Concussions In The NHL

Hockey is “…an aggressive fast moving game that sees players moving at speeds of up to 30 kilometers per hour. Given the speed and aggressiveness with which the game is played, it should come as no surprise that ice hockey has the highest rate of concussion incidence amongst contact sports”. On June 2nd of 2018 during the Stanley Cup Playoffs, Brooks Orpik of the Washington Capitals sustained a massive blow from another player, James Neal. “His skates came off the ground, and he landed hard”.

This hit, and the decision by the NHL whether or not to take him off the ice, was the topic of the article that I chose. A concussion is a brain injury characterized by some kind of force afflicting the head, neck and can even be caused by hits to various other parts of the body. A test called the SCAT3 is used to determine to what degree a player is concussed.

This test is characterized by series of smaller tests, including a symptoms report from the player, having them do various balance testing stances, a heel to toe walk to determine if there is an error in the player’s regular gait, a coordination test where they touch fingertips to the nose, and a cognitive function assessment where players are asked to answer common sense questions such as the date or their names, or to remember a list of words that they will be asked to recall later in the day.

If there is even a small suspicion of a head injury, this test is administered first thing after a player is pulled from the ice because it can sometimes be harder to tell whether or not a player has been afflicted.

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In the NHL, less than a quarter of the players deemed to be concussed showed any symptoms of head injury while being assessed on the ice.

On-ice symptoms often include: being slow to get back on their feet, clutching of head or helmet, and disorientation. After leaving the ice, on day of injury symptoms could also include loss of balance, decrease in cognitive functions and even emotional changes or symptoms. Especially in such a fast and full contact sport, it is especially important to pay close attention to the head injuries that players sustain. The article written by Jason Izraelski discusses the effects of concussions in the NHL and the risk factors that increase the risks of injury. He states that 2-14% of all hockey injuries are concussions and, in this country, “at least eight players have been forced to retire due to lingering concussion symptoms, while many more missed weeks, months and entire seasons”. This alone should speak to how serious a head injury could be, and it proves that the symptoms could possibly last a lifetime. In the recent decades, concussion rates in the sport have risen from a mean of 12 per season in the 80’s and early 90’s to a mean of 56 per season in the late 90’s to early 2000’s.

This article cites the reason for that being was the start of the NHL Concussion Program in 1997. This program was a joint project with the NHL and the NHLPA and it was created to bring more awareness to the condition and educate those working with the affected players (Izraelski, 2014.) The development of these protocols and programs brought to light the amount of head injuries that went unnoticed. Along with discussing the rise in concussion rates, this article also considers the certain risk factors that could contribute to the number of players that end up concussed. The most obvious of the risk factors is the position the player is in on the ice. From the late 90’s to the early 2000’s, roughly 64% of players who sustained head injuries were forwards, 31% were defense and 5% were goalies.

Given that the job of the forward is to be in possession of the puck with the intent of scoring, it is safe to say that they are the players who take the most hits in the game. Another important risk factor is how tall and how heavy a player is.  The author states, “the hitter was taller than the injured player in 52% of the events, with the hitter being heavier than the injured player in 65% of the cases”. According to NHL protocol, in order to be removed from the game for suspicion of concussion by the league, there has to be clear contact with the player in question’s head, if not it is at the discretion of the coaching and medical staff of the team.

When the replays of the hit were viewed, there was no indication that Neal had hit Orpik in the head, therefore it was not required by the NHL that he be removed from the game. Even though he remained down on the ice for a period of time, he did manage to skate back to the bench on his own. Orpik was benched for the last few minutes of the game, and he was put in for his next shift immediately following the hit. This was cause for much criticism, especially because It is well known that repeated head trauma can in some cases lead to CTE, and “Commissioner Gary Bettman has said that he does not believe there is proof of a link between concussions and Chronic Traumatic Encephalopathy, the degenerative brain disease several deceased hockey players have been shown to have”.

Also to be noted, this is not the first time in the recent years that Orpik has sustained head trauma. In 2013, he was benched for two weeks, and in 2016 missed three playoff games, both due to possible or confirmed concussions. Given Orpik’s concussion history, there is no question that he should have been removed from play. An article in The Journal of Science and Medicine in Sport, the authors state that being able to recognize concussion symptoms and immediately removing the player from the game will dramatically reduce the probability of the player becoming more injured and will allow them to return to the game faster. Concussions are a serious and sometimes life-altering injury that most certainly deserves the amount of attention, if not more, that it receives. Along with continuing to bring awareness to this issue, “The NHL should continue to take strict action in enforcing bans on hits to the head…” and continue to be vigilant with its protocols for head injuries to protect its athletes.

References

1.  Izraelski, Jason. ‘Concussions in the NHL: a narrative review of the literature.’ Journal of the Canadian Chiropractic Association 58, no. 4 (2014): 346+. Academic OneFile (accessed September 8, 2018). http://link.galegroup.com.online.library.marist.edu/apps/doc/A394517006/AONE?u=nysl_se_marist&sid=AONE&xid=1b6f170e.
2.  Comper, P., & Hutchison, M. (2013). Acute clinical signs and outcome of concussion in national hockey league (NHL) players. British Journal of Sports Medicine, 47(5) doi:http://dx.doi.org.online.library.marist.edu/10.1136/bjsports-2012-092101.34
3.  Hänninen, T., Parkkari, J., Tuominen, M., Öhman, J., Howell, D. R., Iverson, G. L., & Luoto, T. M. (2018). Sport concussion assessment tool: Interpreting day-of-injury scores in professional ice hockey players. Journal of Science and Medicine in Sport, 21(8), 794-799. doi:http://dx.doi.org.online.library.marist.edu/10.1016/j.jsams.2017.12.001
4.  Kilgore, A. (2018, June 03). Brooks Orpik returns after brutal hit, prompting scrutiny of NHL concussion protocol. The Chicago Tribune. Retrieved September 11, 2018, from http://www.chicagotribune.com/sports/hockey/ct-spt-brooks-orpik-concussion-20180603-story.html