Crosby Calls for No Head Hits in Hockey After Concussion

Allison Gandey

September 08, 2011

September 8, 2011 — Sidney Crosby, one of hockey's biggest assets and one of the league's most visible ambassadors, told reporters Wednesday he supports a total ban on hits to the head at the National Hockey League level regardless of whether they are intentional or accidental.

The strong stance stunned some hockey fans, but Crosby argues the game would not be diminished if head shots were halted. "At the end of the day, I don't think there's a reason not to take them out," he said. "It's an important thing to really look at."

Crosby told reporters Wednesday there is no timeline for his return.

Crosby praised Hockey Canada's decision to ban hits to the head for young people, noting that kids will now grow up learning to play the game without them.

Crosby, who hasn't played hockey since January, when he suffered back-to-back hits to the head, said there is still no timeline for his return to the game. Crosby says he's felt very close, and is practicing at about 90% capacity, but isn't ready to return to play.

"You've got to listen to your body, you've got to listen to your doctors," Crosby said.

The Stanley Cup–winning captain and Olympic gold medallist has the most-talked-about brain in recent history.

At the news conference, Michael Collins, MD, director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Centre in Pennsylvania, said, "We are seeing significant improvements recently. I anticipate Sid returning to hockey and playing well into the future."

"I'm lucky, I feel like I'm in pretty good shape and on the right end of this," Crosby said, adding it's possible he'll suit up in 2011-12. When asked if there was a possibility he wouldn't return to hockey, he smiled and said, "I wouldn't bet on that."

The Penguins season starts next month, but Pittsburgh general manager Ray Shero told reporters the team will take every precaution with Crosby and won't rush him into the lineup.

Some are questioning whether the season-ending blow for the Penguins star center could have been avoided if he'd been kept off the ice after the first hit.

During the Winter Classic matches, Crosby sustained a hit to the head by Washington's David Steckel. Days later, instead of sitting on the bench, he suffered another crushing blow, this time from Tampa Bay's Viktor Hedman. Crosby has been off since January 5.

The NHL star tried to return to play, but concussion symptoms halted his plans. The Penguins' elimination from the Stanley Cup playoffs removed the pressure on Crosby to push himself to get back on the ice. He was hopeful a summer to recuperate would do the trick, but when he works out too hard, his symptoms return to the point Crosby says it is difficult to drive or even watch television.

"In my experience, it takes about 2 to 3 weeks for recovery," Jeffrey Kutcher, MD, director of the University of Michigan's Eurosport program told Medscape Medical News. Dr. Kutcher is currently developing concussion guidelines with the National Basketball Association. "If it takes longer, there is usually some other complicating factors. Being hit again could be a factor," he said.

Dirty Play

"There is an acceptance of violence in sports that needs to shift," Paul Sean Echlin, MD, from the AIM Health Group, in London, Ontario, Canada, said in an interview. Dr. Echlin has conducted studies in this area and says he's alarmed by what he sees.

If I smashed someone's head, I'd be in court the next day.

"Attempts to injure can have life-long ramifications. If I smashed someone's head, I'd be in court the next day and yet in professional sports we act like this is acceptable," he said.

Dr. Echlin works with athletes and loves sports. "We don't need to stop all contact, but there is a big difference between a clean play and a brutal attack."

Dr. Echlin said the consequences of concussion cannot be overstated. "There are young men and women who can't go to school because of their injuries, they have severe headaches, some develop photophobia and can no longer go in bright light. Others can't remember the names of their loved ones."

Players, coaches, and mangers can be too quick to write off hits, calling them "little dingers" or "bellringers," Dr. Echlin said. "Concussion is a serious brain injury and the medical community needs to lead the way on this issue."

Sports Legacy Institute

Over 6 NHL seasons, New York Ranger Derek Boogaard suffered 3 concussions.

The mission of the Sports Legacy Institute is to advance the study, treatment, and prevention of the effects of brain trauma in athletes and other at-risk groups. After partnering with the Boston University School of Medicine, the Institute formed the Center for the Study of Traumatic Encephalopathy.

Investigators are exploring whether cumulative head trauma causes changes to the brain that can result in a progressive decline in memory and executive functioning. Some have suggested that behavior changes, such as mood swings, bursts of anger, and substance abuse problems, can be traced back to a history of repetitive concussions over the course of a career.

Many pro athletes and their families are consenting to the studies and have agreed to donate their brain after death. One of these is Derek Boogaard.

The New York Ranger was sidelined in December 2010 with a season-ending concussion. The blow came during a fight with Ottawa Senator Matt Carkner. Complications from the concussion kept him off the ice through March, and no one predicted the 28-year-old, who built his career as a so-called enforcer dishing out punishment during the game, would die just 2 months later.

Many had considered the 6-foot-7 and 265-pound athlete, nicknamed "the Boogeyman," indestructible, but he was not immune to the ravages of the game. Tragically, Boogaard was found dead in his Minneapolis apartment May 13.

The medical examiner said the death was accidental, the result of a lethal combination of alcohol and oxycodone. At the time, Boogaard was in the NHL Players' Association Substance Abuse and Behavioral Health Program.

At the June draft, the New York Rangers honored Boogaard and invited his younger brother Aaron, also a hockey player, to make the pick. He was drowned out by a standing ovation from the crowd. There were few dry eyes in The Xcel Energy Center that night.

However, in July the case took another tragic turn when Aaron was arrested on suspicion of prescription fraud and possession of oxycodone. Prosecutors in Minneapolis charged the 25-year-old with the third-degree sale of a controlled substance, a felony, and 2 counts of interfering with a death, a gross misdemeanor.

The younger Boogaard allegedly told police he was holding pain relievers for his brother, who he did not believe was in pain, when he gave him a pill. He said his brother "was celebrating and intended to go on a binger."

Over 6 big-league seasons, Derek Boogaard suffered 3 concussions.

More Deaths

The tragic death of retired football player Dave Duerson is raising questions about permanent brain injury.

Since Boogaard's death, 2 more so-called enforcers have died suddenly. Winnipeg Jets forward Rick Rypien and former Toronto Maple Leafs Wade Belak both died last month from apparent suicide.

Hockey lost 3 notable enforcers in the space of 3 months — news that no doubt hit home for the family of Bob Probert, who died suddenly last summer when he suffered a myocardial infarction while boating. Probert, also known as an NHL tough guy, battled his way through more than 200 fights during 16 seasons with the Detroit Red Wings and Chicago Blackhawks. The 45-year-old had suffered at least 3 concussions and wrestled with substance abuse.

The Sports Legacy Institute has also been studying Probert's brain and announced recently he had chronic traumatic encephalopathy.

The problems are not limited to hockey, however, with high-profile examples also seen in football. Researchers at the Institute had the same diagnosis for David Duerson, the retired football player who committed suicide in February.

Duerson was a well-liked player on 2 Super Bowl–winning teams: the 1986 Chicago Bears and the 1990 New York Giants. Before the 50-year-old's death, Duerson wrote a suicide note requesting that his brain be donated to the NFL's brain bank. He then shot himself in the chest instead of the head.

Duerson's ex-wife and their 4 children took part in a news conference that raised serious questions about professional sports and permanent brain injury.

The National Football League's Players Association has launched a concussion and traumatic brain injury committee.

Could these untimely deaths be linked to pathologic changes associated with repetitive head injury? It is a subject of some debate.

One hypothesis that Christopher Randolph, PhD, a neuropsychologist and clinical professor of neurology from Loyola University Medical Center in Chicago, says he's inclined to believe is that brain cell loss can rob individuals of cerebral reserve, leading to an earlier expression of mild cognitive impairment and Alzheimer's disease. It could be "a unique pathology, and something called chronic traumatic encephalopathy has been discussed, and that might eventually be a clinically distinct disorder, something a little different than Alzheimer's disease," he said.

He presented data in July at the Alzheimer’s Association International Conference showing increased cognitive impairment among retired NFL players.

However, Dr. Randolph told Medscape Medical News he's skeptical about the existence of chronic traumatic encephalopathy and is concerned about the lack of blinding in the ongoing brain autopsy study at Boston University. "They seem to find this pathology in the brains of most people they look at, even teenagers who have never had a concussion, so I think we need more systematic study of that phenomenon to be able to reach any conclusions," he said.

Sports-Related Concussions on the Rise

The Centers for Disease Control and Prevention reports that among young people aged 15 to 24 years, sports-related injuries are now second only to motor vehicle collisions as a leading cause of traumatic brain injury.

The American Academy of Neurology is updating its guidelines on the management of sports concussion for an anticipated release date of April 2012.

In the meantime, the academy has released online safety courses to help high school and youth coaches recognize the signs of concussion and know what to do in the event of injury. The 20-minute courses are free, and a printable certificate is available after participants have passed the online quiz. Downloadable coaches' reminder cards are also posted on the site.

"Just about everyone knows a kid who plays a sport," Dr. Kutcher said. "The player doesn't need to be unconscious for the injury to be serious. A headache, loss of memory or balance, even subtle personality changes can all signal a problem," he said. "Unfortunately, the level of care has been inconsistent."


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