The Sport Information Resource Centre
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The Sport Information Resource Centre

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


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.