Dr. Michael Stuart is concerned about concussions in all levels of hockey, and he is doing something about it.

While much has been discussed about the serious injuries in the NHL and what steps the league has taken to try to limit their occurrence, Dr. Stuart and the Mayo Clinic are trying to fix the problem way before players grow up to be pros.

Stuart, the vice chair of orthopedic surgery and the co-director of sports medicine centre departments at the Mayo Clinic, is spearheading a two-day summit on concussions beginning Tuesday.

Scientists, trainers, coaches, officials, and equipment manufacturers from the United States, Canada and Europe will gather at the clinic’s sports medicine centre for the “Ice Hockey Summit: Action on Concussion” conference.

Representatives from the NHL, USA Hockey, and youth leagues will be in attendance. The focus will be on the science of concussions, their impact on children, and how sports organizations react to the often devastating injuries. The conference will be about hockey, but the issues apply to all sports.

“We want to evaluate every possible avenue to try and reduce the risk and consequences of concussions, especially in youths and adolescents,” Stuart said in a phone interview with The Associated Press. “Tomorrow is going to be a very full day of looking at the up-to-date science on everything from what goes on in the brain to how they’re evaluated, to equipment issues, and behavioural modifications.”

The summit will begin Tuesday with six focus groups: one to look at databases, one to look at recognizing and diagnosing and caring for concussions, one to study player equipment, one on education, and one on rule changes and enforcement.

Each group leader will then present the findings and an action plan. The audience will then vote on the plans.

“When this is done, we’re not only going to have the most up-to-date information about concussions, but we’re also going to have an action plan which has been prioritized by leaders in the medical community as well as the sport of hockey,” Stuart said.

Stuart has more than just a casual interest in hockey concussions. Since 2001, he has served as USA Hockey’s chief medical officer, and he was also the doctor for the U.S. men’s Olympic team this year at the Vancouver Games.

And it doesn’t stop there.

Stuart is the father of Boston Bruins defenceman Mark Stuart and forward Colin Stuart, who is in the Buffalo Sabres’ organization.

Concussions in hockey are nothing new — they ended the Hall of Fame careers of players such as Pat LaFontaine and Scott Stevens — but the awareness is, as well as actions created to try to limit them. The NHL has introduced new rules, such as banning blindside hits to the head, that now can be penalized during games as well as with supplemental discipline.

Phoenix’s Shane Doan was given a three-game suspension on Monday for delivering an illegal hit to the head of Anaheim’s Dan Sexton. Doan is the third NHL player to be punished this season for such an action.

“I’m encouraged by some of the recent developments,” Stuart said. “I’m still concerned as a hockey doctor and as a hockey parent because there always is an element of risk. I think that the NHL has made some strides, and I know that they are committed.

“They do have a group of physicians and neuropsychologists who are looking into reducing the risk of concussions. They’ve been working on it for years. The most recent rule change is a step in the right direction.”

Much has to be done with youngsters from the time they first lace up their skates.

“The main thing is for youths and adolescents because that’s the largest group as far as numbers in the United States, Canada and even outside North America,” Stuart said. “We’re concerned about professional players, as well. We hope there will be spinoffs from this summit for pro hockey and other sports.”

Stuart is stressing that education be given to young players about respecting the boards around the rink, respecting their opponents, and learning the proper ways to give — and receive — contact before they are allowed to do it in a game.

More injuries occur in leagues that allow body checking, but Stuart believes it is because the players don’t know the proper techniques to do it. It is one thing to say a player must be at least a certain age before they can participate in a checking league, but Stuart feels that education and experience is every bit as necessary.

“When it’s allowed in games, players either don’t know how to do it correctly, they put themselves or their opponents at risk, and it tends to result in illegal activity,” he said. “Many of these injuries that occur from body checking, in my opinion, are actually boarding, high-sticking, elbowing, charging, checking from behind.

“So it’s really not the fault of a legal body check, but by allowing legal body checking in games it seems to foster illegal activities.”

Mayo clinic to take in-depth look at hockey concussions

A study recently published in the British Journal of Sports Medicine suggests that accidents are more commonly to blame for on-ice amateur-hockey injuries than bodychecking. The findings were based on a five-year study of 3,000 boys aged four to 18 in a youth hockey program in Burlington, Ontario. The study, conducted by researchers from the University of Buffalo, found that 66 per cent of overall injuries were the result of accidents that happen during a game, such as colliding with teammates, sliding into the boards or posts or getting hit with the puck. The remaining 34 per cent were attributed to players checking each other. The researchers only took into account injuries serious enough to cause players to be off the ice for at least 24 hours. This begs the question…how many of the injuries not taken into account may have been concussions and not diagnosed? For the record, the findings of this study conflict with those of another study mentioned below. Regardless of whether most injuries are intentional or not, the sad and harsh reality is that minor hockey is plagued with a serious injury factor and bodychecking is responsible for a disproportionately large number of those injuries, including concussions.

A landmark study released on June 8 revealed that 11- and 12- year old hockey players in leagues that allow bodychecking are 2.5 times more likely to get hurt and 3.5 times more likely to suffer a concussion. In Quebec, players do not bodycheck until bantam ages (ages 13 to 14), and even then it is only introduced at the elite levels of the game. Pee wee (ages 11 and 12) is when bodychecking begins in Alberta. The joint University of Calgary, McGill University, and the University of Laval study tracked 2,200 pee wee hockey players from both provinces for the entire 2007-2008 season to measure injury frequency. The findings of this study were published in a recent edition of the Journal of the American Medical Association.. This study suggests a case can be made for raising the bodychecking age and for limiting bodychecking leagues across the board. One of the researchers for this study, Dr.Carolyn Emery from the department of kinesiology at the University of Calgary has been quoted as saying: “Having a concussion increases your risk significantly of another concussion and some kids are dropping out of hockey because of concussions, fractures and other severe injuries.” Dr. Emery estimates that if bodychecking was not permitted in peewee hockey this would reduce the risk of injury by over 1,000 injuries and 400 concussions among the nearly 9,000 peewee level children playing hockey in Alberta

This study should serve as a wake-up call for those Canadians concerned with the health and safety of all players, especially minor leaguers, and the future of the game as we know it.

The consequences of traumatic hits to the head speak for themselves. Research done by Dr. Shree Bhalerao, director, medical psychiatry, St. Michael’s Hospital, Toronto and Deborah Pink, resident in psychiatry, University of Toronto reveals the following. Traumatic brain injuries, via hits to the head or bodies colliding against the boards or other bodies can cause: post-concussive symptoms, cognitive disorders, depression, personality changes, and substance abuse.

Indeed, an emotional debate has been raging for years about our national sport. Should body checking be allowed in minor hockey? According to the Canadian Institute for Health Information, 8,000 people were treated for hockey related injuries in Ontario hospital emergency rooms in the 2002-2003 seasons. Based on this rate, more than 25,000 people were injured across the country. In 93 cases of the 8,000, the casualty was admitted to hospital, 15 directly to critical care units.

Among young hockey players (18 and under) 62 percent of the injuries were a result of checking. Injuries caused by body checks were the most common in the 14 to 16 age group, after players have been exposed to body checking for several years.

The decision to allow body checking in minor hockey is unquestionably jeopardizing this wonderful sport and favourite pastime by turning it into our most dangerous game. It is easily argued this practice borders on child abuse. It certainly flies in the face of public health, safety, and injury prevention; it trumps medical science, commonsense, and civility.

Hockey is an inherently dangerous game. That said, when medical experts and safety advocates say evidenced-based research show injury-prevention and harm-reduction initiatives are good for the health and safety of the game and the players, everyone-hockey organizations, coaches, players, parents- should take note.

Emile Therien,
Public Health & Safety Advocate,
Past President, Canada Safety Council
Ottawa, Ontario
July 31, 2010.

By Susan Perry | Published Wed, Jun 9 2010 9:56 am MinnPost.com

Permitting body checking in youth hockey increases the risk of game-related injuries, including concussions, threefold, according to a Canadian study published today in the Journal of the American Medical Association (JAMA).

That finding will undoubtedly raise concern among the parents of the 35,000 or so Minnesota kids who play hockey. Here, as in most places in the U.S., body checking is permitted in youth hockey (played by boys and girls) — but not in girls’ hockey — starting at the Pee Wee level (ages 11 and 12).

For this new study, Pee Wee players — 2,154 in all — were followed for a single season (October 2007 to March 2008). Roughly half (1,108) played for a league in the Canadian province of Alberta, which permits body checking at that age level. The other half (1,046) played for a league in Quebec, whose Pee Wee players are not allowed to body check.

At the end of the season, there were 241 injuries (including 78 concussions) in the Alberta league versus 91 injuries (23 concussions) in the Quebec league. Injuries were defined as those “requiring medical attention, resulting in the inability to complete a session, and/or time loss from hockey.”

Body checking represents a “significant” public health concern, the study’s authors concluded.

Gathering injury data in Minnesota
Of course, many parents and other adults involved in Minnesota’s youth hockey programs are already aware of the sport’s physical risks, particularly when body checking is allowed. Up to 86 percent of youth ice hockey injuries that occur during games have been linked to body checking. The most common injury: concussion.

“We’re very concerned about the risk of traumatic brain injuries or concussions,” Dr. Michael Stuart, co-director of the Mayo Clinic’s Sports Medicine Center in Rochester and chief medical officer for U.S.A. Hockey, the nation’s governing body for all amateur hockey, told me in a phone interview earlier this week.

But, he added, no one really knows right now how many of Minnesota’s youth are getting injured playing hockey, or under what circumstances, or even if the incidence of injury is going up or down. There is no official registry for such data.

“We think it’s probably increasing, but if somebody tells you that, they’re only speculating,” Stuart said.

Minnesota Hockey, a U.S.A. Hockey affiliate, began collecting injury reports voluntarily from some of its teams two-and-a-half seasons ago. That data has yet to be officially crunched and analyzed, but Hal Tearse, coach-in-chief for Minnesota Hockey and chair of its safety committee, believes he’s seen an increase in injuries over the 39 years he’s been coaching hockey.

“Concussions seem to be much more severe than they were 25 years ago,” he told me. That increase in the severity of the injuries — if it holds up when the data is analyzed — may be because players are bigger and faster than in years past, he said. Variations in skill level may also be a factor.

“The data that we’ve collected would indicate that players with lower skill levels, particularly at skating, are most at risk,” he added.

A growing controversy
Body checking has long been a controversial subject. In 2003, two neuroscientists wrote a commentary in the Canadian Medical Association Journal that called for eliminating body checking in youth hockey. Here in the U.S., the American Academy of Pediatrics has repeatedly recommended that body checking be banned in games played by youth aged 15 and younger.

Getting people — players and parents and coaches alike — to recognize the dangers of body checking hasn’t been easy, however. Here are some telling bits of information from the Canadian commentary:

* “In one community, players 14-15 years old were less likely than younger players to believe that sportsmanship was ‘real important.’ Moreover, 26% of players 12-15 years old who understood that body checking from behind could cause serious injury or death reported that they would be willing to do so if they were angry or wanted ‘to get even.’ ”

* “In addition, parents may be encouraging their children to win at all costs in the hope of their pursuing scholarships and professional contracts. In one study, 32% of injured players said that they would continue to body check to ensure a win; an additional 6% said they would do so in order to injure another player.”

But that was then (the 1990s). This is now. Our knowledge about the lifelong impact that even a single concussion has on a person’s physical and mental health has grown significantly during the past decade. Both Stuart and Tearse say the old win-at-any-cost attitudes once espoused by many hockey enthusiasts are changing. Minnesota Hockey has initiated a “Fair Play” safety program. Last year, it also launched a less competitive (and less time-demanding) youth recreational league — one that doesn’t permit body checking.

In October, the Mayo Clinic will be hosting a two-day “Ice Hockey Summit: Action on Concussion” program for medical experts from around the country. “It’s not going to just be a scientific program,” said Stuart. “We hope to develop an evidence-based action plan” — a plan, he added, that may include recommendations for rule changes.

It starts at home
In the meantime, what should parents with kids who love playing hockey do to reduce the risk of injury? Stuart (whose three sons play professional hockey in various leagues around the world, including son Mark, who plays defense for the Boston Bruins) offers a couple of suggestions:

* Keep your perspective. “Parents should always remember that the objectives of hockey are fun and skill development — learning to skate and to play hockey,” he said.

* Enforce the existing rules. “Many injuries are the result of rule infractions,” Stuart said. “It’s important to foster an atmosphere of sportsmanship and mutual respect. That starts at home.”

A landmark study released on June 8 revealed that 11- and 12- year old hockey players in leagues that allow bodychecking are 2.5 times more likely to get hurt and 3.5 times more likely to suffer a mild traumatic brain injury -mTBI also known as a concussion. In Quebec, players do not bodycheck until bantam ages (ages 13 to 14), and even then it is only introduced at the elite levels of the game. Pee wee (ages 11 and 12) is when bodychecking begins in Alberta. The joint University of Calgary, McGill University, and the University of Laval study tracked 2,200 pee wee hockey players from both provinces for the entire 2007-2008 season to measure injury frequency. The findings of this study were published in the recent edition of the Journal of the American Medical Association.

This study should serve as a wake-up call for those Canadians concerned with the health and safety of all players, especially minor leaguers, and the future of the game as we know it. The release of these findings coincide with statements made by Toronto neurosurgeon, Charles Tator at a Hockey Canada sponsored concussion seminar who said there has been too much emphasis on ‘rock’em, sock’em type of hockey in minor hockey. Dr. Tator has been a long-time advocate of findings better ways to make hockey a safer game.

The consequences of traumatic hits to the head speak for themselves. Research done by Dr. Shree Bhalerao, director, medical psychiatry, St. Michael’s Hospital, Toronto and Deborah Pink, resident in psychiatry, University of Toronto reveals the following. Traumatic brain injuries, via hits to the head or bodies colliding against the boards or other bodies can cause: post-concussive symptoms (tinnitus, vertigo, nausea, and unremitting headaches); cognitive disorders (distractibility, antisocial behaviours and development difficulties); depression (fatigue, decreased motivation, suicide and significant psychosocial impairments); personality changes (impulsivity, decreased frustration tolerance, inability to socialize, inappropriate use of expletives); increased use of substances and alcohol with the rare consequence of psychosis, anxiety disorders and chronic sleep disorders.

Indeed, an emotional debate has been raging for years about our national sport. Should body checking be allowed in minor hockey? According to the Canadian Institute for Health Information, 8,000 people were treated for hockey related injuries in Ontario hospital emergency rooms in the 2002-2003 seasons. Based on this rate, more than 25,000 people were injured across the country. In 93 cases of the 8,000, the casualty was admitted to hospital, 15 directly to critical care units.

Among young hockey players (18 and under) 62 percent of the injuries were a result of checking. Injuries caused by body checks were the most common in the 14 to 16 age group, after players have been exposed to body checking for several years.

The decision to allow body checking in minor hockey is unquestionably jeopardizing this wonderful sport and favourite pastime by turning it into our most dangerous game. It is easily argued this practice borders on child abuse. It certainly flies in the face of public health, safety, and injury prevention; it trumps medical science, commonsense, and civility.

Allowing young hockey players to body check, along with a myriad of other factors, in particular, costs, is, as the statistics clearly indicate, driving young players away from the game. The main reason kids play any sport is for fun and recreation. Hitting and the risk of serious injuries, including concussions, remove the motivation. It is shocking to hear enrolment in Hockey Canada approved teams is about 550,000 players, down more than 200,000 from its peak.

Hockey is an inherently dangerous game. That said, when medical experts and safety advocates say evidenced-based research show injury-prevention and harm-reduction initiatives are good for the health and safety of the game and the players, everyone, and especially Hockey Canada should take note. Does Hockey Canada, a publically funded organization, have the credibility, leadership and commitment to address this serious public health and safety problem? The challenge resides with Hockey Canada! Its failure to act may very well lead to a situation where governments may have to intervene.

Hopefully, it is not too late to change and save the game of hockey in Canada, which has such strong and historical roots. A major overhaul is needed and soon. Who is up to the challenge?

Emile Therien
Public Health & Safety Advocate,
Past President, Canadian Safety Council
Ottawa, Ontario
June 9, 2010.

Note: The author played major junior hockey at St. Michael’s College School in Toronto and collegiate hockey at St. Lawrence University in Canton, New York. He has been a long time advocate for greater safety in all sports. His son Christopher, played college hockey at Providence College in Rhode Island, was a member of the 1994 Canadian Olympic hockey team and played many years in the NHL.

The never ending incidents of on ice-thuggery, including hits to the head, a recent one involving QMJHL star Patrice Cormier, along with other factors including body checking in minor hockey, has turned hockey into our most dangerous game. These horrible incidents smack of everything that is wrong with hockey in our country: poor leadership; elitist and exclusionary, lofty and unrealistic expectations; overzealous coaches and parents and no fun and recreational benefits for the players.

The long-term brain damage suffered by Reggie Fleming during his professional playing career, as revealed by researchers at Boston University, should serve as a wake-up call for those Canadians concerned with the health and safety of all players, especially minor leaguers, and the future of the game as we know it. The release of these findings coincided with statements made by Toronto neurosurgeon Charles Tator at the recent Hockey Canada sponsored concussion seminar who said there has been too much emphasis on “sock’em, kill’em type of hockey” in minor hockey. Dr. Tator has been a long-time advocate of findings better ways to make hockey a safer game.

The consequences of traumatic hits to the head speak for themselves. Research done by Dr. Shree Bhalerao, director, medical psychiatry, St. Michael’s Hospital, Toronto and Deborah Pink, resident in psychiatry, University of Toronto reveals the following. Traumatic brain injuries, via hits to the head or bodies colliding against the boards or other bodies can cause: post-concussive symptoms (tinnitus, vertigo, nausea, and unremitting headaches); cognitive disorders (distractibility, antisocial behaviours and development difficulties); depression (fatigue, decreased motivation, suicide and significant psychosocial impairments); personality changes (impulsivity, decreased frustration tolerance, inability to socialize, inappropriate use of expletives); increased use of substances and alcohol with the rare consequence of psychosis, anxiety disorders and chronic sleep disorders.

I am sure other studies reveal similar and alarming results.

An emotional debate has been raging for years about our national sport. Should body checking be allowed in minor hockey? According to the Canadian Institute for Health Information, 8,000 people were treated for hockey related injuries in Ontario hospital emergency rooms in the 2002-2003 season. Based on this rate, more than 25,000 people were injured across the country. In 93 cases of the 8,000, the casualty was admitted to hospital, 15 directly to critical care units.

Among young hockey players (18 and under) 62 percent of the injuries were a result of checking. Injuries caused by body checks were the most common in the 14 to 16 age group, after players have been exposed to body checking for several years.

The decision to allow body checking in minor hockey is unquestionably jeopardizing this wonderful sport and favourite pastime by turning it into our most dangerous game. It is easily argued this practice borders on child abuse. It certainly flies in the face of public health, safety, and injury prevention; it trumps medical science, commonsense, and civility.

Allowing young hockey players to body check, along with a myriad of other factors, in particular, costs, is, as the statistics clearly indicate, driving young players away from the game. The main reason kids play any sport is for fun and recreation. Hitting and the risk of serious injuries, including concussions, remove the motivation. It is shocking to hear enrolment in Hockey Canada approved teams is about 550,000 players, down more than 200,000 from its peak.

Hockey is an inherently dangerous game. Violence degrades the world’s fastest, most physically challenging and most highly skilled game. That said, when medical experts and safety advocates say evidenced-based research show injury-prevention and harm-reduction initiatives are good for the health and safety of the game and the players, everyone, and especially the CHL (Canadian Hockey League), a professional league in its own right, should take note. Need more be said. Hockey is not, and has never been, a law of its own. And contrary to what proponents claim, violence, including fighting, has never been an integral part of the game. Fighting is banned in minor hockey in this country, college hockey in both the U.S. and Canada, in the European leagues, in the Olympics, and in all international play. Banning fighting in all leagues would greatly add to the skill level of the game, by eliminating marginal players in favour of skilled talent.

Hockey Canada, the shill and “business partner” of the professional Canadian Hockey League (CHL) is calling for a safety summit to be held in August. How interesting! The sad and harsh reality is that violence in hockey has been an integral part of the game as long as Hockey Canada and its predecessor organization, the Canadian Amateur Hockey Association, have been in existence. It is easily argued Hockey Canada, through its relationship with the CHL, has been a willing participant in promoting and condoning violence in hockey for years. A case in point! Patrice Cormier should have been, according to IIHF rules, thrown out of the recent World Junior Championship (WJC) for his violent hit on a Swedish player in an exhibition game leading up to that tournament. Unfortunately, this rule was not enforced. Hockey Canada, regardless of the IIHF, should have taken the initiative and expelled Cormier from tournament play. On an issue of safety, civility, and commonsense, it failed the test. For Hockey Canada, it’s called winning at all costs.

In light of its record and apathy when dealing with violence in the game of hockey, Hockey Canada, a publically funded organization, simply does not have the credibility, leadership, reliability and commitment to address this serious public health and safety problem. Calling for a safety summit smacks of sheer hypocrisy and opportunism and masks many of the challenges and problems confronting minor hockey in this country, which it, Hockey Canada, has so blatantly ignored. Shame on Hockey Canada.

Hopefully, it is not too late to change and save the game of hockey in Canada, which has such strong and historical roots. A major overhaul is needed and soon. Who is up to the challenge?

Emile Therien
Public Health & Safety Advocate
Past President, Canadian Safety Council //Ottawa, Ontario

Note: The author played (albeit many years ago) major junior hockey at St. Michael’s College School in Toronto and collegiate hockey at St. Lawrence University in Canton, New York. He has been a long time advocate for greater safety in all sports. His son Christopher, played college hockey at Providence College in Rhode Island, was a member of the 1994 Canadian Olympic hockey team and played many years in the NHL.

From: Emile Therien – To: editorial@reddeeradvocate.com
Dear Editor,
With much interest, I read this article: Meeting injuries head-on.

The never ending incidents of on ice-thuggery, including hits to the head, a recent one involving QMJHL star Patrice Cormier, along with other factors including body checking in minor hockey, has turned hockey into our most dangerous game. These horrible incidents smack of everything that is wrong with hockey in our country: poor leadership; elitist and exclusionary, lofty and unrealistic expectations; overzealous coaches and parents and no fun and recreational benefits for the players.

The consequences of traumatic hits to the head speak for themselves. Research by Dr. Shree Bhalerao, director, medical psychiatry, St. Michael’s Hospital, Toronto and Deborah Pink, resident in psychiatry, University of Toronto has found that hockey-related brain injuries, via hits to the head or bodies colliding against the boards or other bodies, can cause post-concussive symptoms, cognitive disorders, depression, personality changes and substance abuse.

Far, far to many Canadians are willing and ready to blame this thuggery solely on the NHL, and its apparent apathy to the problem. A disproportionately large part of the blame resides with the Canadian Hockey League (CHL) and Hockey Canada!

Hockey is an inherently dangerous game. Violence degrades the world’s fastest, most physically challenging and most highly skilled game. Hockey is not, and has never been, a law of its own. And contrary to what proponents claim, violence, including fighting, has never been an integral part of the game. Fighting is banned in minor hockey in this country, college hockey in both the U.S. and Canada, in the European leagues, in the Olympics, and in all international play. Banning fighting in all leagues, including the CHL, would unquestionably reduce the number of violent incidents and would greatly add to the skill level of the game, by eliminating marginal players in favour of skilled talent.

The sad and harsh reality is that violence in hockey has been an integral part of the game as long as Hockey Canada and its predecessor organization, the Canadian Amateur Hockey Association, have been in existence. It is easily argued Hockey Canada, through its relationship with the CHL, has been a willing participant in promoting and condoning violence in hockey for years. A case in point! Patrice Cormier should have been, according to IIHF rules, thrown out of the recent World Junior Championship (WJC) for his violent hit on a Swedish player in an exhibition game leading up to that tournament. Unfortunately, this rule was not enforced. Hockey Canada, regardless of the IIHF, should have taken the initiative and expelled Cormier from tournament play. On an issue of safety, civility, and commonsense, it failed the test. For Hockey Canada, it’s called winning at all costs.

Hockey Canada, a publically funded organization, and the CHL, most of whose member teams play in municipally owned buildings and which sells/promotes its product as “family entertainment”, have long dodged this public health and safety problem. It is time for them to take their heads out of the sand and deal with this nightmare. The ball is in their court. Are they up to the challenge?

Emile Therien,
Public Health & Safety Advocate,
Past President, Canadian Safety Council
Ottawa, Ontario.

Note: The author played (albeit many years ago) major junior hockey at St. Michael’s College School in Toronto and collegiate hockey at St. Lawrence University in Canton, New York. He has been a long time advocate for greater safety in all sports. His son Christopher, played college hockey at Providence College in Rhode Island, was a member of the 1994 Canadian Olympic hockey team and played many years in the NHL.

Friday, 09.18.2009 / 5:03 PM / News
NHL.com
DALLAS, DENVER — Concussions are by far the most common, and one of the most difficult to manage injuries seen in sports today. According to the Centers for Disease Control and Prevention, there are between 1.6 million and 3.8 million brain injuries that occur in sports each year — and 63,000 occur in high school athletes alone. The National Academy of Neuropsychology (NAN) and National Athletic Trainers’ Association (NATA) have joined forces on a national and local grassroots campaign to educate the public, athletes, health professionals, coaches, parents, administrators and others about concussion in sports. The overarching objective of the campaign is to raise awareness of the importance of identifying concussions and implementing appropriate management when they do occur.

As a centerpiece of the NAN and NATA efforts, a 12-minute educational video titled “Concussions in Hockey: Signs, Symptoms and Playing Safe,” has now been released nationally. The video, sponsored by the National Hockey League and the NHL Players’ Association, features comments from Mike Modano of the Dallas Stars and retired NHL players Pat LaFontaine and Eric Lindros. It is available as a free online download on affiliated Web sites, including www.nanonline.org, www.nata.org, www.nhl.com and www.nhpla.com and also available, upon request, at a cost of $10 at www.nata.org/brochures.

View the video!

“Given the recent advancements in concussion research, education among coaches, parents, athletes, the media, and other influencers is critical,” said athletic trainer Kevin Guskiewicz, PhD, ATC, professor and chair, Department of Exercise and Sports Science at the University of North Carolina, Chapel Hill. “The invisible nature of concussions makes it imperative that athletes and coaches properly recognize the signs and symptoms of concussions, in order to foster quicker diagnosis and medical care when needed.”

“Concussions can be serious injuries if not treated properly. Concussion symptoms can affect players in all areas of their lives including their physical, emotional and cognitive functioning,” said Ruben Echemendia, PhD, NAN past president and director of the NHL’s Neuropsychological Testing Program. “Swift and appropriate evaluation by trained sports medicine professionals is crucial before an athlete returns to play. That is why we counsel students and coaches to err on the side of caution and ‘when in doubt, sit out.’”

This educational campaign explicitly urges athletes to immediately consult with their athletic trainer, team physician or coach if they think they might have a concussion. “Even if an athlete’s symptoms appear to be very mild, if they don’t feel right, they must immediately tell somebody in charge,” Echemendia said.

The Canadian Press

LONDON, Ont. — Fighting should be eliminated from hockey at all levels of the game, according to recommendations released Tuesday from an expert panel dealing with concussions in hockey.

“Fighting is one of the known causes of concussion, and may result in the related long-term complications,” the panel’s summary statement says. “Fighting can cause needless death.”

The recommendations, resulting from meetings at the London Hockey Concussion Summit on Jan. 17-18, also calls from an elimination of high hits/head hits.

“Those are significant ones,” Summit chair Dr. Paul Echlin said. “The reduction of hits from behind has had a major effect on the incidence of broken necks in hockey and similarly, the reduction of high/head hits should reduce the incidence of concussions.”

Panellists on The Concussion Summit included four former players, three of whom were knocked out of the National Hockey League as the result of concussions – Eric Lindros, Jeff Beukeboom and Alyn McCauley – along with Canadian national women’s team player Jennifer Botterill, who was sidelined for a protracted period with concussion.

Echlin stresses, however, that there was no consensus on all the recommendations.

“The recommendations in this statement are designed to serve as a framework for future discussion, and to promote significant change concerning the prevention, recognition, and management of concussions in hockey,” the statement says.

Echlin and co-chair Dr. Charles Tator, professor of neurosurgery at the University of Toronto, put their recommendations together via e-mail with the participants after poring over the minutes of the day-after meeting.

The recommendations will go to the media, various hockey groups and medical associations.

Along with the rules recommendations, the panel advised a concussion certification program in which trainers, coaches and officials would gain knowledge aimed at recognizing and treating concussion.

Those teams that have pre-season physicals with medical professionals, Echlin said, have added benefits. Few young players ever see a doctor and physicals sometimes indicate problems other than neurological, such as cardiac-related.

Other recommendations in today’s release are the adoption of an NHL/Ontario Hockey League role model program, studies leading to a data collection system, pre-season screening and a survey of protective equipment.

Echlin and Tator said were gratified by the turnout of 380 hockey people Jan. 17 and felt a step closer to their goal – a unified body that involves all levels of hockey and could expand into other sports.

Football Canada was a non-hockey participant in the recommendations along with the NHL, NHL Players’ Association, the OHL, Ontario Hockey Association, Ontario Hockey Federation along with a number of medical and therapeutic bodies.

Echlin said the prospective name for a central agency dealing with concussion is Hockey Concussion Initiative, which would first involve hockey and ultimately serve as a model for all sports in which head injuries occur such as football, soccer, rugby, skiing, skateboarding and cycling.

“Sometimes, events like the Concussion Summit are held and everyone departs until another one is held,” Echlin said in an interview. “Our goal is to move forward from this and work to find solutions to a growing problem”.

Echlin has hands-on experience with concussion this season.

Six of 23 players on the junior development team he works with have suffered concussion, one requiring disqualification for the remainder of the season.

GATINEAU, Québec—The Brain Injury Association of Canada (BIAC) calls on Canadians to contact their Member of Parliament and declare their support for Private Members Bill C-289, which would amend the Hazardous Products Act so as to prohibit the advertising, sale, or import into Canada, of recreational snow sport helmets that do not meet a national standard. The amendment is being re-introduced, today, by the Honourable Dr. Hedy Fry (Vancouver Centre), in an attempt to have it passed by Cabinet through an Order-in-Council.

“It would be significant if this is done in time for Canada’s 2010 Olympics,” explains Dr. Fry. The Canadian Medical Association, BIAC, and various organizations which promote preventable injuries, are all in support of this proposed amendment to the law.

“We are very pleased that Bill C-289 has been introduced into the House of Commons,” says BIAC executive director, Harry Zarins. “It’s been almost two years since the bill was originally introduced, and we are hopeful that this time the bill will receive unanimous approval from the House in the next few weeks, and be implemented shortly thereafter.”

In Canada, the annual cost of sport-related head injuries is over $100 million, while the cost of preventable injuries—the leading killer and disabler of young Canadians—is estimated at $14.7 billion. The average daily cost of caring for a brain injury survivor is $2,867.59 (Canadian Institute for Health Information), yet the purchase of a Canadian Standards Association-approved helmet would save lives and money. According to a 2006 report (Economic Burden of Injury in Ontario, published by SmartRisk), every dollar spent on a sport helmet saves the Canadian health care system $29.

Given the burdensome costs of brain and preventable injuries, BIAC hopes Parliament will prioritize Bill C-289 and take a leading role in protecting Canadians, and the economy.

Contributions to the Brain Injury Association of Canada can be made to directly to the Brain Injury Association of Canada (http://biac-aclc.ca/en/donate/), or through CanadaHelps (www.canadahelps.org). BIAC is funded by the generosity of donors, as well as sponsors of its national Hawaiian Oyster Odyssey events.

For more information, please contact:
Harry Zarins, Executive Director, Brain Injury Association of Canada, 1-866-977-2493
harry.zarins@biac-aclc.ca

HAYLEY MICK
From Wednesday’s Globe and Mail
January 28, 2009 at 9:41 AM EST

Athletes who suffered concussions in their youth show a far more rapid mental decline as they grow older, according to a new Canadian study that suggests sports-related head injuries may plant the seed for Alzheimer’s disease.

The study, which looked at university-level hockey and football players now in their early 60s, found that the group who had no history of concussion scored much higher in tests of memory, motor skills and reaction time compared with former athletes who had suffered one or more concussions at least 30 years ago.

This type of mild cognitive impairment, especially premature memory loss, can be a risk factor for Alzheimer’s disease, which most often affects people over 65, said the study’s lead author Louis De Beaumont, a graduate student at the University of Montreal.

“To us, this type of cognitive decline in memory and motor impairments could be indicative of problems in future years,” said Mr. De Beaumont of the study participants. Though he noted that the people who took part in the study are “still maintaining active daily lives,” he added that they are relatively young to be experiencing cognitive problems.

Over the past decade, doctors and scientists have sounded the alarm on the effects of concussions in contact sports. They have found poster boys in high-profile athletes such as hockey star Eric Lindros, whose stunted athletic career, and boxer Muhammad Ali, whose failing health, have been linked to repeated head trauma.

But this study – published yesterday in an online version of the journal Brain – adds to growing evidence that shows concussions can leave long-lasting damage and may even accelerate the aging process.

Yesterday, Boston researchers released another study that showed former Tampa Bay Buccaneer Tom McHale, a nine-year National Football League veteran, was suffering from chronic traumatic encephalopathy, a degenerative brain disease caused by head trauma, when he died in 2008 at age 45.

Since 2002, according to Boston University School of Medicine, six former NFL players have been diagnosed after death with the condition, which is known to develop into debilitating dementia in old age. While more research is needed, the group of researchers from Harvard and Boston University said their results should serve as a wake-up call that radical change is needed to protect people playing football.

In his study, Mr. De Beaumont and his team compared 19 healthy former Canadian university athletes who had sustained one or more concussions 30 years ago with 21 former athletes with no history of concussion.

Medical records were of little use in his search for subjects, because decades ago an athlete would soldier on after getting his bell rung, conked or dinged.

So he turned to athletic and alumni associations for help. Many former athletes didn’t know the symptoms of a concussion, which include dizziness, headache, lack of focus, fatigue, blurred vision, despondency and general malaise. But once he described what he was looking for, some could relate. “Athletes who have had a concussion will remember it for the rest of their lives,” Mr. De Beaumont said.

Relative to former athletes with no history of concussion, those who had been concussed had significantly lower performance in memory tests, delayed response to unpredictable stimuli, and reduced dexterity.

Mr. De Beaumont said he hopes to do a larger study, which would follow these athletes to see whether they are more vulnerable to developing more severe mental and physical deteriorations in later life, such as Alzheimer’s and Parkinson’s diseases. In the meantime, the focus has to be on prevention, he said.

But persuading people to be careful isn’t easy, says Charles Tator, a neurosurgeon at Toronto Western Hospital and founder of ThinkFirst, a non-profit organization that educates coaches, parents and children about safe sporting practices.

Better equipment, better helmets and changes to the rules have all been suggested as ways to prevent concussions, Dr. Tator said, but “there is a lack of respect among players for the opponent’s body, but also for their own body.”

It’s crucial that athletes take proper precautions when returning to the field or rink. After a concussion, an athlete must stop and rest immediately, Dr. Tator said. Their return to regular activity should be gradual and follow a medically approved protocol, which is available on thinkfirst.ca.

And at the very least, athletes should be forewarned, Mr. De Beaumont said.

“We’re not saying that sports should be banished,” he said. “We’re certainly saying that people should be informed about the risks.”