Hockey players may think they’re taking one for the team by soldiering on through a concussion, but the numbers tell a different story.
According to a landmark University of Calgary study published today in the Canadian Medical Association Journal, 27 per cent of National Hockey Leaguers who play in spite of a concussion – for whatever reason, without in-game medical examination – ended up missing more than 10 days of action.
On average, concussed players recuperated for six days before receiving medical clearance to return to the lineup.
“That’s what the data shows,” says lead author Dr. Brian Benson, a researcher and physician at the Sport Medicine Centre in the University of Calgary’s Faculty of Kinesiology.
“Those players who ignore the symptoms and continue to play may potentially have a more severe injury and take longer to recover.
“We need to educate all involved in the sport – including players, coaches, management, physicians, medical staff. Certainly, the players should report symptoms to the medical staff and not continue to play while symptomatic.”
The warning comes during the opening round of the 2011 Stanley Cup playoffs minus Sidney Crosby, who is believed to have suffered a concussion in the Winter Classic on New Year’s Day. The Pittsburgh Penguins captain – arguably the best player on the planet – absorbed another head blow in his next game and hasn’t played since.
“That’s a sure sign of how early on in understanding post-concussion we really are,” says Keith Primeau, a 14-year NHL veteran who was forced to retire due to post-concussion syndrome. “Crosby was not diagnosed with a concussion. At the time, he didn’t show signs of a concussion or he felt well enough to ignore them. And then he returned to play and has ended up missing four months on a far less physical hit.
“It’s nobody’s fault. No one made a mistake. We just don’t completely understand the injury.”
The U of C researchers – in conjunction with the NHL and the NHL Players Association – compiled reports from every team doctor in the league from 1997 to 2004 in the largest concussion study ever conducted in professional hockey.
Post-lockout data from 2006 to 2011 is slated for release later this year.
In practical terms, researchers found four warning signs at the time of the head trauma that lead to extended time on the sidelines: headache, amnesia or memory loss, low energy or fatigue and an abnormal neurological exam.
“Concussion severity to date has only been able to be determined after the injury is fully recovered,” Benson says. “You look back in time and you say, `OK, they missed this much time lost.’ The symptoms lasted this long.
“This study is unique, because it adds a prognostic factor with regards to concussion severity at the time of injury.”
Just last month, the NHL instituted a new protocol for head injuries. Players suspected of having a concussion are removed from the game and sent to a quiet place free from distraction so the on-site team doctor can examine them.
In the past, the trainer or a doctor on the bench initially evaluated a player suspected of having sustained a concussion.
“The league now has the rule where every suspected concussion needs to be evaluated by the medical staff,” Benson says. “If they highlight or note any of these factors, certainly the red flag should go up.”
Primeau applauds the researchers for pinpointing the four symptoms, but warns against players feeling they are OK if they have no headache, memory loss, fatigue or an abnormal neurological exam.
“I wouldn’t disagree with the fact those are four very common symptoms,’ he says. “But I also know through the course of my ordeal – and speaking to other players who suffered post-concussion – that no two concussions are alike.
“We shouldn’t negate other symptoms, I think that would be dangerous.”
Other highlights of the study include:
– The number of reported concussions actually dropped during the study period from 7.7 concussions per 100 players during the 2001-02 season to 4.9 per 100 players in 2003-04.
– The number of days lost per concussion increased slightly over the seven-year period. “That can be for several reasons,” Benson says. “Either the injury itself is getting more severe or team physicians are being more conservative in their management. There’s some speculation and suggestion that players are bigger, stronger and faster – and the increased force is transmitted to the brain. It’s all speculative, but certainly a possibility.”
– Concussions do indeed get worse over time. For every recurrent concussion sustained over the study period, a player faces 2.25 increase in time lost. “I lived that,” says Primeau, who battled on for the Philadelphia Flyers after suffering two concussions in the 2004 playoffs, only to miss 73 games the following season. “Trust me. You don’t want to wake up every morning with a headache. It’s not a good feeling, and it’s real. I guess I’ll always know that I damaged my brain.”
Calgary Herald
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