NHL Concussions: Time to Act!

Researchers from the Universities of Calgary, Toronto and Pittsburgh analyzed concussions that took place in the NHL over seven seasons - from 1997-1998 through to 2003 2004 - right before the lockout that resulted in the 2004-2005 season being cancelled.   Team doctors reported five hundred fifty-nine concussions during regular season games. The good news was that over time, the incidence of concussions went down from a peak of a shade under eight concussions per one hundred NHL players during the 2000-2001 season to just under five per hundred NHL players in 2003-2004.  The bad news is that the amount of time lost on the injury list gradually increased over the years.  The study is published in the Canadian Medical Association Journal.

There are a number of possible reasons why concussed players gradually spent more time on the shelf.  It could mean that concussions became more severe as protective shoulder and elbow pads got harder and players skated faster.  It's also possible that NHL teams became more cautious in allowing players to return to the ice.

The researchers did not design the study to determine why the rate of concussions went down over time.  Still, that didn't stop the researchers from speculating.  One clue comes from the study results themselves.  Concussed players form the largest group of players at risk of subsequent concussions.  Each day they spend on the injury list is a day they can't develop a new concussion.  Along the same lines, more severe concussions mean longer time off the ice.  If you take the most severely concussed players off the ice, you're taking the group of players off the time who are most likely to have recurrent concussions. 

Another related explanation is that over time, teams kept players all concussed players - mild and severe - off the ice for longer periods of time - perhaps because they made increasing use of neuropsychological testing before making return-to-play decisions. 

A third equally plausible explanation is the most ominous.  It's possible that the rate of concussion went down because players didn't report symptoms because they didn't want to be taken out of games and because they didn't want to be seen by opposing players as vulnerable to subsequent concussions.

To me, the most maddening aspect of concussions is that it appears as if doctors have no idea whatsoever how long it takes a player to recover. This study is one of the first to use modeling and regression analysis to try and predict recovery time.  These researchers identified several symptoms that predict a more serious concussion.  The symptoms include headache, low energy or fatigue, amnesia (loss of memory before, during or after the concussion), and any abnormality of the neurological examination.  The presence of these symptoms indicates that the concussion was severe and the period of time away from hockey will be long.  Just how long is still a matter of conjecture.

The study just published uses data that is seven years old.  The NHL released statistics last month.  As reported in the New York Times, there were eighty reported concussions to the middle of March of this season.  Let's call it eighty-five or eighty-seven or so if we take it up to the end of the regular season.  The current season is up year over year from the year before.  Still, compared to five hundred and fifty concussions over seven seasons, the number this season is consistent overall.  That suggests to me that the NHL is continuing to underestimate the problem. 

The NHL also published a breakdown of the causes of concussions from this season.  According to the NHL says forty-four percent came from legal hits to the body.  Fourteen percent came from legal hits to the head.  The NHL says that if shots to the head were a big reason for concussions, then legal headshots would have comprised a much larger percentage of the total. 

I agree with the NHL that headshots are only part of the problem.  But that's the only thing we agree on.  I think headshots should be banned with perpetrators receiving a ten-minute penalty (during which the team would play short-handed) plus a suspension.  I also like the idea of deducting the salary withheld during the suspension from the team's salary cap.

But headshots are only the most visible cause of concussions, and the greatest distraction to solving this problem.  Once headshots are banned, the NHL can and should concentrate of determining the other causes of concussions and taking steps to eliminate them from the game as well. 

What I take from these figures is that while the number of concussions may be steady, the severity of these concussions is the real problem.  To me, it doesn't matter how many there are.  If professional athletes and your kids are having concussions, then we have a big problem.  Not only that, but there's growing evidence that players can be subjected to repeated trauma that does not cause concussive symptoms yet leads to brain damage and long-tem consequences..  Sometimes, it's what you can't feel that can hurt you.

The other take home message is aimed at parents of kids who participate in contact sports or other activities that put them at risk of head injury.  If your kid has headache, fatigue or amnesia, ask your child if he or she has had a head injury.  If so, make an appointment with the family doctor to get your child referred to a neurologist or neurosurgeon who can arrange for testing.

Do not assume that no news is good news.