RICE & MICE: Concussions are the flavor of the month…

Well, according to Matt Carle on HBO’s 24/7 Road to the NHL Winter Classic last night, concussions are the flavor of the month.

I think it’s safe to say that Claude Giroux has had enough of the current flavor. Giroux returned to game action last night, posting yet another impressive 4 point game. I know many people were concerned with his relatively quick return to the ice. Concerned that he would aggravate his concussion and miss even more time; concerned that he would somehow end up like Marc Savard, Sidney Crosby, or even Chris Pronger. What makes Claude different is that the play resulting in the concussion was recognized and he was shut down immediately and he didn’t return to activity until he was 100 percent symptom free.

Unfortunately, concussions are extremely unpredictable, as no two brains are alike. Take, for instance, St. Louis Blues player, David Perron, who became well acquainted with Joe Thornton’s shoulder during a game in November of 2010. Perron was down on the ice for a minute, didn’t exhibit any other symptoms that night and finished playing the game. Sounds like a similar situation to Sidney Crosby’s concussion in the 2010 Winter Classic. To me, if a player gets hit and doesn’t get up right away, that’s a big clue that points to a possible concussion.

Remember, loss of consciousness is not needed to be concussed and the severity of the concussion doesn’t always match the severity of the hit. In both Crosby’s and Perron’s cases, both seemed stunned or dazed after impact and probably should have been shut down right after the hits. If they had, maybe Crosby would be playing right now. You may recall, Crosby not only finished the game, but continued playing for several days after the hit, when his brain was the most fragile. Maybe Perron wouldn’t have missed a year of his hockey career if he had left the game right after he was hit by Thornton.

The loss of Derek Boogaard over the summer and subsequent confirmation that his brain showed signs of chronic traumatic encephalopathy (CTE) has helped redirect the injury spotlight onto head injuries in the NHL. CTE is similar in symptoms and course of progression as Alzheimer’s disease, yet CTE has been found in young hockey players. The enforcer role has especially come under fire and fighting has gotten the stink eye from many fans as well as non-fans of the sport. I think one of the problems with “tough guys” is that they aren’t necessarily thought of as being concussion prone. As long as fighting is allowed in hockey, the same concussion protocol should be used post-fight as the one used currently after hits to the head or collisions in which a head injury might be suffered.

Of course, what exactly happens to brain cells in a concussion isn’t fully known, but we do know that there is a change in the chemical processes; there is a change in function on the cellular level. We also know that, while post concussion symptoms may not appear for a day or two after the hit, the brain is vulnerable during that time. Unfortunately, concussions aren’t always noticed or diagnosed until nagging symptoms show up days later. None of these symptoms are visible, so the athletes themselves may not realize they have been concussed, since one of the hallmark symptoms is short term memory loss, they may not remember how and where their injury occurred. They may develop fatigue, memory issues, depression and other concussion-like symptoms over the course of a few days that worsen with physical exertion.

In HBO’s 24/7: Road to the Winter Classic, the documentary that gives a behind the scenes look at the two hockey teams that are to compete in the annual outdoor game, we were able to see some of the process involved in handling Giroux’s concussion.

While we don’t know exactly what symptoms Claude exhibited, we were able to see the progression from a symptom-free period, to some light exercise on a stationary bike, to more exertion and finally culminating in a return to play in Dallas last night. Symptoms may not be the same for everyone, some may appear later, while some appear immediately, they may be subtle, or they may be suggestive of whiplash or neck strain and not necessarily a concussion. Symptoms may be a little different for everyone, although certain combinations of symptoms classically occur.  Symptoms can include: nausea and/or vomiting, dizziness, confusion, fatigue (fatigue is very common and often one of the symptoms that players report as being more debilitating and bothersome), light headedness, headaches, irritability, depression or a change in behavior, cognitive or memory difficulties including simple math or problem solving.

Sleep disturbance is also common and overlooked as being a symptom of concussion in professional hockey players because of their travel schedule, which often takes them across time zones and on late night flights, causing difficulty sleeping as well. Balance and vision are also some key areas in which players may not be 100 percent post-concussion. Players often complain about difficulty focusing and just not feeling “right”. The best and most important initial treatment for a suspected concussion is both physical and mental rest.

It may seem that there are many more concussions occurring in the NHL than previously, but I think the NHL has been more aware of the impact of concussions and has taken the stance of playing it safe and not turning a blind eye to the issue.

Giroux may not have had symptoms right after the hit that caused his concussion, but without the diligence of the medical and training staff recognizing that there was a potential concussion, Giroux may have returned to play and caused even more damage to his brain. In fact, following the game, Paul Holmgren said they held Giroux out as a precaution, and said he would be re-evaluated the following days. The training staff, medical doctors and management did the right thing here. Hopefully we will see more teams taking similar precautions with head injuries, and subsequently less long term effects from concussions.