The phenomenon of concussions in professional sport

Recently, the Philadelphia Flyers announced that all star defensive stalwart Chris Pronger has been shut down for the rest of the NHL season with what the team has described as “post-concussive syndrome”.  Pronger joins Pittsburgh Penguin superstar Sidney Crosby, teammate and NHL leading scorer Claude Giroux, and Ottawa Senator forward and NHL second leading scorer Milan Michalek out of action due to concussion.  To list every star player currently on the shelf would fill several blogs.  The NHL may well call these an unfortunate coincidence.  I call it the tipping point beyond which the NHL will take effective action to prevent further carnage or will risk losing a multitude of fans - including this die-hard Leaf fan.

Until now, the NHL has exhibited a form of inertia common to organizations seeking to maintain the status quo.  It has used time-honored techniques to accomplish these aims.  These include taking advantage of gaps in scientific knowledge on the causes of sports concussions as well as disagreements between experts as opportunities to play for time.

Case in point:  in a disturbing series of articles and interactive videos published earlier this month, the New York Times documented at the time of his death at age 28 that NHL enforcer Derek Boogaard had evidence of severe CTE (chronic traumatic encephalopathy), a condition that causes emotional lability and cognitive deficits not dissimilar to Alzheimer’s disease.

Clearly, repeated blows to the head are often associated with CTE.  And yet, when asked to respond to the Times series, NHL president Gary Bettman issued a statement saying the findings in Boogaard’s death would not result in additional steps to curb fighting or immediate steps to try and reduce the number and severity of concussions.

To know what took place in a person’s life to determine what may or may not have caused a particular injury is something that’s going to take years for people who have the expertise in this field begin doing,” Bettman was quoted as saying shortly after the articles appeared. “It’s way too premature to begin drawing conclusions.

Don Fehr, executive director of the NHL Players’ Association, said this following publication of the articles in the Times:

The findings released by Boston University to the New York Times regarding CTE found in Derek Boogaard’s brain, and the forthcoming medical journal article, should be seriously considered by everyone associated with the game.  It is certainly important information that we will be discussing with the Players.

In my opinion, the phenomenon of concussions in professional sport in general and the NHL in particular needs ongoing study.  But the need for study does not absolve the NHL and the NHL Players’ Association of the responsibility to take action now.

In a blog, former NHL skilled tough guy Jeremy Roenick blames hits involving elbows, shoulders, hits from behind near the boards, and jumping off the ice at the moment of impact as factors fueling the increase in concussions.  NHL Senior Vice President of Player Safety Brendan Shanahan has his work cut out for him.

There are suggestions that current and former NHL players consider litigation as a way of making the impact of concussions as damaging to the league and NHL teams as it is to players.  Elbow and shoulder pads can be softened immediately to reduce their effect on vulnerable players.  Innovations like the concussion collar conceived by Dr. Joseph Fisher could reduce the impact on the head.

All of the above could help set NHL players and the league on a safer course.

One voice heard across Canada this Saturday could galvanize action.  If this weekend, Don Cherry uses his Coach’s Corner segment on Hockey Night in Canada as a bully pulpit to inspire the NHL and the Players’ Association, it would be one voice too many too ignore.

Your move, Mr. Cherry.

Adapted from a blog post that appeared on White Coat, Black Art.

Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R., published by HarperCollins.

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  • http://warmsocks.wordpress.com/ WarmSocks

    It’s good to see the NHL start to address this issue.  Now to get the NFL and PBR on board.

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    The question needs to be addressed throughout all levels of sport. When my girls played high end competitive soccer we looked at heading the ball as a source of chronic brain injury. Should youth players be permitted to head the ball at all?  Should protective helmets be developed for soccer?  Should youth boxing be permitted even with the heavily padded helmets and gloves so padded that the youngsters can barely punch?  Police Athletic League and Golden Gloves programs are a ticket for some kids out of poverty but is the price of head injury too costly? The American Academy of Pediatrics has just come out against youth boxing. What about pee wee and youth tackle football?  Although injuries are rare, as the kids get bigger, stronger and faster should we be limiting contact until they complete puberty or eliminate the sport at the youth level entirely? These are difficult questions for our society but must be addressed by us all with the risks clearly outlined to parents signing their kids up to play.

  • Sanford Felzenberg

    The false security of helmets that prevent superficial injuries but not internal brain trauma is one reason for disabilities. In hockey, the removal of the red line has increased the speed of the skaters and the force of hits to the body and to the head. Worse is the NFL, which has neglected the problem of brain injury for its entire history. 
    The brain cannot ricochet around the skull without injury.Sports fans will be watching the surviving players and walking wounded during playoffs.

  • Anonymous

    I agree with Mr. Reznick.  All levels of sports, and all types of sports must be addressed.  Growing up as a figure skater, I more than once experienced head trauma.  But I skated in the days of “skate it off and try again”.  We had no helmets, no padding.  Just our blades and the hard ice.  The problem of concussions in sports is not merely the lack of initiative on the sports association to address the serious health complications but the lack of society to realize how concussions affect all levels of sport – not just pros – and all types of sports.  Think soccer, gymnastics, and figure skating too.  Why are we focusing only on the big boys?  So many more are effected by head trauma.  And we need to figure out how will we address these injuries and protect all of our athletes.

  • Anonymous

    How can one distinguish a true problem from a litigation ploy? Wouldn’t all former professional wrestlers be infirmed? Whether fake or not (It is!), those guys (and now girls) get bounced around pretty good without helmets.

  • http://www.facebook.com/people/William-Daniels/100001706564045 William Daniels

    Dr. Goldman is right on.  There is a frightening lack of awareness about the dangers of concussion in sports.  The fact that professional sports organizations are hiding their heads in the sand speaks volumes about the need for heightened awareness and better prevention and detection standards.

  • Anonymous

    Everyone keeps talking about fighting in the NHL regarding concussions and brain injury. Let’s consider the real culprit here. The helmets and how the players wear them. The helmets haven’t changed since I played 35 yrs ago, still the same CCM helmet! Joffa used to make a helmet that moved in sections to absorb the force of the hit, buy I don’t see anyone wearing them, if they are still made. And then the chin straps hanging an inch below the chin, loose. These are the real culprits that need to be addressed and can be very easily to start.

  • http://www.facebook.com/people/William-Daniels/100001706564045 William Daniels

    Dr. Goldman is right on.  There is a frightening lack of awareness about the dangers of concussion in sports.  The fact that professional sports organizations are hiding their heads in the sand speaks volumes about the need for heightened awareness and better prevention and detection standards.

  • http://twitter.com/TmyersMD Timothy Myers

    My god, would you listen to yourselves? No one knows better than someone who has played sports that sports causes injuries. No one knows better than a professional in any of these sports that sports causes injuries. Yet, they and we continue play.

    I grew up in an era when injuries seemed so common that we kids hardly ever acknowledged them unless there was a bone sticking out of the skin. In addition to playing all of the usual sports, we fell out of trees, played pickup games of tackle football without pads that can only be described as close to rugby-like in its intensity, fell off bikes, skied without helmets and developed and learned how to skateboard on what can only be called primitive equipment without pads. We did this without CT, MRI or for the most part without stitches or even x-rays. Yet, we seem to have survived.

    If you personally do not want your children playing sports don’t let them. If you want your kids to play sports with the additional protective equipment, buy it and have them use it. My 3 kids all played sports including soccer and football, with injuries. Yet, I have a daughter in a master’s degree program, a daughter who is a teacher and a son who has been a corpsman with the United States Marines.

    Yes, I agree that if there is something that can be done we should try to make things safer; however, I do not believe we should mandate these actions. If you don’t believe that professional sports and professional athletes should be allowed to perform their respective activities then don’t buy tickets or watch TV. If the athletes themselves do not wish to add these additional protective items or pursue additional forms of protection for themselves, they only have themselves to blame. Remember, we live in an age where these athletes make between $500k dollars per year and tens of millions of dollars per year. They don’t need our help or money to push them to do the right thing. And, as for any type of restitution to these athletes for injuries; don’t get me restarted on that…..

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