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February
2007
Head Games
Concussions are a major concern in pro hockey,
but they’re no less of a headache in youth leagues. It’s
just a matter of how you deal with it.
By Chris Nowinski
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From 
Concussions are a bigger problem in hockey than you think.
The perception is that the NHL has the worst problem
because of the many players who’ve retired due to post-concussion
syndrome – like Pat Lafontaine, Mike Richter, Brett Lindros,
Jeff Beukeboom and Keith Primeau. And then there’s the laundry
list of notable players who have missed considerable time with concussions
– most notably Eric Lindros, Jeremy Roenick, Jason Allison,
Peter Forsberg, Scott Stevens, Tim Connolly and Paul Kariya.
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Jeremy Roenick
GETTY |
But while these cases grab the headlines, few
people are aware that the NHL’s concussion problem pales in
comparison to the concussion crisis that exists in youth hockey.
As researchers learn more about this injury, it’s becoming
clear that the most common and the most dangerous injury in hockey
is the one that, at the youth level, we are least prepared to treat.
Groundbreaking research on sports concussions
has revealed that these injuries are more than meets the eye. For
the last few decades, the most publicized safety concern was minimizing
the risk of catastrophic injury and potential sudden death from
second impact syndrome, a rare outcome of two concussions in a short
period of time.
But a survey of 2,500 former NFL players found
a linear correlation between lifetime severe concussions and risk
of both depression and ‘mild cognitive impairment’ (MCI),
a precursor to Alzheimer’s disease. Those who had suffered
three severe concussions had around a 20 percent risk of depression
and MCI, both of which were triple the rate of players with zero
concussions. No similar research has been performed on hockey players.
Limiting these long-term risks in active athletes
is not simply about limiting the number of concussions they suffer.
How a concussion is managed in the minutes, days, and weeks following
the event strongly influences the extent of the damage. That is
why current international guidelines, and those endorsed by USA
Hockey, advocate never putting an athlete back into play when he
or she is still suffering symptoms from their concussion, either
at rest or at exertion.
In fact, so much can be gained by better concussion
management at the youth level, the prevention discussion that seems
to dominate the concussion dialogue at hockey rinks across the Northeast
seems premature. We aren’t yet at the point where discussions
over helmets, masks, the size of shoulder pads, the give in the
boards, or lax rule enforcement should be the No. 1 priority, when
research shows that we are only treating, and therefore managing,
around 10 percent of concussions.
Hockey team medical records show that about 10
percent of youth hockey players report a concussion each season.
Yet direct surveys of the players reveal that they only ‘report’
or tell an adult about less than 1 out of 10 of their concussion-like
experiences.
There’s a similar trend in high school football,
and a survey of those players who didn’t report their concussions
found that, among other reasons, one-third didn’t know they
had one and two-thirds didn’t think the injury was serious
enough.
If we’re only convincing players to report
less than 10 percent of their concussions – and the main reasons
stem from a simple lack of education – then at some level
we are failing them. It seems only right to teach youth athletes
about the most common, most dangerous, and also most difficult to
understand injury in the game.
Some attempts by independent medical bodies to
provide free educational materials have been stonewalled at the
youth level by coaches. In one well-documented example, an educational
video on concussions developed by the reputable ThinkFirst Canada
was offered to the coaches of 34 teams of 11 year-olds. Twenty-two
coaches didn’t respond to offer, and of the 12 who did seven
refused to show their team the video out of the fear it would decrease
aggressive play and therefore their chances of winning.
Yet even if the children understood the risks
and chose to report their concussions, who would they tell? According
to Massachusetts Hockey, there are no doctors or athletic trainers
available except at large tournaments, so they can only tell their
coach. What does that coach know? A Mass Hockey coach is required
to attend a certification clinic every three years, where they receive
about 10 minutes of concussion education per session along with
literature. While the material is valuable, Dr. Alan Ashare, Chair
of the Mass Hockey Safety Committee and a major concussion education
advocate, he told me, “We’re not trying to make our
coaches into doctors.”
So the next time you worry about your favorite
NHL player getting a concussion, rest assured that he is getting
the best treatment money can buy. But at the youth level, the lack
of attention, education, and resources given to manage the most
common and dangerous injury in hockey should keep you up at night.
So if a parent wants to feel secure that his or
her kid will make the right decision and get off the ice when he
gets his ‘bell rung,’ the best move may be to take it
upon themselves to learn about the injury and then educate their
athlete.
Christopher Nowinski is a former Harvard
football player and WWE professional wrestler who had his career
ended prematurely by post-concussion syndrome. His new book, "Head
Games: Football's Concussion Crisis," is available at www.concussioncrisis.com
and at bookstores everywhere. Nowinski can be reached at feedback@hockeyjournal.com.
This article appears in the February 2007
issue of New England Hockey Journal. Click
here to subscribe to the magazine.
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