Brain trauma and hockey

Transcript of CBC's interview with Chris Nowinski on the possible connection between concussions and chronic traumatic encephalopathy (CTE).

Analyzing Bob Probert's brain


Q & A with CBC


The Center for the Study of Traumatic Encephalopathy in Boston issued a statement Thursday saying that NHL's Bob Probert had chronic traumatic encephalopathy (CTE) when he died last July of heart failure at age 45.

Probert, who lived in Windsor, Ont., played 16 seasons in the NHL for Detroit and Chicago between 1995-2002. He racked up 3,300 penalty minutes during his hockey career.

Chris Nowinski, a former wrestler, is widely credited with putting the concussion issue on the map. He is the co-founder and president of the Sports Legacy Institute (SLI), a non-profit organization dedicated to researching the sports concussion crisis, and serves as a co-director of the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine.
Chris Nowinski, president of the Sports Legacy Institute, former Harvard football player, and World Wrestling Entertainment wrestler, had to retire due to concussions. (Steven Senne/Associated Press)

CBC:   Were you surprised that chronic traumatic encephalopathy (CTE) was found in Probert's brain?

Nowinski:   We’re not surprised to find CTE in Mr.Probert's brain.  We’ve studied the brains of over 40 professional athletes, football players, boxers; over 30 have shown signs of the disease. 

Considering Mr. Probert played 20 years of hockey, 1000’s of games, he also participated in [many] fights and so he had a lot of total brain trauma and it’s not surprising to find CTE.  

CBC:  Can you explain CTE?

Nowinski: It’s a degenerative brain disease that’s linked to brain trauma. It essentially starts while you’re an athlete and then progresses after you stop getting hit in the head.  It leads to symptoms of memory problems, emotional problems, behavioural problems, like loss of impulse control and eventually will cause dementia.  

CBC:  Were Probert's behaviours consistent with CTE?

Nowinski: With this sort of research, only seeing his brain after his [death], we can’t really make statements to understand why specific behaviors may have happened in somebody’s life.  Its sort of a chicken and egg question. Certainly in the cases we’ve seen cumulatively we do see these sorts of behaviours. 

However, in Mr. Probert's case, I recently read his book, he talks about how some of these behaviours started very young so  it’s difficult to say, impossible to say with any certainty, if the brain trauma may have contributed to his behaviours. Although his wife did say he was having increasing memory problems and impulse control problems in the last few years of his life, which follows the trend in other athletes.   
Bob Probert died after collapsing with severe chest pains while enjoying an afternoon of boating with his family. (Julian H. Gonzalez/Detroit Free Press/Associated Press)

Sidney Crosby is suffering from post concussion syndrome which I experienced myself for multiple years. That doesn’t necessarily mean it will lead to CTE in the future, the actual disease.  I’m happy to see Crosby resting with his concussion until his symptoms clear because that’s something we didn’t do in the past and that’s cost a lot of people their careers. 

CBC:  Is there a connection between hockey and CTE?

Nowinski: Well the NHL and the NHL Players Association sent doctors to our laboratory in September and we did review a number of cases so I think they do have a good understanding of what CTE is.  Unfortunately, the first two cases we’ve identified in NHL players were also were enforcers and involved in a lot of fights.  So it’s tough. 

The Probert findings are not an indictment of how hockey is played today.  However, I am very happy for the discussion of concussion that’s going on in hockey, increasing the age of checking, certainly penalizing blind side hits — because the concussion problem is absolutely in hockey, we just don’t know yet if the CTE problem is in hockey.  

CBC:  Can anything be done?

Nowinski: Do you ban all hits to the head? Frankly, knowing that no hit to the head is a good thing and seeing players like Crosby and Marc Savard with the Bruins being out with concussions, I would love the NHL to take the tack that they need to protect their assets; they need to protect their best players and they need to eliminate hits to the head entirely so we can watch great players playing great hockey. 

CBC: How did Probert's CTE compare with those of football players?

Nowinski: It wasn’t as extensive as football players and boxers we’ve seen of the same age, from their mid 40’s, meaning the disease wasn’t as progressed and considering Mr. Probert was one of the five all-time on penalty minutes and considering he had such a long career, makes us hopeful for hockey but we don’t have enough cases to really understand the severity of the disease in that sport.  

The take-home message here is the brain is really more fragile than we believe.

I think it lends a bit of urgency towards how we can change hockey to prevent this sort of thing happening to future players. There’s a lot of big questions here we need to figure out with some urgency considering how frequently we’re finding this disease in former athletes and just how destructive the disease has been within those athletes.  

CBC: What's next?

Nowinski: Over 10 former NHL players have signed up to donate their brains and the call is still out. One of the reasons Mr. Probert's wife wanted to make this public is to get others to get involved.    There's a giant hole in medicine. We don’t really understand a whole lot about this disease.  We can’t diagnose it in living people and we can’t treat it.  A cure is the end goal and  how to we prevent it in current athletes.  

I have concerns and some of my best friends — all of us took a lot of brain trauma and a lot of us are in the high-risk category.  There's a little bit of a ticking clock before certain symptoms like memory problems or impulse control problems take over. I try to channel that concern into helping make research go faster.