HockeyHow can concussion problem in hockey be fixed?

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It was a nationally televised U.S. college football game between Texas Christian and Southern Methodist. TCU's star running back, Ed Wesley, fell on his head after a tackle and was knocked out.

The team physician, Dr. Samuel Haraldson, told The American Medical News what happened next.

"[Wesley] was knocked unconscious, and any loss of consciousness is automatically considered a concussion. He had an unsteady gait and a few memory problems."

According to NCAA rules, once a player is diagnosed with a concussion, he is not allowed to return.

"Then five or six plays later," Dr. Haraldson added, "I literally was verbally accosted by the coach, screaming at me insanely at the top of his lungs that he doesn't think [Wesley] has a concussion and what right do I have to hold him out."

Days later, the coach, Gary Patterson, told ESPN, "As far as I'm concerned, he was fine 10 minutes after he got hurt."

The good news is that more of us are realizing that kind of thinking is beyond moronic. The bad news is that we've still got a ways to go.

Philadelphia Eagles Kevin Kolb and Stewart Bradley ignored concussions in Week 1 of this NFL season. Ian Laperriere and Marc Savard tried to play through them in last spring's Stanley Cup playoffs.

Savard needed more rest: Dr. Cantu

Dr. Robert Cantu, author of 23 books about brain trauma, believes Savard would be playing now if he'd rested last spring. (Dr. Cantu has an autographed "thank you" picture in his office from Bruins forward Patrice Bergeron.) And that's why another doctor told Hockey Night in Canada that he wants to see more concussions - for now.

His name is Dr. Ruben Echemendia.

The NHL went to him and Dr. Mark Lovell in 1997, asking them to establish the neuropsychological - or "baseline" - test that helps monitor concussion symptoms. It allows teams to get a better handle on when a player is truly recovered.

This was his first-ever TV interview.

The NHL is averaging 75 recognized concussions per season since the lockout, down from a high of 109 in 2000-01. This year's total is poised to smash the record.

When I asked Dr. Echemendia if he had a target number he wanted to drop to, he blew me away by saying he wanted to see the total increase in the short term.

"It sounds counter-intuitive, but the reason I say that is that means we have more awareness. We know that we're doing our job when the rate of concussions increases. But, if we start seeing an increase in the severity of the concussions, or a longer duration of the symptoms, then I would certainly be concerned."

Is that happening?

"Not in our league," he said, which seems surprising, considering high-profile cases like Willie Mitchell, David Booth, Savard, Laperriere and Paul Kariya. "We're seeing lesser and lesser symptom burdens. Because we're evaluating them earlier... their symptoms don't last as long."

Here is the total number of man-games lost due to concussions in that past four seasons:

2006-07 - 615
2007-08 - 548
2008-09 - 487
2009-10 - 407

Can't imagine that number dropping again this season, with almost 20 concussions so far. Plus, Kariya and Laperriere will miss 164 between them.

Teenagers push for early return

 After really thinking about it and talking to a few players, I can understand where Dr. Echemendia is coming from. The hockey (and football) mentality is tough. No one likes to miss games when it really matters. (I wrote here that if I was Laperriere, I probably would have done the same thing.) That's not limited to professionals. Dr. Echemendia says he sees 13-year-olds who try to convince him to return too early. 

But it does have to change if there's to be a decrease. That's going to be very hard.

It is impossible to do justice on this topic in a six-minute television feature.

Some other things I learned while compiling my report:

• Dr. Cantu on fighting: "With enforcers who've had a lot of fights, roughly one in four fights, they'll take a blow that stuns them - in essence a concussion. They'll go the penalty box, put their five minutes in and then, when they come back to the bench, they won't acknowledge that they've been concussed. So we really find a high incidence of concussions happening, roughly 20-25 per cent of the time." Think Derek Engelland-Colton Orr. In the symposium held last week at the Mayo Clinic, only six per cent of concussions were linked to fighting. If Dr. Cantu is right - and I have no reason to believe he's wrong - that number is way off.

• There were 300 diagnosed concussions in the NHL between 1997-2004. Baseline testing showed that in 30 per cent of them, players who thought they were recovered still had symptoms. And it's not that anyone believes they're lying, it's just that they don't realize it until pushed by a test.

• If there is one crack in the baseline exam, it's that there is no accepted method of testing a player's balance on skates. Both doctors say that measuring balance is an important part of determining a full recovery.

• Players from certain countries tend to downplay any kind of head trauma. So, if they come to the bench/room complaining about wooziness, etc., teams are told to be very careful. (the doctor wouldn't tell me which countries).

• Only 25 per cent of the hits that caused concussions involved players who had the puck. Of the rest, the vast majority (76 per cent) came within half a second of the victim releasing the puck. This is the tough one for the NHL. The league still considers that possession, because the game moves so quickly. Any contact to the head after half a second is when you get in trouble, which is why Shane Doan got three games for hitting Dan Sexton. (It might be a good idea to have any contact after half a second be grounds for suspension, so Erik Cole can't get away with what he did to Drew Doughty).

• Last year, there were almost 55,000 hits made in NHL games. The year before the lockout, there were 38,831. That's an increase of 40 per cent.

• Most concussions occur in the first period. Dr. Echemendia's believes it's because teams come out hard at the start of a game, wanting to set the physical tone.

• The real danger area is in women's hockey, especially at the college level. There are several theories, but two stand out. First, since there is theoretically no hitting allowed, the players are not taught to properly protect themselves from contact. Second, as Cassie Campbell-Pascall points out, most teams don't travel with anyone qualified to diagnose a concussion.

• In football, first-stringers go through hundreds of head hits a year, including practice. There are fewer in hockey, but the force of those collisions is much greater because of the speed at impact.

Game-changer

The Mike Richards hit on Booth was the game-changer. "That's when the attitude amongst GMs really turned," said one NHL executive.  

But has it turned enough? Mitchell had a really interesting quote when asked about Rick Rypien getting into a physical altercation with a fan last week.

"My opinion is that everyone has made a big issue out of this and I think there's other things that are going on in our game that are much more severe, whether it's headshots -- and I keep going back to that - and the lack of action on that," Mitchell told The Los Angeles Times. "It's something we've seen the NFL start to do and hopefully our league follows suit. The game's faster, guys are bigger, it would be nice to see if they protected the players a little more."

The GMs broke down 22 randomly selected games from last season. Every hit to the head - no matter how innocent - was noted. Here's what they learned: 62 per cent of them came along the boards, 38 per cent in open ice. What connected with the head? Well, 40 per cent of the time, it was the hands. Next: 30 per cent from the shoulder, 15 per cent from the elbow, 13 per cent stick and two per cent other helmets/knees.

Here's the problem: no one can agree on how severe head contact should be to call a penalty. There's been call for a zero-tolerance policy, but the GMs looked at all of the incidental contact and said, "We're going to throw out guys for that?" Even Dr. Cantu, who said in the piece, "I think that, eventually, all head checks need to be eliminated," admitted there are mitigating factors.

When I played devil's advocate, asking about the speed of the game and the differing heights of players leading to accidental head shots, he said that he was talking about situations where the head was targeted and it could be left to the discretion of the referees.

Of course, retired referee Kerry Fraser, who joined Ron MacLean in studio immediately after our Inside Hockey piece, completely disagrees. It just shows how little consensus there is.

How do we fix the problem? I like the idea of stiffer suspensions for those who do target the head.

Brad May thinks some degree of interference must be allowed back in the game. That adds even more subjectivity to the rulebook, but is that the answer?

Can we remove concussions from hockey?

"No," says Dr. Echemendia, shaking his head. "When you have players that size and that speed playing the game, you're not going to get rid of concussions. It's not going to happen unless we fundamentally change the game in such a way that you won't recognize it."

That's the big question for everyone: fans, media, players and execs. We love the way the game is played. We're all concerned about the head injuries. What's our choice?

Note: I'll post my weekly 30 thoughts blog on Tuesday.

 

(Photo Credits: David Booth: Matt Slocum/AP; Jason Pominville: David Duprey/AP; Marc Savard: Keith Srakocic/AP; Derek Engelland: Jamie Sabau/Getty Images) 

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