The underlying issues of concussions in hockey
Concussions are widely regarded as one of the most dangerous injuries in sports. Football is usually the sport openly criticized when talking about concussions, but concussions in hockey are not to be disregarded. The NHL has recently come under fire being accused of not informing its players of the dangers surrounding concussions, as well as Chronic Traumatic Encephalopathy.
According to the Centers for Disease Control and Prevention, a concussion is “a type of traumatic brain injury (TBI) caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”
You can see how easy a concussion could be had in any contact sport, let alone a fast-paced, hard-hitting sport like hockey.
Dr. John Dewitt is a former football player who has played in college, the NFL, AFL, CFL, and XFL. After retiring from football, Dr. DeWitt earned his Doctor of Chiropractic degree from Los Angeles Chiropractic College. He is practicing in Orange County, at Bergman Family Chiropractic, specializing in concussion assessment. He is also an author of a book on Concussions and CTE.
“You can't look at somebody and tell they have a concussion, because to the naked eye they will look fine. The injury is internal, but there are ways you can tell if someone is concussed by the symptoms they display. Sometimes people can’t even tell when they are concussed,” Dr. DeWitt said.
Concussion symptoms that can be noticed right away include: headache or a feeling of pressure in the head, temporary loss of consciousness, confusion or feeling as if in a fog, amnesia surrounding the traumatic event, dizziness or “seeing stars”, ringing in the ears, nausea, vomiting, slurred speech, delayed response to questions, appearing dazed, and fatigue.
But other symptoms can arise hours or even days after the injury. These symptoms include: concentration and memory complaints, irritability and other personality changes, sensitivity to light and noise, sleep disturbances, psychological adjustment problems and depression, and disorders of taste and smell.
“When you hit helmet to helmet Newton’s third law of motion takes effect. So when you stop abruptly your brain keeps going and bounces off of your skull in different directions. When you have the collision you can build anywhere from 30 to 130 G’s of force. That’s like a car accident every time you hit head to head,”Dr. DeWitt said.
“If you’ve had three or more concussions you’re three to six times more likely to have another,” said Dr. DeWitt.
At the beginning of the 2010–2011 season the NHL introduced Rule 48, designed to eliminate checks to the head. Even so, the incidence rate of concussion steadily rose from 2009–2010 to 2011–2012. A 2011 study on the NHL found 559 physician-diagnosed concussions over a seven-season span from 1997–2004. That means on average there were about 80 concussions per season. Since the study the numbers have gone down, which happens when new rules, concussion protocol, suspensions, and fines are introduced to limit blows to the head.
The one issue that remains constant is the amount of time or lack of that players undergo while in protocol before being cleared to return to action. Off-ice officials will in some cases who deem a player required to undergo concussion protocol, but they will return in the same game. One reason that protocol is so inconsistent is that if a player chooses to risk their own safety they can find ways to evade the protocol and get back in the game.This isn’t entirely in the hands of the NHL; the players hold fault as well if they are evading protocol. That’s not to say these players should be able to evade the process in the first place, or not be as informed as well as they should be on the dangers of concussions by the NHL.
In 2014, James Wisniewski was a prime example of evading concussion protocol when he did so in a playoff game. Wisniewski told the Columbus Dispatch: “ I said my back hurt so I didn’t have to do the 20-minute protocol and go through that whole concussion process… A lot of guys were playing through things… That’s playoff hockey. It’s survival of the fittest.”
Some players will do whatever it takes to help their teams, but the NHL can try and put a stop to that with a stricter protocol.
In 2016 the NHL once again updated the protocol — in the middle of playoffs. With the change coming at the most important time of the year it showed the urgency the NHL felt they needed to bring to player safety. The league hired off-ice “spotters” for concussion-like symptoms. The spotters are a part of a team of Central League Spotters based out of New York who watch the games on T.V. When they see a player they believe to be exhibiting concussion-like symptoms they make a call to in-arena spotters and on-ice officials to tell them to send the player back for protocol.
This wasn’t the first major change to improve player safety in respect to concussions. Just three years prior, two rules were added in 2013. The first being that hybrid icing was introduced in 2013 to eliminate the race between two players for an iced puck that sometimes ended in a high-speed collision with the boards. The second being that a minor penalty would be assessed if a player took off his helmet voluntarily before a fight. (Which did not work as planned as some players just took their opponents helmets off for them before fighting.)
Two players, two different perspectives
The views on concussions from players can be polar opposites, as shown in this interview with former Florida Everblades teammates Mike Aviani and Chris Kushneriuk. Both of which have had concussions. Kushneriuk had at least 4 (diagnosed) concussions in his playing career. While Aviani has had two (diagnosed) concussions so far in his career. Kushneriuk, 31, retired in 2016 and is now the assistant coach of the Ottawa Junior Senators. Aviani, 25, plays in Europe with the Zagreb Medvescak of the Austria league.
I talked with two of them separately and asked them the same questions, but the answers were very different.
Before your concussion, were you aware of the symptoms?
Kushneriuk: No. My general knowledge about concussions and concussion symptoms was pretty accurate.
Aviani: I had never had a concussion until my second year pro. I mainly had headaches daily, I could not watch TV or play video games. I felt as if I was in a fog and had some trouble remembering things. I felt very tired and spent a lot of the day sleeping. All the stimulation would bring back headaches. It was a difficult time, just very boring and frustrating. Basically had to just rest to get back to full health with no exercise. You have to be careful coming back from an injury like that, or else you could set yourself back. It was a huge learning experience for me having never experienced that type of injury in all my years of playing hockey.
Have concussions ever made you consider stepping away from hockey?
Kushneriuk: Yes. I would say it factored in about 50/50 with my decision to stop playing. I was offered full-time employment in the field that I studied after my last season of playing. The fear of dealing with post-concussion syndrome, and with the increasing number of neurologists bringing attention to CTE in athletes that participate in contact sports, I felt the best decision for my long-term cognitive health was to take the job offer and avoid another headshot.
Aviani: Being as I have only had two in my career, the thought of stepping away from hockey has never crossed my mind. I’m 25 and I still feel like I have a long career ahead of me.
Have concussions taken away any of your love for the game of hockey?
Kushneriuk: Yes. It brought about an anxiety towards playing at a high level (in this case professionally) knowing that I was becoming more susceptible to this type of injury, with less impact.
Aviani: I still love the game just as much as when I started as a kid! That has not changed at all despite having had two concussions. I don’t think it will ever change for me personally.
Is there anything you think could be done to limit concussions? Whether it be a rule change, equipment improvement, or material the boards are made from?
Kushneriuk: The biggest thing I have noticed is that the standard for rink boards, and glass is not the same in every arena — especially in city rinks at the youth hockey level. The boards in newer facilities/NHL rinks have some ‘give’ — especially the glass. The glass in NHL rinks is made with a Plexiglass, and is designed to absorb impact with flexibility. City rinks are almost all built with steel reinforcement on the boards, and a heavier type of glass (designed to last literally forever) which doesn’t absorb the impact at all. It’s like getting hit into a solid brick wall. I have always been surprised that more awareness/conversation about making rink boards/glass safer at the youth hockey level hasn’t occurred.
Aviani: It’s hard to limit concussions because the game is so fast. The leagues today are trying their best to put in severe penalties and suspensions for headshots and elbowing. I think it’s helped somewhat over the past couple years to limit concussions. Then again the game is so fast and physical that it is hard to prevent these types of injuries from occurring altogether.
Do you believe there is a link between CTE and hockey?
Kushneriuk: I do believe there is a link between CTE and hockey. I think most of the research so far has followed football players. Hockey players may not be subject to the same volume and impact of direct headshots, but there is a lot of jolting of the head when your body gets hit, which happens many times a game.
Aviani: I’m unaware of what CTE is and how it relates to hockey.
Do you believe players are adequately informed about the dangers of concussions when they begin playing professionally, as well as when playing at a younger amateur level?
Kushneriuk: I believe that players are more informed now on the dangers of concussions, but this change has only occurred over the last few years. Prior to this, I always felt there was a stigma attached to concussions from ‘old school’ coaches that did not believe in them. They felt they were a coward’s way out of playing, or a way of collecting a free paycheck — which is flat out wrong. Now, teams are mandated to do baseline concussion testing even at youth levels, they have protocols that require the clearance by a neurologist before returning to play (they call it the return to play protocol), and athletic trainers that are better trained at pulling players out after they’ve taken a blow to the head or shown symptoms. Players now have a much better understanding of what a concussion is, the seriousness of it, and the potential long-term implications.
Aviani: I think that players are definitely being more informed in today’s game of the dangers of concussions. I was unsure of the dangers of concussions when I was growing up, but I have definitely learned a lot just from my experience because of the two concussions in my career. I do think it is a good thing to be made aware of growing up and to know the proper precautions to take when you first have a concussion. It’s good to see people are being much more careful after taking big hits and taking the issue of concussions in sports very seriously.
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It’s clear that Aviani, who is still playing, takes a very different stance on concussions from Kushneriuk, who is retired. Aviani’s comments indicate there isn’t much fear of concussions in today’s professional level of hockey. While Kushneriuk’s comments show almost the exact opposite.
Their differences would indicate that the not only should the NHL, and all other levels of hockey (professional or amateur), take a closer look at educating players about the dangers of concussions, but also come admit their prior and ongoing incompetence.
