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2017.2.8

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Video Recording

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Dr. Charles Tator Interview

Interview Summary / Résumé d'entrevue

Dr. Charles Tator, Order of Sport recipient, inducted in 2017, born in Toronto, Ontario, is asked about his career in neurosurgery and his work on concussion prevention research. Dr. Tator describes his early interest in neurology and how realizing severe brain injuries are untreatable; therefore, the focus must be prevention. He further describes how concussion issues became his focus because of the increase in concussions in young athletes. Dr. Tator describes his work with Parachute Canada and the Concussion Harmonization Project, which emphasizes concussion prevention. The group has developed a code of conduct that discourages hitting from behind in ice hockey, translating into on-ice rules for players about hitting from behind. Dr. Tator talks about the differences between female and male athletes from the physiological perspective, in which women's necks are smaller and are more susceptible to brain and spinal injuries. He emphasized the importance of isometric neck exercises. Dr. Charles Tator elaborates on his research on neck injuries in ice hockey players and how, once he figured out how player necks were being broken, he went about "knowledge translation," which included cross-country speaking events. Dr. Tator is asked about chronic traumatic encephalopathy (CTE) and his advice to athletes who suspect they may have a concussion. He addresses the death of Rowan Stringer and the need for concussion legislation. Dr. Tator is honoured to be inducted into Canada's Sports Hall of Fame and believes that being inducted is an endorsement of his work.

2017.2.8 Entrevue avec Charles Tator, 2017, MP4 d'origine numérique. Quatre vidéos d'une durée totale de visionnement de 00:29:08.
Le Dr Charles Tator, récipiendaire de l'Ordre du sport, a été intronisé en 2017 et est né à Toronto, en Ontario. On lui demande de parler de sa carrière de neurochirurgien et de son travail de recherche portant sur la prévention des commotions cérébrales. Le Dr Tator décrit comment il s'est intéressé à la neurologie et comment il a réalisé que les lésions graves au cerveau étaient intraitables; il fallait donc se concentrer sur la prévention. Il explique plus en détails qu'il a choisi de se spécialiser dans la prévention des commotions cérébrales en raison du nombre grandissant de commotions cérébrales chez les jeunes athlètes. Le Dr Tator parle de son travail avec Parachute Canada et du projet d'harmonisation des Lignes directrices et des protocoles sur les commotions cérébrales, qui met l'accent sur la prévention des commotions cérébrales. Le groupe a développé un code de conduite qui décourage les coups donnés par derrière au hockey, menant à des règlements sur la glace visant à interdire aux joueurs de donner des coups par derrière. Le Dr Tator parle des différences physiologiques entre les hommes et les femmes, soulignant que le cou des femmes est plus petit et plus susceptible aux traumatismes cervicaux et aux blessures à la moelle épinière. Il s'attarde sur l'importance des exercices isométriques du cou. Le Dr Charles Tator explique plus en détails les résultats de sa recherche sur les blessures au cou chez les joueurs de hockey et raconte comment, lorsqu'il a compris comment les joueurs se cassaient le cou, il a entrepris de transmettre ce savoir, notamment en agissant à titre de conférencier dans des événements partout au pays. On lui demande de parler de l'encéphalopathie traumatique chronique (ETC) et de partager ses conseils aux athlètes qui pensent souffrir d'une commotion cérébrale. Il se penche sur le décès de Rowan Stringer et sur la nécessité de développer la législation sur les commotions cérébrales. Le Dr Tator est honoré d'être intronisé au Panthéon des sports canadiens et croit que cette intronisation constitue une validation de son travail.

Scope & Content

Dr. Charles Tator interview, 2017. Born digital MP4 videos. Four vidoes with a total viewing time of 00:29:08.

Were you involved in any sports as an athlete, and did you have any sports heroes growing up?

00:25.02-01:13.06Well, when I was a youngster I was passionate about hockey, so hockey was my major sport. In fact, I probably skated to school almost every winter day of my life in elementary school, and the in high school I played for my high school hockey teams, and also in university I played for the Faculty of Medicine's hockey team, and I was a huge fan of hockey, especially stars like Gordie Howe, Ted Lindsay, George Armstrong, Teeter Kennedy, Howie Meeker, Turk Broda, etc., were really my heroes.

Did that influence your decision to become a sport-related doctor?

01:21.22-02:17.29Well, when I was in high school I really didn't want to be a doctor. But when the time came to choose a career, I was really interested in the brain and how it worked, and so neurology and neurosurgery became my chosen career, and it was through my work as a brain surgeon that I became aware that a lot of athletes were getting injured, and when they were severely injured, it was beyond my skill to put the pieces back together again, and that's when I decided that more needed to be done in injury prevention, because most injuries are preventable.
This is a great segue because you've had a major impact on spinal cord injury research prevention treatment and transforming people's understanding of concussions. What drew you to concussions?

02:43.11-04:51.13Well, the concussion issue became a major preoccupation with me because so many people were getting concussed, especially youngsters who at 14, 15, 16. We started to see a huge rise in incidents of concussions in the older teens, and that means running fast enough, they were skating fast enough, and hitting hard objects fast enough to generate the force to produce a concussion; and I realized many of them were not getting better. There are about 200,000 concussions a year in our country, and only a fraction of the people don't get better, which means there's a lot of people out there suffering from concussions, and that includes amateurs and professionals. So, I started worrying about how to treat them, and I found that the only evidence-based treatment is small. We don't have a lot of effective treatments for concussions, so again it really means that prevention has to be stressed, and so I began being involved in what was being called "Concussion Roadshows"; and through organizations such as "thinkfirst" and now "Parachute Canada", we have bring able to bring the messages to a lot of young people about how to play sports safely. If you play safely, it means you're going to play longer, which means you're not going to be taken out to recover from a concussion or end a career. Look at how many NHLers have had their careers ended by repetitive concussions. We want to prevent that, so play safely, play longer.

What is the most important contribution Parachute Canada has made to raise the awareness of sport injury?

05:23.13-06:46.11The most important contribution currently is to carry out the mandate of our Prime Minister, who has in fact asked the Minister of Sport and the Minister of Health to do something about what he calls the "harmonization" of concussion guidelines. Currently, various organizations use different guidelines to advise doctors, parents, athletes, and coaches about what to do with concussions. I've been given the job at Parachute to harmonize these guidelines: in other words, to have common language, common ground so that parents aren't confused about "What is a concussion?" What are the signs and symptoms of concussion?" We want that to be standardized so there's one set of messages so people won't be confused about "What is a concussion?" How do you deal with a concussion? Do you have to take a player out of action?" It's better if we're all on the same page, and I'm part of the Parachute team that is going to accomplish that.

What are you most proud of in your distinguished career in medicine?

06:58.06-10:45.10One of the things that I'm really proud of is the fact that our group was one of the first to recognize that broken necks were happening in hockey, because people were being pushed or checked from behind into the boards, and so they were catapulted horizontally because they were up-ended, and they crash into the boards head-first, and the poor neck suffers the consequences, which often means a broken vertebrae in the neck and a crushed spinal cord. We can't put those pieces back together again perfectly, so the emphasis has to be put on prevention. Simple measures such as developing a code of conduct where we discourage hits from behind. Hitting from behind is terrible, but more importantly hitting from behind can cause terrible injuries. Yes, it's bad sportsmanship, but if you want to put somebody in a wheelchair for life because you did a stupid thing like hitting from behind. So when we brought this to the attention of organizations like Hockey Canada, fortunately they did something about it, and they instituted specific rules against hitting from behind. Before we brought forth this information that hitting from behind is a big deal in terms of broken necks in hockey, there wasn't a specific rule against hitting from behind. Now there is, and people know you just don't hit from behind, because that can break the neck. Other things that I'm really pleased about are, for example, neck muscle strengthening exercises. We also were probably the first to point out that you really have to strengthen your neck muscles to withstand the forces that can be put upon the neck in sports like football, hockey, soccer, rugby, and especially women. Women have to strengthen their neck muscles. Girls have much thinner necks than boys, it's just something that you're born with. That's just anthropology, that's the way it is that a girl's neck musculature is not as well-developed as a boy's, but girls can develop their neck muscles by doing neck muscle strengthening exercises, of what we call the isometric type of neck strengthening exercises, which are really quite simple. You do it against your own hand, and push against your own hand on all four directions for a period of time, and that will strengthen your neck muscles so you are better able to withstand the forces that can cause whiplash injuries, that can cause broken necks. It's rather interesting that we can now recognize that the movement of the head back and forth, because the neck muscles aren't as strong as they should be, and also they can cause concussion, so if you have weak neck muscles, you're setting yourself up not only for a neck injury, but also a concussion. So strengthen those neck muscles!

Let's open up the floor about women's participation in sports.

12:12.06-14:14.10Well, in fact we are concerned that women are going to get some injuries that boys don't get, but the reverse is also true. For example, women are smarter than men, and girls are smarter than boys because they are not getting the catastrophic injuries that boys get. When we look at catastrophic injuries in sport and recreation, and I mean really bad injuries to the brain and the spinal cord, women and girls are getting fewer of those injuries; they are smarter. In fact it's probably about 80 to 20: every 80 men and boys who are getting catastrophic injuries to the brain or spinal cord, there are only about 20 women and girls who are getting those injuries, so yay women! Yay girls! You're smarter, but you are susceptible to other injuries, especially concussions. In fact, our data show that sports like hockey and basketball, women are getting concussed more often than men per number of athletes who are playing those sports. So why is that? A lot of people are pointing to the fact that the neck muscles are not as well-developed in women , and therefore the whiplash type of effect on the brain, where the brain and the whole head move back and forth. That type of motion, the kind that can be prevented by strong neck muscles is happening more in women because the neck muscles are not as well developed, so get those neck muscles developed.

TAPE 2

During the 1970s, you got yourself into sports safety when you saw that five hockey players broke their necks due to sport-related injuries. Can you tell us about this and how it impacted your focus on sports going forward?

00:13.05-03:02.11 Well, we did research on why the necks were being broken in hockey, and we did find that certain mechanisms (especially hitting from behind) were big. That showed me the importance of research: in other words, you have to figure out why an injury is happening, who's getting that injury, and what gender, what mechanism, what type of lead. It turned out to be the older boys, like we didn't see a broken neck in hockey in a ten-year-old for example, so you had to be skating fast enough to generate enough force to break the neck essentially. When we did the research, when we figured out what was causing broken necks in hockey, that showed the importance of doing the research, and then you had to do something about it, you had to educate people about it, and that's called "knowledge translation." We had to translate that into action, so we made videos, and we got the help of other organizations; like Hockey Canada was extremely helpful; the International Ice Hockey Federation was helpful; a lot of the local teams in our area were helpful in disseminating the message. They would invite people from our research team and go and speak at events. We put on events: we put on a number of events called "concussion roadshows" where we went across the country. In fact, we were in Calgary, Saskatoon, Regina, Montreal, etc., right across the country with sports medicine doctors, with surgeons, with othomologists who also had a role to play in protecting the eyes in sports, so it really is a team effort among many organizations to try to educate people on how to avoid these major injuries. I strongly believe that if children and youth especially are educated on what causes injuries, they will then be part of the prevention team that can do something about it. In turn, their parents, their coaches, the referees, the teachers, all have to knowledgeable about injury prevention. It really is a team sport.

If you were to speak to young athletes about concussions and safety in general, what would be the biggest bit of advice that you would offer to them?

03:29.10-04:04.28Well, I think it's very important to play sports. Sports are perfect for companionship, for camaraderie, for physical development, to get your muscles developed. The brain likes to be perched on top of a moving body, so exercise is good for your brain, so we really want kids to play sports. But the message is that you have to play safely, in order to play longer.

Why do you feel so strongly about concussion research in sports?

04:26.17-07:21.22We went into concussion research because there were so few answers available. We really didn't know why people failed to recover from concussions. We don't really have good tests for concussions, for example we don't have a good imaging test, so we can't take a picture of the brain and say, 'ah, that's where concussion is in the brain', so there's a lot of unknowns about concussions, and that's why we felt like the Canadian Concussion Centre at the Toronto Western Hospital is so important so we can learn about concussion, because one of the features of concussion that's puzzling is the fact that you can be concussed at an early age, get over those concussions, and then in a small number of people, the older you get, you can have long term consequences of those concussions. One of the long term consequences is actual brain degenerations. That's one of the unhappy things that has happened to many athletes; they've actually shown late degeneration of the brain, another which you can do well as a teenager, and into your twenties and thirties, but then when you get to be sixty or seventy, your brain can show evidence of degeneration because of those previous concussions. We still don't know why that happens: Why does that affect some athletes and not others? That's the purpose of the Canadian Concussion Centre and the Canadian Concussion Project at the Toronto Western Hospital, and I'm currently the project director. We have about twenty scientists who have put their heads together (if you excuse the pun) to try to solve this problem of why do some athletes suffer this late effect. We also don't know why the post-concussion syndrome affects only a portion of the athletes who get it. That means the vast majority of athletes who get a concussion should recover promptly, and that's the end of it. But a small number have lingering symptoms, and sometimes those symptoms can last a long time. In fact, we have records that about 35 NHLers, so great athletes, have had to give up their careers as professional hockey players because of the effects of concussions, and some pretty famous players have had that happen.

Can you talk a little more about chronic traumatic encephalopathy (CTE)? It's very topical in sports news right now.

07:45.01-09:05.24One of the long-term complications we've been talking about is chronic traumatic encephalopathy, which means that later, long after concussions have been sustained by an athlete, the brain can actually show degeneration. That can cause significant issues with personality change, memory loss, mental health issues like depression and anxiety. It can have pretty severe consequences, and most importantly we don't have good tests to detect when that is going to happen, and also we don't have any treatment for it other than prevention, so it's a hot topic now in my field to try to come up with ways to discover it before it's too late, and ways to try to treat it. I'm hopeful that the Canadian Concussion Centre, where I work, will contribute to the knowledge of how to treat that condition.

If a young athlete were to suspect he/she was having a concussion, what would be your best advice be for them to do?

09:19.22-12:28.27So, it's very important to get over a concussion; to get over it completely before you go back into play. So if you are recognized or suspected of having a concussion, you need to come out of the game or practice and be examined carefully. Now, sometimes that examination can be done at the sideline if there is someone who has had any training in concussions at the game (there may be a doctor nearby or a nurse they can be examined by). But if there isn't, you really should go see a doctor, either in the doctor's office or in the emergency department and be examined to determine whether or not there has been a concussion. Because the consequences of getting another concussion before you have fully healed from your first concussion are severe, and we call that the "second-impact syndrome". So if you have a concussion, and you play anyway, and get a second concussion, that can be terrible, especially if you're a youngster, if you're a teenager, or if you're in your early twenties, the brain can swell enormously, and there have been deaths from second and third concussions. The most recent one in Canada was Rowan Stringer, who was seventeen years old and having two or three concussions in one week, went back to play, she was the captain of her team. She suspected she might have a concussion, but she didn't tell adults about it. She went back and had a catastrophic injury and essentially died of it. Her parents Gordon and Cathleen Stringer have advocated strongly for what was called "concussion legislation", and were strong in recommending this type of way of dealing with this concussion problem. We think there should be concussion legislation in every province of the country, and that's what Parachute Canada is currently working towards. We strongly support the Rowan Stringer Committee is underway now in Ontario. Manitoba is also considering bringing in concussion legislation, so that is a movement that I certainly support as a way in preventing some of the complications of concussions.

What does being inducted in Canada's Sports Hall of Fame mean to you?

12:43.22-13.31.06To me, it's a great honour, and it's also a pat on the pack, and an endorsement of what I do, and that is injury prevention. It means that the whole Canada's Sports Hall of Fame is now part of the injury prevention team, and that makes me really happy because it really is a team sport. It does depend on everybody putting their heads together to solve this problem, especially the problem of repetitive concussions and the consequences of them.

TAPE 3

Thank you for visiting!

00:08.01-00:21.01Hello, I'm Dr. Charles Tator. I'm a brain surgeon, and I'm so honoured to be part of Canada's Sports Hall of Fame, and to welcome you to this great facility.

TAPE 4

00:01.19-00:22.23Hi, I'm Dr. Charles Tator. I'm so pleased to be part of this great Canada's Sports Hall of Fame, and I'm so pleased that you came to visit, and I hope you are now also part of the injury prevention team for sports safety.

Date

2017/ /

People

Tator, Charles

Search Terms

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chronic traumatic encephalopathy