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Home , Brendan Shanahan, Dave Steckel, Marc Savard, Max Pacioretty, Patrice Cormier

HOCKEY AND THE CONCUSSION DEBATE Introduction For real hockey fans, few sights are more their sport too soon. We know that one Focus upsetting than seeing a favourite player, concussion makes an athlete much more Hockey concussions have figured after a major hit, lying motionless on the susceptible to further concussions. And significantly in the ice. we know that repeated concussions can news over the last Over the last few seasons that sight result in permanent, debilitating brain two years, but even seemed a much more common one. damage. more so since the Despite attempts by the National Hockey Hockey concussions made the news injury to superstar and League (NHL) to reduce the number of big time after was hit Canadian hero Sidney hits to the head, more and more players twice in January 2011 and forced to Crosby. This News in Review story examines seem to be sidelined by injury—some withdraw for a large part of the 2010- what we are learning of them for months at a time. For many, 2011 (at the time this is being about the causes that injury is a concussion—a condition written, he has not played for three and consequences of in which the brain is shaken or twisted months). This incident, as well as concussions, and the during a hit, sometimes, but not always, injuries to several other players, has response of the entire causing a loss of consciousness. led to many calls for the NHL to take hockey community to There was a time when it was not strong measures to curtail the kind of the dangers they pose to players. uncommon for players to shake off a play that causes severe head trauma and concussion and return immediately to concussion. The league remains resistant play. A concussion was considered to to any rule change that will undermine be an accepted aspect of the game. You what it calls the “physicality” of the toughed it out and returned to play as game. soon as possible. There are grounds In minor hockey circles, however, to suspect that, during this period, increased awareness of the dangers of concussions were under-reported. concussion is having an effect. Rules In recent years, however, medical against violent hits are being tightened. science has taught us a lot about Some leagues are not allowing body concussions. We now know that there checking until players are at least 13 is really no such thing as a minor years of age. concussion. We know that immediate As awareness of the dangers of brain proper diagnosis is difficult but critical. concussions continues to grow, pressure We know that there is no treatment for will likely increase on the NHL to find a a concussion other than rest. We know way to reduce the risk to players. What that the brain is extremely vulnerable that way will be remains a subject for to severe injury if players return to debate.

To Consider Like any professional sport, the NHL is a business. Bearing in mind that, like any business, the NHL is out to make money, what arguments or methods might be used to convince the team owners to improve player safety in its approach to concussions?

CBC News in Review • April 2011 • Page 29 HOCKEY AND THE CONCUSSION DEBATE Video Review

Further Research Before Viewing Find out more about In a small group, preferably with one hockey player in the group, discuss the the NHL’s position on following questions and make notes based on your discussion. concussions by visiting 1. Have you or has anyone you know ever suffered a concussion? If so, how the league’s Web site did the injury occur? at www.nhl.com.

Further Research Visit the Web site of Hockey to 2. How was the diagnosis of concussion made? review their position on checking in hockey and concussion at www.hockeycanada. ca. 3. What were the consequences of the injury? How did the injury affect daily life, sports play, school, etc.

Viewing Questions Respond to the following questions in the spaces provided. 1. Briefly describe the root cause of concussions.

2. How effective are helmets in preventing concussions?

3. How are concussions diagnosed? Are there special tests to assist in diagnosis?

4. Michael Serapio reports that experts say there are two reasons why more isn’t being done to prevent concussions in hockey. What are these reasons?

5. According to the NHL, how many concussions occur annually in the league’s games?

CBC News in Review • April 2011 • Page 30 6. Earlier studies indicated that concussions occurred in about six per cent of junior games. What did Dr. Paul Echlin’s new study indicate was the real percentage?

7. Describe the treatment Brad Madigan is undergoing for his series of concussions.

8. A number of the people interviewed in the video blame a variety of individuals for the tendency to downplay the seriousness of concussions. Whom do they blame?

9. What support has Echlin received for his study’s results from Hockey Canada?

Post-viewing Discussion In your small group, makes notes on the following questions. You will use these notes for a class discussion, or a discussion with another group. 1. How do you respond to the argument that the “physicality” of hockey makes concussions almost a byproduct of the game? What would you list as the fundamental aspects of hockey?

2. When it comes to ensuring that a young hockey player’s possible concussion is correctly assessed and diagnosed, who bears the ultimate responsibility? The player? The coach? The trainer? The parent? Someone else?

3. What is the responsibility of the league to its players when it comes to concussions? Is there a difference in responsibility between professional and amateur leagues?

CBC News in Review • April 2011 • Page 31 HOCKEY AND THE CONCUSSION DEBATE Why the Uproar?

Did you know . . . Focus for Reading Women are much As you read this article, make notes to summarize: more prone to • Why concussions in hockey are in the news concussions than men. • What incidents, reports, and individuals have been responsible for making hockey concussions newsworthy • How the NHL and other hockey leagues have responded to the dangers of concussion Hockey is very much a physical game. • After a severe hit, athletes are often As in any contact sport, player injury allowed to resume play without a is always a possibility. Concussions, in proper assessment for concussion. particular, have always been a threat to players. Why have they recently become Harder Hits, More Concussions? a major subject of debate? Hockey observers note that the game has changed. Players are bigger, heavier, Increased Awareness of and faster than in the past. Thanks to Consequences modern equipment, they are also better The simple truth is that, until recently, armoured. not all that much was known about how Basic rules have also changed. and why concussions occur or their Following the 2004-2005 player lockout, often ongoing, life-long effects. Some of new rules came into effect to increase the the things recent research has taught us speed of the game. With that increase in include the following: speed came an increase in player contact; • Concussions are far more serious hits are now up about 50 per cent over than simply “having one’s bell rung.” the pre-lockout period. Many players Doctors now insist that there is no such believe that this has made the game far thing as a “minor” concussion, and that more dangerous for the players and that the term “mild traumatic brain injury,” some way has to be found to slow the or MTBI, should no longer be used game down. when referring to concussions. • Once a player has suffered a Evidence from the Pee Wee concussion, he or she is four times Leagues more likely to suffer a second one. How and why concussions happen is • There is no treatment for a concussion the subject of a recent (2010) study that other than rest. examined concussions in 11- and 12- • Untreated and/or multiple concussions year-old hockey players in the Alberta can lead to permanent brain damage, and Quebec hockey leagues. Alberta and ultimately to a permanent condition allows body checking; Quebec does not. called chronic post-concussive The results: Out of 1 000 athletes in encephalopathy. each province, there were 73 concussions in Alberta in 2007-2008, but only 20 • In hockey, as in many other sports, in Quebec. “The researchers found the number of concussions is under- that Alberta players in the study were reported. This seems to be true at all three times more likely to suffer either levels.

CBC News in Review • April 2011 • Page 32 a concussion, a severe concussion or a The Incidents severe injury that resulted in more than • A deliberate head hit to Mikael Tam a week away from the rink” (The Globe of the by Patrice and Mail, June 9, 2010). Cormier of the Rouyn-Noranda Studies have also shown that Huskies on January 17, 2010. Cormier young players know very little about left the bench, skated directly at Tam concussions. They do not realize that and hit him with an elbow to the jaw. they can suffer one without being Footage of Tam lying on the ice in knocked unconscious. In one study, half convulsions was replayed over and the players questioned couldn’t identify over on the news and on the Internet. any of the symptoms associated with • ’s brutal blindside head hit concussions. to Marc Savard of the But the research in youth league play, in a game against Pittsburgh. Savard combined with educational outreach, has lost consciousness and was taken to made many more parents, coaches, and hospital. Cooke was not penalized; the fans aware of the dangers of concussions. hit was considered legal. As Dr. Charles Tator, the founder of • In the 2011 New Year’s Day Winter ThinkFirst Canada—a brain and spinal Classic, Dave Steckel, then of the cord injury prevention foundation—has , drove his said: “Most people are now aware of shoulder into the chin of Pittsburgh what a concussion is. It’s really quite Penguins superstar Sidney Crosby. amazing, the turnaround I have seen in Crosby shook off the hit and returned the past 12 months that parents, referees, to play. A few days later he was driven coaches, and trainers are more aware head first into the boards by Victor of concussions. The majority of people Hedman of the . now actually know what a concussion is, Crosby subsequently began to whereas before very few really labelled experience symptoms associated with concussion correctly. You know, they concussion and is generally believed by were using terms like “having your bell doctors to have suffered a concussion rung” ( Star, February 8, 2011). as a result of the first—Steckel—hit. So, it appears that more people No was awarded to Steckel; are aware of the consequences of Hedman received a minor boarding concussions. But the question remains: penalty. why is there currently such uproar in the media about hockey and concussions? • On March 8, 2011, Max Pacioretty of the Canadiens was ridden Raising the Profile into the boards by Zdeno Chara of The new attention is the result of a series the Boston Bruins, his head driven of particularly vicious hits during the into a metal post holding up the 2009-2010 and 2010-2011 NHL seasons. glass. Pacioretty was hospitalized And one of these hits caused a severe with a broken vertebra and a serious concussion in hockey’s highest profile concussion. Chara received a five- player. Four incidents seem to have minute major penalty and a game resonated most with fans and sports misconduct. commentators. Each incident focused public attention on the consequences of The Aftermath severe hits in hockey. • Mikael Tam recovered from his concussion and was back on the ice

CBC News in Review • April 2011 • Page 33 by the end of the season. He continues 48—calling for an automatic review by to play in the Quebec Major Junior the league of any hit to the head from Hockey League (QMJHL) and hopes behind or from the blindside. The review to someday play for the NHL or in a includes the possibility of fines and European league. Patrice Cormier— suspensions even if a penalty was not who had just returned to the Quebec called during the game. league after serving as of But the current season has Canada’s silver-medal-winning junior demonstrated that concussions remain world team—received the toughest a problem, and Crosby’s injury—more sentence ever handed out by the than any other—has aroused public QMJHL. He was suspended for 20 interest and sharpened the debate. games and for the . He now On February 24, 2011, Roy plays for the . MacGregor wrote in The Globe and • Marc Savard returned to hockey in time Mail: “The hit on the Pittsburgh for the 2010 playoffs. Unfortunately, he Penguins star—the player, as well, suffered another concussion on January who scored the that gave 22, 2011, when he was hit by Matt Canada the gold medal at the Hunwick of the . Winter Games—has had a most profound The hit did not target his head, but his effect on the heated debate concerning concussion symptoms did return. As a hits to the head at the NHL level as well result, he will be out for the remainder as hits that are occurring in minor-league of the 2010-2011 season. hockey. It has captured the attention of a lot of people who weren’t paying • Sidney Crosby was having a dream attention to this .” season until the hit on January 1 that Eric Lindros, for years one of the left him with a concussion. He was game’s top players, suffered a series of leading the NHL in points, having up to eight concussions before finally scored 32 goals and 66 points in 41 retiring in 2007. Lindros believes that games. Crosby resumed skating with some of the better players become the Penguins on March 30, 2011, but targets: “What happens is you get tagged expects it will be some time yet before as being concussion prone, and there’s he is able to play. a huge decline in the respect you get • Max Pacioretty was released from because of it. It’s people trying to make hospital two days after the hit. It is their name, you know? It’s little things unclear when he will be able to return that occur after the play, like when it to hockey. Chara did not receive a switches out of the corner and the play suspension from the NHL. Quebec goes up the ice and you’re spinning prosecutors have asked the Montreal around heading back up to back check police to see if evidence exists to lay and—bam! You know . . . where they criminal charges against Chara. kind of catch you” (The Globe and Mail, January 21, 2011). The NHL Responds Under considerable pressure because What Next? of hits like the ones against Tam and Will the NHL change its rule to eliminate Savard, in March 2010 NHL general all head shots? It seems unlikely at managers recommended changes to present. The result of the most recent rules dealing with punishing hits to the spate of concussions, including Crosby’s, head. The result was a new rule—Rule has been a new concussion protocol. It

CBC News in Review • April 2011 • Page 34 demands that any player suspected of despite recent surveys that show that suffering a concussion be subjected to two-thirds of believe the NHL a 15-minute physical examination by is not doing enough to curb violence a doctor (rather than a once-over by (aol.sportingnews.com/nhl/story/2011- a trainer). Many of the NHL general 03-19/head-hits-violence-anger-fans- managers have already objected to this survey-shows). directive. But some general managers, like And always present is the fear that Darcy Regier of Buffalo, remain new contact rules will somehow affect convinced that not enough is being the nature of hockey—making it less done to prevent concussions. They will physical—and as a result, turn off a large continue to pressure league officials to portion of the fans. This fear is present explore ways to reduce concussions.

For Discussion Consider the following statement by Roy MacGregor (The Globe and Mail, January 21, 2011): “Most lesser leagues and minor hockey have taken steps to cut down on head shots, several organizations banning them outright, but everyone in the game is acutely aware that youngsters take their lead from their NHL heroes and will attempt to copy whatever they see on television.”

1. Is the perceived imitation of NHL players by younger athletes a valid argument for changing NHL rules dealing with player contact? Why or why not?

2. Do you think there is any truth to the argument that cracking down on illegal hits that often result in concussions will slow down the game? Explain.

CBC News in Review • April 2011 • Page 35 HOCKEY AND THE CONCUSSION DEBATE Reaction

In determining one’s own position on an NHL vice-president (The Globe and issue, it’s always helpful to hear what Mail, June 19, 2010) the experts have to say. As you read the following quotations, note at the end of After 33 players missed games in 2010- the quote whether you agree or disagree 2011 because of concussions: “We had with the assessment of the situation a candid discussion with how the rule expressed in each comment. After is working, and I think people in the you’ve completed this exercise, meet in room [at the NHL Board of Governors groups of three or four to compare your meeting] were comfortable it’s working responses with those of your classmates. the way intended. It will continue to evolve, it’s a work in progress, but Views from Owners and people were comfortable we’re on the Managers right track.” — Gary Bettman, NHL The NHL is under considerable pressure commissioner (Toronto Star, December to go beyond their ban on blindside 15, 2010) hits and to make all head hits subject to penalty. Owners and league officials “The question is to what extent can we have responded in various ways. manage it? By this I mean where are most of these hits happening? Where on “We, as a league, must do a better job the ice? Is it close to the boards? Is it a of protecting the integrity of the game result of charging? Is it a result of the and the safety of our players. We must [back-of-the-net] trapezoid, meaning that make it clear that those kinds of actions the goalies don’t come out to play pucks will not be tolerated and will be met anymore? Is it a result of having taken with meaningful disciplinary action. If the centre line out?” — Darcy Regier, the events relating to Friday night [a general manager of the particularly violent game that included (The Globe and Mail, March 19, 2011) a blindside hit to a Pittsburgh player followed by a fight] reflect the state of “The players are so smart, that every the league, I need to rethink whether time we establish a rule they figure out I want to be a part of it.” — Mario a way around it. We need to protect Lemieux, owner of the Pittsburgh vulnerable players but there’s a fine line. Penguins (The Globe and Mail, February In hits from behind, players started to 14, 2011) turn their backs to protect the puck and draw a penalty. But they put themselves “We’ve made improvements to the in danger.” — Jim Rutherford, general game. Everybody agrees that the game manager of the (The is faster, the skill level gets shown on Globe and Mail, March 8, 2010) a nightly basis, we’re very happy with it. But the game evolves and one of the “Every time a guy gets hit now you’re things that’s evolved is our collisions holding your breath. It’s affecting our have gotten more intense. So you make sport. It’s paralyzing.” — Dave King, little adjustments and tweaks to keep assistant coach of the Phoenix Coyotes the players safe.” — Brendan Shanahan, (The Globe and Mail, January 19, 2011)

CBC News in Review • April 2011 • Page 36 Views from Sports Columnists A Sponsor’s View As one might expect, the columnists Finally, some people believe the only (and at least one former player, now a real way to guarantee a change in the politician) have had plenty to say on the culture of professional hockey is to issue. threaten the owners’ pocketbooks. The following is a letter to the NHL from “If any hit to the head resulted in Denis Vandal, Air Canada director of a major, a game misconduct and a marketing and communications. suspension, there wouldn’t be any “We are contacting you today to voice debate, would there? You get caught our concern over last night’s incident knocking an opponent in the melon, involving Max Pacioretty and Zdeno it’s your fault. Sort of the antithesis of Chara at the Bell Centre in Montreal. the ‘keep your head up’ mentality. But This is following several other incidents the only one that will truly work.” — involving career-threatening and life- Damien Cox, sports columnist (Toronto endangering head shots in the NHL Star, January 11, 2011) recently. “. . . While we support countless “The only fair and safe answer to ‘intent’ sports, arts, and community events, we is to move beyond it to ‘result’—and are having difficulty rationalizing our for hockey to stop bickering about sponsorship of hockey unless the NHL how something happened and turn its takes responsibility to protect both the attention, instead, to what happened players and the integrity of the game. and how that might be prevented from From a corporate social responsibility happening again.” — Roy MacGregor, standpoint, it is becoming increasingly columnist (The Globe and Mail, March difficult to associate our brand with 12, 2011) sports events which could lead to serious and irresponsible accidents; action must “Max Pacioretty was only the latest; be taken by the NHL before we are he will not be the last. Arguments and encountered with a fatality. explanations don’t matter any more. The “Unless the NHL takes immediate NHL has to risk the big steps that are action with serious suspensions to the needed: If some of them prove wrong, players in question to curtail these life- they’ll still be far less wrong than what threatening injuries, Air Canada will we have now. It is time to stop being withdraw its sponsorship of hockey” stupid.” — Ken Dryden, MP and former (www.theglobeandmail.com/report-on- hockey goalie (The Globe and Mail, business/see-air--letter-to-the- March 12, 2011) nhl/article1937106/).

Follow-up 1. A recent Angus Reid public opinion poll of more than 1 000 Canadians indicated that three-quarters of them felt that violence in professional hockey needs to be reduced. Do you feel this is a fair description of how most Canadians feel about the game?

2. What does a hard but safe player check look like? What constitutes an unsafe check? Are all unsafe checks ones that are also illegal?

3. Is Air Canada’s threat to pull its financial support of the NHL likely to have much effect in changing the rules and/or culture of the game?

CBC News in Review • April 2011 • Page 37 HOCKEY AND THE CONCUSSION DEBATE Concussions: A Primer

As you read the section, make a list in your notebook of the main points Definition covered under each heading. Concussion is defined as a traumatic injury A doctor’s examination usually begins to tissues of the body Causes as a result of a violent A concession can be the result of a with questions to determine the patient’s blow, shaking, or direct blow to the head, but this is not level of consciousness and ability spinning. The term a requirement. A concussion may also to concentrate and remember basic is most commonly occur when another part of the body information. He or she will review with applied to such is suddenly hit hard and the brain is the patient any or all of the symptoms in injuries when they shaken and knocked against the skull. the above list. happen to the human A physical examination will brain. In this section A concussion may also be the result of we will use the word an impact that causes the brain to twist. concentrate on the nervous system, concussion to mean a During that action some brain nerve checking things like balance, co- brain concussion. fibres may even be sheared. ordination, and reflexes. If the possibility Most concussions happen in collisions, of serious brain damage is suspected, a Further Research when a person collides with another brain scan will likely be required. Learn more about person or object, with one or both head injuries at the moving at high speed. Treatment TeensHealth Web The only real treatment for concussion site, a U.S. children’s Signs and Symptoms is physical and mental rest. It is health network, at absolutely critical that the patient not http://kidshealth.org/ It is extremely important to know teen/safety/first_aid/ that an individual does not have to fully resume normal activities until the concussions.html. lose consciousness to have suffered a symptoms have completely disappeared. concussion. In fact, most people who In fact, guidelines from the American Academy of Neurology recommend Further Research are concussed do not pass out. But loss To learn more about of consciousness can be an indicator, that any athlete whose symptoms do not concussions and and anyone so affected should seek clear within 15 minutes (or who loses other brain injuries immediate medical attention. consciousness for even a brief moment) visit the ThinkFirst Signs and symptoms of concussion be kept from competition for a minimum Web site at www. include nausea, vomiting, dizziness, of one week after his or her symptoms thinkfirst.ca/programs/ confusion, fatigue, headache, and are completely gone. Meanwhile, the concussionqanda.aspx. inappropriate behaviour. Symptoms resting patient may have to forgo even and their severity vary from individual everyday activities—things as simple as to individual. Some symptoms may watching television. appear immediately, while others may Finally, anyone who has suffered a show up at a later date. Sydney Crosby, concussion should be aware that research for example, did not begin to notice shows that he or she is now permanently symptoms from his concussion until five at increased risk of another concussion; days after it occurred. up to four times the risk of the average person. Every concussion also increases Diagnosis the risk of permanent brain damage, In most cases of concussion there is no including serious conditions that reduce detectable physical evidence—bruising cognitive function and mimic conditions or bleeding in the brain—to indicate that like Alzheimer’s disease. damage has occurred.

CBC News in Review • April 2011 • Page 38 HOCKEY AND THE CONCUSSION DEBATE Activity: Cleaning Up Hockey

How would you reduce the number and severity of concussions in hockey? Is there a need for minor or major changes to the rules under which hockey is played? Can this be done without sacrificing what Canadians see as the necessary physicality of the game?

Many Canadians believe so. They point to the excitement and physicality of Olympic hockey, which manages quite well without the violence so common to the NHL. They point out how thrilling women’s hockey is when it is played with the skill of the athletes on the Canadian and U.S. national teams. And they also point out that young people begin playing hockey as a non-contact sport; that Quebec allows no contact before a player turns 14; and that non-contact leagues are growing in popularity in many parts of Canada.

In groups of four, develop a plan to make hockey safer while still retaining its appeal. Construct your plan as a series of recommendations.

Completed plans will be presented to the entire class. Be prepared to present the reasoning behind each of your recommendations.

To help you get started, you might like to take a look at an article by Globe and Mail columnist John Allemang, available online at www.theglobeandmail. com/sports/hockey/a-10-step-hockey-reformation-as-imagined-by-john-allemang/ article1939534/.

Notes:

CBC News in Review • April 2011 • Page 39