The Impact Of Concussions On The NHL

con·cus·sion  [kuh n-kuhsh-uh n]  noun

1.  injury to the brain or spinal cord due to jarring from a blow, fall, or the like.

2. shock caused by the impact of a collision, blow, etc.

3. the act of violently shaking or jarring.

Travis Hughes of sbnation.com compiled a list of NHL players that are out of the line up due to being diagnosed with a concussion or suffering from concussion-type symptoms.  The list includes (at the time I wrote this article); Sidney Crosby, Claude Giroux, Mike Richards, Michael Sauer, Jeff Skinner, Joni Pikanen, Kris Letang, Chris Pronger (out for the season), Zbynek Michalek, Marc Staal, Robert Bortuzzo, Jay Beagle, Milan Michalek, Brayden Schenn, Radek Martinek, Marek Zidlicky, Nathan Gerbe, Peter Muller and Nino Niederreiter.  Other players injured from the Islanders are Steve Staios and Brian Rolston.

Players have been either forced to retire or be limited in the amount of games they were able to play over the course of a given season - all due to the after effects of a concussion.  These man games lost must amount to millions of dollars lost each season by their perspective clubs.  Rick DiPietro has been the most prominent example of this condition in the Islanders organization over the past few seasons.  DiPietro suffered a concussion in 2007 in a game against the Montreal Canadiens when he came out to cover a puck and collided with Montreal F Steve Begin.  Since then, DiPietro has missed significant periods of time with concussion type symptoms.

In April of this year, a major University of Calgary study on consciousness was concluded after research was conducted over 7 NHL seasons.  The study was led by sports medicine researchers with the aid of Kinesiology professionals. (Kinesiology addresses physiological, mechanical, and psychological mechanisms as they relate to physical activity.)  The study can be found on sciencedaily.com.  Its major finding was seeing that although the rate of injuries had evened out over the 7 seasons within the study period, the number of days or time lost increased with each concussion.

The study concluded that, “Headache, low energy or fatigue, memory loss, and abnormal neurological exam were significant predictors of time loss for players with concussions.”  The study was able to isolate and track the progression of the injury and estimate trends that would follow an athlete after he had suffered his initial head trauma.  "Our results suggest that there was a trend toward a gradual increase in post-concussion time loss over the study period," said lead author Dr. Brian Benson, a researcher and physician at The Sport Medicine Centre in the University of Calgary's Faculty of Kinesiology. "  More should be done to educate everyone involved about the potential adverse effects associated with continuing to play while symptomatic, failing to report symptoms to medical staff and failure to recognize or evaluate any suspected concussion."

The fact that concussions have come to the attention of sports teams and their medical staff’s will help players be more accurately diagnosed and treated to a more efficient level by team doctors.  Where, in the past “getting your bell rung,” and sitting out was an embarrassment, today’s recognition of the chronic deterioration in an athletes’ quality of life are the issue if precaution is ignored.  The possibility of ongoing head injuries getting so pronounced, that they cause traumatic brain injuries is a serious concern for anyone involved in competitive athletics.  Repeated mild brain injuries may cause cumulative damage and lead to more serious and possibly fatal issues.  NHL icon, Bob Probert passed away from chronic traumatic encephalopathy in July.  KoC spoke about it here.

“In the United States it is estimated that roughly 1.6 to 3.8 million sports and recreation-related brain injuries take place each year.  The study looked at 559 concussions suffered by NHL players in regular season games between 1997 and 2004 and was based on physicians' reports from every team in the league.

The estimated incidence was 1.8 concussions per 1,000 player-hours. The post-concussion symptom reported most often was headache (71%), followed by dizziness (34%), nausea (24%), neck pain (23%), low energy/fatigue (22%), blurred vision (22%), amnesia (21%), and loss of consciousness (18%).

Typical time loss in days increased 2.25 times during the study period for every recurrent concussion.”

Seemingly the more times a player suffered a hard blow to the head or was violently jarred during body contact, the chances of re-experiencing the effects of the initial concussion increased.  The chances of “re-injury” became easier as it related to the symptoms were greater as time went on and could take longer to recover from.  "The findings also suggest that more conservative or precautionary measures should be taken in the immediate post-concussion period, particularly when an athlete reports/experiences a post-concussion headache, low energy/fatigue, amnesia, recurrent concussion, many different postconcussion symptoms, or has an abnormal neurologic exam," conclude the authors.

The NHLPA and NHL have been working together and sharing data to help combat the condition by looking at the rules of the game and the types of equipment that factor into sports collisions.  When the league wanted to increase scoring, the rule changes made the game faster, cut down on obstruction and restricted goalies from playing the puck.  This meant more urgency for speed and as the players get bigger and stronger with each passing year, those bigger, stronger and faster players play a physical brand of hockey. 

Body checks and physical play in today’s game have been addressed at the start of the season by League Officials, Board of Governors.  Things like hits to the head, hitting from behind and leaving ones feet to lay a hit on an unsuspecting player have been a focus to eliminate from the game.  With the drastic increase in speed on today’s game, these are good changes to make.  A major issue that hasn’t really been addressed to my satisfaction has been the players own equipment.  With equipment, I mean shoulder pads and particularly, helmets and the overall head protection policy. 

The shoulder pads have hard plastic domes and plates that can be used as a weapon of sorts when delivering a hit.  While they greatly reduce chances of injury to the player delivering the hit, the hard plastic and shape of the “cups” can often cause more damage than the jarring hit alone.  These type of “protections” need to be removed or modified to become safer for the players involved.

NHL players are now required to wear helmets.  But what qualifies a helmet as “fastened to head” is laughable.  Some players say that secure fitting helmets are uncomfortable so they loosen the chinstrap.  From watching thousands of NHL games, I have seen several players hurt as their helmet slipped out of position as they fell to the ice.  A majority of players do not use any type of face shield.  Face shields are made in different sizes, some barely shielding the eyes while other coming down to partially protect the nose.  Players complain about them fogging or obstructing their vision.  In addition, the cages worn after a player has been afflicted by a serious injury are also scorned for similar reasons as mentioned above.  The popular style of helmets worn by NHL players are light shells with open cell foam designed to disperse light to medium impacts to the head.  They are more of a preventive type of helmet that would be designed to come into play if something inadvertently was to strike the players head.  To me, this type of helmet is not enough.  I feel it’s the main reason for so many head injuries in the game of hockey.

Helmets that meet the criteria approved by the National Operating Committee on Standards for Athletic Equipment (NOCSAE) are used in most collegiate and professional contact sports and have been readily accepted as the standard for protective athletic equipment.  Modern sports helmets are designed to employ tolerance curves.  They are measured to determine impacts that would cause brain injury vs those less serious in nature.  Data is collected and minimum standards are applied for an average standard of acceptable protection or susceptible risk. 

The NFL recently met with helmet manufacturers to evaluate the safety and efficiency of different helmet designs.  A study showed that 40% of NFL players were using a helmet that was among the lowest rated certified helmet for safety and protection.  I wonder what the actual numbers on NHL injuries based on brand and style of helmet worn would tell us?

A new type of helmet that is stronger, lighter and uses a closed cell or better quality foam is needed for the NHL.  A mandated face shield or cage that provides protection, but still allows players to be recognized to the satisfaction of the NHLPA could be investigated as well.  More attention to the rules and improvements on the playing surface should be employed to provide a more complete picture for the league.  These are all necessary actions to combat what is rapidly becoming the biggest enemy of the game, the head injury.

I do not believe that a ban on fighting is necessary in the NHL.  Rules and regulations can be put in place to discourage fighting if a ban is seen as unavoidable in the future to the Board of Governors.  I believe that more efficient equipment and helmets that provide a better level of protection should be the main priority of the league.  All forms of technology, civilian and military could be investigated to find the best solution.  Perhaps all the major equipment brands could be made to compete for exclusive placement of the best product available to the league.  The need to protect NHL players as human beings should be of paramount importance.  There has to be a way to cut down the amount of gifted athletes that are having their careers cut short, and the others that are affected by head injuries damaging their quality of life while they are so young.

A more complete awareness by the league and more importantly, by its players would help immeasurably in combating the concussion legacy.  I have quickly changed my mind about Brendan Shanahan, and how he and his staff have been doing a great job enforcing the rules and punishments against offending players. They provide a valuable system to instruct players who need more guidance on how to deliver a hit on the ice.  More respect between players in the heat of competition should be exercised as well.  Players need to be fully accountable for their playing style and their demeanor on the ice.  Actions like hits to head, leaving your feet in a check and hitting from behind, especially into the boards cannot be tolerated.  I understand wanting to lay a solid hit on your opponent, but I would never do so if it would not just injure the player, but affect his future quality of life. 

Caution has to be exercised at all cost to avoid a dirty hit that was a deliberate attempt to injure.