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NHL taking proactive approach to concussions
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Penguins captain Sidney Crosby has not played since Jan. 5 due to a concussion.
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RALEIGH, N.C. -- Last month, before Penguins center Sidney Crosby sustained the concussion that forced him out of the All-Star Game festivities this weekend, the NHL's leading medical expert on that type of brain injury wondered if the league is doing enough.
That is not to say that neuropsychologist Ruben Echemendia faults the NHL for its work in preventing and treating concussions.
"I think that the NHL is doing more than anyone else at the professional level in this area," said Echemendia, a former director of the psychological clinic at Penn State and current chairman of the NHL and NHL Players Association concussion working group. He was a founding co-director of the league's neuropsychological testing program in 1997.
"Whether we're doing enough, that remains to be seen," he said. "I think that we can always do more. I think that we can always do better, and that is part of what our group aims to do.
"We're carefully evaluating where we are at any given point and changing as we go along."
Concussions, which are a form of brain injury, have been a point of concern in several sports, and talk about rules and treatment has heated up since Crosby, considered the world's finest player and the face of the NHL, got hurt by some combination of hits from Washington's David Steckel Jan. 1 and Tampa Bay's Victor Hedman Jan. 5.
The topic surely will be broached today at an NHL Board of Governors meeting in conjunction with the All-Star weekend.
Within the past year, the NHL enacted Rule 48, which cracks down on lateral and blindside hits to the head. The rule evolved, in part, because of a hit by Penguins winger Matt Cooke that, while legal at the time, left Boston's Marc Savard with a concussion severe enough to keep him out for months, and, in part, because studies show those hits are the most likely to cause concussions and leave the injured athletes with more severe symptoms.
A next step might be to ban all hits to the head, regardless of intent, angle or circumstance.
Even that likely wouldn't prevent all concussions in NHL games -- there were 33 in the regular season as of Dec. 1, the same count from the same date a year earlier -- but it might reduce the number.
Just as important is how a player with a concussion is treated. The best option is with kid gloves.
"We're sorry that concussions are continuing to occur, but we think there are things that can help," said Julian Bailes, chairman of the neurosurgery department at West Virginia University, consultant with the NCAA and medical director for Pop Warner football.
"There is no concussion pill," Bailes said. "You treat the symptoms -- insomnia, headaches, poor energy levels -- and use a conservative approach to removing them from play and using a very graded response-and-return-to-play approach."
That is exactly what the NHL prescribes and what the Penguins have done with Crosby, who was barred from any physical activity as long as he was experiencing symptoms. Before he can play, he will have to pass what Echemendia called a "fairly extensive neurological test battery" that will be compared with Crosby's most recent baseline test.
Players with concussions can be out a matter of days, weeks or months.
Bailes said it is possible Crosby's situation was exacerbated by Hedman's hit if Steckel's earlier hit caused an undetected concussion. Crosby, however, has said he had nothing more than a sore neck after the Steckel hit and that he doesn't know exactly when he got his concussion.
Echemendia said awareness of the serious nature of concussions -- and the knowledge that sustaining a second concussion before the first has healed can compound the problem exponentially -- has led to a better culture of understanding. As a result, NHL players are more honest about their symptoms and team management is more tolerant of the time those players need to recover.
Crosby has kept in constant communication with the Penguins' medical staff about how he feels.
"I think that where we are now relative to where we were 10 years ago is night and day," Echemendia said. "I think there's always that tension of having a healthy player and wanting to promote healthy play, while, at the same time, needing to have players on the ice. And one of the things that we're finding in our work is that, if we identify these injuries early and we manage them early and appropriately, there's going to be less time-loss over time.
"So, it's the understanding of that risk-benefit tradeoff."
In the general public, Bailes said, concussions generally are an injury that is treated and, for the most part, forgotten.
"I think it's important to note that, in most cases, concussions will heal," he said. "If a concussion heals, especially if there's been considerable time, I think you're recovered.
"But the contact-sport athlete is coming back and saying, 'I've had a concussion. Is it OK to go back and hit my head some more?' "
Athletes who have had previous concussions might be more susceptible to more concussions or might have more severe symptoms with subsequent ones.
"It can begin to snowball on you," Bailes said.
Making sure an initial concussion is healed might reduce those risks. Research is still being done in that area.
Reducing the number and severity of hits to the head through rules changes, penalties, fines and suspensions might also help.
"We need to very carefully follow the concussions this year and next year and see to what extent the rule changes have or have not had [on] a change in behavior," Echemendia said.
First Published January 29, 2011 12:00 am
