Losing NHL star Sidney Crosby to a concussion is a reminder that all players are vulnerable, Canadian hockey Hall of Famer Marcel Dionne says.

"That's the scary part," said the retired NHL player. "Now it's affecting our superstars. It takes that to review what's happening."

But ask Dionne about the NHL's latest high-profile hit on Maple Leaf Mikhail Grabovski — who experts believe suffered a concussion after two hard hits in the Feb. 15 game but was allowed back on the ice and scored the winning goal — and he appears to take a more typically tough-guy approach.

"Absolutely," Grabovski should've been allowed back on the ice after a second hit, Dionne said. "He came back and proved it.

"I watched him play against Buffalo," Dionne said, referring to a later game. "I think he's playing better than ever. They woke him up or something."

Dionne, who played 18 seasons in the NHL, is indicative of a bravado that persists in the National Hockey League — an attitude that experts say needs to change.

Dr. Richard Wennberg, a neurologist and concussion expert at the University of Toronto, says that watching Grabovski slip and slide as he tried to rise to his feet and the rubbing of his neck once he reached the bench were clear indications to him that the hockey player had a concussion.

"By observation, it can be stated with certainty that he had a concussion," Wennberg said. "It would be against current medical management to continue playing the game."

But continue he did. Leafs management said Grabovski responded coherently to questions. Some critics said a doctor should have made the call instead of a trainer and that Grabovski should have been taken away for 15 minutes for an assessment.

NHL urged to adopt return-to-play protocol

Crosby, the Pittsburgh Penguins captain, has been out of action since Jan. 6 after taking hits to the head in successive games. He says he expects to play again this season but admits he can't be sure.

Dustin Fink, a trainer who tracks concussions on his blog Theconcussionblog.com, says the NHL is behind the times when it comes to in-game diagnosis and return-to-play protocol for concussions.

National Football League players who show symptoms of a concussion aren't allowed to return to play the same day. They must be symptom-free and cleared by an independent neurologist before returning to the field.

"The bigger sports tend to be a lot less proactive," Fink said. "They are protecting their multibillion-dollar industries and their players themselves."

si-concussion-morneau-190
Concussion symptoms

Classic concussion symptoms include confusion and amnesia, especially of the event that caused the concussion.

Other immediate symptoms may include:

  • Headache.
  • Dizziness.
  • Ringing in the ears.
  • Nausea or vomiting.
  • Slurred speech.
  • Fatigue.

For more on this and other questions, see our FAQs.

Professional football and hockey leagues aren't the only ones struggling to minimize the risk of concussions.

U.S. downhill skier Lindsey Vonn participated in the World Cup on Feb. 13, winning silver, despite later admissions she felt foggy after a concussion suffered during training. The U.S. lacrosse league is currently debating whether to require girls to wear helmets — and wondering whether extra armour might actually increase aggression.

33 concussions despite rule

Fink acknowledges the NHL at least introduced Rule 48 — which makes blindside head hits illegal — but says it's not enough. Despite that rule, the league saw 33 reported concussions by Dec. 1, as many by that date as in the previous season in total.

NHL commissioner Gary Bettman has said the number of concussions are up this season due to accidental or inadvertent collisions, but the number caused by blindside hits are down.

The U.S. Centers for Disease Control and Prevention estimates there may be up to 3.8 million sports and recreation-related concussions in the U.S. each year, with concussions accounting for one in 10 of all sports injuries.

Fink says the hockey league needs to create a standard return-to-play protocol for concussions in line with the NFL's and give medical teams the independent power to decide whether to pull a player.

But he understands the difficulties in changing the culture.

"Hockey is a tough-guy sport. You definitely don't want to show weakness with your opponent," Fink said

In the end, he says, it's an important issue that needs to be taken seriously by players, management and the league.

"I don't care how tough you are," Fink said. "You only have one brain. We can't fix that brain."

Sports culture a major barrier: doctor

si--concussion-phil-golden-hawks-cbc-190-022111
Injuries to young athletes

Michael Stuart, chief medical officer at USA Hockey, is behind a proposal to raise the age of bodychecking in U.S. youth hockey. Stuart says there's more than enough evidence for Canada to do the same — and a large reason for that is a study conducted by the University of Calgary that showed bodychecking in Pee Wee hockey more than tripled the risk of concussion and injury. Find out more.

However, despite an evolving wealth of knowledge about concussions, the culture in sports remains an impediment, says Paul Echlin, a sports medicine physician based in London, Ont.

"The No. 1 thing is not wanting to leave the playing field or the ice surface or the football field regardless," Echlin said. "Unless somebody drags you off, you're not going to go."

Echlin was the lead author of a study on concussions in hockey players published in the Neurosurgical Focus journal in November 2010 that found a lack of standardized knowledge among athletes, coaches, trainers and parents about the signs and symptoms of a concussion.

The concussion expert says it's what leagues do with the information that is telling.

"When you start to turn your head when you know this knowledge, that's a problem," Echlin said.

Players never had it so good: Dionne

However, Dionne argues, players have never had it so good — with their health so top of mind.

si-concussion-soccer-190
Career-ending concussions

Former San Francisco 49ers quarterback Steve Young, New England Revolution soccer player Taylor Twellman, Colorado Avalanche forward Steve Moore — a photo gallery showcases these and other professional athletes  whose careers have been hampered or ended by concussions.

"We never had this," said Dionne, who played from 1971 to 1989 for the Detroit Red Wings, Los Angeles Kings and New York Rangers. "I think the players' association recognizes that we have to protect our players, so is the league, the insurance companies.… And on top of that, the doctors are right there."

But Dionne, who says he suffered a single concussion during an NHL career nearly two decades long, worries that concussions are becoming more prevalent because the sport is getting faster, players are bigger and stronger, and hard equipment is less forgiving.

"There will always be concussions," said neurologist Wennberg. "There's no way to legislate concussions out of the game."

Both Dionne and Wennberg suggest part of the solution could be to increase the rink size, a change that studies show reduces contact.

Dionne, though, may have a simpler idea.

"The little guys have the stop sign," Dionne laughed, referring to use in the minor leagues of a stop sign to reduce hits from behind. "Maybe we're going to have to do this ourselves!"

With files from the CBC's Aaron Saltzman