Concussion discussion V: NHL fighting and the elusive nature of recovery times

Fighting in hockey. They go hand in hand like, well, toothless grins and hockey. Over the years, the NHL has taken steps to reduce fighting in hockey, while still leaving enough wiggle room for the rare enforcers left in the game. Like all sports, hockey culture once considered the concussions that came with fighting merely a minor nuisance. Recent data, however, appears to support the notion that head injuries may contribute to long-term disability. For instance, enforcer Derek Boogaard, who passed in 2011, was found to have developed Chronic Traumatic Encephalopathy (CTE). Data linking CTE to fighting is scarce, but the possibility remains very real. In fact, experts at the recent Ice Hockey Summit on Concussion recommended that fighting be removed from all levels of hockey. Former enforcer Nick Kypreos gives one of the best interviews concerning the role of fighting in hockey, its cultural meaning and the challenges in the life of a fighter, VIDEO: The Code.

Source: ArtBrom

An unintended consequence of the loss of fighting is that it could result in liberties being taken against players, especially star players without repercussions. This trend started in the 1990′s when strategies like the “trap” or the left wing lock brought a wave of hooking, holding and interference that almost ground the NHL to halt. The idea that fighting acted as a deterrent to violence against the game’s stars goes back to the days when Wayne Gretzky had enforcers Dave Semenko or Marty McSorely to prevent teams from taking liberties with the Great One. However, the old protections were been swept away and new ones have yet to take hold. If fighting is no longer the deterrent, then referees must fill the void and protect players by strictly enforcing the rules. Whether this is even possible is the million dollar question. This year, ex-power forward Brendan Shanahan is taking the most aggressive approach concerning enforcement ever seen in the NHL. Although concussions are reportedly down this year, head injuries have claimed the likes of NHL point leader Claude Giroux and superstar Sidney Crosby. Only time will tell whether these new rules enforcements are being successful.

Overall, more concussions are being reported in recent years (559 NHL concussions between 1997 and 2004, Benson et al., 2011), due in part to our increasing awareness and abilities to detect such injuries. With all of this information, teams are now keeping their players out longer than ever before (see Fig, 1). For instance defenseman Chris Pronger has been ruled out for the remainder of the 2011-2012 season, including the playoffs. This decision was made in DECEMBER. However, even prolonged rest is not a guarantee of recovery. The hockey world now holds its collective breath as Sidney Crosby is again sidelined after just 8 games back from a year long absence. With all of our testing and protocols, we still appear to lack a reliable method of dealing with concussions.

From Benson et al., 2011. A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program

So how long should players be kept out? Speaking only from my own experience having had two hockey related concussions in one month (and possibly a third), it took two years to recover from my symptoms. After 1 year I was seemingly back to normal without headaches, nausea or memory loss. The only time that I could tell that my head was still not right was any time I was on a boat, even in calm waters, where I was overcome by nausea and felt like I was going to throw up. I’m not sure what exactly was wrong, but some ability to balance was still missing. I thought my head would forever be “fragile” in this sense, but with another year, the symptoms faded. I’ve never heard of any studies on the recovery 1,2 or 3 years after a head injury. It’s a long time for typical research studies to track and for professional teams, it is an extremely long time to wait for a player. But could this be the future of hockey? Take steps to prevent concussions or wait 2+ seasons to get players back on the ice? How often can professional players not named Mario Lemieux make it back after two years away from the game? If true, we won’t just be talking about rule enforcement, we’ll be talking about serious litigation. These are the hard questions that face the NHL.

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