RICE & MICE will periodically review injuries that are common, uncommon or just plain unique in hockey. I hope to provide some insight to the “how’s, why’s, and when’s” of the injuries that might keep players out of the lineup.
“The NHL player is a marvelous subject for everyone but his physician; they will happily and freely lie to you with a smile on their face about their health,” said Toronto Maple Leafs GM, Brian Burke, in a recent Sporting News article.
When a player gets “dinged,” has his “bell rung,” or just plain gets “knocked out,” a concussion by any other name is still a brain injury. Concussions have long been an overlooked injury because it’s all in the head, so to speak. A concussion is defined by the Center for Disease Control as a traumatic brain injury caused by a bump, blow, or jolt to the head that can change the way your brain normally works. The initial clinical symptoms are from a disturbance in brain function rather than an actual structural injury; however research is underway to examine possible long-term structural and functional effects of concussions in the brains of former NHL players. One has to wonder if long-term damage is a result of a single concussion versus a result of consecutive concussions or not recovering fully from an initial concussion.
Assessment for a concussion starts with observation of the on ice action, watching a player move after impact, a series of questions to test alertness, memory of the injury both before and after impact as well as concentration and orientation or awareness of the player’s surroundings. Symptoms that the player may report include headache, nausea, dizziness, double or fuzzy vision, sensitivity to light or noise, grogginess or fogginess and the ever so popular, “I just don’t feel right.” Signs of concussion include loss of consciousness (though not necessary), looking dazed or stunned, clumsy movement and slowed speech.
Post concussion syndrome encompasses a large number of possible symptoms and is a complication of some concussions. Symptoms can include: headache, dizziness, nausea, tinnitus, blurry vision, hearing loss, double vision, diminished sense of taste and smell, light and noise sensitivity, anxiety, irritability, depression, sleep disturbance, change in appetite, decreased libido, fatigue, personality change, memory impairment, diminished concentration and attention, delayed information processing and reaction time. Loss of consciousness, amnesia, or loss of memory put people at higher risk of developing post concussion syndrome.
We often hear questions asked about “baseline testing” to assess for concussion. Baseline testing is done at baseline or, in other words, when not concussed. Baseline testing simply is a way of measuring how well the brain functions and is integral part of measuring how well the brain has recovered after a concussion. Baseline testing is a great tool when used correctly, because it provides a more objective measurement of recovery rather than allowing an athlete to deny symptoms to return to play. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is widely used by the NFL, NHL, MLS, MLB, and other professional and amateur sports leagues and is widely available. It is a computerized test that takes approximately 25 minutes and measures symptoms, verbal and visual memory, processing speed and reaction time.
Seems foolproof, right? Well, not exactly. Just look at the number of NHLers that make miraculous recoveries from concussions, only to have setbacks and in hindsight eventually admit that it was “too early.” How is this approach not preventing players from early returns that could put them in serious danger? I don’t think a player can fake a post injury test, so what gives? It’s a tool, not a perfect instrument. Players may have a lower baseline test to begin with, which allows them to pass while still having symptoms or most recently, like Jason Pominville, they may be symptom free and have trouble matching their baseline score which could hold them out of action. Baseline testing is meant to be used in combination with clinical judgment.
The quote from Brian Burke above is probably the most accurate assessment of the biggest obstacle to concussion management in contact sports such as hockey and football – the players themselves. There have been a slew of concussions early on this season. Recently concussed, Johan Franzen, joked in an interview that the key to passing the test after a concussion is to not do well on your baseline test. He, like other players, has admitted a willingness to lie about symptoms in order to return to play. Even beloved Flyer, Ian Laperriere, has hinted that if he was 22 he may not be sitting out right now. He also admitted to lying to himself about his symptoms in order to be a part of the Flyers Stanley Cup run of 2010. Maybe it’s an attitude left over from an antiquated school of thought that concussions make you weak and vulnerable.
We have all heard stories of concussed players being targeted when they return to play. Maybe banning hits to the head is an answer to the “warrior mentality” that so many of these players have grown into. For now, teams and players shouldn’t be lulled into a false sense of security because a baseline test is passed just as team physicians and training personnel shouldn’t be lulled into a false sense of security when a player assures them that they are symptom free.
More about the ImPACT test here:
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