Time to think clearly about the dangers of concussions

During this past all-star weekend, the NHL board of governors obtained a report showing an increasing trend of concussions in professional hockey.

The other important finding of the report is that the majority of those injuries are not necessarily from deliberate, intentional hits to the head. Instead, they appear to be accidental collisions like the one Sidney Crosby sustained in the Winter Classic game, where the head may not sustain any direct impact. In fact, Crosby is one of 12 players not currently playing because of head injuries. NHL injury reports also indicate that 43 concussions had been sustained to date since the start of exhibition play, and if that trend continues that would put the figure at 75 concussions by the end of this season.

This situation is made even more disturbing with the results of the November 2010 report on junior hockey players published in the journal Neurosurgical Focus that not only found that the rate of concussions in junior hockey is very high, but that there are many underlying issues that need to be addressed in order to reduce these concussion rates.

Among the many interesting conclusions of the study were that contributing factors to the perpetuation of this situation has as much to do with ignorance about concussions and competitive culture as it has to do with physical impact.

Although players know how a concussion happens, they often don’t know what actually happens to the brain or what the symptoms of concussions are.

The players in the study also demonstrated a “disturbing lack of compliance to undergo neuropsychological evaluations,” which indicated to the researchers that players do not have a good understanding of how serious brain injuries are.

They often don’t know if they have sustained a concussion either.

Even some professional athletes have admitted that they were unaware that they had a head injury and kept playing. Add to this a culture of win at all costs which surely stigmatizes athletes who are supposed to be tough and play through pain (or admit they have an injury that can’t be seen like a bruised muscle, swollen joint or broken bone) and you have a recipe for serious problems.

A 2009 study in the Canadian Journal of Neurological Sciences found that players and parents also had other misconceptions which included believing that concussions can be treated with medication and physical therapy, and that it was probably alright to return to play while still experiencing symptoms. The importance of being symptom-free and cleared by a physician (even for minor concussions) is extremely important because if not, further blows to the head can lead to second-impact syndrome which is an accumulation of effects of multiple concussions. The syndrome is caused when players who remain symptomatic sustain a second blow to the head. Even if this second blow is minor, the brain may swell rapidly, resulting in further injury, long term degenerative complications or even death.

The NHL has taken steps to reduce intentional hits to the head by suspending and fining players which arguably has had some effect, but what about situations in which a concussion occurs without direct contact of the head on any surface? The high velocity movement of the head during a whiplash event alone could produce the same effects. This is a situation that may prove hard for hockey leagues to remedy. The technology of building better helmets that will cushion blows to the head may or may not be able to help, and rules can be enforced to eliminate intentional head-shots, but if players continue to become stronger, faster and more massive, then body contact without head contact will continue to cause concussions and this would appear to have no obvious solution.

And finally on the topic of eliminating intentional hits to the head, Bettman recently admitted that there has been an increase in concussions due to fighting. What could be more intentional than throwing a punch to your opponents head? Is the league prepared to be consistent across the board and suspend or fine players for fighting?

Become familiar with the concussion protocols for your child’s sports league and with the signs and symptoms of concussion which can include any of the following: headache, dizziness, nausea, loss of consciousness, memory loss, confusion, irritability, vomiting, drowsiness, fatigue, slurred speech, difficulty with coordination or movement, perseverating (saying the same thing over and over), blurred vision, changes in sleep pattern or mood, ringing in the ears, sensitivity to light or noise, loss of taste or smell, lack of concentration, and balance problems.