RICE & MICE: JVR’s Concussion

So, last season I wrote about the travesty that was Mark Recchi questioning the severity of the concussion that Max Paciorretty suffered during the violent collision between his head and the turnbuckle in Montreal.

At the time I talked about how irresponsible it was for Recchi to pass his uninformed judgment about how severe another player’s head injury was to the media, when all head injuries should be considered severe. Thankfully, Pacioretty has returned to hockey and has been healthy this season.

Unfortunately, I have seen and heard more than once, fans making the implication that James van Riemsdyk is faking his concussion and it honestly just leaves me shaking my head. Yes, his name came up numerous times in trade rumors last week, but honestly, shame on those people that think it may be an act.

Yes, concussions are an epidemic in the NHL, though I don’t think they are increasing in number, I think they are being diagnosed more often and though I commend the NHL’s official stance on handling suspected concussions by taking a player into a quiet room for testing. However, the NHL has to be and do better.

Players like Sidney Crosby, Chris Pronger and now JVR have suffered concussions in games where they continued to play. I suspect that this may be why these players post concussion symptoms have lingered. In contrast, Claude Giroux was taken immediately to the quiet room for assessment after the impact of Wayne Simmonds knee to the back of his head. He was shut down immediately and Giroux missed only 4 games and has returned with no lingering symptoms.

Unfortunately I could write about a different concussion each week , however, I hope that this is the last one I write about for a while. JVR is the latest Flyer to be registered out of commission due to concussion and I am writing about it for a couple of reasons.

First, I am both shocked and disappointed with all of the discussion there has been that he is embellishing or faking the concussion in order to keep his name out of trade.

Second, he played in several games after the concussion occurred, even though training staff tended to him on the ice. In my opinion, if a hit is bad enough and the player needs assistance getting up or a trainer has to set foot on the ice in order to tend to him, that player needs to come out of the game and be assessed in the quiet room.

Third, the way his concussion occurred is a little different than the concussion suffered by Giroux. Yes, he was hit in the head, but not in the 2 games that Paul Holmgren indicated, but in the first game against Ottawa on January 7, 2012.

I suspect that JVR’s concussion occurred on this hit:

Doesn’t look like such a bad hit does it? I mean, one could argue that the impact wasn’t that bad. I even heard a fan (or two) mention that he rubbed the left side of his jaw, when it was the right side that took the impact. Although concussions are still yet to be fully understood, the suspected mechanisms of the injury include compressive forces (directly injury to the brain at the point of contact), tensile forces (injury to the brain opposite the contact), and rotational forces due to stretching and perhaps shearing of the axons of the brain cells.

With rotational injury, the direct force at the point of contact is not solely responsible for the severity of an injury. While the impact of JVR’s injury doesn’t look so bad, the rotational whip of the head after the impact is certainly not good. Imagine a boxer taking a punch to the same area and what the consequences may be.

To complicate matters, in JVR’s case is the impact on his jaw. The joint between the jaw and the skull is fairly unique in that it is fairly freely mobile and provides another area of impact to the skull between the condyle of the mandible (the part of the jaw bone that articulates with the skull) and the glenoid fossa (the part of the skull that houses the condyle of the mandible, creating the joint).

Borrowed from http://www.aaoms.org/tmj.php

Move your jaw around. It can act as a hinge joint, but you can also shift it forward, backward and side to side. It’s a fairly mobile part of the body. Taking impact on one side of the jaw could result in a bruise on that side, but you could also have subsequent damage to the opposite side of the jaw to include, bruising and straining of the muscles.

Hence the reason why JVR was rubbing the opposite side of his jaw.
I don’t think JVR is only suffering from a jaw injury, however some of the symptoms of such an injury are consistent with concussion symptoms, including headache, decreased hearing, dizziness or vertigo, ringing in the ears, neck pain or stiff neck and impaired balance. Also keep in mind that the ear canal sits just behind the jaw joint (Temporomandibular Joint) or (TMJ), so it’s not uncommon to have hearing and inner ear related symptoms with trauma to this area. Hopefully, JVR doesn’t miss a lot of time with his concussion, but I hope he misses enough time to sufficiently heal.

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In a separate thought, Chris Pronger made his first statement in a while in regards to his concussion. Via the team’s official Twitter account, Pronger’s statement: “It is very, very tough right now. I don’t feel well and it hurts so much not to be playing.”

Sounds like a guy that is down and depressed, right? I hope the NHL and the Flyers are getting him help in regards to depression treatment, it sure sounds like he may need it.

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