There has been considerable attention for the past few years, but especially in recent weeks with more big-name NHL scorers suffering concussions, including Sidney Crosby, Milan Michalek, and Jeff Skinner.
Some of these have been accidental, such as Michalek, Crosby and Claude Giroux, while others have been as a result of body contact. But the incidence and severity of concussions seems to be growing, despite what the NHL officially declares.
Is it overblown as some think, or is it becoming an epidemic problem – and if so, how do we manage it?
The assessment and management of concussions is one of the most important changes that have occurred in the past few years, including the consensus of the Zurich Protocol having been adopted by most sports leagues. More research is supporting the fact that there is a period of vulnerability of repeat concussions within seven to 10 days of the first concussion. And it is the early management to reduce second-impact syndrome and the careful progression with return to play that has been emphasized in this protocol.
Of course, a hit to the head may cause a concussion, but body-to-body contact can also jar the head or cause a whiplash acceleration effect, causing trauma to the brain.
A couple of studies done in North Carolina and Oklahoma University on NFL players have brought up other issues pertaining not just the number of concussions, but the number of sub-concussive impacts over a long playing career, as well as the actual forces to the head.
The study states that on most plays, linemen sustain impact forces of around 30 Gs and receivers and quarterbacks can sustain 90-100 Gs on high-velocity hits, and those were deemed to be on the threshold of causing concussions. The study indicates that a player who has sustained three or more concussions during his career is five times as likely to being diagnosed with cognitive impairment after the age of 50 compared with players who have had fewer than three. And that player is three times more likely to be diagnosed with depression at age 50. Athletes with multiple concussions are also seven times more likely to demonstrate a major drop in memory performance compared to athletes with no previous concussions. And a study of wrestlers, football players and MMA fighters reported in the American Academy of Sports Medicine show that those with more than 10 concussions have significant brain deterioration, and there may be a link between that and violence with spouses and suicides amongst those athletes.
Apologists, and there still are some out there – though decreasingly so, maintain either that it’s not as bad a situation as we are led to believe, or that these athletes know what they’re getting into and making good money at it. However, most of these athletes probably did not know what kind of damage can occur and what the after-effects were. And when a player like Crosby can have his whole career in jeopardy, others start to listen.
Fortunately, taking deliberate head-shots out of the game is being increasingly implemented in football and hockey. Unfortunately, the single most deliberate head-shot that can occur, fighting, is still in the game. After all, the goal of fighting, the thing that makes many fans cheer – is a knock-out punch. And even though these are rare, that is the purpose of both fighters. So it is hypocritical for the NHL to try to eliminate intentional head-shots while not outlawing and suspending fighting. Body-to-body contact, however, will pose a bigger problem to manage as athletes get faster and stronger. Further improvements to equipment or the rules of the game will need to be honestly discussed if these sports are to be played at a high level.
Many players, when interviewed, including NHL ‘enforcers’, say they are quite concerned. They feel that in the past someone got ‘their bell rung’ and just came back and played despite the symptoms. The culture of contact sports just fosters that kind of behaviour, but the science was inadequate years ago. And although the science has improved and players are coming forward to donate their bodies to science to help further improve the research findings, there is still more to be done. Erring on the side of caution is not only smart for player’s careers, it’s smarter for their long-term health, especially considering the window of time most professional players is small compared with the rest of their lives when put in context. The scientific research continues to flood in and the damage to the brain appears to be much worse than most people thought.