Concussions and Hockey – What Can Be Done?
This past Super Bowl weekend, I wrote about some interesting connections between neuroscience and football, including a variety of statistics and opinions about brain injuries and football. Now that football season is over, I’ve noticed an increasing number of headlines about brain injuries in hockey players. Recent research in Canadian Medical Association Journal (CMAJ) found that while the concussion rate among National Hockey League (NHL) players has leveled out in terms of total number of concussions, the number of days lost per concussion is increasing. Players lost play time for symptoms like headaches, fatigue, and memory loss. First-time concussions took, on average, 6 days to recover before returning to the ice, while each subsequent concussion added about one extra day to the recovery period.
Why is the time loss increasing while the rate stays the same? There are two theories: one is that sideline coaches and medical professionals have become more cautious about post-concussive play. The other is that concussions have become more severe or that players are experiencing a cumulative effect of multiple concussions.
In Canada, over 500,000 youth play hockey, and currently suffer a 25% concussion rate. Due to the preponderance of severe and debilitating brain injuries on the ice, hockey’s popularity among Canadian youth, and a noticeable rise in brain injuries of junior hockey players, CMAJ has recommended that body checking be banned from youth hockey to reduce the risk of concussions. Researchers note that the majority of injuries in youth leagues are caused by legal body checking (defined as using the body to knock an opponent against the boards or to the ice.) In Ontario, youth leagues also have a new, high-tech tool to help properly gauge hockey-related brain injuries–a computerized neurocognitive test that will be given to each player before the season to establish a baseline, and again post-injury to judge severity.
The NHL has a somewhat confusing stance on body checking and head shots (purposely hitting an opponent in the head with body or equipment.) In 2010, after a spate of high-profile brain injuries occurred, they banned “blindside” head shots. Last month, despite deepening external pressures, they decided against a ban on all head shots, keeping just the blindside ban in place.
Adding to the confusion is the fact that many feel that the NHL is spotty in enforcement of head shots and body checks–while others posit that there is a blatant double-standard for regular and post-season play, noting that the NHL seems to excuse and encourage injurious plays in the post-season. There is a rule on the books which says players will be punished if they “deliberately attempt to injure or deliberately injure another player in any manner,” but just a few days ago they failed to apply this rule against Raffi Torres, who delivered two brutal, purposeful blows against Brent Seabrook in one game. Torres received no penalty for these hits, with the NHL citing an obscure exception which hasn’t yet been found in the NHL rule book.
What’s worse, on-site doctors and coaches cleared Seabrook to continue on the ice within moments of being injured, even though it’s well known that concussion symptoms may not immediately appear. Indeed, after suffering up to three likely concussions in the span of one game, the next day Seabrook presented with signs of serious concussion. Seabrook was out the following two games, but will play again tonight. It remains to be seen how that decision will affect Seabrook’s recovery and cognition in the long term.
Leading medical professionals support an all-out ban on shots to the head and more stringent enforcement by the NHL. To this casual observer, it definitely seems like NHL players, coaches, and officials have a cavalier attitude about the serious long-term consequences of repeated severe brain injuries.
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Posted: Neuroscience, Research studies
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April 25th, 2011 at 12:37 pm
How about making your articles readable, especially by those with visual processing deficits caused by concussions? The standard for publishing is 60 to 80 characters and spaces per line. This makes it easier for the eyes to follow from line to line. It also makes it so the brain can read and comprehend better.
This is a common mistake with online articles but being like the crowd does not set Posit Science apart from the crowd.
April 25th, 2011 at 12:42 pm
Hi Mark- thanks for the comment. In most Internet browsers you can click on the “View” tab to make the text larger. In Firefox you can choose “Zoom text only” and then zoom in to get larger text. Hope that helps!
April 25th, 2011 at 12:58 pm
After copying and pasting this article into MSWord so I could format it to make it readable, I am shocked at the lack of serious review and a knowledgeable response by Karen.
The biggest risk to hockey players is not the noticed concussion. It is the sub-concussive impacts that go unnoticed. The cumulative effect of these impacts can be far more devastating that a full concussion. They happen much more frequently and do not cause any time off the ice or field.
In football, the average seasonal rate of subconcussive impact is 600 to 800 per SEASON per player. The full blown concussion rate is similar or less than hockey so do you own extrapolation.
Dr Julian Bailes and the Dr Kevin (Ph.D.)at the Sports Training Department at University of North Carolina at Chapel Hill have done great research regarding sub-concussive impacts.
Regarding the increased delay in Return to Play, I think both comments are at play. Doctors may be getting a bit more cautious but without any knowledgeable understanding are just adding a day or two to the time off. If they really understood Multiple Concussion Syndrome and Second Impact Syndrome, they would be demanding a longer time off the ice.
Even using the ImPACT system leads to an unsubstantiated reason for allowing return to play.
If 25% of the hockey youth suffer a concussion in each season, there is a serious risk of permanent brain injury that will show up with intensity when the player reaches their 40′s. If the Canadian Health care system is not already overwhelmed by these patients, it will be soon.
Those I know who suffer from Post Concussion Syndrome and live in Canada complain about the lack of access to reasonable and knowledgeable medical care for their PCS.
Not much different that the lack of comprehensive understanding of concussion in the USA, except for the few research leaders as mentioned above and others such as Dr Robert Cantu in Massachusetts.
April 25th, 2011 at 1:03 pm
Thanks for the comments and elaboration of the topic – great to have more depth on the topic.
April 25th, 2011 at 1:19 pm
Karen, it is not font size that is the problem. It is line length. The eyes cannot see such a long line at one time. The New York Times never uses such long lines. You have 105 characters and spaces per line. It is a simple process to set your web page formatting to 60 or so characters and spaces per line. Set the word wrap setting to a lesser number.
April 25th, 2011 at 1:50 pm
Hi Mark – I will share your concerns with our webmaster. Thanks.
April 25th, 2011 at 9:21 pm
How about a rule in Hockey that says if the injured player needs to sit out the game, a player of equal status on the offending team sits out the rest of the game? The coaches would need to decide pre-game what the match-ups would be.
No enforcer taking out a lead scorer or lead defenseman without losing the same on the offending team.
Then, the offender has to sit out any games the injured player sits out.
The same should go for football.
Otherwise, we are teaching our youth the wrong idea of Sport. If they want to fight to the death, join the infantry in the Army.