National headache league

Now it's hockey's turn to examine a growing concussion problem

Updated: December 29, 2009, 9:30 AM ET
By Peter Keating | ESPN The Magazine

This column appears in the January 11 issue of ESPN The Magazine.

It ends like this: You're dead, your body on a slab, slices of your brain under a microscope, your family sobbing as doctors try to figure out what happened to you.

This is the final stage of the brain damage that can result from too many hits to the head, which can lead not only to early dementia and memory loss but to irrational and violent behavior. Scientists have seen this damage inside the skulls of boxers, football players, wrestlers and, now, for the first time, an NHL player: Reggie Fleming, who skated from 1959 to 1974 and died last July at 73. "The brain doesn't know what causes it to be shaken, whether it's a helmet-to-helmet hit, a left hook or a check," says Robert Cantu, a neurosurgeon and co-director of Boston University's Center for the Study of Traumatic Encephalopathy. Cantu and his colleagues have examined the brains of Fleming and nearly two dozen other athletes who sustained repeated head trauma. Their analysis shows the same evidence in all sports: a buildup of a protein called tau that forms in tangles and threads, destroying cells and causing brain malfunction.

The 2009-10 NHL season has already been marred by a series of horrific hits, each resulting in a concussion: Florida's David Booth left the ice on a stretcher after being smashed by Philly's Mike Richards; Chicago's Jonathan Toews was barely able to make it back to the bench following a hit by Vancouver's Willie Mitchell; Colorado's Darcy Tucker was knocked out and rushed to the ER because Carolina's Tuomo Ruutu rocked him. The hurt has underscored how easily hockey players can receive concussions and how hard those injuries are to prevent and treat. Body checking and fighting are rampant, and ice, boards and glass all inflict serious damage when heads hit them at high speeds. But the long-term trauma on the brain caused by a severe blow can be assessed primarily posthumously. In the early stages, CT scans and MRIs are often useless, so doctors and trainers rely on athletes to communicate symptoms. That, in turn, highlights a problem specific to the NHL: Players speak at least eight languages, complicating the interactions that are crucial to analysis and treatment.

Medical experts believe that head injuries are alarmingly common in the NHL, and the number of games lost to concussions is increasing faster than the league's overall rate of injuries, which could indicate either that concussions are getting worse or that teams are taking them more seriously. A 2007 study by the Orange County Register found that NHLers are five times more likely to experience concussions than NFL players. One thing is for sure: Brain trauma is sending hockey players to the bench and into retirement. And, as Fleming's case suggests, it is putting them at risk for memory loss, depression and dementia.

To its credit, the NHL has started looking at the causes and effects of concussions and has conducted baseline tests of players since the 1997-98 season. The league mandates thorough neuropsychological evaluation after a player is injured, and team medical staffs administer follow-up memory and motor-skill tests to make sure he has returned to his baseline, or preinjury, level of cognition and performance. The NHL has also made important discoveries unique to hockey. For example, the symptoms that players report vary by native language. Swedes are more likely to admit to sleeplessness than Czechs; French speakers are more likely than Russians to say they have headaches.

Still, there's a lot the league doesn't know. What causes more concussions: hits to the back of the head, the side of it or the jaw? What effect do helmets and shoulder pads have on head injuries? What percentage of concussions come from fighting? How long should players sit out? How many concussions can a player safely endure? Do subconcussive hits cause cumulative brain damage?