Friday, May 29, 2009

Over Their Heads

The NHL has a big problem. For the last couple of seasons, it's been paying lip service to the idea of maybe, potentially, possibly studying the idea of penalizing hits to players' heads. In the meantime, shots to the head and resulting concussions are on the rise.

I've ranted about this in the past, but this week several factors have converged in a way that make me want to talk about it again. The first was Martin Havlat, lying on the ice in Chicago with his open eyes rolled back after getting nailed in the head by Nicklas Kronwall. Two days later, after obviously suffering a concussion, he was back in the lineup...only to leave again after the first mild contact he encountered. Dr.Michael Czarnota is the neuropsychology consultant for the Canadian Hockey League. He was quoted as being "shocked" to see Havlat back on the ice so quickly. The experts are shaking their heads because the NHL is so careless with those of its players.

Even more disturbing, however, was the conversation on TSN's Off the Record yesterday. The discussion was between Capitals coach Bruce Boudreau, Thrashers coach John Anderson, former Hurricane Kevyn Adams and former Flame Ric Nattress and the topic was concussion, specifically Havlat's. The consensus seemed to be that the onus of whether to play again rests on the player. There are tests, sure. But if a player insists he's fine and doesn't need to be tested, more often than not the trainers take his word for it. They talked about the pressure on players to "tough it out" and come back quickly. The two coaches on the panel talked in dismissive tones about it not being up to them. The players and the medical staff decide a player's fitness and the coaches abide by that decision. The question host Michael Lansburg didn't ask was "If you think the player is hurt and is ignoring advice, will you stop him?" The passing of the proverbial buck by both coaches on the panel made me think the answer would be "no."

The third factor that put concussion back on the radar for me was a news report on CBC Radio this morning. The subject, again, was Havlat. Only this time the expert being quoted was Keith Primeau. Primeau talked about how his life has changed since concussions ended his career. He's on medication to control headaches and vertigo. He's forgetful. His family says his personality has changed and he's much more irritable than he once was. He thinks the league needs to crack down harshly on hits to the head. Glenn Healey is also quoted in that story, explaining how the NHLPA considers concussion its number-one concern, and is asking for automatic penalties on "the most flagrant and reckless" hits to the head. What Healey doesn't address, however, is the need for a deep attitude adjustment among players from their earliest years in the game all the way up to the NHL. If the onus is on them to decide their fitness to play, they need to be educated about the consequences of playing through a head injury.

Primeau talks about how the NHL treats concussion as "part of the game." That's the attitude that comes across when Colin Campbell plays down the number of concussions in the league and the number of players who've had career-ending head injuries. It's the attitude that people like the coaches and players on the TSN panel exude when they're talking about concussions. They're treating what amounts to traumatic brain injury with a sort of shoulder-shrugging contempt.

Neurologists in the United States are studying the impact of repeated concussion on NFL football players. They've concluded that players recover less well from second, third, and later concussions than they do their first. And they've documented retired players dying in their fifties, after suffering health problems, depression and personality disorders...all of them attributable to repeated head injury. The scientists have studied the brains of deceased players and found them to carry symptoms of dementia one would expect to see in a ninety-year old. This is scary, life-threatening stuff. Keith Primeau told CBC he's planning to leave his brain to science when he dies, because he hopes when the scientists find similar damage in the head of an ex-hockey player, as he believes they will, maybe someone will listen and change things.

The fourth thing that came to my attention about this issue this week is a report by Toronto neurosurgeon, Dr.Michael Cusimano. He found that one in four minor hockey players don't know when it's okay to return to the ice after a concussion, and half the players interviewed either couldn't identify any concussion symptoms or knew of only one. This underlines the serious need for education about the nature and consequences of concussion. But the study's conclusion about numbers of concussions is the most frightening thing of all.

Cusimano calculates that before players ever reach the NHL, they've already accumlated multiple head injuries. He says players aged five through seventeen have about 2.8 concussions per thousand hours of ice time. University players have 4.2 concussions per thousand hours of ice time, while major junior players have 6.6 per thousand hours of icetime, on average. That means that by the time an average player gets to the pro ranks, he's had about six concussions in his lifetime.

If this is happening at minor league levels, it's up to authorities like Hockey Canada and the NHLPA to educate minor league coaches and players about head injuries. Players need to know when they have one, and when they're safe to return to the ice. But, even more importantly, they have to learn how to prevent them. They need to be taught that checking is intended to separate an opponent from the puck...not his head from his body. Hits to the head need to be strictly penalized from the earliest days of minor hockey, and automatic suspensions handed out under certain circumstances, such as when a player leaves his feet to deliver a hit, if the opponent does not have the puck or if the player hits the opponent's head with a stick or elbow. Young players need to learn how to position themselves to safely take a hit and not turn their backs or duck to put their heads in jeopardy.

The problem with the NHL's lip service on this issue is that it's not actually doing anything to change things. So maybe while the pros dither around, the problem can be addressed by training minor hockey players how not to be the next Martin Havlat or Keith Primeau. Then, by the time they get to the NHL, they'll have succeeded in changing attitudes. In the meantime, the league that should have lead the way and been the shining example for change sat on its butt and did nothing while players sacrificed their health...and maybe their lives...for a game.


Woodvid said...

Once again, I agree with all; did you notice that Primeau mentioned it all started to go really wrong for him when he got knocked out, then came back to play 2 days later -- exactly like Havlat did?

The only problem is, if the NHL eliminates hits to the head, what's to prevent players from skating around with their head down all the time, making them very difficult to check?

Anyway, on a completely unrelated note, I thought Ryan Dixon's off-season game writeup for the habs was spot-on:

V said...

I'm not sure the solutions you propose are enough. Increasingly, I think that the only way to reduce concussions (and other serious injuries) is to reduce the number of games played in a season. Of course, in a league that relies on ticket (+concession sales) revenue, that's not likely to happen.

Concussion, from Merriam-Webster online: Etymology: Middle English concussioun, from Latin concussion-, concussio, from concutere to shake violently, from com- + quatere to shake
1 a: a stunning, damaging, or shattering effect from a hard blow ; especially : a jarring injury of the brain resulting in disturbance of cerebral function b: a hard blow or collision
2: agitation, shaking
As you pointed out, concussions have many serious health effects. I believe three issues are important to highlight:
1. Receiving one concussion makes an individual more likely to receive another.
2. Latter concussions appear to cause greater damage.
3. Brain injury can reduce an individual's ability of judgement.

Combine this with the fact that the only way to heal a concussion is to rest and with the peer pressure to return to the game.

It would be easy to say that players shouldn't be allowed to make the decision to return playing on their own, but it's a very personal injury that outsiders can't judge, so it's not that simple. The only solutions that appear to me are reducing the physicality of the game and/or reducing the number of games played. Since *ice* hockey is played on ice, some level of physical play (and the corresponding injuries) will always be present. And given how much whining there is about "changes to the game", cutting the schedule may be an easier solution.

I've had a minor concussion (deemed minor because no evidence showed up on an MRI). It probably took me six months before I felt 'normal', although I was pretty functional within a week or two. But just thinking of that time makes me feel sick to my stomach. Perhaps another day I'll try to describe the sensations.