Brain Trauma in Youth Sports: CTE and Concussions

Welcome to Where Parents Talk.

My name is Leanne Castellino.

Our guest today is the executive director of the Concussion Legacy foundation of Canada.

Tim Fleiser is also a retired professional football player.

He's the only player in CFL history to have won four Grey cup championships with four different teams.

Tim is also a father of three boys under the age of nine, and he joins us today for from Montreal.

Thank you so much for taking the time.

Thanks for having me.

What specifically brought you down this path?

So it actually predated that.

It all started with my college teammate from Harvard, Chris Nowinski.

And Chris.

Chris was two years behind me, also played defensive line.

We were friends in college, but not particularly close, with him being a couple years younger.

And right towards the end of my pro career, I was down for the Harvard Yale game.

And Chris, I knew, had been wrestling in the wwe, which is certainly an interesting career choice.

And so I had been tracking him from afar and knew that he was successful terms of establishing himself as a professional wrestler.

And saw him and what had happened is he had had a series of brain injuries, hadn't realized that they were brain injuries.

It's the story that you hear over and over again, and was experiencing some really difficult symptoms, had ended up in the offices of a number of different physicians that couldn't tell him what was going on.

And he ultimately ended up in Dr.

Bob Cantu's office, who's been a real leader in the field.

And the way Dr.

Cantu said it to him was instead of asking whether or not he had had a concussion, he asked him if he ever experienced any of the symptoms associated with concussion and listed them, which is a much better way to ask that question.

And Chris's answer was, well, yeah, all the time.

Right.

That's.

We all experience those as athletes.

And again, you'll hear this story over and for anybody that participated in those kind of sports in that era.

And Chris ultimately had identified that there was this hidden epidemic happening right under all of our noses.

And he wrote a book about it.

And so back at that Harvard Yale game, he put his book in my hand, and when I read it, I was floored by the data that he had been able to pull together and became convinced that there was this issue of brain injury in sport that nobody was talking about.

And so this was very early days.

I mean, I was around when he was still out doing presentations for 50 parents at small high schools in Massachusetts.

I had just retired, was starting my career as a sports agent.

And so as I was signing up players to represent them, I felt like it was a responsibility to be up to speed on everything that was happening with regard to brain injury.

And that if I was telling these guys I was going to take care of them toe to head, I better be up to speed of what was going on.

So much has happened in that time span, certainly.

And when we talk about the field of neuroscience, the latest in, you know, brain science is really quite staggering.

Let's talk about Chronic Traumatic Encephalopathy, Encephalopathy, CTE for a second.

Why is being a champion of CTE so important to you?

Well, for a number of different reasons, certainly.

Let's start with my kids.

They, they unsurprisingly came out of the womb, little potential contact sports athletes.

You know, we often laugh with my wife, you know, as the executive director of Concussion Legacy Foundation Canada, and my host looks like MMA match a lot of the time.

And so, you know, certainly thinking about their brains and their brain health and their development both as people, as students and as athletes, and how important their brain health is to that, that's a big part of it.

My father was also a really good athlete.

Won the Canadian version of the Heisman Trophy, won the heck Creighton Trophy here for, for the most valuable player in Canadian college.

And so, you know, he's experienced a bunch of cumulative brain trauma.

And it is importantly and that we point out that the risk factor for chronic traumatic encephalopathy is not the number of concussions you've had.

And that's one of the.

What comes out in the public a lot is people think, well, if I've had a lot of concussions or I haven't suffered any concussions, somehow that's going to affect my risk factor.

The risk factor for CTE is the number of exposures that you've had in the course of your career.

So I actually point to Dan, Dan Shivar's research that's come out in the last couple of years, where it's basically how many times you've been hit in the head and how hard is when you really think about your risk factor.

And so, you know, for my father that played a ton of football, you know, he's at higher risk.

For someone like me who grew up playing soccer and rugby and hockey and football year round for years, you know, my cumulative head trauma is the risk factor, is very Very high.

I mean, fortunately at this point, I am asymptomatic.

And that's actually one of the things that we're trying to figure out is why somebody like me is asymptomatic.

And there are other guys that I played with that have had one tenth of the cumulative brain trauma that I have that are having really serious issues.

And so, you know, for all those reasons and for all of my teammates, my friends, the guys that I played against, I mean, you develop this huge network through sports.

I mean, it's one of the wonderful things about sports and about playing team sport is you have these great relationships and these great bonds.

And for all those reasons, you know, as well as I was very fortunate to grow up, my father was a physician for the Alouettes and for the Canadians.

So I just grew up in and around sports.

I got to go to great schools in my life, like someone else here in Montreal, and show Rosemary hall and Harvard, and then got to be part of playing pro sports for 10 years.

And so that's put me in a very unique position of being able to engage the sporting community, engage the medical community, and then and then ultimately the type of folks that you need to support these kind of issues, whether that be in government or business or, or whatever industry.

And so all these reasons, I felt like it was really important for me to do this work.

So with that multi layered perspective that you bring to this question, Tim, and certainly on that list, you know, being a parent is got to be right up there, as you had mentioned at the outset, and protecting your own children, what do you believe that parents really need to understand about CTE and its risks if they have kids who are athletes?

So we call the initiative, it's the very deliberately, provocatively titled Stop Hitting Kids in the Head.

And one of the big mistakes that we're making right now in Canada, and they're doing it all over the world.

So we actually have an opportunity to be a world leader in this, although we are starting to fall behind as compared to some of our close allies, allied countries.

And that's that we should not be exposing children to any sort of head impacts, certainly under the age of 12 and probably under the age of 14, just to be safe.

So think tackling in football or rugby, think body checking in hockey.

But actually the number one issue that we have right now in Canada is actually soccer.

They just recently banned it also in the UK, we're now behind in that, just for context, there's 550,000 youth hockey players in Canada and 750,000 youth soccer players.

Bang for your buck.

If there was one single policy change that we could make in Canada to protect kids brains, it would be taking heading out of soccer.

Remember, for kids, especially the little kids, these headers don't really happen very much in games.

They typically happen in practice and they typically happen with an adult lobbing a ball at a child repeatedly and having them head balls over and over again.

It seems like a really innocuous thing.

But our data has shown that doing that actually puts them at risk for a lot of this nasty stuff that's associated with non concussive impacts.

So how does a parent find a balance with respect to encouraging their child to be active and participate in sports?

And in some cases kids, you know, who are naturally athletic versus the potential risk to injury, risk for injury like cte.

So the last thing we want our messaging to do is to discourage kids and parents from participating in sports.

We should be playing more sports.

There's all sorts of benefits to athletic participation, whether that be health, whether that be personal development.

And so what we're suggesting is not having kids play these sports.

We're saying that particularly for the little kids, kids under the age of 12, we should be playing them better.

And what I mean by that is no heading in soccer for kids under the age of 12.

Hockey Canada has actually been good on this.

13, they actually raised the age of body checking in Canada.

I think it's, it's kids now.

You got to be 13 and older to actually start body contact.

So that's a very, very positive thing.

Kids shouldn't be playing tackle football.

They should be playing flag.

Football is a wonderful game.

I love football.

You know, if my kids want to play when they get older and their brains and their bodies are more developed and if they're working with coaches that practice the right way.

And again, a lot of these injuries don't happen in games.

These injuries happen in practice where we have full control over how many times our kids are exposed to head impacts.

And so for that and for rugby, you know, we certainly recommend flag until they're at least 12 years old.

Is there any element in this equation, Tim, where you believe that parents also need to advocate for whatever is going on with the youth league that their child is participating in while government and policy makers and all of that, all of that happens on the side?

Is there an advocacy piece Here for parents?

Well, yeah, I mean, you can, you can decide whether or not your kid, you know, plays, plays tackle football or, you know, if you see a coach lining them up and trying to do headers and practice, you should say something.

Now I realize this is actually easier said than done.

And even for somebody like me, you know, that's got a pretty extensive athletic background.

When my two older guys were young, the coaches, and again, they're not bad people, they're not trying to hurt the kids.

They just don't have access or didn't have access to this information.

He was doing what so many soccer coaches do and lining them up along the sideline and having them start to practice headers because that's just kind of been the way that people have, have developed youth with this game.

And so, you know, even knowing everything that I know and even with my own athletic background, you know, I, it's an uncomfortable conversation.

It's, it's not nice to have to go and pull somebody aside and say, hey, listen, like, I don't think you're doing this right.

And I think all the time about, you know, what would it feel like if I was a single mother with no athletic background, you know, and a bunch of like these big guys as like coaches, like, would I feel comfortable going and having those conversations.

Conversations.

And I realize that's actually a very, very tricky thing to do.

So, you know, it's all about, you know, what you sign your kids up for and then just paying attention to how the, how the coaches are coaching those sports.

And you know, if a parent needs help or they need to be able to, you know, cite research or cite experts in the field, they can always go to our website at concussionfoundation CA and, and get that information.

And if they need more information, they can just send emails into our inbox at infoconcussionfoundation ca and we're happy to provide them with all kinds of information to back this up.

You were in your early 30s at the time.

Knowing what you know now, with respect to where brain science, neuroscience is, with respect to cte, among other things, would you have continued to pursue a career in professional football?

So, very tricky question because I have such wonderful memories from my career and my experiences were great and like I mentioned, you know, so so far I'm totally asymptomatic.

So, you know, for me there's certainly no regret with doing that.

If I was doing it all over again Knowing what I knew now, would I have played for 10 years?

Probably not.

But again, very tricky question to ask because, or I guess maybe a different way to talk about it is if I lose the last 10 or 15 years of my life because of this, would it have been worth it?

And the answer is no.

My time with my kids and getting to watch them grow and develop and wanting to be around to see them get married and, and you know, potentially have grandchildren of my own someday, I would not trade that I was wonderful of my football career wise and my pro football career.

I would, I would happily trade all my rings to, to be there for my grandkids.

So what other changes then would you like to see, Tim, with respect to where we are with youth sports and in terms of brain injuries, are there any other specific, specific changes that you believe need to happen in the short term to address potential brain injuries in young athletes?

Yeah, so we talked a little bit about limiting exposures for little kids as they become teenagers.

You also again, want to try and limit or minimize total exposures.

So what do I mean by that?

I mean, if you're practicing body checking or tackling in football or rugby or headers in soccer, a coach should try and limit those in practice as much as possible.

So you need to, let's just use football and rugby as example.

So you need to do some sort of contact in practice to be able to prepare for games.

But as long as every time you're doing a tackling drill, it's not spurious in any way.

You know, you're doing it very specifically to teach skills and to get people ready and just understanding that every impact creates additional risk.

If coaches go in and they create their practice plans doing that, then they're going to be able to minimize the risk for that.

What's really important to understand about that, and this is research that came out of Western University from a gentleman named Jeff Brooks, who was actually our first ever hire at Concussion Legacy Foundation Canada.

And Jeff was a linebacker for the Western varsity football team for five years.

And once he finished his career and started on his master's and then ultimately his PhD, what he did is he put accelerometers in the helmet of the varsity football team there for five years.

So he measured every impact those guys took practice and games.

And what he found was really interesting.

So if you think about sports performance, one of the biggest indicators of an elite athlete is superior reaction time.

And so what he looked at specifically was saccades and anti saccades, which are involuntary.

So you can't control those things.

And we'd always theorized that based on the number of impacts that you took that react, there would be some sort of effect and some sort of reduction of reaction time, which is what happened.

But we also theorized there'd be some sort of return to baseline or some sort of improvement during the off season once the impact stopped.

That didn't happen.

So proportional to the number of cumulative impacts that these athletes received, their reaction time was reduced and in some cases got 15 to 20% slower during the course of one season.

So that's a significant number.

So, again, take the health out of it, which, again, we know it's very well documented at this point, the health issues of smashing athletes in the head over and over and over again, the effect on mental health, the effect on impulse control, executive function, substance abuse, addiction, all these different issues that are associated with brain injury, those all come with increased risk.

And so put that aside, and put aside the ethics of subjecting kids that are not necessarily old enough to truly consent in a legal way to participating in activity that causes brain damage.

Put all that stuff aside and focus just purely on developing the best athletes that we can.

You still don't want to smash kids in the head over and over and over again because it's going to affect their reaction time.

So this whole idea of an athlete losing a step at the end of their career in this context, when it comes to contact sports takes on a whole new definition.

Is there a particular story that you have come across, whether it's a former teammate, you know, somebody you represented, a story you.

You saw on the news about somebody with CTE that, you know, really marked you and impacted you.

Yeah, the.

The most challenging one for me was, was losing one of my college teammates who was a guy who was a year behind me, was, was captain of the team the year after I left, had.

Had actually played in the NFL for four, three, four years after graduating.

That had a huge impact on me.

And I mean, there's unfortunately been quite a number of folks who have come in through our brain bank who I've either played with or had relationships with.

But that was the toughest in terms.

Of sort of characterizing cte.

The research shows that it is the only neurodegenerative condition that one can have that is entirely preventable.

Why is that message, or where are we with that message getting out there?

I don't think it's really gotten out there.

And again, I think there's still confusion around what, what the cause of CTE is.

And it's, again, it's not concussions.

It's.

It's the total number of repetitive head impacts that somebody's been subjected to and how hard those impacts have been during the course of their career.

And we found CTE and military personnel, we found CTE in victims of violence, accident victims.

So there's.

Anybody who's getting subjected to repetitive hits to the head would be at risk for this.

And so I think that's the most important thing to understand.

One of the things that has been noted in, in news stories certainly is various prominent individuals, most recently Ontario's Minister of Sport and former CFL player Neil Lumsden, pledging to donate his brain to science.

We also have NHL players like Jonathan Huberdot who's done the same.

Can you characterize what these types of pledges, what kind of impact does that have on what you and your organization are doing?

That stuff is incredible in terms of bringing overall awareness to the issue, but also encouraging others to support.

We think about our mission in three ways.

We think about prevention, we think about treatment, and we think about research.

The research component is incredibly important.

I'm happy to tell you that we're doing absolutely phenomenal research here in Canada.

We are partnered with the Brain Health Imaging center at Camhouse and they've recently come up with a radio tracer.

They inject subjects with a radio tracer and then do PET scans to be able to try and diagnose CT in vivo or during life, which is really the holy grail of CTE research.

Again, leading the world here in Toronto at CAMH, Dr.

Neil Vasdev and Dr.

Isabel Boileau and their team.

It's just incredible stuff.

I had the great honor of being the very first scan, met Neil five, six years ago, and we talked about this far off, distant dream of being able to try and diagnose CT in vivo.

And we're there.

We started with five healthy controls.

I was the first one in.

Mark Garneau, the former astronaut and politician, generously went second.

Major General retired.

Dennis Thompson came in, was third.

You know, Mark's also a veteran.

So wonderful to have, you know, these prominent Canadians stepping up and bringing attention to the issue.

Our brain bank partner up here in Canada is the Canadian Concussion Center, University of Toronto, Dr.

Carmela Tartelli and Dr.

Gabor Kovacs.

And they're doing fantastic work where they're doing the autopsies, similar to our partners at Boston University with Anne McKee and her team, where they're able to diagnose CTE posthumously for athletes, military personnel, victims of violence and accidents as well.

And so, I mean we're still, there's so much to learn in terms of just how prevalent that brain disease is, how it advances and what the associated symptoms are.

So we have absolutely phenomenal research in Canada.

And when somebody like Minister Lumsden pledges to donate their brain, and the media writes the story from coast to coast to coast, we always see a spike in brain pledges, which is wonderful.

And when somebody's offering you a body part, I mean it really shows they support the cause.

And so like I was on Parliament Hill last week testifying before the health committee.

And you know, when you're able to have that sort of support from those kind of prominent Canadians, but Canadians at large, right?

And you don't necessarily need to be experiencing any sort of symptoms to pledge to donate your brain because we actually, we need to look at healthy controls, we need to look at more women.

You know, we found CTE in a handful of women, but we need to do way more research to understand gender differences and sex differences when it comes to brain injury.

And so just having people sign up, which 1 supports the research, but 2 also more broadly, just shows that they support the work, is huge for us.

So that's something that everybody can do@concussionfoundation CA is go in there and sign up and pledge to donate your brain.

It goes a long way in helping us advance our work.

You talked about Canada being behind other parts of the world, but still in a position and poised to lead in this space.

Can you take us through why Bill C277 is important in that context and what do we need to know about it?

So really important, and I think, you know, any discussion of legislation in Canada has to be talked about within the context of Rowan's law being passed in Ontario and have gotten to know the Stringer family very well over the years.

The story of Rowan Stringer, who was a 17 year old rugby player who tried to play through a series of concussions and ultimately passed away from Second Impact Syndrome, is really important to understand.

And that's really where the start of legislation in Canada really happened.

And so the stringers and Lisa McLeod, longtime member of Parliament for Ontario, Member of Provincial Parliament, former Minister of Sport and her efforts to make sure that this legislation happened.

Just for context, all 50 states in the US have some sort of legislation with regard to brain injury.

So far in Canada, we're only in Ontario and it's very sports specific.

So what's wonderful about Bill C277 and highly encouraged by the direction, we spent a couple of days on Parliament Hill in May they had the second reading.

It's a private members bill that's come out of Vancouver island through MP Alister McGregor and one of his constituents.

Very similar to the Rowan Stringer story who was actually sitting next to me testifying last week.

Her husband was a police officer, had gotten a serious motorcycle accident, was in a coma for a while and ultimately ended up passing away as a result of his brain injuries.

And she's been in and advocating for brain those who have been affected by brain injury for three decades.

A very, very impressive woman.

And she went in and saw Alastair McGregor and same as Rowan's law, started with a private member's bill and in June it passed second reading unanimously, 323 votes to zero.

We've just gone in, come through the committee stage.

It seems like we're headed to the third reading and ultimately hoping to have the bill passed.

But you really need some sort of coordinated strategy that's going to pull together the provinces and the territories where we're thinking about education and awareness.

We're supporting our research, we're supporting treatment.

And one of the other big things that we really need to do on this subject is make sure that healthcare providers are educated.

I mean, it's remarkable how quickly the speed of the research and what we understand about treatment is accelerating.

And we need to try and make sure that healthcare professionals are up to speed.

Because with all of our messaging, when we go and tell people if you think you've suffered a brain injury or you think you're suffering from mental health issues because of a brain injury, and then we ask them to go see a healthcare provider, if the healthcare provider doesn't give them the correct treatment, then the system breaks down.

So we got to be doing both.

We got to be educating the public and getting them to go look for help when they think they need it.

But we also got to make sure that if and when they do go, the health care providers are doing the right thing.

Tim, any final thoughts that you'd like to share with parents who might be listening to or watching this interview and who have maybe not been up, kept up to date on, on cte, maybe, you know, are now listening to it, thinking, boy, I better get on top of this.

What should their first next step potentially look like?

So, so I think when I See and talk to a lot of parents.

You got to make sure that you don't overreact and underreact.

There's really, there's, there's trying to find that sweet spot of being educated, understanding.

But again, having your kids, you know, continue to participate, continuing to live their lives and not barring them from, from sport or, you know, other opportunities.

Like, you know, one of the things that, that's really important is rough play, right?

It's one of the things that people are starting to understand and starting to figure out is that's an important part of development.

It's important skills for kids to learn is how to play rough and what's acceptable and what's not.

And again, you talk about some of these contact sports and it's like, well, in the context of this brain injury, why even bother continuing to play these sports?

And the answer is because the personal development that's associated with them is just so strong.

The best lesson that I ever learned in my life was from my father, which is why if you get knocked down, you got to get back up.

And you just like, you need to do that in life over and over and over again.

And contact sports are uniquely positioned to teach that lesson.

What we're trying to do is to figure out how to do that with an acceptable risk when it comes to brain injury.

And that's the sweet spot that we're trying to figure out.

So again, in my experience, parents are either underreacting, dramatically underreacting, or dramatically overreacting.

Not saying you have to fully bubble wrap your kid.

You know, your kids are going to fall.

Like, there's my household, a lot of times looks like mma and that's healthy and that's okay.

And, you know, it's teaching kids about their brains, by the way.

That's one of the big areas that we failed with with all things brain injury education is we've gone in and tried to teach kids about dysfunction before they even understand about normal function.

So if you need to educate your kid, the first thing you start with is what is your brain?

How does it work?

Having them understand that?

And then you can start to talk about risk of injury and what to look for.

And you always need, when it comes to brain injury, you always need the bystander model.

Asking somebody to self diagnose when they're neurologically impaired is a terrible strategy.

It's like asking somebody if they're too drunk to drive when they've had too many drinks.

And so you need to teach, you know, parents, you need to teach friends, right?

In Rowan Stringer's case, she didn't tell her parents, she didn't tell the coach, but she told her friends.

And so you need to give kids the information of what to look for in their friends, give them the words of how to properly intervene, you know, what brain injury looks like, what some of this associated symptoms are, and then tell them exactly what to do if they suspect that one of their friends or one of their teammates has had a brain injury.

Parents should be vigilant about that.

You know, when a kid has a big fall, we always focus on the cuts on their knees or the bruise.

You just got to train yourself.

The first thing you should be thinking about is brain injury.

And remember, sometimes symptoms don't appear immediately.

Sometimes it takes weeks, and sometimes it takes months.

So your kid has a big fall or a big crash or, you know, has a collision on the ice of the field somewhere, make a mental note of that.

Even if they seem okay in the short term, you just.

You got to monitor that stuff through into the.

To the long term.

And so, you know, and then.

And then the other way, too, though, is, is, you know, unfortunately, we hear this all the time, you know, particularly in hockey, is.

Is a kid will take a big spill, there'll be a big game coming up, and the parent, you know, the kid will sort of be like, I don't know.

And the parent will be like, no, no, the kid's fine.

Like, they can play.

And it's so much better to have a kid sit out for a game or two, miss a couple of games, than to miss an entire season or have their entire athletic career affected, which happens.

We see it all the time, right?

Where kids try to go to back after.

Go back too fast after they've had a brain injury.

So it's finding that reasonable middle ground when it comes to approaching this issue.

Certainly lots of important food for thought for parents, families, educators alike.

Tim Fleiser, executive director of the Concussion Legacy Foundation Canada, really appreciate your time and your perspective today.

Thank you so much.

Thanks for having me on, and thanks for helping us get our message out there.

It is so important that parents know about this stuff.

And we were just reflecting earlier today.

And the amount of research and the amount of information that's changed in that time is astonishing.

And so that's the other part of it.

It's just trying to be up to speed, and it's thanks to people like you and the media that allow us to get that information out there so that parents can fit it into their busy schedules, which you and I both know is often challenging.

Definitely important information.

Thanks again.

Take care.