Concussions and Hockey - What Can Be Done?This past Super Bowl weekend, I wrote about some interesting connections between neuroscience and football, including a variety of statistics and opinions about brain injuries and football. Now that football season is over, I’ve noticed an increasing number of headlines about brain injuries in hockey players. Recent research in Canadian Medical Association Journal (CMAJ) found that while the concussion rate among National Hockey League (NHL) players has leveled out in terms of total number of concussions, the number of days lost per concussion is increasing. Players lost play time for symptoms like headaches, fatigue, and memory loss. First-time concussions took, on average, 6 days to recover before returning to the ice, while each subsequent concussion added about one extra day to the recovery period.

Why is the time loss increasing while the rate stays the same? There are two theories: one is that sideline coaches and medical professionals have become more cautious about post-concussive play. The other is that concussions have become more severe or that players are experiencing a cumulative effect of multiple concussions.

In Canada, over 500,000 youth play hockey, and currently suffer a 25% concussion rate. Due to the preponderance of severe and debilitating brain injuries on the ice, hockey’s popularity among Canadian youth, and a noticeable rise in brain injuries of junior hockey players, CMAJ has recommended that body checking be banned from youth hockey to reduce the risk of concussions. Researchers note that the majority of injuries in youth leagues are caused by legal body checking (defined as using the body to knock an opponent against the boards or to the ice.) In Ontario, youth leagues also have a new, high-tech tool to help properly gauge hockey-related brain injuries–a computerized neurocognitive test that will be given to each player before the season to establish a baseline, and again post-injury to judge severity.

The NHL has a somewhat confusing stance on body checking and head shots (purposely hitting an opponent in the head with body or equipment.) In 2010, after a spate of high-profile brain injuries occurred, they banned “blindside” head shots. Last month, despite deepening external pressures, they decided against a ban on all head shots, keeping just the blindside ban in place.

Adding to the confusion is the fact that many feel that the NHL is spotty in enforcement of head shots and body checks–while others posit that there is a blatant double-standard for regular and post-season play, noting that the NHL seems to excuse and encourage injurious plays in the post-season. There is a rule on the books which says players will be punished if they “deliberately attempt to injure or deliberately injure another player in any manner,” but just a few days ago they failed to apply this rule against Raffi Torres, who delivered two brutal, purposeful blows against Brent Seabrook in one game. Torres received no penalty for these hits, with the NHL citing an obscure exception which hasn’t yet been found in the NHL rule book.

What’s worse, on-site doctors and coaches cleared Seabrook to continue on the ice within moments of being injured, even though it’s well known that concussion symptoms may not immediately appear. Indeed, after suffering up to three likely concussions in the span of one game, the next day Seabrook presented with signs of serious concussion. Seabrook was out the following two games, but will play again tonight.  It remains to be seen how that decision will affect Seabrook’s recovery and cognition in the long term.

Leading medical professionals support an all-out ban on shots to the head and more stringent enforcement by the NHL. To this casual observer, it definitely seems like NHL players, coaches, and officials have a cavalier attitude about the serious long-term consequences of repeated severe brain injuries.