanthropy, it strives to foster quality sport experiences at the community level. But, as Executive Director Marcia Morris states, education is perhaps its biggest task.

“At the end of the day, funding for community sport often gets forgotten in all the initiatives that get rolled out from Sport Canada,” says Morris. “So, we’re really interested in the grant to help promote SIRC’s resources, but also to amplify the work that we’re doing and have already done, and pull it all together to make community sport safer.”

Prior to the pandemic, OSC had major concussion education programs and resources ready to roll out. However, with minimal in-person sport activity over the past year, the focus became finding new ways of dispersing information to those who need it.

Ottawa Sport Council Concussion Education Video – August 2020

One outcome of the OSC’s “pandemic pivot” was its successful Concussion Education Initiative video. Another is its online Safe Sport toolkit. Currently in design, the toolkit is meant to be a user-friendly resource for any sport or organization. It will provide bite-size pieces of information sectioned into different “drawers” (for example, policies, minimum training requirements, and resources). The goal of the toolkit is to ensure that every sport gets the information it needs.

“Some sports weren’t getting any Safe Sport information from their NSO [National Sport Organization], and others are way beyond in their policies. So, everybody’s at a different part of their journey,” says Morris. “The whole point [of the toolkit] is that you can hop in and just look at one drawer. But, all the drawers will be available for the people who don’t have that luxury of being a well-funded, well-defined sport.”

The grant from SIRC is helping to launch the Safe Sport toolkit. It will serve as a major asset for community sport organizations, especially those looking to start or fill in gaps in their concussion and Safe Sport initiatives.

Conclusion

Our conversations with some of SIRC’s Community Activation Grants recipients unearthed stories of resilience, success and innovation within community sport. After the abrupt and extended disruption by the pandemic, the grants provided many recipients with the boost they needed to get their Safe Sport and concussion awareness programs up and running. For others, the grants provided additional capacity and support while pivoting existing initiatives to align with pandemic restrictions.

When we interviewed grant recipients, several also shared suggestions for how other community sport organizations could enhance their Safe Sport and concussion awareness initiatives, or simply get them off the ground. Top tips include:

Aligning with the federal government’s commitment to reactivate local sport organizations as they recover from the COVID‑19 pandemic, SIRC’s Community Activation Grants provided support to community sport organizations moving toward national standards for concussion safety and Safe Sport.

According to David Hill of CW Rugby, fostering Safe Sport environments is a sure bet for enhanced sport performance:

“The biggest thing about sport safety is that it’s a performance enhancer. The safer [an athlete] feels the more they can push the envelope on performance.”

Recommended resources

Learn more about the Community Activation Grant recipients.

Discover SIRC’s concussion in sport resources.

Explore SIRC’s Safe Sport hub.


Highlights


Youth concussion in Canada is a serious public health concern. Concussions in Canadian youth, aged 12 to 17 years old, have increased annually by 10.3% between 2004 and 2015 (Rao et al., 2018). High-school students experience the highest rates of concussion among all children and youth. Additionally, their concussions are often under-reported. The reasons for under-reporting are suspected to be high-school students’ lack of knowledge about concussions, the influence of their social environment, believing that reporting their concussion wouldn’t help, concern about how they think their peers will react, and a lack of self-efficacy (“Sports-Related Concussions in Youth: Improving the Science, Changing the Culture,” 2015).

In the past, youth with histories of concussion have identified that their social participation during their concussion recovery was affected by their peers’ lack of understanding about concussion (Valovich McLeod et al., 2017). Because youth are strongly influenced by their social networks, peer education can play a big role in students’ knowledge (what they know about concussion), attitudes (what they think about concussion), and intended behaviours (how they would act if they experienced a concussion or if a friend had a concussion).

In this article, we’ll describe You-CAN, our peer-led education program to help high-school students understand concussions. We’ll also define what social support is and how it can help youth with a concussion. Additionally, we’ll explain how youth in sports can help each other with concussion recovery, and how coaches, administrators, parents, and others involved in youth sport can help youth athletes who have sustained a concussion.

What is You-CAN?

Group of diverse high school students standing in front of a row of lockers.The Youth Concussion Awareness Network (You-CAN) is an ongoing research study and education program, funded by the Canadian Institutes of Health Research. Its team members and collaborators are located across Canada, and it has been created with project co-lead Parachute Canada. As the first program of its kind, You-CAN uses a peer-led approach that aims to raise concussion awareness among Canadian high-school students, promote positive change in concussion knowledge and attitudes, and foster connections between participating schools and students.

You-CAN’s overarching goal is to change Canadian students’ behaviours specific to:

  1. reporting a suspected concussion to an adult
  2. supporting their peers who experience a concussion

The concept of You-CAN is simple: provide a platform and resources for youth to learn with their peers, and in turn, support their peers. To do this, participating high schools nationwide have created Concussion Councils. Like other clubs and councils within their school, the Concussion Council meets regularly. Members of the Concussion Council plan and execute ways to share information about concussions and provide other students with appropriate concussion resources.

As well, the Concussion Councils create and host annual week-long concussion awareness campaigns within their schools. The Concussion Councils are encouraged to be creative with their campaigns, enabling participating students to create the campaign that they feel best matches the wants and needs of their school community (see Figure 1). To make sure that the campaigns share up-to-date and accurate information, students can access a web-based portal. This concussion resource portal contains evidence-informed, concussion education resources from across North America. We’ve approved these resources using specific criteria to ensure they’re both accurate and written specifically for youth.

To celebrate the incredible work of participating high schools and students, each spring the Concussion Councils will share their work with other councils from high schools across Canada. This will happen during the annual Rowan Stringer Concussion Awareness Campaign Showcase. While the virtual showcase hasn’t started yet because of COVID‑19, it will highlight the efforts of participating schools, spark ideas and make new connections nationally. We can’t wait for the first showcase!

https://www.youcanportal.com/uploads/Campaign/Your%20Campaign%20(v3).png Strategy for campaign ideas -Create a Concussion Council social media page with fun, educational posts about concussions using some of You-CAN's resources -Put up fun facts and quotes on monitors or TV screens around your school -Print out posters and infographics from You-CAN's Resources page or design your own to post around your school -Get creative and make a video or large banner to display in the halls -Create an interactive activity for other students. You can have students share their experience with concussion or a friend who has had one -Create a game of Concussion Trivia and host it before school or during lunch
Figure 1. Concussion Council campaign ideas shared with students to get them started.

Learn more about You-CAN, the ongoing research study to evaluate You-CAN. You can also find out about how appropriate resources were identified for participating high-school students and their Concussion Councils’ awareness campaigns.

What’s social support and how does it relate to concussion?

A unique aspect of You-CAN is its emphasis on using peer-led concussion education to change behaviours. This is specific to providing a peer with a concussion with social support. For our purposes, social support is an exchange of resources between 2 individuals with the goal of enhancing the well-being of the recipient (Shumaker & Brownell, 1984). There are 3 types of social support: emotional, tangible and informational, as described in Figure 2 (Schaefer et al., 1981).

Types of support 1. Emotional: building a sense of social inclusion, reassurance and care 2. Tangible: direct physical aid such as physical support or services 3. Informational: Information and advice can help a person understand or solve a problem
Figure 2. Types of social support

Best-practice approaches to concussion recovery and rehabilitation involve the potential for restricted activities across many areas of life, including school, sports, social life and family life (McCrory et al., 2017). Although necessary for a safe return to school and sport, these approaches may also lead to social isolation (Karlin, 2011). For children and youth, social isolation can negatively affect health, happiness and quality of life (Karlin, 2011). That’s why social support is so important.

A recent study conducted by our research team within the OAK Concussion Lab at the University of Toronto used semi-structured interviews to explore the topic of social support following concussion in high-school-aged youth. The study’s goal was to better understand what social support means to high school youth, what type of social support they need after a concussion, and the role that peers play in supporting an individual after a concussion (Kita et al., 2020). The youth who took part identified 3 key providers of social support following concussion:

  1. Close friends who helped to minimize feelings of social isolation through texting and visiting
  2. Other youth with experience of concussion, who validated the challenges and communicated empathy
  3. Parents who used their “adult power” to assist with practical challenges like getting accommodations provided at school

Overall, the youth participants wanted their peers to know more about their lived experiences. They proposed solutions that involve educating peers on what it’s like to have a concussion and what supports they need to best help with recovery.

You-CAN attempts to be one of these educational solutions. It can act as a platform to help youth better understand what it’s like to have a concussion. By teaching approaches to social support (see Figure 3 for examples) and encouraging members of the Concussion Councils to include concepts of social support within their annual awareness campaigns, You-CAN enables youth to help each other after a concussion, leading to recovery and positive health outcomes among the youth peers who experience a concussion.

Examples of how to support a friend who is concussed - Keep in touch with them - How? Call or text your friend and make sure they aren't missing out - Adapt your social plans - How? Modify how you hang out with your friend by including quiet environments, small groups and rest breaks - Find ways to include them - How? If you play on the same sports team, fill them in on any new strategies or skills for when they're able to return - Listen to your friend - How? Ask about your friend's experience, try putting yourself in their shoes and help them feel understood - Help your friend with school - How? Share notes with your friend, help them carry their books, offer to drive or walk with them to avoid the bus
Figure 3. Examples of ways to support a friend after a concussion

Learn more about the experiences of high-school-aged girls receiving social support during concussion recovery.  

You-CAN and sport

To date, You-CAN has been used in Canadian high schools with ongoing research to examine the impact of this novel approach to raising concussion awareness, changing behaviours specific to reporting a concussion to an adult, and providing social support to peers who experience a concussion. There’s great enthusiasm for new approaches to concussion education in the school setting and particularly approaches that consider youth as capable and important leaders. We believe these approaches hold promise for youth in the sport community as well.

Teen female soccer player in Left wing position carrying the ball up the fieldSports teams and organizations may be an important and ideal environment to facilitate peer-led concussion education, particularly since youth who participate in organized sports have significantly higher rates of concussion (Ippolito et al., 2021). Our research has also shown that these youth have room to improve their attitudes about concussion and their intended concussion behaviours, such as reporting a concussion to an adult and providing social support to a peer with a concussion (Ippolito et al., 2021).

Let’s paint this picture for you: Imagine if 1 team in a sport club, league or organization became the Concussion Council and developed and delivered annual concussion awareness campaigns to other teams within their sport organization or league. Perhaps it’s the Bantam hockey team or the U-16 soccer team that becomes their league or association’s Concussion Champions, and all teams, younger and older, look to them for concussion education and support. Players and teams from various sports organizations could come together annually to celebrate their achievements, share ideas and knowledge on concussion to make their team, league and sport safer and more enjoyable. Not only could this approach play a meaningful role in increasing concussion awareness, reporting and social support, but perhaps it could do more. With peers providing concussion education and support through this approach, the information would be better received than if delivered by coaches, parents, healthcare professionals or researchers.

To create a sport-based You-CAN, it will be essential to hear from the youth sport community (such as athletes, coaches, parents and guardians, referees, administrators and others). It will also be vital to create a network and platform that best meets the needs of this community.

A key finding from our current research from You-CAN in school settings is that youth with higher concussion knowledge are more likely to report a concussion to an adult and to provide social support to a peer (Ippolito et al., 2021). Otherwise, youth who participate in sport (such as organized sports, team sports and high-risk sports) are at higher risk of concussion, but also express they’re less likely to report a concussion or support a friend with a concussion. An educational intervention is necessary to improve and change these behaviours in the sport population. Behavioural changes would lead to improved concussion outcomes, happiness and quality of life in youth athletes who’ve sustained a concussion.

How can I increase my concussion knowledge and better support youth athletes?

Youth hockey team putting hands together with coach in a huddle, showing teamworkTo best support youth athletes, it’s essential that everyone involved in youth sports is knowledgeable about concussion, including the related signs and symptoms. Additionally, it’s essential for everyone to know what to do when they suspect someone has a concussion. Lastly, you should know your sport’s policies and procedures about removal from play and return to play after a concussion.

Recently created community resources within the Living Guideline for Diagnosing and Managing Pediatric Concussion provide the following information and direction specific to how you can best support youth athletes in playing the sport they love in a safe and enjoyable way:

  1. Know about concussion
    • It’s essential you’re aware of the signs and symptoms of concussion. Through concussion identification, you can remove an athlete from play and get them the appropriate medical care.
      • Concussion signs are how an athlete might look or act after they’re injured. Signs can include getting up slowly after an impact with another player or the ground, holding their head or having difficulty standing, walking or skating.
      • Concussion symptoms are how an athlete might feel after they’re injured. Symptoms can include an athlete reporting a headache, nausea, dizziness, difficulty concentrating or changes in emotions.
  2. Know your sports organization’s role in concussion
    • Be sure to know if your sport organization has a concussion education program and a concussion policy or protocol. Ensure that everyone involved with your team or within your sport organization is aware of that concussion policy or protocol, and knows what to do if an athlete experiences a concussion. Make sure that these concussion policies or protocols are reviewed and updated regularly. If your sport organization doesn’t have a concussion policy or protocol, then talk to the administration about putting one in place.
  3. Stay connected and communicate
    • To best support a youth athlete after a concussion, it’s a team effort. Communication is essential between the athlete, parents, coaches, teachers and healthcare professionals to be aware of the athlete’s abilities and limitations, and to best support the athlete’s safe return to meaningful activities, including sports.

Conclusion

Youth are strongly influenced by their social networks and often lose out on social participation during concussion recovery. Youth report that having understanding friends who provide them with social support during recovery is very helpful. To best provide this social support, their peers, such as teammates and friends, must have a good knowledge of concussion. You-CAN, a peer-led concussion education intervention, can help provide this knowledge. This way, teammates can support each other when recovering from a concussion. Teammates support each other in many ways, and with the right information and support, concussion recovery should be no different. A sport-based You-CAN, where youth athletes help educate and support other youth athletes with a concussion, could positively influence concussion outcomes and get youth athletes back to what they need, want and love to do.

Next steps

For anyone interested in exploring peer-led concussion education programming in youth sports, please get in touch with us at you.can@utoronto.ca or nick.reed@utoronto.ca.

Recommended resources

You may find these resources helpful as you build your concussion knowledge to best support your youth athletes:

For additional resources, check out SIRC’s concussion hub.


Highlights


Improving concussion care and prevention in girls, women, and female athletes has become an area of increased interest and importance for many coaches, team trainers and rehabilitation specialists. This is especially true as more and more research points to potential negative consequences that multiple concussions can have on brain health. For example, a person who sustains multiple concussion may have an increased risk of developing neurodegenerative diseases such as Alzheimer’s disease (Hay et al., 2016).

Rear view of a young female lacrosse player wearing a helmet and holding equipment.Tailoring concussion management and prevention strategies to the specific needs of girls, women, and female athletes is important to create safer sport environments and ensure that these groups can continue to enjoy the many benefits that sports has to offer. This article highlights current research exploring how biological sex and gender can influence concussion risk, management and prevention. Additionally, we identify strategies that coaches, team trainers and rehabilitation specialists can use to better recognize, manage and prevent concussions in girls, women, and female athletes.  

Throughout this article, we use words drawn from the type of research being described. We only use the term female when research refers specifically to biological sex (that is, an individual’s biological attributes such as chromosomes, genes and hormones assigned at birth). Otherwise, we use the terms girls and women when referring to gender (that is, socially constructed roles, behaviors and expressions that form one’s identity).

Sex versus gender Sex means biological differences like chromosomes, genes and hormones. Gender means social and cultural differences like behaviour, identity, norms and roles.

What is a sport-related concussion, and how does it affect the brain?

A sport-related concussion is a traumatic brain injury resulting from a hit to the head, neck or body that causes a sudden jarring of the head. For example, a sport-related concussion may occur when an athlete falls to the ground, receives a bodycheck, or is struck in the head with a piece of equipment.

Female doctor interviewing patient in an office.This direct and often sudden impact causes the brain to accelerate within the skull, causing damage to important brain structures. This damage is the cause of common concussion symptoms such as difficulties with concentration and memory. When an athlete follows proper return-to-play protocols, damage to the brain can be short-lasting, often resolving on its own in 85% to 90% of cases (Thornhill et al., 2000; Whitnall et al., 2006). But for a small proportion of athletes, this damage can have long-lasting effects on daily activities such as attending school or work.

Axons are fibre bundles that are responsible for transmitting information between different areas of the brain. When a person sustains a concussion, their brain’s axons are injured (Alexander et al., 2010). Damage to the brain’s axons is called diffuse axonal injury (DAI). DAI can lead to changes in the brain’s structure and function (Gardner et al., 2014; Multani et al., 2016; Pasternak et al., 2014) and have a negative impact on cognitive processes such as attention and memory (Hsu et al., 2015; Czernick et al., 2015).Concussion leading to axonal damage leading to altered brain function and the symptoms associated with concussions

Female athletes have a higher risk of concussion than male athletes

Research suggests that female athletes may be at an increased risk of concussion when compared to male athletes. For example, researchers in one study found that concussion risk for female soccer players is around 1.8 times higher than for male soccer players (Bretzin et al., 2021).

Rear view of a young girl holding a soccer ball on sidelines during a soccer match, wearing a yellow jersey.Female athletes may be at greater risk of sustaining a concussion than male athletes, in part because they’re more vulnerable to DAI (Rubin et al., 2018; Sollmann et al., 2018). In other words, when a female axon is exposed to the same force as a male axon, the female axon is more likely to be more damaged (Dolle et al., 2018). The reason for this increased risk of DAI is because female individuals generally have smaller axons and fewer microtubules, compared to male individuals. Microtubules are microstructures that support axons.

But it’s not just the brain’s structure that contributes to female athletes’ increased risk of concussion. Decreased neck strength and a smaller neck size may also contribute to the higher concussion risk seen in female athletes. This is because weaker neck muscles have been associated with more head acceleration during an impact (Honda et al., 2018). With stronger neck muscles, female athletes may experience less head motion during an impact, therefore reducing concussion risk (Honda et al., 2018).

Given that multiple factors can predispose female athletes to concussions, their coaches, trainers and rehabilitation specialists may consider the following injury prevention and risk reduction strategies:

https://youtu.be/GH0eHpH69QM?t=160
SIRC’s educational video about the role of protective equipment in concussion prevention.
  1. Incorporate strength training for neck muscles. Adding isometric neck strength training to a female athlete’s workout routine may help to reduce their risk of injury.
  2. Ensure athletes wear a properly fitted helmet. When a helmet fits properly, it can reduce the severity of a concussion (Greenhill et al., 2016). Encourage female athletes to check the fit of their helmet regularly, particularly those who change their hairstyle frequently (for example, from a braid to a bun).

Male and female athletes experience concussions in different ways

DAI causes damage to the brain’s structure, which can affect how messages are sent from one area of the brain to another. At least in the long term, concussions appear to impact male and female participant’s brain connectivity, and in turn function, in different ways (Shafi et al., 2020).

Research has shown that female participants who have sustained a concussion experience more changes in communication between the brain regions that specifically support goal-directed behaviour. In contrast, male participants who have sustained a concussion tend to experience changes in communication between the brain regions that guide behaviour based on cues from the internal or external environment.

https://youtu.be/LJHLx7_oIAg
Dr. Reema Shafi’s presentation at SIRC’s 2021 Canadian Concussion in Sport Virtual Symposium.

What does this mean? While both male and female athletes may experience challenges after experiencing a concussion, the types of challenges they face may differ depending on the parts of the brain that are affected. For example, female athletes may have difficulty completing a new drill because they have trouble planning the steps and/or developing strategies needed to complete it.

Alternatively, male athletes may have difficulty completing a new drill because they’re unable to filter out distractors in their internal environment (such as negative thoughts about their performance) or external environment (such as cheering or heckling from spectators).

While more research is needed to understand how biological sex influences sport-related concussions, we offer the following recommendations: 

  1. Coaches: Consider how biological (sex-specific) differences may impact an athlete’s learning and adapt your teaching strategies accordingly. For example, when working with a female athlete who has experienced a concussion, consider budgeting extra time to break down a new skill or drill when it’s safe for them to return to sport.
  2. Rehabilitation specialists: Consider what internal factors (for example, functional brain changes) may be contributing to an athlete’s difficulties post-injury and work to tailor their management plan accordingly. Remember, when it comes to concussion management, an individualized and patient-centred approach is needed!

Female athletes take longer than male athletes to recover from a concussion

Coaches, team trainers and rehabilitation specialists play an essential role in encouraging an athlete to follow the appropriate recovery protocols. Given the structural and functional differences in a female athlete’s brain, it may be even more important to have an informed and individualized approach to concussion recovery.

Research suggests that female athletes often take longer to fully recover after a concussion compared to male athletes (Covassin et al., 2018). These longer recovery times may be associated with the greater symptom burden (meaning a greater number and severity of symptoms) often reported by female athletes after their injury.

However, longer recovery times may also be linked to differences in concussion care for male and female athletes. Unfortunately, research suggests that compared to male athletes, female athletes are around 1.5 times less likely to be immediately removed from play after an injury (Bretzin et al., 2021). This variability in immediate, sideline care may also reflect differences in gender norms in sport. It also highlights the importance of considering both sex and gender when managing concussions.

Since the return-to-play process will look different for all girls, women, and female athletes, it can be helpful to have concussion testing data as a baseline comparison to help assess when the athlete is ready to get back into play. While not mandatory, baseline testing can be helpful as it allows rehabilitation specialists to determine when an athlete has returned to their “healthy” or “baseline” state (McCrory et al., 2017). Without this data, it can be difficult for rehabilitation specialist to determine when an athlete has returned to their pre-injury or “healthy” state, which may delay their return-to-play.

How can you help a girl or women through their return to play?

The first step in helping an athlete return to play is to recognize when a concussion may have happened. And then, remove the athlete from play so that they can be assessed and can start the appropriate return-to-play process. Throughout this process:

Girl with head in her hands

Lastly, it’s important to recognize that the concussion recovery process can be overwhelming for an athlete. In fact, research shows that girls often report more negative emotions (such as frustration) around concussion recovery than boys do (Claire et al., 2020). As such, it’s essential that coaches, team trainers and rehabilitation specialists provide support early on and throughout their recovery (Clair et al., 2020). To help support the recovery process, coaches, team trainers and rehabilitation specialists can:

  1. Educate the athlete about their likelihood of making a full recovery. Knowing how likely they are likely to recover completely has been shown to have a positive impact on recovery outcomes (Bazarian et al., 2020)
  2. Accommodate the athlete’s needs. For example, when the athlete has received medical clearance to reintroduce sport-specific activities into their training, consider altering drills to be contact-free to support safe participation.
  3. Check in on the athlete to see how they’re doing, let them know that they’re missed and reassure them that their spot on the team will be waiting for them whenever they can safely return to play. Check-ins can help the concussed individual feel included and highlights that you’re there to support them (Kita et al., 2020).

Conclusion and next steps

Concussion research involving girls, women, and female athletes has grown significantly over the past decade. Despite progress that’s been made, there’s still work to be done. This includes gaining a deeper understanding of factors that contribute to increased risk of injury and the long-term effects of a concussion on the health and wellbeing of girls, women, and female athletes.

It’s important to remember that each athlete will require an individualized approach to concussion management and prevention. As researchers and other sport stakeholders work toward making sport safer, coaches, trainers and rehabilitation specialists can use the recommendations provided in this article to reduce the known risks of concussion that seem to be more prevalent for girls, women, and female athletes.


Highlights


https://youtu.be/UymHfFBZS7E
Get to know Dr. Jamie Kissick of the Concussion in Para Sport (CIPS) Group.

In 2020, an international group of clinicians, researchers and athletes met virtually to explore how to best assess and manage concussion in an athlete with a disability. This group’s individuals had experience and expertise in the care of Para athletes, and in the assessment, management and prevention of concussion. They named themselves the Concussion in Para Sport (CIPS) Group.

Their fruitful output included producing the “1st position statement of the Concussion in Para Sport Group,” published in April 2021. Recommendations and guidance were based on the group’s experience and on available evidence. Through this position paper and CIPS’s plan to promote research and knowledge translation, the group hopes to close the gap in Para concussion knowledge, and optimize concussion care and prevention strategies for Para athletes.

Based on the CIPS position statement, this article summarizes what we know (and don’t know) about concussion in Para sport. It also provides evidence-informed recommendations for assessing, managing and preventing concussions among Para athletes.

https://youtu.be/qmVANe3Ya3s
Join Dr. Kissick as he explains what we know (and don’t know) about concussions in Para sport.

Does one size fit all?

As recently as 25 years ago, physicians used various concussion management guidelines based on guideline developers’ experience, supported by little-to-no scientific evidence. In 2000, the Canadian Academy of Sport and Exercise Medicine published the first “modern” management guidelines. Those guidelines called for initial rest following a concussion, then a graduated return-to-sport approach once the athlete no longer had symptoms. Next, in 2001, the First International Conference on Concussion in Sport brought together clinicians and sport scientists with expertise in concussion. The first international consensus paper was published that same year.

Photo: Canadian Paralympic Committee

Since then, the Concussion in Sport Group has met 4 more times, most recently in Berlin in 2016. During this time, updated consensus statements were published along with assessment tools such as the most recent versions of the Sport Concussion Assessment Tool (SCAT5) and the Concussion Recognition Tool (CRT5). These statements and tools have provided guidance on the recognition, assessment, management and prevention of sport-related concussion (SRC). But while these guidelines and tools have been developed for anyone participating in sport, does a one-size-fits-all approach work for concussion?

Consider if someone suspects a goalball player has sustained a concussion. When assessing the potential severity of that athlete’s head injury, the concussion guidelines and assessment tools advise healthcare providers to look for a blank or vacant stare. This may be hard to determine for a goalball athlete with visual impairments. That athlete also couldn’t report double vision as a symptom that’s listed on the SCAT5 checklist. Likewise, depending on the level of visual impairment, the athlete may be unable to complete a written symptom checklist.

Now consider a wheelchair basketball player who’s being assessed for concussion. One of the physical tests in the SCAT5 is to assess balance using 3 different conditions, all involving standing. How do you appropriately assess balance when an athlete is using a wheelchair? Would the SCAT5 balance assessment be valid if an athlete is using lower extremity prosthetics? Various other examples could be made, but it’s clear that a one-size-fits-all approach for concussion management and assessment simply doesn’t apply to many athletes with a disability.

To quickly explain preferred terms, a Para athlete is what the International Paralympic Committee (IPC) calls an athlete with a disability. We’ll reference Para athlete for the rest of this article. Para sports are sports played by Para athletes. It’s important to remember that Para athletes are a heterogeneous group, with athletes having a number of different impairments and disabilities allowing them to compete in various sports.

Para athletes are frequently exposed to concussion risk, particularly in high-speed and impact type sports such as Para alpine skiing, Para ice hockey and wheelchair basketball. They’re also exposed to concussion risk in sports where the risk to the non-Para athlete would be considered low, for example, in track-wheelchair racing, where crashes aren’t uncommon. Unique Para sports such as goalball or football 5-a-side (commonly known as Blind Football) also present an increased risk of collision and therefore concussion, given that athletes can’t see other players, the ball or the goalposts.

In fact, a recent study of elite Swedish Para athletes showed that concussions happened at about the same rate among athletes with and without disabilities, and that athletes with visual impairments had both a significantly higher proportion of reported concussions and a higher incidence rate than athletes in other impairment groups (Lexell et al., 2021).  Given the outlined discrepancies between concussions manifestation, assessment and management in Para athletes compared to their unimpaired counterparts, clearly one size doesn’t fit all.

Minding the gap

In London, England, passengers riding the Underground are reminded to “mind the gap” when stepping on and off trains. That warning would also apply to the gap in our knowledge about anything relating to concussion in Para athletes. Despite an increase in concussion research in general, unfortunately there hasn’t been similar growth in research for concussion in Para sport.

https://youtu.be/x_QebMOKcJ0
Dr. Kissick discusses gaps and opportunities for research on concussions in Para sport.

A 2018 literature search identified over 6000 articles using “athlete plus concussion” (and related words) as the search terms, but only 60 articles when search terms reflected an athlete with a disability and concussion (Kissick & Webborn, 2018). The previously mentioned International Conferences on Concussion in Sport didn’t address concussion in Para athletes at all. And at the most recent conference, of 202 oral and written abstracts presented, only 2 abstracts were specific to athletes with a disability.

The IPC has conducted injury surveillance studies at every Paralympic Games since 2010, but specific questions about concussion weren’t added until Rio 2016. A review of that data found 10 reported injuries to Para athletes’ head, neck and face, but none were identified as a concussion (Derman et al., 2018). That said, IPC Medical Committee members witnessed 2 incidents during a Blind Football match (live and on subsequent video review), where there was an obvious blow to the head, followed by apparent balance issues. Both incidents weren’t reported as a concussion and the players weren’t removed from play. While it’s impossible to diagnose a concussion from the stands, reliable guidelines exist to assess concussion using video analysis playback (Gardner, 2021), which suggest these players should have been removed from the game and further assessed.

Unfortunately, this isn’t unusual in Para sport where scarce resources may limit access to medical care and the luxury of live video playback. A now retired Canadian Para alpine skier reported she had falls that she suspected she might have caused concussions, but coaches told her, “You hit your face, not your head, so it can’t be a concussion” (Wisniewska & Kissick, 2020).

skieurWhile 4 concussions were reported at the 2018 PyeongChang Winter Paralympic Games, including 2 in Para alpine skiing and 2 in Para ice hockey (Derman et al., 2020), the question remains, were all concussions truly recognized and reported? Given studies on under-reporting of concussion in mainstream sport, it’s likely that IPC surveillance data isn’t reflecting the true number of concussions at these Paralympic Games (Pennock et al., 2020).

Data from the 2016 Paralympic Games did suggest a higher risk of injuries to the head and face in Blind Football, a finding supported by other Blind Football research (Magno e Silva et al., 2013; Webborn et al., 2016). Additionally, a study looking at American wheelchair basketball players, aged 18 to 60 playing in tournaments during the 2009 to 2010 season, found that 6.1% of players reported a concussion (Wessels et al., 2012). Of concern, however, is that 44% didn’t report their symptoms to staff, two-thirds of those players didn’t want to be removed from play, and half didn’t know they had a concussion at the time (Wessels et al., 2012).

In addition to the increased concussion incidence in visually impaired athletes, the previously mentioned study of Swedish Para athletes found that female Para athletes reported a significantly higher incidence of SRC than their male counterparts (Lexell et al., 2021). And collisions with either an object or another person were most common ways injuries happened. Further studies to determine how often concussions occur in Para sports, including how and when they occur, will be critical to help direct efforts toward concussion prevention and risk reduction.

To close the gap in knowledge related to concussion in Para sport, the Concussion in Para Sport (CIPS) group published its 1st Position Statement of the Concussion in Para Sport Group in April 2021 (Weiler et al, 2021). Current evidence and the experience of the expert group formed the foundation for the recommendations and guidance included in the position statement. Now we’ll take a closer look at the recommendations from the CIPS Group regarding concussion assessment, management and return to play, and prevention strategies for Para athletes.

Assessing concussion in Para athletes

https://youtu.be/0Ly2wb28wws
Join Dr. Kissick to learn more about assessing concussions in Para athletes.

The Sport Concussion Assessment Tool 5 (SCAT5) is the most well-established and widely used tool in the sideline assessment of sport-related concussion (Echemendia et al., 2017). Much of the SCAT5 (and the general guidance of the Consensus Statement of the Fifth International Conference on Concussion in Sport, “The Berlin Consensus”) still applies when assessing concussion in Para athletes. However, as noted earlier, several aspects of SCAT5 simply may not apply or would require altered assessments.

The Berlin Consensus outlines the “11 R’s” of concussion assessment and management. The first 2 R’s (Recognition and Removal) remain critical in all cases, Para athlete or able-bodied. The most important step in concussion assessment and management is to recognize a concussion may have occurred and to remove that athlete from play or practice. Our previous examples from Blind Football, Para alpine skiing, and wheelchair basketball show that these crucial first couple steps are often missed. Without proper recognition and prompt removal, the athlete won’t be appropriately assessed and treated. This speaks to the importance of education about concussion recognition.

Potential issues with using existing concussion assessment tools like the SCAT5 extend to other factors, such as performing cognitive screening in athletes with cognitive impairment or learning disability, assessment of neck pain and movement in athletes with cervical spine dysfunction, neurological tests like “finger to nose” in athletes with a coordination impairment, and memory and concentration tests in athletes with cognitive or hearing impairments. The CIPS position statement uses a “traffic light” analogy to dig deeper into using the SCAT5:

Potential modifications are discussed in the CIPS position statement, such as the Wheelchair Error Scoring System (WESS) for assessing balance for wheelchair athletes (Wessels, 2013).

A crucial fact to emphasize is that Para athletes are far more likely to have pre-existing symptoms and medical problems compared to non-Para athletes (Weiler et al., 2018). Accordingly, some symptoms and signs evaluated in a concussion assessment may exist in a Para athlete’s usual (or baseline) state. For example, athletes with cognitive impairment may have difficulties with memory and concentration, and athletes with visual impairments are more likely to have pre-existing dizziness, headache and poor balance (Fahger, 2019). Therefore, it’s absolutely critical that healthcare providers have a thorough knowledge of that Para athlete’s baseline status, which is best obtained by performing a thorough baseline assessment.

https://youtu.be/83hdO_PSQAA
Join Dr. Kissick as he explains why baseline testing is critical for Para athletes.

Managing concussion and return to play in Para sport

The CIPS Group recognized that concussion management recommendations made for general athletes in the Berlin Consensus would also apply to Para athletes, with some differences. For example, an athlete with an intellectual impairment may have difficulty understanding the importance of being removed from play (that is, the increased risk of worsened concussion or other injury if the athlete remains in the game or activity). On the other hand, the recommended period of physical and cognitive rest is much more difficult for the athlete using a wheelchair, given their need to propel the wheelchair and to engage in transfers as part of their activities of daily living. We don’t know yet whether some Para athletes should have a longer period of physical and cognitive rest before returning to sport, but this may be a consideration for athletes with impaired central nervous system function.

High angle portrait of young woman in wheelchair playing badminton during sports practice at indoor court.Provided symptoms don’t worsen, a graded increase in daily activity is recommended for Para athletes, but the grading may need to be customized. For example, many non-Para athletes start their graded return-to-play process on a stationary bike, but this wouldn’t be possible for an athlete in a wheelchair or someone with a marked discrepancies in leg length. An alternative, such as a handcycle, may be needed. Monitoring of balance and gait must also be adapted for wheelchair users or athletes with gait or balance issues. An additional consideration for athletes with spinal cord injuries at the sixth thoracic vertebrae or above is to monitor exertion level by measuring heart rate. These athletes may have dysfunction of their autonomic nervous system that limits their ability to alter heart rate with exercise.

As with all concussed athletes, before return to sport happens, the first priority for recovery should be a return to school or work, when appropriate and without aggravating symptoms. For athletes with symptoms following a concussion, therapists may try cervical spine and vestibular rehabilitation, which are often helpful. But these therapies must be done with caution and be adapted for Para athletes with spinal cord injuries or neck dysfunction. A final consideration is that monitoring the return-to-sport process may be more complex for Para athletes, because of pre-existing symptoms and signs present in their baseline measures (that is, in the “non-concussed state”). Again, this reinforces it’s important to conduct a thorough pre-season assessment.

Preventing concussions in Para sport: The 3 E’s

Decades ago, renowned injury epidemiologist Susan Baker described the “3 E’s of Injury Prevention”: education, enforcement, and either engineering or environment (Baker, 1973). The E’s are endorsed by Parachute, a Canadian national charity dedicated to injury prevention, and all E’s apply to preventing concussions too. The key to implementing effective prevention strategies begins with a better understanding of the incidence and mechanism of injury. Additionally, more research in the Para sport domain is urgently needed.

https://youtu.be/FGsSKcFBBm8
Dr. Kissick explains the importance of getting the message across that “Para athletes are elite athletes.”

The obvious gap in concussion education (the first E) isn’t only an issue for athletes, but for coaches, officials, sport organizations and healthcare providers. It’s imperative they all appreciate that concussion is a significant injury. Para athletes who already experienced severe illness or physical trauma (such as cancer or spinal cord injury) may not consider concussion as a concern. Many Para athletes are risk takers and effective education strategies must address these issues. Strategies must also be implemented at multiple levels, and address how critical it is to recognize concussion, stop play and medically assess the athlete.

Enforcement, the second E, refers to the sport’s rules. This might involve introducing new rules or changing existing rules to increase athlete safety. For example, the 2014 Sochi Winter Paralympic Games had a very high incidence of serious injury in Para Alpine events. Analysis of these injuries led to a close collaboration between sport technical officials, host officials and the IPC Medical Committee. That collaboration led to changes that greatly reduced the injury rate at the 2018 Winter Paralympic Games. The changes included more training runs and racing earlier in the day when snow conditions were better (Blauwet et al., 2019). As another example, Cerebral Palsy Football and Blind Football (soccer) have introduced temporary concussion substitution rules. When there’s a suspected concussion, a 10-minute window allows a substitute to play while the injured player is carefully assessed for concussion by medical staff. If the player is deemed to not be concussed, they can return to play, without the team losing a substitution (Ahmed et al., 2020).

Photo: Canadian Paralympic Committee

The third E can refer to changes to the environment or engineering. Environment might include slope alterations in Para alpine skiing (such as more “waves” and fewer “jumps” which are particularly dangerous for sit-skiers). Engineering involves preventative measures that focus on infrastructure and equipment. Protective equipment, such as helmets, haven’t been evaluated well in Para sport. However, the International Blind Sports Association (IBSA) has engaged in research to determine the effectiveness and feasibility of softshell helmets with integrated goggles or blindfolds for Blind Football players (Kissick & Webborn, 2018).

Not “the final frontier” but the “next frontier”

At an American College of Sport Medicine meeting in 2016, one of this paper’s co-authors (J. Kissick) was asked to speak on concussion in athletes with disabilities. He was given the title, “Concussion in the disabled athlete: The final frontier.” Thankfully, more is known now and there’s more to say on this topic than 5 years ago. But to keep athletes safe, there’s still much work to be done and a lot more that needs to be known. Concussion in Para athletes won’t be the “final frontier,” but it is and should be “the next frontier.” In keeping with the Star Trek analogy, Captain James T. Kirk perhaps said it best: “… there is no such thing as the unknown, only things temporarily hidden and not understood.”

One size doesn’t fit all for concussions. However, the CIPS Group and its position statement together are a step to emphasize and address this.

https://youtu.be/oTtsmMTGW1U
What can you do? Dr. Kissick recommends that you get involved in Para sport!

Highlights


Sport, like all industries, adapted to the challenges of the ongoing COVID‑19 pandemic. Competitions and events were cancelled or they continued in empty stadiums. Over the past year, high-performance athletes have become used to long periods of isolation and competing on the world’s biggest stages without the roar of the crowd. At the same time, fans found new ways to engage, from home, with their favourite athletes and teams.

Following the announcement that no foreign spectators could enter Japan this summer for the Tokyo 2020 Olympic and Paralympic Games, the Games will be a unique spectacle. Having been postponed to 2021 due to the COVID‑19 pandemic, the Games present a challenge for Canadian sport organizations looking to build their fan base and raise their sport’s profile during the Games, despite the absence of foreign spectators.

Fortunately, Canadian sport organizations, broadcasters, leagues and teams have had nearly a year and a half to adapt to the ‘new normal’ of the pandemic. During this time, digital innovation has driven engagement and evolved the fan experience. Nonetheless, the fundamental principles of being a sports fan remain the same: It’s all about engaging with favourite athletes or teams, building a sports-centred community and experiencing special moments.

This article dives into the pandemic lessons and teachings of a Canadian sport broadcaster, professional sports and entertainment company, sport streaming business, and a professional league and team. Their stories offer strategies and examples to improve the viewing and engagement experience for any spectator.

Driving engagement through innovation

For Canadian sport organizations, businesses and broadcasters, the pandemic presented new opportunities alongside challenges. These opportunities led to new and more diverse audiences tuning into sports throughout the country. The driving force behind these opportunities? New technologies and digital innovation.

For example, as Team Canada’s official broadcast partner, CBC Sports adapted its coverage of a wide range of sports, from basketball to curling. This was largely facilitated by new technologies that Monika Platek, Senior Producer of Social Media at CBC Sports, likes to call “the shiny new things that we didn’t have a year ago.”

Man wearing headphones speaking into a camera inside an office.

Over the past year, CBC Sports started to use Instagram Reels, short online videos that allowed Canadians to experience jaw-dropping moments or incredible athletic feats, and to reshare athlete-generated content. Another pandemic-spurred innovation was the introduction of StreamYard. As an easily accessible social broadcasting platform for podcasts and web shows, StreamYard allowed CBC Sports to produce sport-specific shows with contributors from across Canada. For example, figure skaters Dylan Moscovitch and Asher Hill hosted “That Figure Skating Show” on CBC’s YouTube channel throughout the winter. Additionally, Canadian curler and media personality Colleen Jones joined CBC journalist Devin Heroux to host “That Curling Show.” By highlighting underrepresented sports, CBC Sports received great feedback from the sports community, and reached new fan bases.

“StreamYard allowed us to break down geographical barriers and suddenly have all sorts of people in the same virtual space,” says Platek.

Like CBC Sports, many leagues, teams and companies across Canada have taken advantage of digital innovations to connect with fans and spectators. At the professional level, Maple Leaf Sports & Entertainment Ltd. (MLSE), owner of Toronto-based professional teams including the Toronto Maple Leafs and the Toronto Raptors, created the Digital Arena where fans could interact with each other and participate in online games. Similarly, the Canadian Premier League (CPL), a professional soccer league, developed an augmented reality “virtual stadium” during its 2020 season that enhanced the viewing experience for fans watching from home.

Duncan Fraser, Director of Event Experience at MLSE, says his team is “starting to use the term ‘hybrid’ a lot” when discussing post-pandemic plans. While everyone is eager to return to in-person sports and spectator experiences, there are some benefits of the virtual experience that will likely continue.

For instance, MLSE hosts workshops for local hockey and basketball coaches at the Maple Leafs’ and Raptors’ respective training facilities. During the pandemic, these clinics moved online. Instead of the usual 300 to 400 coaches in attendance, the online platform reached 2500 coaches from 43 countries worldwide. Although not fan specific, this experience showed MLSE that virtual platforms had the potential to expand the organization’s reach.

Two young female basketball athletes jump for the ball during a game.

In 2020 and 2021, organizations have accelerated their implementation of streaming services for youth, amateur, and scholastic sports. GameOnStream is a Canadian company that provides state-of-the-art streaming technology for sports leagues and venues across North America. Using artificial intelligence (AI) technology to operate its camera systems instead of an in-person camera operator, GameOnStream’s services became increasingly popular during the pandemic.

“The pandemic has increased the speed of people realizing that if they don’t have streaming, that they should have it, and then figuring out how to do it,” says GameOnStream’s CEO Bob Wilkinson.

Wilkinson believes that “streaming has a positive impact on keeping people engaged in following and supporting sports, especially at the youth level.” These benefits can extend beyond spectators to analytics, teaching, game-tape reviews and evidence for in-game penalties.

From national sport broadcasters to independent streaming services, these examples show how new technology and digital innovation are driving fan engagement and virtual spectator experiences at all levels of sport, not only during the pandemic, but for years to come.

Building connections and a sense of community

While technology has kept the fan experience afloat during the pandemic, it’s only a part of the equation. At its core, being a sports fan is about building connections, either with a favourite team or athlete, or with other fans. The meaning and construction of these connections has changed significantly during a year defined by social distancing, quarantine and isolation. While quickly pivoting toward engaging fans virtually early in the pandemic, the sports sector’s big focus was on ensuring that connections were still being built and maintained. This required sport organizations to recognize some honest truths and get creative.

“As marketers, we asked: How can we create an at-home experience that makes it feel like you’re in the arena? We can’t. That’s the beauty of live sports,” says Fraser.

Rear view of female hockey spectators watching a hockey game in an arena.

MLSE compensated for this reality with extensive innovation. In spring 2021, MLSE launched the Digital Arena to introduce elements of a live venue to fans at home. While watching a Maple Leafs or Raptors game on their televisions, fans could access Digital Arena through a smartphone app. This app facilitated fan engagement by using tools like trivia competitions, chatrooms and 50/50 draws. As a result, fans connected with their favourite teams, as well as with each other, and built a sense of community.

National Hockey League (NHL) and National Basketball Association (NBA) games were also able to reach millions of fans consistently through broadcasting partners such as TSN, CBC and Sportsnet. In fact, Canadian hockey viewership during the pandemic has increased substantially relative to past years.

While MLSE took strides to promote fan engagement during games, it also realized that most fan experience occurs outside game time. “A year ago, a live experience event group facing a pandemic is not necessarily exciting, but we’ve created a ton of amazing at-home experiences for our fans that have been elevated throughout the entire year,” says Fraser.

MLSE’s event experience team has planned hundreds of events ranging from intimate Zoom calls with Maple Leafs legends to cooking lessons with MLSE’s chefs to sending game-day pucks to lucky season-ticket holders. These wide-ranging and creative ideas allowed fans of all sorts to get excited and stay connected with their favourite teams. MLSE effectively coupled its game-time experiences, such as Digital Arena, with non-game-time experiences, like virtual meet-and-greets that continually engage teams’ fan bases.

That said, MLSE was fortunate to have entered the pandemic with ample resources and large, long-standing fan bases for their teams. Meanwhile, lesser-known sports and leagues had to find ways to build connections with new fans and use more limited resources to reach out to their followers.

For example, Canadian soccer has persisted as a fan-centred sport with devoted supporters’ groups and dedicated followings throughout the pandemic. Nowhere is this clearer than in Nova Scotia, home of the Halifax Wanderers Football Club (HFX Wanderers). Despite HFX Wanderers being a brand-new team in the Canadian Premier League, its supporters banded together to form a vibrant and inclusive community whose influence extends beyond the sport.

Side-view of a men's soccer team lined up in two rows before the start of a match. Wearing blue uniforms.

The club’s #TogetherFromAways motto exemplifies the strength of the team’s community in the face of challenge. HFX Wanderers Marketing and Brand Manager, Dylan Lawrence says, “In Halifax, we don’t have these larger NHL or NBA franchises. I think there’s a lot of people in this community that needed a platform like the Wanderers to showcase that love for each other and the support of the game.”

Lawrence also describes the pandemic as “a blessing in disguise … it was good for us to have an opportunity without soccer being the prime focus to understand the market a bit better.” This helped the club find new ways to interact with its fans and establish its presence within the Halifax community. For instance, HFX Wanderers players participated in vaccination initiatives and developed relationships with local youth soccer clubs. Fans responded in kind. An example is superfan Missy Searl, widely known as “Mama Searl.” She cooked and delivered personalized meals to HFX players during Nova Scotia’s most recent lockdown. Throughout the pandemic, HFX Wanderers and fans formed new connections and deepened pre-existing ones.

MLSE and HFX Wanderers represent opposite ends of the professional sports spectrum in Canada. One owns some of Canada’s most recognizable sports franchises, while the other is building itself from the ground up as part of a new league. However, both recognized the importance of connecting with fans during the pandemic by continuing to build their respective sports-centred communities.

Creating special moments

The pandemic provided sports with opportunities to engage new audiences and experiment with state-of-the-art technologies. But the most exciting part of being a sports fan remains the same: the special, edge-of-your-seat moments. These are what make sports memorable.

Group of fans watching a soccer game on the couch at home. They are celebrating a goal.

Fortunately, you don’t have to be there in person to experience the excitement. Millions of Canadians celebrated Sidney Crosby’s 2010 golden goal at home with family and friends. Entire households cheered from their couches as Penny Oleksiak stormed back to claim gold in the 100m freestyle in Rio de Janeiro. Fans right across the country celebrated the Toronto Raptors’ 2019 championship run. Despite the challenging circumstances of the pandemic, moments such as those haven’t disappeared. Fans can experience them from home, and the pandemic has even made these moments more accessible to all Canadians.

“At the onset [of the pandemic], we were always looking for what is the biggest and best idea. How are we going to get thousands of people to all watch the game together?” says MLSE’s Fraser. This turned out to be a trap. As MLSE quickly realized, driving fan engagement is often less about the size of the crowd and more about the quality of the experience.

“People are tired of screens. Unless that moment is really special, or feels individual to that person, it’s just not going to be worth it,” says Fraser.

This prompted MLSE to implement smaller virtual meet-and-greets and personalized experiences that created special moments for both fans and athletes. Whereas in-person meet-and-greets can sometimes be awkward for professional athletes, Fraser says the players had outstanding feedback for this year’s virtual events: “They were funny and engaging…. The players didn’t stop talking. They loved sharing stories.”

Interestingly, the pandemic has prompted a new hunger for ‘special moments’ at the grassroots level, as well. With family members often unable to attend their children’s practices and competitions because of capacity limits and social distancing requirements, streaming technology has played a key role in bringing youth and scholastic sport events to family, friends and classmates.

Parents who can’t make it to a game can still watch their kids. And students can cheer on their school’s team from afar. “You can watch the game from the parking lot on your phone or on your tablet at home… all the games are live and on demand there,” says GameOnStream’s Wilkinson.

Elderly individuals, who have been especially isolated during the pandemic because of health concerns, can also watch their grandchildren on the field, court or ice, from their computers.

“You get some of the most amazing letters and notes from grandparents being able to watch their grandchildren,” says Wilkinson.

There may be fewer people in the stands seeing a special highlight-reel goal, but there are many more people watching from behind a screen.

Toward a ‘new normal’ for fan engagement

Family in red and white sports jerseys cheering in living room

With Tokyo 2020 on the horizon and Beijing 2022 just around the corner, the lessons for fan engagement learned during the pandemic are already being put into practice. CBC Sports extended its use of the StreamYard platform to cover Swimming Canada’s Olympic trials as well as late June’s final Olympic qualification tournament for Canada’s men’s basketball team. In addition, a virtual watch-party featuring guests and commentators is planned for Tokyo 2020’s opening ceremony, on July 23. And while a small media delegation will travel to Japan this summer, most of the Olympic and Paralympic coverage will originate in Canada.

“We are in really good shape to take on the Games from this sort of virtual space, because we’ve been doing it now for 16 months. We have really innovated and changed a lot in the last year, and I think we’re really prepared to take on these games from our at-home offices,” says CBC Sports’ Platek.

Through tough times, sports have proven to be a uniting factor for fans around the world. In the face of immense challenge, Canadian sport businesses and organizations have adopted several innovative strategies to engage their fans virtually and strengthen sports-centered communities. From intimate Zoom calls with athletes to new sports-specific programming, digital innovation continues to thrive and connect fans with each other and the special moments that sport offers. All the while, the sports community continues to grow.

As HFX Wanderers’ Lawrence remarks, this year for sports fans has been about “recognizing that we all wander individually, but it’s when we wander together that life is how it should be.”


Highlights


SIRC asked former sports journalist Teddy Katz to sit down (virtually) with leaders from the Canadian Olympic Committee (COC) and Canadian Paralympic Committee (CPC) for a behind-the-scenes look at the challenges of preparing for 2 Olympic and Paralympic Games amid a global pandemic. After a one-year postponement, the Summer Games, set to be held in Tokyo, Japan, will be held just 6 months before the Winter Games kick off in Beijing, China.

During the conversations with COC and CPC officials, a few key themes emerged for these Games like none we’ve ever seen before. This article shares that athletes, coaches and staff have faced enormous challenges and have had to deal in new ways with risk, uncertainty, safety, communication, and mental health.

The risks: To go or not to go

Tokyo Olympic Stadium in Shinjuku City, Tokyo, Japan
Tokyo Olympic Stadium in Shinjuku City, Tokyo, Japan

Ever since the Games were postponed in 2020, there have been lingering questions about carrying on with them and whether it was worth the risk. The International Olympic Committee and International Paralympic Committee have been working closely with experts from the World Health Organization guiding them to find a way to have the Games take place safely. But the Japanese public has been jittery. The roll-out of vaccinations has been slow in Japan, and polls show many people oppose the Games happening mid-pandemic. With 15 000 Olympic and Paralympic athletes due to arrive this summer, along with thousands more media, sponsors and other stakeholders, some have concerns that the Games will become a petri dish for the virus.

Grace Dafoe, a member of Canada’s national development team for skeleton, understands those concerns better than most. Dafoe contracted COVID‑19 in April from a close contact while she was training in Calgary. She says it “walloped” her. She felt incredible fatigue, and had a horrible dry cough and raging headaches. “It was scary and unlike anything I’ve ever felt before.”

Still Dafoe isn’t worried about the Games going ahead. “There’s a risk in going to the grocery store at home in Calgary. There’s risk everywhere. We just have to accept that.” She says her concerns were eased when the Canadian Olympic and Paralympic Committees made the dramatic move last year to withdraw from the Games in 2020.

“One of the most comforting things for me was actually when Canada was the first to pull out of Tokyo. I think that sent a message to me as a winter athlete as well that they’re going to have our best interests in mind when it comes to our health.”

Uncertainty: A pre-Games like no other

It’s never been a more challenging time for Canada’s Olympic and Paralympic athletes, what with the Tokyo postponement, athletes scrambling to train from home and unable to travel, cancelled qualifying events, and athletes with disabilities unable to get classified. Karen O’Neill, Chief Executive Officer (CEO) of the CPC, says everybody is feeling unprecedented stress. “I don’t think there’s ever been such a sustained period where our coaches, our athletes and sport members have been tested so much and been asked to perform so many accommodations.”

David Shoemaker, CEO of the COC, and Marnie McBean, former Olympic rower and the Canadian Olympic Team’s Chef de Mission in Tokyo, co-hosted a Canadian Club luncheon, held virtually in May. They took turns asking each other questions and speaking to the difficult lead-up for the Games.

Tokyo 2020 Olympic Games“Tokyo was going to be these really easy Games when they got them,” McBean reminded Shoemaker and the audience. The IOC was turning the Games over to what they referred to as “a safe pair of hands.” She added, they wanted to avoid some of the chaos they dealt with in previous Games in Russia, with exorbitant costs, and Brazil, with its financial troubles, Zika virus and other issues.

The reality is that the pandemic has turned these Games into one of the most challenging ever. “These bumps in the road, in some cases huge potholes, are things that we need to assume are going to happen on this journey to Tokyo,” Shoemaker says.

Every athlete, every sport, has been impacted in their own way. McBean says the swimmers, for example, have been out of the water and unable to train the way they normally would for 120 days because of the lockdown of facilties during the pandemic. “There’s an Olympic thing happening every day. And there’s Olympic things not happening every day. It’s been really challenging.”

“But that’s what Olympism is, right? That’s the whole idea of why people go, ‘Oh, that’s a Herculean or an Olympic sized task’. It’s always been hard. It’s never been a straight line to Olympic gold.”

Canadian Paralympic Committee logoThe uncertainty that’s been difficult to manage will continue throughout the Games, says Catherine Gosselin-Després, who is the Executive Director of Sport for the CPC. At Games time, Tokyo organizers are employing strict COVID‑19 guidelines to limit everybody’s movement. They’ll go to their events and then back to the Olympic Village. “We’ve been working with the national sport organizations trying to explain the environment. But obviously, none of us have lived this before.”

At the time of the interviews with fewer than 60 days to go to the Games, Canada’s Olympic and Paralympic planners usually know almost every detail right down to the size of the doorknobs for the 400 or so athletes who will be going for the Olympics and 130 athletes headed to the Paralympics. Typically, planners would have made many trips to the site to prepare for the Games. But that hasn’t been the case during the pandemic. With the Winter Games in Beijing kicking off just 6 months after the Summer Games in Tokyo, planners will cut and paste to try to reuse many of their Tokyo plans for Beijing.

Céline DesLauriers, Senior Manager of Games at the COC, says the master plan is 20 000 lines long. Her logistics team has gone from using Excel spreadsheets to an online software program where they can track changes on the fly. Instead of shipping the teams’ necessary sports gear and equipment, the way they have in the past, they’re chartering a cargo plane.

Another tricky part comes with travel arrangements. With the new COVID‑19 guidelines, athletes can only check into the Athletes’ Village up to 7 days before they compete. They must leave within 48 hours after their competition ends. For a team sport, that will require juggling for everyone involved when teams get eliminated.

“Normally, a couple of months out to the opening of the Village, the national sport organizations pretty much know who’s coming and everything. They’re just waiting for the final qualification. What we’re seeing is right now it’s being pushed till the very last seconds. We’re just learning to be nimble and adaptable,” DesLauriers says.

The priority: Health and safety

The COC and CPC aren’t releasing their usual performance benchmarks that normally proceed the Games. While they know most athletes will be aiming to get on the podium, they don’t want anybody feeling any added pressure. According to the CPC’s O’Neill, the overall well-being of Team Canada is the primary goal in Tokyo.

“What keeps me up at night, it’s my personal and professional commitment to the responsibility of ensuring that Team Canada is supported. The primary objective is that everyone is safe, healthy, both heading into Tokyo, during the Games and coming back afterwards.”

The COC’s Shoemaker says that includes keeping people in the host country safe as well. Until now, Japan has done a pretty good job of minimizing infections from the virus. With more than three times Canada’s population, Japan has had half our number of cases and deaths. And there are many COVID‑19 countermeasures to keep things that way during the Games. These include two negative tests prior to going, testing everybody daily upon arrival, and keeping everybody contained in the Village or at competition venues.

Red striped line sign for keeping social distance. Woman standing behind a warning line during covid 19 coronavirus quarantine.

“Everyone should wipe clean from their minds what they think an opening ceremony or what a competition will look like. There will be no overseas spectators. There won’t be friends and family. We won’t have a Canada Olympic House in Tokyo. That doesn’t guarantee the complete safety but we’re doing our absolute best to prioritize the health of everybody involved,” Shoemaker says.

The CPC’s Gosselin-Després says many athletes have received their first vaccine and breathed a sigh of relief with the news in May that Pfizer would donate 2 doses for every athlete who wants to be vaccinated. “For us, that was key. I think the athletes would have probably had questions if there was just one dose. But now with the announcement, I think that’ll help everyone.” However, the Pfizer vaccine isn’t approved in all countries and there still could be positive COVID‑19 tests even among those who have been vaccinated.

Stephanie Dixon, who is a former Paralympic star athlete and now Chef de Mission for the CPC in Tokyo, says COVID‑19 just adds to the usual stress of performing at the Games. “I don’t think we can underestimate that level of stress,” Dixon says. “People are going to be nervous, if they feel a tickle in their throat. Every single one of us in the world has suddenly given new meaning to having a tickle in the throat or to a runny nose.”

The CPC and COC always plan for many different scenarios. For Tokyo, that includes a number of plans specifically for COVID‑19. For example, what to do if there’s a positive case? And what happens if there’s a false positive that forces somebody to miss their event? These are among the new questions they need to consider.

Finding new ways to communicate and connect

Every media story out of Japan has raised doubts about the Games and added to the uncertainty. It’s been hard to separate fact from fiction. That’s why a fundamental part of the CPC and COC plans for Tokyo and Beijing has become communicating and providing constant updates with the latest facts for all stakeholders. Since the fall, both committees have adopted a crisis communications approach.

In a crisis, communications experts say it’s important for leaders to clearly state what they know, what they don’t know, and when they hope to provide an update on what they don’t know. DesLauriers of the COC says, “That’s exactly the strategy we’ve taken in all of our communications.”

As Chef de Missions, Dixon and McBean have been meeting virtually every few weeks with athletes and other stakeholders. “This is the most engagement with athletes that I’ve ever seen prior to the Games,” says Dixon. “I think it’s important we’re getting them into a virtual, figurative room together because they can hear from each other what each has been going through. It helps us as a support staff really see into the minds of the athletes and see what they need from us.”

Canadian spectators cheer on Wheelchair Tennis athlete at Lima 2019 Olympic Games
Photo: Scott Grant/Canadian Paralympic Committee

Before the pandemic, McBean expected to be travelling the country and providing a different kind of motivation. “Suddenly my interactions with the team and the conversations we were having with the athletes weren’t about this fun ambitious management to the podium. It was more life management.”

McBean advised the different teams and athletes that the fear and doubt they might be feeling are part of every athlete’s path. She told them not to worry about the big things. Focus on the little things that make you better and that’s when great things happen.

Dixon says at Games time, one of the issues they’re dealing with revolves around the team being told they must social distance when they aren’t competing. “One of the primary measures is to stay away from each other. If we can’t physically get close to one another, we can’t be cheering and singing. How do we get a sense of team unity?”

She says they’re looking for creative ways to connect the team. They’re thinking of having athletes post sticky notes with messages for one another, or doing virtual team recognition and medal ceremonies every day in Tokyo.

“At the end of the day, when athletes isolate after their events and go back to their rooms, we’re thinking about how we can break down those isolation walls in a virtual way.”

A focus on mental health

The prolonged sense of uncertainty added to the usual stress of the Games has created fertile ground for anxiety. It’s taking a toll on athletes as it has for the rest of society. Susan Cockle is a psychologist who is working with the CPC. She’ll be on site in Tokyo as the Mental Health Lead. It’s the first time the CPC has ever had one at the Games.

Creative silhouette image of the brain, shown with gears and lights.

She says anxiety is actually the body and brain’s way of protecting us as humans. When things are uncertain, we go on high alert. “It’s like our emotional psychological furnace has been running on high for a while. When, our anxiety – our furnace – has been running on high, it doesn’t take much for it to break down,” says Cockle. “That’s why we need some ongoing service to the furnace, why we want to do some mental health mitigation. We want to do some prevention so that we can have that furnace run on a lower temperature, and not burn out.”

Normalizing the conversation and creating social support around mental health and wellness are 2 of the most important ways to do that. Shoemaker says it’s been a key focus for the COC too. “We have found it’s very important for us as we are delivering our team to two Games in six months to be very focused on how people are doing. I have found myself asking questions I would have never dreamt of asking a couple of years ago: ‘How are you doing and how are you feeling?’ and getting people to talk and open up.”

Cockle says checking in is important and recommends asking specific questions to help people focus their responses. “How are you doing with COVID‑19 is a big question. If you can make that question a little more contained, then people are more likely to answer more genuinely,” she says. “If you actually say, ‘how are you doing today’, you’re more likely to get an emotion. That’s what we want. We want those types of responses to be real and out in the open. Normalizing that can make people feel less alone.”

It’s not just the athletes who they’re concerned about for mental health, according to the COC’s DesLauriers. “It’s also for all the support staff and the mission team that will be on site. As an example, I’ll be in Tokyo 44 days. I’m not used to wearing a mask every day, having to do a test every day, doing the work that is normally pretty hard, amplified with all of the COVID‑19 countermeasures and restrictions that will be put on us.”

If things go sideways, both the COC and CPC have put plans in place with extra support, more reaching out and more points of contact. Athletes will know about extra resources from Game Plan or from the Canadian Centre for Mental Health and Sport.

Marie-Claude Molnar competes in Para Cycling at 2019 Paralympic Games in Lima, Peru
Photo: Dave Holland/Canadian Paralympic Committee

Cockle says mental performance consultants are also helping with mental health preparation. Penny Werthner is one of them. She’s assisting both the Olympic Athletics Team and the Paralympic Athletics Team among other athletes. Werthner always works with athletes and teams on distraction control and focus, emotional agility, dealing with disappointment and embracing chaos and uncertainty. 

Werthner says COVID‑19 has added a few new areas. “There will presumably be distractions from people testing positive whether you’ve been vaccinated or not. That’s a whole added layer that we’ve never faced before.” Werthner says talking about it ahead of time helps athletes prepare if it does happen.

She says managing isolation is another new area. “In previous Olympics, athletes would have friends and family there. For many, that’s a comforting thing. They can actually escape the Olympics for a day or so.” But athletes won’t have that same luxury in Tokyo. “There’s presumably no escape. You’re not going to be able to go around the city in Tokyo and do something fun,” says Werthner.

That’s a concern for the CPC’s Dixon. “There’s so much stress and tension that builds up in the lead-up to the Olympics and Paralympics. Whether it is the performance you were looking for or not, you always need a release afterwards.” After years of preparation, Dixon worries many athletes may miss out on the vibe and hype that normally comes from connecting with teammates and performing in front of fans in the stands. That’s why she says the team needs to address mental health before, during and after the Games, and she is happy to see the support being offered. “We’ve never been so focused on mental health and wellness at the Games,” she says. 

But despite the challenges of preparing for these atypical Olympic and Paralympic Games, Dixon believes the world will see strength, grit and determination of the human spirit in a way we’ve never witnessed before. 

“We will see great performances brought and fueled from these great challenges and adversity. It’s incredible what we can accomplish when we’re given no choice.”


Highlights


In November 2018, Calgarians participated in a plebiscite to decide if the city should proceed with a bid to host the 2026 Olympic and Paralympic Games. Calgary’s shot at hosting its second Olympics and first Paralympics came to an end as 56.4% opposed bidding. This was perhaps the final straw in what we, Calgary-based academics at Mount Royal University, had seen as a trend: sport and recreation were being minimized and underappreciated in Calgary

Another example was the ongoing debate and public pushback about whether Calgary should fund a field house, a conversation that started in the 1960s. Calgary is the only major Canadian city without such a facility. Other examples included the moral outrage over the expansion of separated bike lanes, the city considering closing public golf courses, and WinSport shuttering the bobsled, skeleton and luge run, a legacy track of the 1988 Olympic Games. 

The past few years have been volatile for Calgary’s sport and recreation sector. Every week, it seemed, we debated and questioned our commitment to being a city that promoted and supported an active life. We considered Calgarians as members of an Olympic city, one that embraced, celebrated and aspired to lead in sport and recreation, as well as health and wellness. But was this still true? 

Defining a ‘great sport city’ 

In January 2019, we assigned a question to undergraduate students who were studying sport and recreation management: Is Calgary a great sport city? We gave students latitude in how they defined a great sport city, with ideas ranging from the number of fans attending professional sport events to the number of world-class events hosted by the city. Students presented their findings to local sport leaders at the Canadian Sport Institute Calgary. When asked to rank Calgary against these findings, the results of the student analyses were mixed. Despite its status as an Olympic city, Calgary fell in the middle of most rankings. 

Moodle from the words submitted by attendees to the Sport Business Roundtable as to what our collective represented.
Moodle from the words submitted by attendees to the Sport Business Roundtable as to what our collective represented.

After further considering this question, we gathered 50 sport leaders from Calgary and the surrounding area for (what we called) the Sport Business Roundtable, in the Mount Royal University library. Delegates were from grassroots clubs to high-performance sport, including representation from ski hills, eSport, and postsecondary athletics and recreation. We spent the morning debating the future of sport. This included a welcoming plea from City Councillor and mayoral candidate Jyoti Gondek asking the sport community to provide a meaningful business case for why taxpayers should support and engage in sport.  

Three takeaways emerged: 

  1. We concluded that “sport business” was the wrong term to describe ourselves. We collectively decided to start using “active city.” 
  2. The people we invited didn’t really know each other. We had assumed they would already know one another. 
  3. This group genuinely wanted to connect and collect, which was reaffirmed when most delegates stayed well past the session’s ending time. And lunch wasn’t even provided! 
Attendees at the Sport Business Roundtable hosted at Mount Royal University.
Attendees at the Sport Business Roundtable hosted at Mount Royal University.

From this meeting, we concluded that Calgary’s rich regional active ecosystem was fragmented and inefficient. The result was its contribution to Calgary’s economic, human, social and environmental prosperity was being underleveraged.

The ActiveCITY Collective

The response was to create the ActiveCITY Collective: a collaboration of not-for-profit, for-profit and public-sector organizations as well as individuals engaged in Calgary’s regional active economy. Our goal was to transform Calgary into Canada’s most livable region through its active economy, and do this by facilitating collaboration, debate, learning and connection. The Collective would need to be independent and inclusive. It should be anchored in a systems perspective and work towards generating community prosperity. Finally, the Collective must use evidence and not anecdotes.

The New Zealand Model of Community Prosperity (also known as the Living Standards Framework).
The New Zealand Model of Community Prosperity (also known as the Living Standards Framework).

The ActiveCITY Collective was built upon the idea of an active economy that was grounded in 2 models. First, the New Zealand Model of Community Prosperity (also known as Living Standards Framework), which recognizes that benefits can be felt in the human, economic, environment and social spheres (New Zealand Treasury, 2018). The second model was Dr. Richard Florida’s idea of a creative class. In the early 2000s, Florida noted that “Beneath the surface, unnoticed by many, an even deeper force was at work—the rise of creativity as a fundamental economic driver, and the rise of a new social class, the Creative Class” (Florida, 2002). Could a similar argument be made about an active economy? Could Calgary and region mimic the growth of cities such as Nashville, which hung its hat on the idea of a creative class?

Downtown Nashville – Music City.
Downtown Nashville – Music City.

Nashville wasn’t an accident. Its creative ecosystem was built and nurtured for more than 100 years. It harnessed all its resources, from universities to musicians to entrepreneurs, to build a city and region that would attract and retain the best and the brightest. In 2006, Nashville included 80 record labels, 100 music publishers, 150 recording studios, 17 of the top 25 country music artists, and 39 fully integrated collaborative organizations (Raines & Brown, 2006). Could Calgary and region do the same thing but from an active economy lens?

Therefore, we began the process of trying to map and understand the breadth and depth of the active economy.

Mapping the active economy

The process of mapping the active economy included a series of steps that started with the creation of categories of organizations. This was followed by groupings of individual participants and concluded with a mapping of their interrelationships.

The first step was to create groupings that would enable measurement and a better understanding about what types of organizations constitute an active economy. We created 11 categories including organized sport, health and wellness, sport betting, professional services, media and content, products and gear, active life, equipment and accessories, tourism, design and infrastructure, and active recreation.

Categories of businesses and organizations in the active economy.
Categories of businesses and organizations in the active economy.

The second step was trying to understand the people in the active economy. Every individual or organization with an interest in or impacted by the active economy was considered an important player. This includes all forms of engagement, including professional or volunteer. Therefore, the ActiveCITY Collective defined engagement in 5 categories: participant, administration, enabler, policymaker and supporter. An individual or organization may encompass one or more forms of engagement.

Key players in the active economy.
Key players in the active economy.

In the third step, we attempted to map the interrelationships of the various factors of the active economy. The categories that we noted earlier didn’t operate in isolation. The potential benefits from the active economy would require interrelationships among the categories. While conceptual, our map showed the series of hypothesized links between different aspects of the ecosystem. For example, environmental value can be gained through the connections from design and infrastructure through active recreation. While complex, this map was central to our understanding of where and how to allocate resources that would generate maximum return on the public’s investment. This was answering City Councillor Gondek’s call for action at the Sport Business Roundtable.

A map showing the interrelationships between the various factors of the active economy.
A map showing the interrelationships between the various factors of the active economy.

During the mapping phase, we cajoled and recruited a broad cross-section of leaders in which to debate, discuss and consider how the sector could better work together. Due to overwhelming interest from would-be participants in the lead-up to a fall 2019 summit, the venue had to be changed 3 times! The summit was eventually held at WinSport with 300 participants and a waiting list.

Clearly, the idea of an active economy had struck a nerve. After launching an ActiveCITY website, we began to measure the active economy through research. With a team of students and colleagues, we enacted Calgary’s largest public engagement strategy, collecting input from more than 23 000 individuals. In addition, we hosted 20 virtual ‘FutureMaking’ Forums on topics ranging from eSport to First Nations and Indigenous persons in the active economy. We recorded more than 25 podcasts with community leaders discussing the future of Calgary’s active economy. We also helped coordinate province-wide longitudinal research on the intersection of arts, culture, and sports and recreation in a pandemic and post-pandemic environment. We determined that the active economy includes 95% of the 1.5 million people living in the Calgary region, incorporating 4000 enterprises, employing 43 000 people, and contributing $3.3 billion to the regional economy.

This led to the creation of Playbook 2030 and provided direction for Calgary’s support of the active economy.

From pandemic to Playbook 2030

The impact of COVID‑19 can’t be understated. The pandemic is causing seismic economic, human, and social costs to our city and region. Since travel and large gatherings are restricted, our outdoor recreation facilities face unprecedented capacity pressure. This has only accelerated the urgency of creating an integrated master plan for our regional active economy. The resulting master plan is known as Playbook 2030. It’s anchored in a strategic framework that will harmonize resources from across the commercial, social, and public sectors to strengthen our economic, human, social, and environmental prosperity. While Calgary is facing unforeseen challenges, Playbook 2030 identifies unrealized opportunities and unique advantages. The time is right to deliver a renewed vision of our city and region that leverages our greatest natural resource, an active economy.

Key metrics demonstrating the reach and engagement of Playbook 2030.
Key metrics demonstrating the reach and engagement of Playbook 2030.

We presented Playbook 2030 to the community during a virtual online summit on December 2 and 3, 2020. The theme was From Pandemic to Playbook 2030. At the summit, we reviewed the path from the devastation of COVID‑19 to the vision of a world-leading active economy as detailed in the Playbook.

In the press release following the summit, Cynthia Watson, the newly named co-chair for ActiveCITY and Chief Evolution Officer of Vivo for Healthier Generations, noted that “Calgarians challenged us in November 2018 to think differently. They wanted us to look forward, not backward. With the guidance of thousands of Calgarians and insight and inspiration from global leaders, we have defined a city that is not only a player, but a leader in the $3 trillion active economy.”

Cover of Playbook 2030.

The Playbook 2030 plan was based on 6 pillars: a shared vision, embedded in life, built on community, innovate and grow, drive sustainability, and inspire others. The plan also returned to the New Zealand Model of Community Prosperity, including links to the human, social, economic, and environmental impacts. For example, under economic impact we referenced a study for the British Columbia Ministry of Health Planning that estimates an annual cost savings of $49.4 million if physical inactivity could be reduced 10 percent.

Conclusion

We’ve attempted to create an ActiveCITY that is inclusive. It brings together volunteers, coaches, entrepreneurs, educators, policymakers, parents and guardians, in areas ranging from tai chi and gardening to soccer and emerging sport technology. What we share is a passion for the unique role that the active economy can play in moving our city and region forward.

For other cities and regions attempting to mirror this process, we offer the current steps being taken to implement our Playbook. The first is to transition the ActiveCITY Collective into a more formal structure. The second is to establish a harmonized governance model for implementing the program. The third step is to deliver a few quick wins with research studies showing benefits of how collaboration has worked. And the final step is to prioritize high-impact, ecosystem projects for Playbook 2030.

To support the implementation of Playbook 2030, the ActiveCITY collective has received a 2-year grant from the Government of Alberta’s Civil Society Fund. The goal of Playbook 2030 is to establish a framework to maximize the impact of Calgary’s regional active economy on both individual and community well-being, and in doing, transform Calgary into Canada’s most livable region. At times, the scope and depth of Playbook 2030 may feel daunting. For this reason, we think it is best to consider Playbook 2030 as a critical step in a ten-year master business plan for Calgary’s regional active economy. As a complex $3.3 billion business that incorporates 4000 enterprises across 10 sectors and impacts 1.3 million people, the business plan must be systematic, rigorous and evidence-based.

Playbook 2030 is uniquely Calgary. Its approach combines academic rigour, community spirit, entrepreneurial optimism, and a belief that this is a promotable differentiator that defines our civic culture and identity for a generation. We’re facing challenges unforeseen and unprecedented. This is a necessary and opportunistic time to be contemplating a new vision for our city and region, based on collaboration and leveraging our greatest natural resource, our active economy.


Highlights


Perhaps not surprisingly, the unofficial theme of the Tokyo 2020 Olympic and Paralympic Games has been ‘safety first.’ Postponed from 2020 to 2021 due to the COVID‑19 pandemic, the Summer Olympic and Paralympic Summer Games are scheduled to take place respectively from July 23 to August 8 and from August 24 to September 5.

Even before the word COVID‑19 entered our global vocabulary, safety was top of mind for national sport organizations (NSOs). In the years leading up to the pandemic, more and more high-profile abuse and maltreatment cases in sport had made national and international headlines. From these revelations, the Safe Sport movement was born.

The words safe and safety often make us think of preventing physical injury or harm. But the Safe Sport movement is about more than that. It’s about optimizing the sport experience for everyone involved in sport. Safe Sport involves the reasonable expectation that the sport environment will be free from all forms of maltreatment (that is, abuse, neglect, bullying, harassment and discrimination) and that it will also be accessible, safe, welcoming and inclusive.

A prime example of how Safe Sport has advanced in recent years is the Universal Code of Conduct to Prevent and Address Maltreatment in Sport (UCCMS) coming into being. Officially released in 2019, the UCCMS encourages a Safe Sport environment by providing NSOs with guiding principles, defining prohibited behaviours and outlining sanctions for misconduct.  

With both the Tokyo and Beijing Olympic and Paralympic Games set to take place over the next several months, NSOs have been hard at work on Safe Sport policies and initiatives. NSOs want to ensure the safety and well-being of their sport communities, from the grassroots level all the way up to their national teams. In this article, we take a deep dive into how 4 NSOs (Alpine Canada, Gymnastics Canada, Hockey Canada and Softball Canada) are advancing Safe Sport. We also discuss tips, strategies and lessons learned for other sport organizations working to optimize the sport experience for everyone.

Building and strengthening Safe Sport policies

For all 4 NSOs we interviewed, advancing Safe Sport meant first addressing policy to protect their sport communities, including athletes, coaches, staff and others involved in the sport environment. For example, after the UCCMS was established, each sport went straight to modifying their existing bullying and harassment policies.

“The Safe Sport movement has allowed us to re-address some of those areas, and certainly start to build and strengthen them as we move forward,” says Todd Jackson, Director, Insurance and Risk Management at Hockey Canada.

Male gymnast performing on rings.

The idea of Safe Sport as a “movement” was echoed by other NSOs. They viewed the UCCMS as more than just a document to integrate into their existing policies, but rather the driving force behind a cultural shift in the way we see, think, and speak about maltreatment in sport. That shift has begun to take hold, but it requires continued action.

“While updating our organizational policies has been an important step for enhancing safety, there is still much work to do in education and advocacy to bring them to life in practice,” says Ellen MacPherson, Director, Safe Sport at Gymnastics Canada.

Part of that shift is to consider the language we use to describe and discuss Safe Sport. For instance, the use of terms like maltreatment have been adopted to discuss abuse and harassment in sport. According to Kristin Noonan, Manager, Coaching & Safe Sport at Softball Canada, consistent terminology was an important part of Softball Canada’s first step toward revising their policies and developing Safe Sport initiatives.

“With the release of the UCCMS, we wanted to ensure the terminology used within was consistent with the terminology on our website, within our own policies and in all of our Safe Sport initiatives,” says Noonan.

Having a shared understanding of key terminology and being consistent in its use is an important step for any organization, club or team when making changes and advancing toward a “new normal” or culture. Something as simple as creating a glossary can help make sure everyone is on the same page.

Another strategy is to seek out and lean on experts in the field. As part of their efforts to refresh policies, the NSOs we interviewed touched on the importance of consulting with experts in the field, including researchers and lawyers.

“I think anytime that you’re integrating new guidelines like that, to have the experts around you and have people who can give you input on what you’re doing and not doing is a real benefit and helps to alleviate some of those challenges,” says Jackson.

diverse group of childrens' hands cheeringFor example, Gymnastics Canada developed a new policy, dubbed the “Diversity, Equity and Inclusion Policy,” in collaboration with researchers and experts within and outside of the sport. In addition to that policy’s launch, Gymnastics Canada is currently creating supplemental eLearning resources that highlight key aspects of the policy and can be shared by the broader sport community. According to MacPherson, “The Diversity, Equity and Inclusion Policy is a foundational policy from which further initiatives designed to enhance diversity, equity and inclusion in Canadian gymnastics can be built.” It was put in place to ensure all participants feel welcome, respected and have equitable opportunities to experience the physical and mental health benefits of sport participation.

Finally, NSOs are increasingly turning to independent third parties to resolve violations of Safe Sport policy. For instance, Alpine Canada formed the Alpine Independent Supervisory Board: A group of professionals including lawyers, researchers and other independent investigators who are external to the organization and solely responsible for the adjudication of major infractions. In addition, the Government of Canada recently announced that the Sport Dispute Resolution Centre of Canada has been selected to establish and deliver a new Independent Safe Sport Mechanism that will oversee the implementation of the UCCMS for federally funded sport organizations. Establishing a third party to specifically handle violation cases not only helps to strengthen policy, but also allows for a neutral adjudication process that minimizes bias and conflicts of interest.

However, according to Joseph Gurgis, who recently left the role of Safe Sport Manager at Alpine Canada to pursue a Postdoctoral Fellowship at Cape Breton University, Safe Sport is about more than policy. “A multifaceted approach that extends beyond policy implementation to include education, advocacy, independent complaint mechanisms, research, monitoring, and evaluation is required to ensure that we adequately advance a culture of Safe Sport,” he says.

This leads us to another cornerstone of Safe Sport: education.

From the ground up: Education and awareness

What is maltreatment? What does maltreatment look like? And what is Safe Sport? Gurgis reflected on this new terminology and how an important part of Safe Sport is making sure people know what it is.

“There’s a lot of behaviours in sport that are harmful but normalized by stakeholders, who are often unaware of how certain sport practices may be harmful to a person’s physical or psychological welfare,” says Gurgis.

Team Canada competes in Para Ice Hockey action in Ostrava
Photo: Canadian Paralympic Committee

Ironically, when discussing Safe Sport with those who are meant to benefit from it, few can articulate what Safe Sport is and what it’s meant to achieve. For Jackson and Hockey Canada, it all boils down to 2 words: education and awareness.

“I think that’s where the education and awareness become so important, because you not only have to put a policy in front of an organization or put a policy in front of people, you have to explain why you’re putting that policy in front of them. And you also have to give them a little bit of background on how to work within that policy,” says Jackson.

Jackson highlighted the Speak Out! program as a foundational component of Hockey Canada’s approach to Safe Sport. Speak Out! Was originally created in 1997 to educate and prevent bullying, harassment and abuse in hockey across Canada. Hockey Canada established the Speak Out! Subcommittee to oversee the building of the Speak Out! program as it progressed.

“[The Subcommittee] put together a framework for the program that included policy building, education at our grassroots levels, screening, which continues at all levels of the game, and creating awareness around the prevention of bullying, harassment, and abuse,” says Jackson. “It continues to be delivered by our members in various forms, to our volunteers, to our coaches, to the people involved with young players across the country.”

More recently, NSOs across Canada have focused their efforts on creating effective and engaging educational tools focused on maltreatment and Safe Sport more generally, especially before sending their best athletes off to Tokyo. This includes increasing awareness of practices that may be harmful or problematic, as well as resources that are available to participants for reporting and assistance. As part of this process, many NSOs are requiring mandatory screening in addition to Safe Sport training for all Olympic- and Paralympic-bound participants. This screening is now also being carried out at lower-level sports organizations.

Little girl doing gymnastics moves with ribbon in studio lit by warm sunlightThe NSOs we interviewed also described unique initiatives to educate and engage their communities from the ground up. For example, Gymnastics Canada has launched a new Safe Sport Learning Series and a Safe Sport Champions Series this summer. Designed to complement one another, these series leverage research experts and mentors in the field of Safe Sport. They’ll share insights and practical tips for creating healthy, safe and positive environments for participants at the grassroots level all the way up to Gymnastics Canada’s national and high-performance teams.

“We’re building on this [Safe Sport] momentum in the lead up to Tokyo by continuing IST (Integrated Support Team), as well as inviting experts and mentors to deliver webinars and workshops for the national team and high-performance community. Topics will include positive coaching practices, enhancing mental health, self-awareness, building resilience and staying positive, and supporting nutrition and healthy eating,” says Gymnastics Canada’s MacPherson.  

At Softball Canada, Safe Sport Onboarding is the newest educational initiative. The Safe Sport Onboarding program is designed to educate, protect and empower all members of Softball Canada. And the program has already been mandated for players, coaches and support staff heading to Tokyo for the Olympic Games.

“Leading up to the Olympics, we are providing a Safe Sport education package to the team and we will also be giving a Safe Sport presentation specifically for our Women’s National Team Program prior to their departure for the Games,” says Noonan.

This initiative will educate Softball Canada’s participants on the reporting processes, policies, guidelines and contacts related to Safe Sport at the Games. Understanding that individuals won’t necessarily read through all policy documents, Noonan spoke to the importance of this education program as a way of providing key stakeholders with the main pieces of information in a more digestible and engaging way.

Thinking outside the box (and other advice for sport organizations)

While policies and educational initiatives are important, they need to be developed and delivered in a way that resonates with intended audiences. The NSOs we interviewed stressed the importance of getting creative with educational tools and policy resources. That creativity is essential not only for promoting key messages, but perhaps more importantly, for making Safe Sport messages stick.

“It’s got to be delivered in a way that’s user friendly, and at the same time effective. Engagement is so important so that people will be responsive and so [the Safe Sport movement] will continue to grow,” says Hockey Canada’s Jackson.

Young high school softball players in action, making amazing plays, during a game.To reach provincial/territorial sport organizations (PTSOs) and grassroots clubs in each sport, some NSOs have come up with innovative strategies to increase uptake. Softball Canada offers a great example. It shares its policy templates and resources, including access to lawyers, with softball PTSOs. Doing so limits the work needed by PTSOs to adjust their policy suite, meaning that implementation is quicker and more consistent across all levels of sport.

“The UCCMS became a backbone for us moving forward with our provincial/territorial alignment, allowing us to take our complete policy manual and provide templates to each of the [PTSOs],” says Noonan.

Her most important tip for sport organizations that are working to build up their Safe Sport initiatives is to think outside the box. “[Think about] what can be done in addition to those policies and procedures. Make it fun and provide awareness by getting it out there in different ways than just on a piece of paper,” Noonan says.

French and English backstop signs developed by Softball Canada. Please remember These are kids This is a game Coaches are volunteers Umpires are human Everyone deserves respect! Softball Canada logo N'oubliez pas Ce sont des enfants C'est un jeu Les entraîneurs sont des bénévoles Les arbitres sont humains Tout le mode mérite le respect! Logo de Softball Canada

For example, Softball Canada has created a short video to educate stakeholders about Safe Sport. It has also developed postcards and backstop signs that reinforce key Safe Sport messages for spectators, including parents and guardians, at youth and adult softball events.

“They [the signs] hang on the backstop so that all the fans and parents can see them. A gentle reminder for all involved that everybody deserves respect,” says Noonan. “Fun, outside-the-box ideas are what has made our initiatives so successful because they’re simple and tangible. It’s more than just reading a policy.”

In addition to getting the message out in an engaging way, it’s important to ensure that the voices of stakeholders are included in decisions about Safe Sport policy and initiatives. At Gymnastics Canada, that involves hearing input from voices within the gymnastics community. Hearing from people who are experiencing or implementing Safe Sport principles was important for figuring out if there were any gaps, resolving any, and thinking about ideas for future development.

“Safe Sport is an ever-evolving portfolio. It’s important to work collaboratively with our stakeholders and incorporate their input to ensure the safety, health, well-being and inclusiveness of all participants,” says MacPherson.

Para-alpine skier going down the hill.For its part, Alpine Canada established a National Safe Sport Committee comprised of 25 individuals, including parents, athletes, coaches and sport administrators, from across Canada’s skiing community. “The advancement of Safe Sport requires the collective efforts of all stakeholders in sport. So, the purpose of this diverse collaboration is to engage participants, from each stakeholder organization, in meaningful conversations regarding Safe Sport and to provide them a platform to openly discuss their Safe Sport needs,” says Gurgis. This committee gathers 4 times per year to discuss key Safe Sport concepts, establish and discuss Safe Sport goals, identify stakeholder responsibilities for advancing Safe Sport in the community, clarify ways to monitor and advance Safe Sport, and evaluate Alpine Canada’s Safe Sport progress overall to provide recommendations for next steps.

Moving toward Safe Sport in Canada

As shown, sport organizations across Canada have taken various steps to advance the Safe Sport movement. Safe Sport, and the UCCMS specifically, are direct in what is “unacceptable” behaviour in sport. However, there’s a growing need to prepare organizations and participants with information about “acceptable” behaviours and best practices.

Ice Hockey Players Celebrating

“Often we say, ‘Don’t do this’ or ‘Don’t do that’ but we rarely say, ‘What does that Safe Sport environment look like?’ and ‘How do we make it safe and welcoming? It really is about following those True Sport principles and reminding everyone what a supportive environment looks like,” says Softball Canada’s Noonan.

Similarly, Gurgis encourages sport organizations to think about Safe Sport beyond the conceptualization of preventing maltreatment.

“At Alpine Canada, it represents so much more. Safe Sport isn’t just about eliminating maltreatment, but it’s also about optimizing the sport experience to ensure that everyone understands their fundamental right to participate in and access a version of sport that embraces values such as respect, inclusion, and fair play,” says Gurgis.

It appears that Safe Sport is more than just a phase, but rather the “new normal” for sport. There’s still much to learn and do to create Safe Sport spaces across Canada, but Alpine Canada, Gymnastics Canada, Hockey Canada and Softball Canada have demonstrated important lessons and learnings to protect the safety and well-being of all participants. For other NSOs looking to advance Safe Sport within their sport communities, key learnings include:

Employing these tips and strategies can help sports to build, strengthen, educate and grow awareness of Safe Sport. Join the movement to optimize sport experiences for all!


Recommended resources

Additional information, the Universal Code of Conduct to Address Maltreatment in Sport (UCCMS) and resources on safe sport in Canada can be found on SIRC’s website: https://sirc.ca/safesport


Highlights


An organization’s culture involves the values, attitudes and goals that are shared by a group of people. These values, attitudes and goals influence how the group interacts and operates as its members work toward a common goal.

Within and beyond sport, culture helps to determine a team’s focus, establishes norms of acceptable behaviour and directly influences a team’s functioning and performance. A team’s culture can dictate to team members how to behave, communicate, cooperate and deal with conflict. When clear norms are set, everyone on a team is more likely to follow them.

Own the Podium, Canada’s technical leader in high performance sport, alongside partners the Canadian Paralympic Committee and Canadian Olympic Committee, identified sport culture as an important performance factor for Canadian athletes to achieve podium success. In this article, we define sport culture and describe a “culture of excellence” in high performance sport. We also provide best practices for sport organizations to foster a culture of excellence that enhances the self-determination, safety, health and well-being of their athletes.

Defining sport culture

Research in the fields of organizational and social psychology has played a key role in understanding the relationship between organizational culture and sport culture (Cannon et al., 2006). In the workplace, an organization’s culture can have a significant influence on employee performance, morale, engagement and loyalty, as well as efforts to attract and retain talented employees (Warrick, 2017).

Synchronized swimming team performing a synchronized routine of elaborate moves in the waterIn sport, organizational culture has been identified as having a significant influence on an athlete’s ability to prepare for and perform at major international games (Fletcher & Hanton, 2003; Fletcher & Wagstaff, 2009). Elements of organizational stress, such as personal, team or leadership issues, are a source of strain for athletes that can ultimately affect talent development and how the organization functions as whole (Arnold et al., 2016; Fletcher & Wagstaff, 2009; Henriksen, 2015).

While it’s largely accepted that developing culture is important, until recently, there had been limited work done to define culture in the context of high performance sport in Canada. Furthermore, sport organizations in Canada have identified culture as an area of improvement.

High-performing cultures in Canadian sport

“Good culture is not about a mysterious chemistry; it’s about clarity.” – Daniel Coyle

Recognizing a need to operationally define sport culture, and more specifically, a culture of excellence, Own the Podium is driving a series of research initiatives. Own the Podium collaborated with the Canadian Paralympic Committee to identify several components that contribute to high-performing cultures in Canadian sport:

Research shows that high-performing cultures are achieved when the beliefs and actions of team members do 3 things (Cruickshank & Collins, 2012):

  1. Support sustained optimal performance
  2. Persist across time in the face of variable results, such as wins, losses and ties
  3. Lead to consistent high performance

When these ideal conditions are met, sport organizations can foster a culture of excellence that supports sustained high performance and personal thriving among its members.

A culture of excellence

At its foundation, a culture of excellence places a balanced emphasis on both person dimensions and performance dimensions of culture (Paquette, 2020). Person dimensions relate to factors that can influence athlete development and performance. Those interpersonal and intrapersonal factors include relationships, happiness, motivation, fulfillment, safety and wellness. Performance dimensions relate to environmental and strategic factors such as effective coaching, optimal training environments, and the integration of sport science and sport medicine.

Table with 2 columns: 1 for person dimensions of culture and 1 for performance dimensions of culture. 1. Person dimensions: - Mental health and well-being - Physical health and well-being - Psychological safety - Physical safety and Safe Sport - Self-determination 2. Performance dimensions: - Leadership and vision - Coaching - Daily training environment - Sport science and sport medicine - Pathways and profiles - Athletes and international results

When these 2 dimensions are considered, various sport cultures can be envisioned as a matrix (Paquette, 2020):

Quadrants for the culture of excellence matrix The Y axis (vertical) relates to the person and X axis (horizontal) relates to performance. Culture of inclusion is the top-left quadrant (Poor to mediocre performance, moderate to strong personal engagement and satisfaction). Culture of apathy is the lower-left quadrant (Poor to mediocre performance, personal engagement and satisfaction). Culture of harassment is the lower-right quadrant (High performance and adverse personal consequences). Culture of quality is the upper-right quadrant and within it is the culture of excellence (Sustained high performance and personal thriving).

An organization can be described as fostering a culture of inclusion when there’s a history of poor to mediocre performance but with moderate to strong personal engagement and satisfaction. Such culture is evident in youth sport contexts, where emphasis isn’t placed on winning, but on participant enjoyment and forming positive social connections.

Organizations are said to cultivate a culture of harassment when there’s strong emphasis on performance outcomes at the expense of personal consequences. For example, a team that discourages athletes from disclosing injury or distress creates a culture that jeopardizes its members’ physical and mental health.

An organization with little consideration for its athletes’ performance or personal outcomes may be described as fostering a culture of apathy. A culture of apathy invites a dysfunctional environment that’s characterized by stress, dissatisfaction and ineffectiveness (Balthazard et al., 2006).

Finally, sport organizations establish a culture of quality when they consider both the person and performance dimensions of culture. When organizations intentionally and consistently work to improve each dimension, they’ll achieve a high-performing culture (culture of excellence) that is sustained long-term. 

Male High School Basketball Team Having Team Talk With CoachIn recent years, sport has evolved. Sport now adopts a person-centered or athlete-centered approach to decision-making and program delivery, which mirrors changes that happened in education, management and healthcare sectors (Paquette & Trudel, 2018). An athlete-centered approach prioritizes athletes’ holistic development. That prioritization happens by promoting a sense of belonging, as well as giving athletes a role in decision-making and a shared approach to learning (Kidman, 2005). A holistic approach is often stressed as a key issue in successful talent development (Henriksen et al., 2010; Martindale et al., 2005), in which the athletes’ well-being is considered first and foremost. While organizations tend to focus on medal counts and marginal gains in high performance sport, those are only 2 pieces of the puzzle. The person dimensions of sport culture are often underused, but they’re crucial for sustained performance and personal thriving.

Sustained high performance and personal thriving

“The number one way to bring athletes on board and support a culture of excellence is understanding what their personal needs are in their own lives first and then balance them in the sport.”  – Robin McKeever, National Team Coach, Para-Nordic

For sport organizations in Canada, it isn’t a new concept to consider the mental and physical well-being of their athletes. However, renewed attention to the person dimensions of culture lets us focus on why we do what we do and gives us a leading edge over competitors. Below, we describe the 5 person dimensions. We also provide key takeaways for each dimension to help sport organizations foster their own culture of excellence.

Dimension #1: Mental health and well-being

Tired young athletic lying on a running track after trainingAthletes aren’t immune to experiencing psychological distress. In fact, rates of mental illness among athletes are comparable to their non-athlete peers (Rice et al., 2016). Traditionally, “tough” sport cultures emphasized that athletes show mental toughness, which created barriers for those athletes to disclose their psychological distress. That emphasis often leads to stigmatization of psychological distress and associated mental health challenges within sport and athletes perceiving them as signs of weakness (Bissett, 2020). Mental health organizations like the Canadian Centre for Mental Health and Sport and national initiatives such as Bell Let’s Talk Day are changing the conversation surrounding mental health in Canada. Sport organizations can further support their members’ mental health by ensuring there’s a detailed mental health strategy in place and it’s effectively communicated to all stakeholders.

Key takeaways on mental health and well-being:

Dimension #2: Physical health and well-being

Nordic ski racer moving in classic style during competition.By its very nature, elite athlete performance is associated with an elevated risk of injury or illness (Engebretsen et al., 2013). A team that encourages athletes to “power through” injury and pain can foster a culture that compels athletes to hide their symptoms, jeopardizing their own physical and mental health. A culture of concealment is driven by athletes’ fear: fear of not being believed, fear of losing, fear of being dropped and fear of being seen as weak or lazy (Wilson et al., 2020). Athletes are more likely to report and seek treatment earlier if their team’s culture openly invites disclosure of pain and injuries, without negative repercussions on sport decisions (for example, team selection). Furthermore, witnessing a trusting relationship between the integrated support team (IST) members and senior athletes can support an open and supportive culture (Wilson et al., 2020).

Key takeaways on physical health and well-being:

Dimension #3: Psychological safety

Psychological safety is believing you won’t be punished or humiliated for speaking up about ideas, questions, concerns or mistakes. In psychologically safe environments, there’s a focus on productive discussion to enable early prevention of problems and the accomplishment of shared goals (Edmondson & Lei, 2014). When sport leaders, coaches and other team members nurture a shared sense of “we” and “us,” they’re able to foster a psychologically safe environment, which in turn paves the way for an optimal functioning and healthier team (Fransen et al., 2020). These teams show greater teamwork, improved resilience, enhanced athlete satisfaction with the team’s performance, and an ability to reduce athlete burnout (Fransen et al., 2020). Organizations can help build psychological safety by setting clear expectations, regularly inviting participation and responding productively.

3 steps to psychological safety
1. Set the stage:
1.1. Set expectations about the quality of performance or interactions, failure, uncertainty and teamwork
1.2. Identify what's at stake, why it matters, and for whom it matters
2. Invite participation
2.1. Demonstrate humility, acknowledge any gaps or failures
2.2. Practise inquiry by asking good questions and model listening
2.3. Set up structures (that is, create forums for input and provide guidelines for discussion)
3. Respond productively
3.1. Express appreciation (that is, listen, acknowledge and thank members for their feedback and comments)
3.2. Destigmatize failure (that is, look forward, offer help, brainstorm and discuss next steps)
3.3. Sanction clear violations and reiterate expectations

Key takeaways on psychological safety:

Dimension #4: Physical safety and Safe Sport

A goal of the Safe Sport movement is to create sport environments that are accessible, safe, welcoming and inclusive (Kerr, 2021). Safe Sport environments contribute to well-being, are enjoyable and respectful of personal goals, and provide a sense of achievement. As such, Safe Sport environments involve both physical and psychological safety.

Para-athletics race. Closeup view of leading athlete during a race on the track.A physically safe sport environment minimizes the risk of injury and physical harm for athletes. Strategies to promote physical safety in sport include ensuring that athletes wear proper protective equipment, training and competition environments are up to code, and support personnel are trained and certified in injury prevention and management. Athletes should reasonably expect that the sport environment will protect their physical safety, and that it’s also free from all forms of maltreatment, including abuse, neglect, bullying, harassment and discrimination. Providing a safe and secure sport environment is paramount for athletes’ success during major games (MacIntosh et al., 2020).

Safe Sport challenges traditional assumptions and practices, such as having coaches share hotel rooms with athletes to save costs or using exercise as punishment. Understanding the process of change and associated emotions (that is, denial, resistance, exploration, commitment) is important for sport leaders to help others adapt better to the Safe Sport journey. While some individuals are already in the commitment stage and have been using Safe Sport practices all along, for others, denial and resistance may exist.

4 quadrants for states of change Top left quadrant: Letting go or Denial stage (It's not happening to me. I don't have to do this.) Lower left and lower right quadrants represent the neutral zone. The lower left is the Resistance stage (This will never work. I want to go back to the old way.) The lower right is the Exploration stage (OK, maybe this can work. There might be a way...) The upper right quadrant represents the new beginning and the Commitment stage (This is how I work now. This is a better way.)
Stages of change (adapted from Scott & Jaffe, 1998)

Key takeaways on physical safety and Safe Sport:

Dimension #5: Self-determination

Self-determination relates to a person’s ability to make choices and manage their own life. To accomplish this, individuals need to feel: in control of their own behaviours and goals (autonomy), capable and effective (competence), and connected with others in their environment (connection) (Deci & Ryan, 2000). When athletes feel autonomous, competent and connected, they are more likely to feel motivated and engaged in their training, which can in turn lead to enhanced performance outcomes.

Woman training kickboxing with coach

Coaches, technical leaders and IST providers can foster:

  1. autonomy by granting ownership, providing options and choice, asking for opinions and offering flexibility.
  2. competence by emphasizing strengths, providing appropriate structure and guidance, embracing errors and failures, and relaying important feedback.
  3. connection by prioritizing positive interactions, demonstrating personal care, communicating regularly and reinforcing program performance.

Key takeaways on self-determination:

Final remarks

The culture of excellence model describes a sport culture that builds on Canadian core beliefs and values. In this model, athlete health, safety and well-being are at the forefront. Sport organizations can be inspired to pursue their own culture of excellence through initiatives that support athlete’s health and well-being, safety and self-determination. By balancing the person and performance dimensions of sport culture, organizations will experience benefits. Not only can they experience improved communication, reduced conflict and better functioning teams, but they may also experience higher levels of performance for all team members.

Next steps

A critical next step is to develop an audit tool that will guide sport organizations to assess their high performance culture and identify its strengths and weaknesses. This tool is currently being piloted. The audit tool will be available in the future for Own the Podium targeted sports with high performance programs. A critical component of the audit tool will be the planned engagement with experts to discuss potential culture mitigation or enhancement strategies.


Recommended resources

Canadian Culture of Excellence in High Performance Sport – Position Statement | Own the Podium

Safe Sport Training | Coaching Association of Canada


About Own the Podium

Own the Podium provides the technical leadership for Canadian sports to achieve sustainable and improved podium performances at the Olympic and Paralympic Games through a values-based approach. To learn more about how your sport organization’s culture can optimize the performance of your high performance athletes, contact Own the Podium and ask about the culture of excellence audit tool.