We’ve all heard about concussions. It’s been instilled in us as to what they are, their prevention, and as of lately, technology has allowed us to delve deeper into the long-term effects of concussions. Now it seems that we hear a lot about concussions, “insert-player-of-choice-here has been put on IR after concussion during last night’s game.” However, the two major sports organizations who deal with concussions the most seem to handle it completely different. So, let’s go ahead and jump into it.
I’m going to begin by debunking some myths about concussions. First, having a concussion does not mean that you must lose consciousness or that you must have memory loss. These are common symptoms but not necessarily indicators that a concussion took place. Recovery after a concussion is also not an exact science; it can take anywhere from a few hours to a few weeks or possibly months to recover.
Now one of the most serious effects of concussions we will cover is the long-lasting problems that concussions can cause, such as learning or speaking impairments and even impairments with emotional control and stability. The symptoms of a concussion are broken down into four basic categories: thinking and remembering (for example not being able to concentrate or remember new information), physical (such as photosensitivity or vomiting), emotional and mood (someone suffering from a concussion may become easily upset or angered or be extremely depressed), and lastly sleep (ranging from getting too much sleep or not enough for example). After the concussion, many experience “post concussive syndrome” which interferes with one’s ability to concentrate and remember as well as causing persistent blurred vision, changes in sleep patterns, and most notably changes in personality such as anger issues or anxiety.
In 2015, almost 4,000 former professional football players sued the NFL for being negligent in how they handled concussions. Why you ask? As it turns out, even when a patient seems to be back at 100% the brain may not be, this per Dr. Maryse Lassonde a neuropsychologist at the Quebec Nature and Technologies Granting Agency. She had previously worked with the Montreal Canadiens players who had suffered severe head trauma and helped with research to aid in the study of long-term effects concussions have on athletes. What she discovered is that there are abnormal brain wave activities years after a concussion, in addition to partial wasting away of motor pathways.
Not only that, among older athletes, patients develop results like the symptoms of early Parkinson’s Disease, as well as memory and attention deficits. Also, more tests showed that older athletes who suffered from a concussion experience a thinning of the cortex in the same part of the brain that Alzheimer’s also effects.
So, let’s compare now how the NFL and NHL treat concussions. The NFL begins with preseason education and assessments (both physical and neuropsychological). They then review their Emergency Medical Action Plans with the visiting team prior to the game. Then, if a player does show signs or symptoms they must be removed from the field until the club’s trainer has been able to complete a full exam, this in conjunction with an unaffiliated neurotrauma consultant. This is an impartial physician that must be independent from both clubs. In addition, the organization has a spotter that stays in the stadium booth and communicates between all athletic and medical personnel on the sidelines if a player exhibits any symptoms of injury. Thus bringing us to the Madden Rule that protects players by providing an adequate environment for them to recover without any distractions, and if a player is diagnosed with a concussion he is not permitted to meet or speak to the press until medically cleared.
Any player diagnosed with a concussion must have an entire sideline exam performed on the day of the injury, components of the NFL sideline concussion assessment enacted, and depending on the situation, the player must be transported to the ER or be reevaluated before being released to go home.
As far as their return to participation protocol goes, there are four measures that must occur before the player can return to play. First, a player must return to baseline status of symptoms and a neurological exam (such as cognitive and balance functions). Next, a “graduated exercise challenge” and a gradual return to practice and play once the player reaches baseline status. However, before that, the team physician must clear the player as well as an independent neurological consultant. Lastly, a player must be able to consistently repeat their baseline results before being cleared.
Now the NHL begins the season with a video for all club staff including any player signed to the club as well as any player currently playing for a farm team and review of an educational brochure. Each club also begins each season with the following baseline exams: X2 SCAT3 App (which is administered by the team trainers, physicians, or consulting neuropsychologists), ImPACT (which is tested every other year if they haven’t had a concussion in the last year or if they have valid ImPACT test data from 3 consecutive yearly English language tests), and lastly paper and pencil testing (which is tested for players diagnosed with a concussion in the previous season).
Next, if a player produces any of the acute signs or symptoms of a concussion they are immediately removed from the ice as soon as possible. Just like the NFL, there are also spotters to identify possible signs of a concussion. The NHL recognizes the concussion symptoms might develop immediately or over time; so even if a player is suspected of having a concussion they are monitored closely. Any player diagnosed with a concussion shall undergo a period of rest with gradual introduction back to the game. If a player is diagnosed with a concussion they must be referred to the club’s neuropsychologist for a post-concussion evaluation, and it must occur prior to the player engaging in an unrestricted practice or game.
Lastly each player must meet three criteria to returning to play. First, there must be a “complete recovery of concussion related symptoms when the player is at rest”. Second, there is “no emergence of concussion related symptoms at exertion levels required for competitive play.” And third, “the player has been judged by the club’s physician to have returned to his neurocognitive baseline following an evaluation by the club's consulting neuropsychologist.”
So, let’s compare. First, the NFL does not require near the amount of baseline testing required at the beginning of the season. The NHL requires three types of testing to establish a baseline for players, whereas the NFL only requires one. Also, the NHL does not prevent their players from speaking with the press after a concussion. The NHL travels with their own personal neuropsychologist who can evaluate their own players objectively, without having to hire a third-party affiliate. Lastly, the NFL will allow their players to return to play after they have been diagnosed with no concussion, whereas the NHL they are not allowed to return to play.
These are sizable differences. Especially considering the career time of an NFL player compared to that of an NHL player. The average career of an NFL player is the lowest at only three and a half years compared to NHL players who average up to five and a half years. There are more notable hockey players that have played up to 20 years more than football players.
Now a disclaimer, it should be recognized that these are two vastly different sports with vastly different game play. But they should be noted as concussions occur more severely and more frequently. For example, last year alone ESPN reported concussions in the NFL rose by nearly 32 percent, totaling almost 350 reported concussions. In 2014, ESPN reported 53 concussions for the NHL which was a sharp decline from 2012 where there were 78 concussions reported.
Now this shouldn’t come as a surprised to anyone, hockey players aren’t charging into each other head first, or being run into as directly and often as it occurs in football. The NHL has been criticized that their concussion protocol wasn't strict enough in the past, however the article reported on by ESPN was written before the most recent update to the protocol. The update gave more power to the clubs and physicians to prevent their players from returning to games if they even suspect they are not capable. In fact, most concussions reported in the NHL were due to illegal hits, crippling their player’s ego and brains.
However, the NFL reported that the three most common causes were contact with another helmet, contact with the playing surface, or contact with a shoulder. These occurrences aren’t because of bad hits, they can be caused by rough and tumble play in the game as well. They’re harder to prevent, so their rules should be stricter. But, in both sports there’s a stigma. There’s a stigma to sitting out and dealing with it when you’d rather go out and be with your team. In August, Gabriel Landeskog wrote an editorial for the Player’s Tribune on why we need to talk about concussions. In his conclusion he wrote, “Unlike broken bones, concussions are invisible, and that means that everyone in the hockey community needs to unite and redefine what we mean by ‘toughness’ and ‘warrior mentality.’ If we continue to keep quiet, it’s sending the message that taking time to recover is not right or that it’s a sign of weakness. We have to stand up and speak up.”
The point is not to place blame. The point is to treat concussions like actual injuries. Not a “c”-word that needs to be hushed and swept under the rug. The point is that each player is facing serious long term effects if concussions aren’t treated properly from the beginning. The point is that as concussions are becoming more frequent, so is suicide and domestic violence because players can’t control their emotions or are too afraid to deal with the fact that it is an injury.
Speak up. Be educated. Get well, but not too soon.