October 20, 2010

By Harry Thompson
USA Hockey Magazine

If an ounce of prevention is worth a pound of cure, the hockey world is hoping that a few days spent discussing the causes and effects of concussions will go a long way toward making a safer and better game.

The issue of concussions in sports has taken center stage in recent months, particularly in the professional leagues such as the NHL and NFL, where hits to the head are happening at an alarming rate. The end results are million-dollar athletes sidelined with head trauma. But the problem is just as likely to be found at the youth level, and in all sports, as youth athletes of all ages are also dealing with the effects of a concussion.

To address these issues, Dr. Michael Stuart, USA Hockey’s chief medical officer, teamed up with his colleague at the Mayo Clinic, Dr. Aynsley Smith, to create the first summit dealing specifically with concussions in ice hockey.

The two-day summit brought together experts from both the medical and hockey communities to address the reasons for the rise in the number of reported concussions and ultimately to create an action plan to help stem the rising time of concussions at all levels of the game, from youth hockey to the professional ranks.

For Stuart, who has served as the team physician for numerous U.S. National Teams, including the silver-medal winning 2010 U.S. Olympic Team, the summit is part of an on-going effort to get a handle on an issue that affects youth hockey programs around the country.

“This summit is unique in that we brought together a very diverse group of people who have a passion for the game of hockey but probably as important a passion for safety,” Stuart said.

“We hope at the very end that we not only had open debate and discussion and shared information but we’re actually going to have a prioritized action item plan to make hockey safer.”

The summit was divided into nine segments in which some of the leading experts in the field of concussions spoke on various topics, including a science of brain trauma, the role that equipment plays in reducing the risk of concussions, evaluating concussed athletes and the importance of following strict return-to-play guidelines.

“When in doubt, sit them out,” was the unanimous battle cry from all the speakers, including Dr. Mark Lovell, who has spent 25 years working with concussed athletes in Pittsburgh.

“A player who suffers a concussion and returns to action puts himself at a greater risk of suffering greater injury if they suffer a second concussion,” Lovell said.

The issue of how equipment can play a role in restricting concussions featured a panel of equipment company representatives, including Cascade, Bauer and Easton, who said that the continued improvement of helmets is a team effort involving a number of different parties involved in the game, including the medical community.

“What we’re trying to do here at the summit is address every piece of the puzzle, and that goes for education, rule changes and enforcement of existing rules, equipment and rink modifications, behavioral modifications, diagnosis and evaluation and management of concussions,” Stuart said.

“All of these pieces of the puzzle are important and if we don’t address each and every one of those I think we’re missing a great opportunity.”

To capitalize on this opportunity, the summit ended with a series of breakout sessions in which an action plan was created to address the issue of reducing the risk of concussions in hockey at all levels of the game.

“Now that the summit is over, the real work begins,” Stuart said. “We need to take this message to all the groups within hockey because each of us is a stakeholder in the safety of our game.”

Among the highlights of the summit:

Robert Cantu, an expert in the field of brain trauma at Boston University – “I am happy to say that we will never return to the day when a child is knocked out of a game and is brought back in and is cheered for his toughness.”

Paul Comper, who has studied concussions at the NHL level by watching thousands of video clips over the past five seasons – “Shoulder hits to the head cause 60 percent of all reported concussions in the NHL.”

Dr. Richard Greenwell, a leading concussion researcher at the Massachusetts Institute of Technology – “It is estimated that while the number of concussions have risen in recent years, 50 percent of concussions still go unreported.”

Kevin Guskiewicz, a professor at the University of North Carolina who studies concussions in sports, particularly football – “We found that 50 percent of high school football players don’t report concussions because they don’t think the injury was that serious, they don’t want to be removed from the game and they don’t want to let their team or coach down.”

Rob LaPrade, a physician at The Steadman Clinic in Vail, Colo. – “The physical exam is a lot harder because no two kids are the same and there is a lot of pressure from parents and coaches to get kids back into action.”

Jim Johnson, a 14-year NHL veteran who suffered from post-concussion syndrome – “I remember coaching a Bantam team in Arizona and having a parent accuse me of wrecking his son’s hockey career because I was going to sit him out because he had symptoms of concussions.”

Mark Lovell, founding director of the University of Pittsburgh Medical Center Sports Medicine Concussion Program – “Athletes often deny symptoms so you can’t believe them because they will say whatever they think you want to hear to get back on the ice.”

William Montelpare, founder of the Play It Cool sportsmanship program in Canada – “Concussions in hockey are the elephant in the room, so it’s great that the hockey world has come together to address this important topic.”

Kerry Fraser, former NHL referee – “Success or failure in reducing hits to the head relies on the enforcement of the rules at the ice level, and that responsibility falls on the officials. But, if you don’t educate the officials and let them know what you want, the program will fail, just like the obstruction policy. Instruction has to be firm, it has to be clear and it has to be concise.”

Pat Bishop, professor emeritus of Kinesiology at the University of Waterloo – “Is there anyone in this room who could not demand in a loud and clear voice an immediate and total ban on head checking.”