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Schools Need to Become Brain Injury Conscious

posted by SK Brain Injury    |   January 16, 2012 15:00

OUT OF concerns about brain damage, the National Football League and college teams are finally taking concussions seriously. But while this cautious new attitude is admirable, it can also create a false sense of security for parents of children itching to play football, hockey, or soccer. For if concussions are the cause of brain damage, the thinking goes, then youngsters have nothing to fear as long as they avoid concussions. That’s not true. There is reason to fear brain injuries from head traumas that don’t result in concussions.

That’s the logical conclusion from the latest evidence, admittedly incomplete, from the Boston University researchers who’ve done landmark work into sports-related brain injuries. But the research, outlined in last Sunday’s Globe by Derrick Z. Jackson, should be thoughtfully reviewed by any parent, coach, or administrator of a school-sports program.

The most chilling case is that of Owen Thomas, the popular captain of the University of Pennsylvania football team, who committed suicide at age 21. His brain, studied by the BU team, showed extensive evidence of chronic traumatic encephalopathy - the degenerative condition linked to behavioral changes, dementia, and premature death in former football and hockey players. The surprise wasn’t just that Thomas was so young; it was that he had never been diagnosed with a concussion. That suggests the disease came about because of repeated sub-concussive head impacts from playing football during his adolescence and young-adult years.

Thomas’s case, combined with other research, leads Robert Cantu, the co-director of the BU center, to recommend that children younger than 14 stay away from sports that involve repeated collisions, with potential hits to the head. That’s merely one person’s advice, not yet anything close to a scientific consensus. But it’s not too early to urge parents to think the risks through carefully. No one should simply assume that if a sport is sanctioned by a school, it’s risk-free for young kids to participate.

The most common sources of brain trauma in team sports are football, soccer, and hockey. Football trauma can be reduced by having less strenuous practices, with limits on hard hitting; the sudden force of two players colliding at a high speed can jostle the brain. School football leagues, like the pros, should strictly penalize helmet-to-helmet tackling and the “launching’’ of tacklers into other players. But even with these precautions, parents should be wary: Football is a violent sport, and young players and their parents should be fully aware of the risks.

In soccer, injuries can occur when players repeatedly head the ball. The game can be played effectively without heading, and that’s an obvious way to all but remove the threat of brain trauma. Soccer leagues may reasonably await more evidence before making a major change to their sport, but limiting use of the head in practice seems like a sensible precaution, even before all the evidence is in.

Hockey is the most vexing case, because some of the worst head traumas occur in fights that have nothing to do with the playing of the game. At the youth level, bans on fighting and rules on hard checking into the boards should be strictly enforced. Meanwhile, coaches would best serve their players’ long-term hockey aspirations by emphasizing skill over aggression.

There is much more to be learned about possible links between chronic traumatic encephalopathy and youth sports. Thankfully, BU is moving ahead with its ground-breaking research. But parents, kids, and especially those in charge of youth sports programs shouldn’t wait for all the data to be in before taking precautions.

Article found in the Boston Globe

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Hiding Concussion in the NHL

posted by SK Brain Injury    |   January 11, 2012 12:14

As Colby Armstrong proved, concussions remain the easiest injury to hide.

The matter of Armstrong keeping his head injury a secret from the Maple Leafs for two days in the heightened awareness of the Concussion Era is instructional. It reveals more than ever the difficulty the NHL will have in trying to curb this epidemic.

“You’ve got to remember it’s still an easy injury to mask — because you can’t see it,” said former Flyers captain Keith Primeau. “You look at an X-ray, you can see a fracture, whereas the head, it might hurt but you have the ability to continue on.”

Not only continue on, but play at a decent level.

Primeau knows that firsthand.

The Toronto native had four recorded concussions in a career that saw him play more than 900 NHL games. The concussion diagnosis was only made when his symptoms were so severe he couldn’t function as a player anymore.

“I would have never divulged that,” he said.

Sound familiar?

It was only when Armstrong became nauseous after Monday’s morning skate before a game against Los Angeles that the Leafs learned he’d suffered a concussion after hitting Ryan Kesler in a game against Vancouver on Saturday night.

You can’t blame the Leafs in this instance. One can also understand Armstrong’s motivation in hiding the injury. He’s a character player who wears an “A” on his sweater not for his scoring prowess but for the intangibles he brings to the team.

But it’s tough to deliver on that when you’ve only played in nine games so far this season and missed 32 games last season. The potential permanent damage from head injuries likely isn’t even in the equation for him at this point.

The pressure to play is much greater — and may come more from the player himself than anyone else.

“I think it’s more internal pressure and desire to compete than any other extenuating circumstances,” said Primeau. “They want to be out there performing. They don’t want what they consider to be a simple headache to be the reason they’re not.”

Dave Scatchard knows that feeling well, too. He was a grinder for 13 NHL seasons, someone who also found a way to keep going even when concussed at times. He remembers telling team officials he was having neck problems when he knew he’d suffered a head injury after getting sucker-punched after scoring a goal.

The reason he didn’t tell the truth was he feared for his job.

“No player wants to be seen as damaged goods or get a reputation as a concussion guy,” said Scatchard, who made it clear he was talking about his own experience and not about Armstrong specifically.

But the concussions eventually exact a price.

Scatchard retired last summer after five spots were found on his brain during an MRI. He has trouble with memory, can’t push his three young kids on a swing without getting dizzy and can’t get his heart rate above 135 or more symptoms return.

He has been at the Mayo Clinic this week for cognitive testing.

“It’s extremely, extremely frustrating,” said Scatchard. “I expected to be in a better place than I am right now.”

Crowded places are also a problem for Scatchard, which can make Christmas shopping tough.

“I was trying to pick out my wife some nail polish to put in her stocking and there were so many nail polishes,” he said. “I was trying to read each label and see the colours and everything and I just freaked out and left. I never got any nail polish. That’s what I deal with daily. Some days I feel pretty good and other days I have a really tough time.”

It can also be hard these days for Scatchard to watch the game he loves.

“When I was a young guy, I loved seeing big hits like Don Cherry Rock ’em Sock ’em and things like that and now every time I see a big hit or see a player lying on the ice, my stomach just turns. It’s just so bad for a player and I pray to God they’re going to be okay and healthy. I don’t want anybody to have to deal with these issues.”

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Ken Dryden Discusses Violence and Head Shots in Hockey

posted by SK Brain Injury    |   January 8, 2012 09:54

A year ago, Sidney Crosby went down with a concussion and the way we see hockey changed. A few days ago in the World Junior Championships, Canada's junior team lost to Russia in a way it shouldn't have lost, and almost won in a way nobody should win. Each speaks to something in our nature.

Where does it come from, this fight that is in us?

Surely, it must have to do with the hard land and hard climate of our past, when illness or injury weren't allowed to keep us from the fields or the forests. That was survival. So when we created our games, we'd play them in the only way we knew how.

Or, in an indirect way, maybe the answer's as simple as the difference between a puck and a football or soccer ball. A puck is hard and small. In hockey's earliest days, when it flew out of play it could travel far and stop the action for many inconvenient seconds. It could injure someone watching. Not so a football or soccer ball. So hockey created boards to surround the ice. Low ones at first, to keep the puck in play; higher ones later when more spectators found reasons to watch the game. For hockey players from the beginning, there was no out-of-bounds. There was no escape.

So the struggle that is hockey began. At first, it was on a much smaller ice surface, seven against seven not six against six, and with no substitutions and no forward pass, there was no way to open up the clutter; no escape even to rest. For the entire game, it was body pushing against body; the boards an unmovable opponent everywhere around the perimeter. To score, a player had to get close to an opponent's net, and in the offensive zone it's as if the oval of the rink suddenly becomes a funnel, the struggle, the strain growing ever more intense.

To get to the net is a fight.

The most legendary player of hockey's first hundred years was Rocket Richard. He was not much more than average size. He possessed no blinding speed, no overpowering shot. The lingering image of him now more than 50 years after his last game is his eyes. Wide, wild, his pupils so focused on his task — to get to the net — they'd bore a hole through anything that stood in their way.

It's the Europeans who first saw this unrelenting will in Canadian players. Before European amateurs were allowed to play against the NHL's best, the Europeans saw only the Penticton Vees, Whitby Dunlops, Trail Smoke Eaters, and those who came before them. By the mid-1950s, the Europeans had closed the talent gap, they could skate and pass as well or better than their Canadian opponents, but still Canada would win. The Europeans had come to hockey late from soccer or bandy (much like field hockey on ice), games played on big, wide-open spaces with strategies, skills, and attitudes to match. Even their "Olympic-sized" hockey rinks were bigger. They'd dazzle in the open ice, but in the funnel to the net, unaccustomed to the smash of bodies, they'd look for a final pass.

Canadians first saw this fighting spirit in ourselves in the 1972 Canada-Russia series, and we only truly saw it when the series was over. Before then, Canadians saw Canadian players who looked slow and undisciplined, thuggish at times, and Russian players who looked the way we'd always seen ourselves. Then, when the eight-game series seemed finally over — after a crushing loss in what had been a very promising first game in Moscow — with the Russians leading the series three games to one with one game tied and the final three games in Moscow, things changed. We won the sixth game, then came from behind to win the seventh. In the last game, down 5-3 at the end of the second period, we scored three goals, including Paul Henderson's winning goal with 34 seconds remaining.

There was a lot not to be proud of in that series. But we were proud that we won, and we were proud that we didn't give up. In a series where one player scores the game-winning goal in the final three games and the series-winning goal in the last minute of the last game, there can be only one hero — Paul Henderson. But there were two — Henderson and Phil Esposito. Moments after the series' lowest moment, our Game 4 loss in Vancouver, Esposito had given his "speech" in a TV interview. With sweat pouring down his face and fight still oozing from him, he took on those who booed us and doubted us. He embodied what we'd show ourselves to be in Moscow — the never-quit, never-say-die Canadians others had always seen us to be.

Canadians love this about their players. We get cut, we lose teeth, and we scarcely miss a shift. This isn't about ourselves; it's about the team. We're going to feel pain anyway; we might as well play. It's the fight that's in us. It's those boards we put up around us when we created this game that gave us no place to escape; no choice but to suck it up. It's the teeth-baring grin we show when we go into the corners and into that funnel to the net. And it's an ethic that's more important now than ever. To fans who "bleed" blue or orange or black, who feel more deeply about their team than they do about themselves, they need to know that the player with the multimillion dollar contract who wears the jersey feels the same.

And it's why most Canadian fans love Don Cherry. If anyone doubts that affection, go to CBC's nextHockey Day in Canada. I was with him three times, in Iqaluit, Shaunavon, Saskatchewan and Whitehorse. No matter how many former stars are also there or who they are, the fans want to see one person — Cherry. No question. No contest. These fans love the dynamic between Cherry and his sidekick, Ron MacLean, on Coach's Corner. MacLean is often described as Cherry's perfect foil, but in fact, the reverse is true. MacLean is Cherry's perfect setup man. Cherry goes over the top; MacLean catches him and comes back with something that seems almost reasonable — and on it goes. But beneath the shtick of outrageous clothes and bluster is a funny, entertaining character who has something to say. No one survives more than 30 years at the centre of a storm with just shtick.

Whatever Cherry's talking about, he's really talking about Canada and Canadian spirit. When European players first began playing in the NHL in any numbers, he trashed them. They weren't Canadian, not in nationality, not in spirit. Just because you wear the jersey of a hockey player, he said to them, doesn't mean you're a hockey player. Prove it. When they did, he wouldn't see it because they weren't Canadian. If they proved it a different way, not with their fists but on the scoreboard, as Wayne Gretzky and Mario Lemieux did, he wouldn't see it either.

Week after week his message carries the same basic truth: In hockey, as in any of other side theme of life he goes off into — "Hey, you kids out there" — you've got to be willing to fight. Who can argue? And to Cherry if you accept that, you've got to accept that any kind of fight or fighting is right. You've got to stand up — shoulder against shoulder; fist against fist.

This is where the debate over head shots and fighting grows confused. Giving up head shots or fighting is not giving in to do-gooders who never played the game. It's not giving in to Americans. It is not giving up something Canadian. It's not even giving up Don Cherry; certainly not his spirit. But it is taking on Cherry or anyone else on hits to the head. The surprise is that Cherry and so many former players who are now commentators defend or minimize these hits — the race for the puck, the last-second shove that catapults an opponent into the end boards and a completely unknowable fate; the cruise-by elbow or shoulder to an unsuspecting player. The hit like the one the Edmonton Oilers' Andy Sutton put on the Carolina Hurricanes' Alexei Ponikarovsky a few weeks ago. Sutton could see that Ponikarovsky couldn't see him, so this was not a knee-jerk reflex. It was entirely premeditated. He had several feet to decide what to do and chose to drive Ponikarovsky's head into the glass — because he could. But Sutton is a good guy. Good guys don't do bad things, so bad things done by good guys can't be bad things.

These are cheap shots and always were. Cherry and the others didn't play this way. Is this fight? Is this standing up? Where's the courage and toughness in this?

"Fight" is not "fighting." Fight is never giving up. Gretzky, Orr, Richard, Lemieux, Lafleur — they were great fighters. They fought with their head, hands, legs, will, and need to be special, and rarely with their fists. The toughest players aren't those who hit but those who are willing to be hit, to fight their way into open ice, to fight their way to the net, to fight expectation and disappointment to score the game-changing goal. Give up fighting and get more stick-swinging?

Who were the stick-swingers? A handful of players; almost nobody — and certainly not these players. Fight is the playoffs, the Olympics, and World Cup, where fighting and head shots are rare because the stakes are so high and the distractions so consequential that there's no place on the ice for goons. "Fight" is fighting spirit. It's Canadian hockey at its best.

After the 1972 Canada-Russia series, the skill gap between the Europeans, the Russians in particular, and Canadians seemed to grow. In the 1990s and early into this century, most of the NHL's top scorers and trophy winners were European or American. That has changed in recent years. Canadians learned that more than fight was needed.

In soccer, England had its "1972 moment" in 1953 when Hungary came to Wembley and won, 6-3. England won the World Cup in 1966, and since that time the skill level of its players has improved, but much less so than for those in the rest of the world. England keeps hoping that "English pluck" can make up the difference. It can't.

We learned in Canada what England has never learned. We learned that to win: Match them with skill; beat them with will.

The debate about head shots and fighting is not a debate about Canada, Canadian hockey, or the Canadian spirit. It's about giving up the fighting, but keeping the fight.

Article from

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Ken Dryden | News

Sidney Crosby's Concussion Trouble has Changed Hockey

posted by SK Brain Injury    |   January 6, 2012 12:00

Amid the memorabilia of a glittering career – a hockey stick, NHL jerseys, a ticket from the 2010 Olympic final and photos of his Stanley Cup ring and Olympic gold medal – is a small sculpture of the word “believe.”

But one year after the concussion that took the sport’s biggest star out of the game, it’s hard not to note the desperation lurking in the inspirational message at the sprawling sports complex in suburban Halifax where a young Sidney Crosby worked on his shot, hustled in practice and began to chase his dream, in earnest, to play for the NHL.

The youthful players at Cole Harbour Place idolize Mr. Crosby. But many of the parents who had a front-row seat to Mr. Crosby's meteoric rise are terrified now when they see their own children playing.

“After every game parents are saying ‘I’m just so glad my son got out of there without a concussion,’ ” said Glen Smith, seated high in the stands of one of the rinks, whose son plays for the Dartmouth Whalers Bantam AA. “You go to your daughter’s game and you don’t have a worry in the world. And you go to your son’s and you’re like ‘glad he made it through that.’ ”

At a mid-day practice for several local high school teams, the notion of concussions, nuanced rule changes and debate of the very nature of the game seem worlds away. But chat to some of those lining the boards, or coming off the ice, or sitting in the sparse stands, waiting for their kid, and worries that Sid the Kid will never again play the game at a professional level begin to surface. Mr. Smith said the superstar’s injury has made everyone aware of the risks faced by boys playing an ever-faster and harder-hitting sport. Some of the skaters say they have become more careful on the ice.

Officials and experts across hockey-playing nations have weighed in with suggestions, including baseline testing for concussion and calls for a ban on checking.

Paul Mason, who coached the young Crosby for four years, finishing when he was 14, said that minor hockey in Nova Scotia now uses tougher rules in cases of suspected concussions. He said the next steps could include looking at some of the equipment players wear and driving a change in culture from behind the bench.

“I think the onus is on the coaches as well,” he said in a phone interview. “They have to say, ‘as a player on my team, it is unacceptable to hit someone in the head.’ ”

Players at the Cole Harbour Place rinks Wednesday were quick to play down their own fears, though some admitted concerns and many said their parents were worried about them.

Luke Stienburg, 12, took a break from practising with his Maritime Hockey Academy team-mates to discuss the impact of Mr. Crosby’s injury. He said referees are stricter about calling penalties now and that, as a player, he’s more conscious of keeping his head up and avoiding damaging contact.

But he finds it disheartening to see the local star out of the game.

“It’s sort of hard because he was a role model to look up to,” said the right-winger, as the smell of sweat hangs over the rink and the sound of pucks hitting the boards echoes the arena. “All the players liked to say ‘you play where Sidney Crosby did.’ I think we care more here because it’s his hometown.”

Cole Harbour, a suburb of Halifax, is Crosby-country and affection runs deep. Only minutes away from the rinks is the home where he played ball-hockey and shovelled snow for neighbours. People on his street who remember him from those days are still fiercely protective, telling a reporter early in the concussion saga that they will gently steer away autograph seekers and celebrity hounds.

“He’s the local boy,” said David Bedford, who played goalie for 18 years in Nova Scotia, rising to Midget AAA, as he waited with his four-year-old son for a skating class at Cole Harbour Place. “He’s something of an icon here. Once the face of the NHL gets hit and put out, everyone pays attention.”

Mr. Bedford is keen for his young children to play hockey. But he notes that his son was in a helmet as soon as he was old enough to slide down a snowy hill.

That concern about head injuries is visceral throughout this building. Strangers will spark up conversations with “do you think he’ll be back” and even people with children far too young to play hockey are concerned.

Nick Blair and Jen Appleby are the parents of Carter Blair, only 16 months but already excited at the sight of the Sidney Crosby memorabilia cases. The boy sleeps with a small plastic hockey stick and his parents would love him to play the game. They’re hopeful the attention generated by Mr. Crosby’s injury will ultimately help clean up the sport.

“For every parent ... instead of it being at the back of your mind, it’s putting up front the risks that you take,” Mr. Blair said. “By the time [Carter] is playing it’ll be a different game than it is now.”

Article from the Globe and Mail

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Eric Lindros' Comeback from Post-Concussion Syndrome

posted by SK Brain Injury    |   January 2, 2012 15:00

When Eric Lindros sat out the 2000-01 season for the Flyers, demanding to be traded after recovering from a disease (post-concussion syndrome) that had not been officially recognized or even known to the NHL, the fans turned on him.
When he was traded to the Rangers that summer, it seemed 60-40 with fans against him in his years-long battle with the Flyers and general manager Bob Clarke.
At the time, I never envisioned that he would be welcomed back with the kind of love and devotion I saw Saturday at the Alumni Game.
That he drew a louder, longer standing ovation than Bernie Parent, perhaps the most beloved Philadelphia athlete of the 1970s, was stunning to me and others who have been around the game all these years.
The reason for that ovation, I believe, is not rooted in a simplistic explanation that fans simply forgive or forget.
It’s more complicated.

For starters, most of today’s generation of Flyers fans weren’t adult season ticket-holders for much, if not all of the Lindros Era. There’s a whole, new generation that were kids watching him. A generation that wasn't even born when he began playing. Those who were there then and remain here were bitterly divided between supporting the club and supporting Lindros in his numerous battles with Clarke.
A generation has come and gone. Everyone involved from back then has moved on. Even Clarke himself has said repeatedly that Lindros belongs in the Hockey Hall of Fame, and no one would have thought he’d say such a thing in 2001.
But the biggest reason I feel Philadelphia again embraced Lindros is that anyone watching today’s game now understands that concussions and post-concussion syndrome is the No. 1 enemy facing hockey.
It has ruined lives – Pat LaFontaine, Paul Kariya, Keith Primeau -- and endangered careers – Sidney Crosby.
We didn’t understand then what we do now about this disease and we still don’t fully comprehend it’s dramatic after-effects.
That, to me, has changed the public perception of Lindros in Philadelphia and everywhere else. People now see him as being at the forefront of this terrible disease when, back then, they questioned his sincerity to play hurt which is the axiom of hockey.
Their view of how he played through and suffered through concussions has been altered.
“That’s a good point,” Rick Tocchet told me. “I think maybe that has a lot of people thinking differently [about him] now. A good point.
“Concussions are an individual thing. You can’t judge people on concussions. Sidney Crosby is the best player in the league and who knows if he is ever gonna get back.”
Regardless of why things have changed, it was great to see the Big E once again embraced by a city to which he gave so many quality years.
And it was even better seeing him laughing and joking with Clarke.
Time doesn’t always heal all wounds, but in this case, time and knowledge about concussions seems to have allowed it to happen.

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"Hide it" Mindset Still Exists in NFL

posted by SK Brain Injury    |   December 30, 2011 10:00

Ask Maurice Jones-Drew, the Jacksonville Jaguars running back, whether he would try to play through a concussion or take himself out of a game, and he provides a straightforward answer.

"Hide it," the NFL's rushing leader said. "The bottom line is, you have to be able to put food on the table. No one's going to sign or want a guy who can't stay healthy.

"I know there will be a day when I'm going to have trouble walking. I realise that. But this is what I signed up for. Injuries are part of the game. If you don't want to get hit, then you shouldn't be playing."

Other players say they would do the same.

In a series of interviews about head injuries, 23 of 44 NFL players told the Associated Press they would try to conceal a possible concussion rather than pull themselves out of a game. Some acknowledged they already have.

Players also said they should be better protected from their own instincts: More than two-thirds of the players interviewed said they would like to see independent neurologists on sidelines during games.

The interviews were with a cross-section of players - at least one from each of the 32 NFL teams - to gauge whether concussion safety and attitudes about head injuries have changed in the past two years. The group included 33 starters and 11 reserves; 25 players on offence and 19 on defence; all have played at least three seasons in the NFL.

The players tended to indicate they are more aware of the possible long-term effects of jarring hits to their heads than they once were. In a sign of the sort of progress the league wants, five players said that while they would have tried to conceal a concussion during a game in 2009, now they would seek help.

"You look at some of the cases where you see some of the retired players and the issues that they're having now, even with some of the guys who've passed and had their brains examined - you see what their brains look like now," said London Fletcher, the Washington Redskins linebacker, the NFL's leading tackler. "That does play a part in how I think now about it."

But his teammate, back-up fullback Mike Sellers, said he has hidden concussions in the past and would "highly doubt" that any player would willingly take himself out of a game.

"You want to continue to play. You're a competitor. You're not going to tell on yourself. There have been times I've been dinged, and they've taken my helmet from me, and I'd snatch my helmet back and get back on the field," Sellers said.

"A lot of guys wouldn't say anything because a lot of guys wouldn't think anything during the game, until afterward, when they have a headache or they can't remember certain things."

Justin Smith, the San Francisco 49ers defensive lineman, captured a popular sentiment: Players know of the potential problems, yet would risk further damage.

"It doesn't take a rocket scientist to figure out if [you have] a concussion, you're probably damaging your brain a little bit. Just like if you sprain your wrist a bunch, you're going to have some wrist problems down the road.

"Yeah, I'd still play through it. It's part of the game. I think if you're noticeably messed up, yeah, they'll take you out. But if you've just got some blurry vision, I'd say that's the player's call. And most guys - 99 per cent of guys in the NFL - are going to play through it."

Smith said he sustained one concussion in high school ("You don't know who you are," is how he described it) and another in college ("Walking around the whole time, but I don't remember anything until six hours later").

The NFL likes to say that views about concussions have shifted from simply accepting they are part of the sport to doing what is possible to lessen impacts. Commissioner Roger Goodell talks about "changing the culture", so players do not try to "walk it off" after taking hits to the head.

Yet the Associated Press interview with players showed there is room for more adjustments, which did not surprise Dr Richard Ellenbogen, the co-chairman of the NFL's head, neck and spine committee.

"The culture change takes awhile," Ellenbogen said. "Why would these guys want to go out? They love playing the game. They don't want to leave their team. They want to win.

"I understand all that. And that's why we have to be on our toes with coming up with exams that are hard to beat, so to speak."

Zach Strief, the New Orleans Saints offensive lineman, put it this way: "We all grew up with, 'Hey, get back in there. You [only] got your bell rung'. And while it's changing now, I think it's going to take time for the mindset to change."

A few players said they would be particularly inclined to hide a concussion if it happened in a play-off game or the Super Bowl. Some said their decision would depend on the severity of a head injury - but they would hide it if they could.

Clearly, there is a stigma associated with leaving the field, no matter the reason. One player who said he would exit a game if he thought he might have a concussion did not want to be quoted on the subject.

Other findings from the survey:

Ÿ Asked whether the NFL should have independent neurologists at games to examine players and determine if they should be held out because of concussions, 31 players said "yes", and 10 said "no". Three did not answer.

"They've got guys looking at your uniform to make sure you're wearing the right kind of socks," said Quintin Mikell, the St Louis Rams safety. "Why not have somebody there to protect your head? I think we definitely should have that."

He said he has tried to clear his head and stay on the field "many times".

"I'll probably pay for it later in my life," Mikell said, "but at the same time, I'll probably pay for the alcohol that I drank or driving fast cars. It's one of those things that it just comes with the territory."

Ÿ Regarding concussions, 28 of the 44 players think playing in the NFL is safer now than in 2009, while 13 think it is the same and two think it is more dangerous.

One was not sure.

Those who think safety has improved gave credit to the rise in awareness; more fines for illegal hits; this season's changes to kick-off rules that have cut down on the number of returns; and the new labour contract's reduction in the amount of contact allowed in practice.

"When I first came into the league, it was like, 'Whatever goes'. It was more of that old-school, just 'beat-him-up' football. Not wanting to hurt anybody, but show how tough you were.

"Back in the day, it was like if you come out [of a game] with [a] slight concussion, then you weren't giving it all for your team," said Andra Davis, the Buffalo Bills linebacker. "But now, they're taking that option away from you."

Davis, a 10th-year veteran, said he has had a couple of concussions. He is one of those whose view on seeking help for such injuries has changed.

"The younger me would definitely hide it," Davis said.

"But the older me now - with wife and kids and looking more at life after football - I would say something about it."

Ÿ Asked whether more can be done to protect players from head injuries, 18 players said "yes" and 24 said "no". Two did not respond.

Players on opposite sides of the ball generally drifted toward opposing views: Those on offence seemed more likely than those on defence to say more can - and should - be done to improve safety.

Linemen, meanwhile, often complained that there is no way to improve their plight, with the helmet-to-helmet banging that takes place at the snap on play after play.

One player described those collisions as "micro-episodes that build up over time".

Nearly three-quarters of the players who said they think safety can improve - 13 of 18 - suggested equipment can be improved, too. Helmet technology, mouth guards and chin straps all were mentioned.

Two players suggested more education about concussions is needed.

Little-discussed until reporting by The New York Times led to an October 2009 congressional hearing on concussions in the NFL, head injuries are now part of the daily conversation about professional football. Last Saturday alone, two starting quarterbacks, Cleveland's Colt McCoy and Arizona's Kevin Kolb, sat out because of head injuries, while a third, Minnesota's Christian Ponder, left his team's game with what his coach called "concussion-like symptoms".

At least eight lawsuits have been filed against the NFL in recent months - including three within the last week - by dozens of former players who say they have medical problems related to brain injuries from their time in professional football. The NFL's stance, in part, is that players knew there were risks of injury, and there was no misconduct or liability on the league's part.

"It's a physical sport. Guys are going to get hit in the head," Brent Celek, the Philadelphia Eagles tight end, said.

"It's not like, 'Oh, I'm going to play this because my head's going to be fine when I'm done playing'. It's a risk you take playing this game, but I think the league is doing everything in their power to make it as safe as possible."

And while the players tend to feel better about the way concussions are handled now than in 2009, they will not deny that dangers lurk.

"You're never going to be totally safe from concussions in this game," said Stanford Routt, the Oakland Raiders cornerback. "This is the only place where you can actually legally assault people."

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Year of Concussion

posted by SK Brain Injury    |   December 29, 2011 14:00

Here's how Canadiens legend Elmer Lach remembers it, and it's a wonder he can remember it at all:

It was Feb. 6, 1947, and Lach, still in uniform, had been wheeled into Western Hospital, across the street from the Montreal Forum. A half-hour earlier, Lach had been blindsided by Don Metz of the Toronto Maple Leafs, knocked unconscious when his unhelmeted head smacked the ice, striking and bouncing off the rink surface.

So there was the future Hall of Famer on his gurney, blinking through his cobwebs at the emergencyward ceiling, when a doctor arrived at his side.

"He put his hands around my neck, gave me a few hard shakes, and said: 'Do you feel anything?' " Lach recalled, laughing at the memory. "I told him I didn't, so he yanked my head some more. Still nothing. I was told: 'Well, then, there's nothing wrong with you.' "

The hospital decided to keep the Canadiens' hardrock centreman overnight for observation before sending him on his way. But just to be sure, they rolled him into X-ray the following morning.

"That's when they discovered," Lach said, still laughing, "that I had a fractured skull."

And surely one of the innumerable concussions he suffered with his bulldozing, headfirst play through 740 National Hockey League games from 1940-54.

Much has changed, obviously, in the 6½ decades since Lach, 94 next month, cracked his head on the ice of the Forum and had it slapped around in hospital triage like it was a basketball.

There is no telling how many concussions went unreported, undetected and untreated in the early days of the NHL. Or, for that matter, last season.

The game wasn't as fast in Lach's day, the players weren't built like today's tanks, the equipment was hardly the battle armour that it is now.

But watch the old, grainy film from games in the 1940s and '50s and you'll see hockey that probably was more vicious than the modern game.

The stickwork was brutal, players often using their heavy ash lumber as weapons; most of the angry post-whistle scrums show players with their sticks overhead, wielded like clubs.

The NHL limps to the end of 2011 trying to deal with the enormous headache of and even career-threatening fallout from concussions, a catch-all description for brain-damaging injuries that have reached epidemic proportions as medical science works furiously to catch up.

The terrible year began New Year's Day at Pittsburgh's Heinz Field during the annual outdoor Winter Classic, a game better remembered for the hurt it inflicted on hockey's best player than for the final result - a 3-1, rain-delayed victory for the Washington Capitals over the Pittsburgh Penguins.

Penguins superstar Sidney Crosby was flattened when blindsided late in the second period by Washington's David Steckel, who caught Crosby in the head with what was, at best, a questionable hit.

Crosby's skull was caught by Steckel's shoulder in a collision deep in Washington ice, behind the play. Crosby couldn't reassemble the play that night, or now.

"I couldn't even tell you what happened," Crosby said after the game. "I think the puck was going the other way. And I turned and next thing I know, I am down. -

"It's pretty far behind the play. Maybe the refs didn't even see it. A lot of people didn't. But I don't even know. (Steckel) got my head, that's for sure."

Crosby finished the game and reported for duty four nights later in Pittsburgh against Tampa Bay, and during that match he absorbed a hard check into the glass from Lightning defenceman Victor Hedman.

The next thing hockey knew, Crosby's season was done. He was sidelined more than 10 months with concussion symptoms that included fatigue and an inability to tolerate loud noise and bright lights.

In Crosby's 320-day absence, the NHL wrote Rule 48 - Illegal Check to the Head, sadly needing a black-andwhite regulation for that. Concussion protocols were introduced and fine-tuned, designed to protect players from returning to action no matter that they believed they'd simply had their bell rung.

Crosby's first game back on Nov. 21 was brilliant - two goals, two assists - and he had a dozen points in eight games before the concussion symptoms returned the middle of this month. He's sat out the past seven games and there's no sign he'll be back any time soon.

Crosby, of course, is only the brightest name on the concussion marquee. But there are many more.

In Montreal, fans were horrified by the March 8 Bell Centre hit by Boston's Zdeno Chara on the Canadiens' Max Pacioretty, leaving the latter severely concussed and with a fractured vertebra.

The wounded list reads like a who's-who of NHL excellence. It has included, among a great many others, Philadelphia's Claude Giroux, the league's most prolific pointscorer; Milan Michalek of Ottawa, the top scorer; defencemen Chris Pronger of Philadelphia, Marc Staal of the New York Rangers, Pittsburgh's Kris Letang.

A handful of goaltenders have even been felled by pucks and by heavy, needless contact in or around their crease.

Veteran journalist Tim Wharnsby of has kept a running, entirely depressing total of this season's concussions and suspensions. Through Thursday, 457 man-games had been lost to head injuries; players had been suspended 80 games, forfeiting nearly $1.3 million in wages.

Meanwhile, NHL disciplinarian Brendan Shanahan has become an online video star in his own right, visually explaining the punishment he metes out as he tries with mixed success to heighten awareness of and discourage headshots.

Three NHL heavyweights who made their living with their fists died over a terrible summer. The losses of Derek Boogaard, Rick Rypien and Wade Belak cannot be attributed directly to concussions, but manic behaviour and wild mood swings can be related to brain trauma that has come from a career of fighting and absorbing blows to the head.

The Canadiens' Pacioretty has found a silver lining to the check that could have crippled him for life. He's created a foundation to buy the Montreal General Hospital a functional magnetic resonance imaging machine for analysis of brain-trauma injuries among athletes and all others, from children falling down stairs to seniors slipping on a sidewalk.

Hockey, meanwhile, tries to solve a problem for which there is no quick fix. Consistent, relentless discipline and thought-provoking, walletdenting suspensions might help deliver the message. So, too, might modification to equipment - not to Dickie Moore's flimsy gear of the 1950s, but to something between that and the jousting armour worn today.

It doesn't help that there's a general lack of respect players hold for each other, some leaving their feet to deliver high, crushing blows, others cavalierly throwing bulletproof-padded shoulders and forearms into the skulls of unsuspecting targets.

It was a year that saw the Boston Bruins perhaps improbably win the Stanley Cup. It has seen turmoil in the Canadiens unlike anything in recent memory, and it has seen an entire Russian hockey club tragically wiped out in a plane crash.

With everything that's transpired, 2011 lurches to a close the same way it began - with the game's greatest player on the sidelines dealing with brain trauma that could well effect not just his career, but his life beyond it.

It's a sad statement about the game, one sadder still about those who continue, by choice, to play it recklessly and irresponsibly.

Not all will be as lucky as Canadiens icon Elmer Lach, who 65 years after the fact still chuckles about his fractured skull. Elmer the Elegant spent the summer of 1947 recovering. And then he went out the following season and won the NHL's scoring championship.

Article from the Montreal Gazette

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Colby Armstrong Scolded for Trying to Hide Concussion

posted by SK Brain Injury    |   December 29, 2011 10:00

Toronto Maple Leafs general manager Brian Burke gently scolded injured forward Colby Armstrong on Monday, a week after the popular 29-year-old winger tried to hide the fact he had suffered a concussion from the team.

Armstrong was concussed against the Vancouver Canucks on Dec. 17, and fell ill during a session on the exercise bicycle the next day. On Dec. 19, as he was planning to play the Los Angeles Kings, Armstrong was nauseated again and was diagnosed and pulled from the lineup.

“Everyone tries to play hurt, but you should never try to conceal a head injury — no one admires that or respects that,” Burke said Monday. “We grudgingly respect when players hide other injuries, because they do it routinely. (Head injuries are) one where we absolutely insist the players be forthcoming.”

There is no timeline for Armstrong’s return. The concussion was the latest in a string of injuries he has suffered over two seasons in Toronto, a list which includes a scratched cornea and a tendon that mysteriously popped of his hand during a game.

“Once the season starts, during the entire season, you’re never pain-free as a hockey player,” Burke said. “Something hurts every day, with varying degrees of severity. I don’t think he’d had a concussion before. He wanted to see if the symptoms resolved on their own. He got through a practice OK, and then felt terrible. He’s in the protocol now.”

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Concussions: A Guide for Parents

posted by SK Brain Injury    |   December 28, 2011 19:00

The subject of sports concussions has been in the news a lot lately. But while the recent media  focus has been on hits to the head in the National Football League which have led to player fines and, most recently, a suspension, and to legislative action at the state and federal level on return to play guidelines, the important role parents play after their kids suffer concussions hasn't received the same kind of attention.

The fact is that an athlete's parents, along with teachers, coaches, school nurses and administrators, play a crucial role in a child's treatment and recovery from a suspected concussion, especially the all-important decisions about when to return to school and everyday social and home activity, and, in most cases, to sports. 

Parent involvement in their child's recovery from a concussive event is, of course, not surprising, considering that:

  • Active involvement of the parent is standard practice in pediatrics (especially, of course, for younger children);
  • The student-athlete's everyday environments at home and at school are important places to observe post-concussion symptoms; and
  • Parents and teachers possess a wealth of information about the child's behavior and ability to function in these settings that is directly relevant to an assessment of their post-concussion symptoms and when it is safe for them to return to the classroom (often with accommodations) and sports.

Parent concussion checklist

But what, exactly, is the parent's role?  Here's a 10-point checklist.

1.  Regularly and closely monitor athlete for first 24 to 48 hours.2

  • Most sport-related concussions are mild, but the potential always exists for a more serious, life-threatening head injury, such as an epidural hematoma (bleeding between the skull and the brain), subdural hematoma, subarachnoid hematoma, or from second-impact syndrome (a rare, but often fatal brain injury suffered before the brain has fully healed from previous brain trauma).
  • Because delayed onset of symptoms during the first 24 to 48 hours is possible (and more likely in children), parents - or another responsible adult - should closely monitor the athlete during this time. 
    • Even if an athlete has been removed from a game or practice because of a suspected concussion (as is required under laws in an increasing number of states), he or she should not be sent to the locker room alone, and should never be allowed to drive home.
    • The traditional rule has been to wake up a concussed athlete every 3 to 4 hours during the night to evaluate changes in symptoms and rule out the possibility of an intracranial bleed, such as a subdural hematoma.
    • The new thinking3 is that there may be more benefit from uninterrupted sleep than frequent wakening, which may make symptoms worse.  As a result, waking up your child during the night to check for signs of deteriorating mental status (see #2) is now recommended only if your child  experienced a loss of consciousness or prolonged amnesia after the injury, or was still experiencing other significant post-concussion signs or symptoms at bedtime. There is no need to check your child's eyes with a flashlight or test their reflexes. 

2. Immediate hospitalization if condition deteriorates. If your child experiences any of the following signs of deteriorating mental status, take her to the hospital immediately:

  • Has a headache that gets worse
  • Is very drowsy or can't be awakened (woken up)
  • Can't recognize people or places
  • Is vomiting repeatedly
  • Behaves unusually, seems confused or very irritable
  • Experiences seizures (arms and legs jerk uncontrollably)
  • Has weak or numb arms or legs
  • Is unsteady on his feet or has slurred speech.

3.  Use acetaminophen (e.g. Tylenol®) or codeine for headache.  Do not give aspirin or non-steroidal anti-inflammatory medicine(NSAIDs)(e.g. Ibuprofen/Advil®). An ice pack on the head and neck is okay as needed for comfort.  A 2010 clinical report from the American Academy of Pediatrics' Council on Sports Medicine and Fitness3 notes that, because no studies have actually documented any harm from use of NSAIDS after a sport-related concussion, the common recommendation against their use is based more on a theoretical risk.

4.  No drugs, alcohol: Warn your child about the dangers of drinking alcohol, engaging in recreational drug use, or using any other substance that could interfere with cognitive function and neurologic recovery.  Do not give sleeping tablets.

5. No driving until symptoms have cleared.  While an athlete is experiencing concussion symptoms - such as sensitivity to noise or light or dizziness, inability to detect quick movements of the head, sleep problems, problems with memory or concentration, or anxiety, even a narrowing of their field of vision - he should not be driving.  If symptoms persist, it may even be advisable for the athlete to be undertake a more formal evaluation to determine whether it is safe for him to resume driving a car. 

6.  Normal diet: Limited information is available regarding the recommended diet for the management of concussion. A normal well-balanced diet that is nutritious in both quality and quantity should be maintained to provide the needed nutrients to aid in the recovery process. Avoid spicy foods.

7.  Physical and "cognitive" rest:

  • Treating young athletes after a concussive event is uniquely challenging, because their brains are still developing. The cornerstone of concussion management of young athletes is physical and cognitive rest until symptoms clear, and then completion of a 5-step graduated exercise program leading to medical clearance and return to play.  
    • limit their day-to-day and school-related activities until symptom free
      • This generally means no homework, video games, text messaging and staying home from school while still experiencing concussion symptoms (although some experts, mindful of the fact that it is difficult for parents to constantly be monitoring their child and to enforce strict limits, along with the lack of research in this area, suggest that the most important thing for a parent to take a common sense approach about their child's level of cognitive activity, having the child avoid activities that seem to make their symptoms worse).
      • Academic accommodations, including temporary leave of absence from school, shortening of the athlete's school day, reduction of workloads in school, and/or allowing an athlete more time to complete assignments or take tests, may be necessary.
      • Taking standardized tests while recovering from a concussion should be discouraged, because lower-than-expected test scores may occur and are likely not representative of true ability.
    • Avoid strenuous activity until the athlete has no post-concussion symptoms at rest because physical activity may make symptoms worse and has the potential to delay recovery.  While bed rest is not recommended, some evidence suggests that a limited amount of physical activity may aid in recovery, and the effect of physical activity on concussion recovery has not been extensively researched, there is general consensus among concussion experts recommending broad restrictions of physical activity, including: 
      • the sport or activity that resulted in the concussion
      • weight training
      • cardiovascular training
      • PE classes
      • sexual activity
      • leisure activities such as bike riding, street hockey, and skateboarding that risk additional head injury or make symptoms worse.3

    • No further treatment is required during the recovery period apart from limiting physical and cognitive activities (and other risk-taking opportunities for re-injury) while concussion symptoms are still present,  and the athlete typically resumes sport without further problem.

8.  Graduated, individualized, conservative return-to-play. The Zurich Consensus Statement on Concussion in Sport and the American Academy of Pediatrics3 recommend against - and most of the new state laws and rules enacted by a growing number of athletic associations at the state and national level  prohibit - same day return to play under any circumstances, or, at the very least, while the athlete is still experiencing symptoms at rest or during exercise.  When returning athletes to play, they should follow a 5 step, symptom limited exercise program with each stage taking 24 hours or longer to complete, and the athlete returning to the previous stage if symptoms recur with exertion or at rest. 

Parents need to remember that concussion management is not one-size, fits all and that it needs to follow an individualized course tailored to their child's unique situation, as each athlete will recover at a different rate (especially for athletes who have a history of multiple concussions).

However, as a general rule, because a number of studies have shown that younger athletes take longer to fully recover cognitive function than college-aged or professional athletes, a more conservative, "when in doubt, sit them out" approach is recommended in deciding when a pediatric and adolescent athlete can return to play, even if they show no symptoms of concussion.

9.  Further testing/management. It used to be that concussions were "graded" based on severity, with the concussion grade, the number of concussion suffered, and whether the athlete suffered a loss of consciousness or amnesia determining return to play. Over the last decade, however, concussion grading scales and one-size fits all return to play guidelines have been abandoned in favor of a much more individualized approach. 

The most recent consensus of experts calls for consideration of so-called "modifying factors," the presence of any of which may suggest the need for more sophisticated concussion management strategies,  such as examination by a specialist, more sophisticated testing, and a longer recovery time.  These factors include:

  • Lingering symptoms. In most cases, obvious symptoms of concussions clear within a week. The presence of post-concussion signs or symptoms lasting more than 7-10 days, or symptoms that recur with exercise, suggest a more serious concussion;
  • Extensive LOC or amnesia.  An athlete who experiences concussive convulsions or prolonged loss of consciousness (LOC) (one minute or more) or amnesia at the time of injury should be treated more conservatively;
  • Multiple concussion history.  If the athlete has suffered one or more concussive events in the past, especially where the injuries appear to be recurring with progressively less impact force (e.g. a minor blow) or takes longer to recover after each successive concussion, a longer recovery time, or even a recommendation against returning that season or to that sport in the future may be warranted; and
  • Other neurological disorders present.  A concussed athlete with learning disorders and/or attention deficit hyperactivity (ADHD) may require different concussion management that takes these conditions into account.

10.  Trust your instincts. Be as involved in the management of your child's concussion as your instincts tell you to be. Don't be afraid to ask your child how he is feeling, or take him to his pediatrician or a specialist if you suspect something is wrong or you notice a change in his/her personality, or that he is "off."  Remember: you know your child better than anyone.  Because there is a lot medical science does not know about concussions, a common sense approach makes - in a word - sense.

"[P]arents should be acutely aware of [concussion] symptoms, potential differences between girls and boys, and alert coaches and healthcare workers to behavioral changes," advises Susan A. Saliba, PhD, PT, ATC, an Assistant Professor at the Curry School of Education; Physical Medicine and Rehabilitation at the University of Virginia, and the co-author of a 2010 study on concussions among high school athletes.

"Parents have the ability to observe the athlete longer and can perceive changes that may affect the outcome.  Any lethargy, continued headache, or change in behavior or affect can be concussion symptoms, especially if agitation or difficulty in concentrating are present.  Many times the parent cannot identify a specific symptom, but should nevertheless alert someone that the athlete is 'not him or herself.' Early return to play during this time presents the most danger," she says.

An athlete's school and coaches should maintain regular contact with his or her parents to update them on their progress.

For the most comprehensive, up-to-date concussion information on the Internet, click here

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Concussions in the NHL: Waiting for Science

posted by SK Brain Injury    |   December 28, 2011 09:30

I like Gary Bettman. I was ready to like him before I had ever met him. He had gone to Cornell University; I went to Cornell. That was a good place to start. When I was president of the Toronto Maple Leafs, I dealt with him often, most directly in NHL governors' meetings. He would sit at the middle of a long table at the front of a room with the league governors, usually team owners, beside him. Team owners are rich. In their own communities, they are important. They are also used to seeing themselves as important, and like to see themselves that way. In their communities and in their companies, they are also used to having their own way, and do not give up their way easily. To suggest that directing them is akin to herding cats is to give cats a bad name.

At the front table was this expressive, bug-eyed bundle of nerve endings. He spoke in bursts of words and emotions. Quick-witted, quick-tongued, aggressive, smart, well prepared — there was never any doubt who commanded that room.

His is a tough job. He presides over a league, but in many ways he also presides over a sport. In Canada, hockey matters. If Canadian NHL teams aren't doing well — on the ice or off — the hundreds of thousands of kids and adults who play recreationally don't seem to be doing as well. And because hockey seems to be a metaphor we as Canadians have applied to ourselves, and others have applied to us, when hockey isn't going well, we don't seem to be doing as well, either. As NHL commissioner, Bettman has a responsibility that the commissioners of the NFL, NBA, and MLB do not have.

In the U.S., Bettman has a different challenge. He has to try to make hockey matter for more than just an intensely dedicated minority, in more than just the North and Northeast of the U.S. In the U.S., it's baseball and football, then basketball, then … hockey. It's MLB and the NFL, then the NBA, then … the NHL. His is a perpetual struggle for attention and importance. To gain that status, it means having teams in parts of the U.S. where the struggle first must be for survival. Ask any CEO what it's like when one quarter of his or her stores, for example, drag down the others. Ask them what they would do. Shut them down; focus on their business' strengths. Bettman can't do that.

In our dealings, I've disagreed with him at times, sometimes strongly, but I've found him right far more often than wrong. Of all the NHL presidents or commissioners I've seen or dealt with, as a fan, a player, an administrator, and a fan again — Clarence Campbell, John Ziegler, and (briefly) Gil Stein — Gary Bettman is easily the best.

Now Bettman, and one day his successors, have a bigger challenge: head injuries. Amid the dangerous mess of the past few years — the premature deaths of former players, suicides, career-shortening or career-ending concussions, and the grave uncertainty over the future of the NHL's biggest star, Sidney Crosby, I was sure there would come a point when Bettman would say, "Enough." That he would intervene as forcibly as he has on franchise and collective bargaining issues. Instead, he has left matters first to Colin Campbell, an NHL executive formerly in charge of player safety, and now to former star player Brendan Shanahan.

Bettman is a lawyer. A good lawyer understands his client's position and advocates strongly for it. A very good lawyer gets inside his client's position, tests and challenges it, shapes it where it needs to be shaped, and comes to know it, and embody it, as well as the client himself. Bettman is a very good lawyer. His relentless rigor gives him his confidence, his presence and posture. When a meeting begins, he's sure — he knows — that he's the smartest guy in the room. For him to be as aggressive and assertive, for him to be him, he needs to know that. That's what allows him to herd his cats.

But on those matters where he can't quite get inside his client as deep as he needs to go, when he can't quite know something as they do, his manner changes. He knows how much hockey means to Canadians, but as an American, he can't quite know. He knows how proud and noble, almost warrior-like, hockey players see themselves, but as someone who has never played the game, he can't quite know. Often criticized in Canada for being an American (and all that means to Canadians), he has been a determined advocate for things Canadian. He knows that hockey's soul resides in Canada. He knows that the NHL isn't strong and healthy unless hockey in Canada is strong and healthy. On matters Canadian, he is respectful and deferential. He listens. About on-ice matters, he is the same. Respectful and deferential, he listens to his "hockey guys."

The problem is that his "hockey guys" are so immersed in a game they have loved and played all of their lives, so steeped in and so respectful of its traditions and understandings, they haven't fully seen all the changes that have occurred. They have seen the changes in technology, strategy, and training that have allowed now bigger players to go faster and with more forceful impact. To Bettman's "hockey guys," these are the natural evolutions of the game. They are good. They are allowed. (Indeed, if you're going to have fighting, why not a better fighter? Why not the best?)

To these natural evolutions, Bettman's "hockey guys" have also seen some unintended consequences — most notably, more, and more serious, injuries — and have responded to them with efforts toward better protective equipment, better medical treatment, and, where these are not enough, "tweaks" to the rules. What they haven't seen fully is that technology, strategy, and training, driven by the creativity of coaches, players, scientists, and entrepreneurs, always run ahead of equipment, medical treatment, and "tweaks" to the rules. Better helmets, more muscular necks and shoulders, MRIs, and Rule 48 haven't offered the answer to 220-plus-pound players moving at 30 mph. Not even close. So concussions are more frequent and more serious. But to intervene with anything else — with significant rule changes or imagining a game played in a more head-conscious, "head-smart" way — to Bettman's "hockey guys," is unthinkable. Natural evolutions that change the nature of a game are OK, but anything else are "unnatural intrusions." They are bad. They aren't allowed. Bettman's "hockey guys" forget that hockey's natural evolution was once toward a jammed-up, goalless future until some president or commissioner intruded unnaturally with player substitutions and the forward pass. Imagine what the "hockey guys" of that time would have said.

When Bettman listens to his "hockey guys," because as someone who never played the game he can't quite know, this is what he hears.

I decided about two months ago to get back in touch with him ("Go Big Red!"). It was a few days after the start of the new season. I sent him an e-mail to congratulate him on the return of the Winnipeg Jets. A minute later, he e-mailed back. This led to a back-and-forth over the next several minutes, at the end each of us promising the other (when I'm in New York; when he's in Toronto) that we'd catch up. Not long ago, we e-mailed each other again. I had been traveling; he'd been traveling. We'd both be away for the holidays, but sometime early in the new year, we would make this happen. And I had no doubt we would.

What I'd say to him is what I've said here, but also that it's time for him to not be so deferential and respectful on hockey matters, on head injuries, but to take these on in his aggressive Bettmanesque way. The stories, almost every week, of another player being concussed (or, to allow for the possibility of a more acceptable earlier return to action, another player having "concussion-like symptoms"), or of a former player now living with the consequences of his head-injured past, are real. They have happened. They are not just a case of bad luck that will surely turn. You have to know that this is your future and the future of all those owners, governors, and players, every week, for so long as you and they are commissioner, owner, governor, or player. You can try to deny the problem or try to manage it or do something. And as overwhelming as it seems — just imagine if even most of this is true: the on-ice consequences, the post-career consequences for former NHL and recreational players, the liabilities, etc., etc. — a lot can be done. The changes that may be necessary are not undoable. Few are blaming you. Most know there is so much we don't know and can't know. We don't know the dimensions of the problem. We don't know the dimensions of the answer. But we do know there's a big problem, and we do know there are some things we need to do.

Hockey isn't the only sport in need of this action. If anything, football's problem is far greater. Soccer and other sports are experiencing their own head-injury problems. Outside sports, the military is faced with many of its personnel suffering the effects of new, more concussive weapons. And for decades, we've imagined the problems without having paid much attention to the consequences of victims of head trauma in child-abuse cases.

It is OK not to know, I was intending to say to him. It is not OK not to begin to puzzle through with others toward some answers.

You and the NHL can do something. You don't need to lead this effort — in fact, it's better if you don't, to avoid the conflicts of interest that would naturally occur and any perception of them, and so not to hold back the work. But you can acknowledge the seriousness of the problem and your determination to deal seriously with it, now and in the future. One way to signal this might be to help create some ongoing structure that would encourage and generate public discussion, ideas, proposals, and action on head injuries in sports, notably hockey. It could begin with an annual conference, hosted by a university, the first one in Canada, but in subsequent years in the U.S. and Europe. The NHL could be one of the major sponsors. You, and not just your "hockey guys," could be there to show that on this "long run" problem you're in this for the long run, and are willing to puzzle through with others how we can do better.

The best brain scientists would be there to talk about what they know, and what they don't know. Players who have suffered brain injuries will provide their personal stories. League officials at different levels, in different sports, will talk about what steps they have taken, what's worked and what hasn't. The best coaches and best players, past and present, will be there to talk about what they've been trained to do and what they've done all their lives. Faced with an opponent, in this case a new "head-smart" set of rules and way of playing that keeps you from doing some things one way, what do you do? What new creative answer can you come up with? What can you do that is even better than what you did before? Each year, there will be new findings, new ideas, and fresh challenges to players, coaches, officials, scientists, and entrepreneurs who, in their DNA, feed on fresh challenges.

There is no running away. Next week's headlines have already been written. The need is to begin.

That's what I was intending to say to him in January or February when I was sure we'd be in touch again. Then I saw his video interview on the New York Times website.

The Times had published an outstanding three-part series of articles by John Branch on Derek Boogaard, a 28-year-old NHL "enforcer" who had died a few months earlier. This was Branch's follow-up video interview with Bettman. Bettman had experienced many interviews like this before, where he was asked to answer questions that weren't really questions, about violence and fighting in the NHL, and he had his usual nervous energy mostly under control.

In response to a question, he began by telling his often-repeated story — fighting has a long history in "the game," he said. Players move at 30 mph in an enclosed area; they carry sticks. There's physical contact. Different from other sports, fighting in hockey is penalized only in a limited way — with a five-minute penalty, not expulsion from the game — not to sell tickets, as is often alleged, but because fighting acts as a kind of "thermostat," as Bettman puts it, so that "things don't go too far." The threat of fighting helps to keep other matters in a game under control. And because fighting is this organic part of hockey, the frequency of fighting changes as the game changes, he says — sometimes more, sometimes less — so you can't predict its future. As for the off-ice deaths in recent months of three former NHL "enforcers" — Boogaard, Rick Rypien, and Wade Belak — he reacted to the deaths more like a father than a commissioner, describing their deaths as a "tragedy" and his "almost disbelief at the coincidental timing of [them]." "The circumstances of all three were different," he continued. "It was a tragic, sad, unfortunate coincidence." When asked by the interviewer to clarify if he thought the circumstances, not the timing, were a coincidence, he replied, "Yes."

Later, the interviewer pointed to the recent findings by Boston University's Center for the Study of Traumatic Encephalopathy that Boogaard had the presence of CTE, chronic traumatic encephalopathy, a close relative of Alzheimer's disease, in his brain, which is thought to be caused by repeated blows to the head. Boogaard is the fourth former NHL player — the others being Reggie Fleming, Bob Probert, and Rick Martin — to show these same indications. What about this research on CTE, the interviewer asked? "I think it's very preliminary," Bettman said. "There isn't a lot of data and the experts who we talk to, who consult with us, think it's way premature to be drawing any conclusions at this point because we're not sure based on the amount of data evaluated." He repeats how "preliminary" all this is, again citing the "handful of samples," all the possible factors in these players' deaths, how with CTE, Alzheimer's, and dementia there's so much we don't know. "There's a long way to go in medical science before people can make definitive judgments," he concludes.

Gary Bettman has arrived at Stage 2 in the NHL's response to fighting and violence. Stage 1, as embodied by Colin Campbell and former Boston Bruins coach and immensely popular TV commentator Don Cherry, was aggressive, belligerent, and dismissive. Look, this is hockey. This is how the game's played. Always has been. If you don't like it, don't play it. Stage 2, as embodied in Bettman's interview, is more modulated, more thoughtful-sounding, and more reasonable-sounding (aided by the interview's setting, a room lighted dark and warm, almost cozy; there's a reason 60 Minutes' interviews and congressional committee hearings are done in the glare of bright lights). Occasionally he strays into a lawyer's gentle, prickly combativeness, but mostly he stays on his message: It is Boston University's scientific work on the brain samples of former players that helped bring head injuries to a focus, he is saying. It's science that I'm going to argue back. Science isn't impressed with anecdote and story. Science demands proof. Four brain samples are merely four anecdotes, and that's out of the thousands who have played this game. Mine is the reasonable, responsible position. Mine is based on science. Science demands proof, and I demand proof, too. And when science gives me what science insists upon for itself, I will go where science takes me. In the meantime, even with science on my side, I will continue cooperating with doctors and researchers and generate rule changes where appropriate. That's how reasonable I am.

By waiting for science, thousands of asbestos workers and millions of smokers died. The fact is, as a society we rarely have the luxury of waiting for science on big, difficult, potentially dangerous questions to meet its standard of proof. We need to take the best science we have, generate more and better information, then apply to it our best intuition and common sense — and decide. Scientists are always disparaging of politicians and other decision-makers for being so influenced by anecdote. But an anecdote, well observed, thorough, rigorous, and truth-seeking (not ax-grinding), can tell a lot. At any moment, it may also be the best information we have.

It is only by tragic fluke — his early death — that we have the Derek Boogaard "anecdote." Normally, we'd have to wait many more years to know what had happened many years before. But now we have this gift from Derek Boogaard. The NHL can also learn from the NFL experience. Many more football players than hockey players are dying now in their 60s and 70s after having spent the last several years of their lives in the living death of dementia. Football, for that generation of players, just as with hockey, was played with primitive equipment. But in football, then as now, every play involves many collisions involving many players, and one final collision. In hockey then, the game moved much more slowly with players playing coasting, two-minute shifts with few collisions. In hockey now, the game moving in full-abandon, 35-second shifts with bigger players, the collisions are never-ending and shuddering. And hockey fighters, once normal-sized and untrained, inflicted little damage. Today, far bigger and having been trained in combat much of their lives, they can cave a face with one punch and have their brains rattled in return.

Gary Bettman said in his online video interview with the Times that he hasn't talked to the doctors at Boston University. I hope he does soon. I also hope he has spoken with Derek Boogaard's family and friends to hear, really hear, about what his life was like. And with Paul Kariya, Eric Lindros, and Keith Primeau — in depth — or with any of a number of players who have had their careers ended early, about what life felt like after their injury, and what it feels like now. Or — in depth — with Sidney Crosby. As hard as it was in the 10 months of recovery after his injury — the pain and discomfort, the unknowns, the hopefulness, the crashing disappointments — now must be his darkest time. It was the sheer routineness of this latest hit. So invisible amid the action that observers assumed it must have been from a collision with his teammate Chris Kunitz. So routine it was only on replay: Crosby and Bruins player David Krejci yapping at each other from their player benches — what could've caused that? — then running the action backwards; Crosby and Krejci shoving at each other on the ice after the whistle — what could've caused that? — and backwards some more; Crosby skating toward the puck near the boards; Krejci, the puck in his skates, bent over, his back to Crosby; as Crosby bumps him, Krejci turns slightly, his left elbow striking Crosby in the visor. It was the kind of light blow that is exchanged without notice or consequence hundreds of times in a game. Krejci, in everything that follows, looks befuddled — Why is he so mad? What did I do? But knowing how he feels, Crosby knows.

If after 11 months this is all it takes …

I hope Bettman and Crosby have a good long talk.

There are debates among doctors, now played out in the media, over the correlation between hockey's blows to the head and CTE, between blows suffered now and a player's long-term future. These debates will continue. But there can be no debate about the impact of those blows on players now. Almost every day there's someone new — this week it's star Flyers' defenseman and tough guy Chris Pronger and his teammate Claude Giroux, the NHL's leading scorer — both gone and for who knows how long. The debate about CTE is important, but it's a distraction. The debate over fighting is a distraction. This is about head injuries. This is about what we can see. This is what we absolutely know. This is about now.

Bettman and the NHL cannot wait for science. They can't hide behind science, using it as their shield. They must move, and move quickly, out of Stage 2 to Stage 3. No amount of well-modulated, reasonable- and responsible-sounding words change the fact that a hit to the head, whether by elbow, shoulder, or fist, is an attempt to injure that needs to result in expulsion or suspension. No amount of hopefulness and crossed fingers will change the fact that the NHL, like the NFL, must begin to imagine and introduce more "head-smart" ways to play. Bettman needs to be Bettman. We look back on those people 50 years ago who defended tobacco and asbestos and think, How could they be so stupid? Bettman and the NHL cannot wait for this generation of players to get old just so they can know for sure.

Article Written by Ken Dryden.

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