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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