A remorseful sounding Owen Nolan recalls the scene as “pretty scary.” During a Feb. 1 National Hockey League game, the San Jose Sharks captain levelled an unsuspecting opponent with a forearm smash to his head. The blow knocked Grant Marshall's helmet forward and the Dallas player's exposed head smacked the ice. For several minutes, he lay motionless before regaining consciousness. Scary, indeed—but his injury is hardly uncommon in hockey. By the end of December, the NHL had already recorded 67 concussions this season. The Calgary Flames alone had 12. Recovering from a concussion is a frustrating test of patience for a fit athlete accustomed to playing with injuries. “You cannot work through a brain injury,” says Dr. Karen Johnston, director of neuro-trauma at Montreal’s McGill University Health Centre. Attempting to do so with pain, headache or other symptoms, she adds, “is a one step forward, two steps back situation.”
Dainius Zubrus learned the hard way. The high-scoring
Montreal Canadiens forward missed 19 games after getting a knee in the head during a game before Christmas. Zubrus, 22, knew he was not supposed to exercise, but as he started feeling better he fretted about losing his conditioning. “I thought if I rode a bike maybe it wouldn’t be that bad,” says Zubrus, but the headaches immediately returned. He went to see Johnston, a neurosurgeon, who has examined many current and retired NHL players, among them Philadelphia Flyers centre Eric Lindros, who suffered six concussions in a 27-month period. Typically, Johnston runs players through a two-day battery of tests that tap into the concussion research she is leading on elite athletes. In an area with few scientific means to assess the injury, the McGill concussion project is exploring ways to evaluate damage to the brain. As it stands, most concussions among athletes go undiagnosed, she says, “mainly because you don’t need to lose consciousness to have a concussion. And that’s a fairly new concept.”
Blows to the head have complicated hockey careers, in-
eluding those of the New York Rangers’ Mark Messier and Anaheim Mighty Ducks star Paul Kariya, and ended many others. Before the current NHL season started, referees warned players they would enforce rules involving blows to the head. And in the case of the Feb. 1 incident, the league suspended Nolan for 11 games. It also supports an ongoing concussion study and set up a panel last fall that tracks and analyzes injuries.
In her hospital office, Johnston grabs a white plastic skull from her bookshelf to demonstrate what happens to a concussed brain. The soft tissue swivels inside the skull and rebounds off the bone. “It’s going back and forth in there like Jell-O,” she says, “and it gets bruised as a result.” But many aspects of concussions remain an enigma. Doctors do not know how to grade their severity or determine precisely when an injured athlete is fit to play again. Standard CAT scans and magnetic resonance imaging (MRIs) are not effective in assessing concussions. “We don’t know the pathology of the concussion,” says Johnston. “I think it’s on a much smaller molecular level than you would see on a scan.”
Johnston and two neuropsychologists are studying different diagnostic tools to evaluate concussions. Traditionally, doctors focused on whether there was loss of consciousness. But the McGill research suggests more emphasis should be placed on post-concussion symptoms. One of the most promising aspects of their work involves measuring electrical activity in the brain. An athlete with electrodes placed on his scalp responds to visual cues on a computer. The brains of concussed athletes who are still experiencing symptoms show abnormal responses, but the researchers have found no co-relation to the severity of the last concussion. “Even if they weren’t knocked out,” says Johnston, “their abnormalities may be greater than someone who was knocked out.”
Follow-up testing has shown that an athlete’s responses return to normal once his symptoms of concussion have disappeared. That finding is important, says Johnston, pardy because it provides the first means of measuring recovery. In another part of the study, athletes perform memory, visual and verbal tasks on a laptop computer while an MRI shows pictures of their brains in action. Athletes who have had concussions frequendy complain of specific types of shortand long-term memory problems. The test shows researchers if an area of the brain is appropriately activated—the MRI will reflect an increased blood supply to that region. “This is the first sense that we can really measure something,” says Johnston.
NHL players also undergo neuropsychological testing as part of the concussion study launched in 1996 by Dr. Chip Burke, the team physician for the Pittsburgh Penguins. A baseline test assesses such things as memory and concentration. When a player sustains a concussion, the results of new tests can be compared with the original findings. “When people have symp-
toms of concussions,” says Burke, “the tests show abnormal results. But as their symptoms improve, their test results improve.” While Johnston thinks the NHL is on the right track in trying to standardize evaluation, she sees a major limitation in the neuropsych test. It is what is called the practised effect— people get better at the test each time they take it. She has examined athletes who return to baseline results on their neuropsych testing while they are still showing symptoms of their concussion and are “clearly not ready to return to play.” Some players and officials familiar with the NHEs efforts feel the league has taken the lead among professional sports when it comes to concussions. Others, including Lindros’s
The testing of injured athletes provides new insight into evaluating concussions
younger brother, Brett, who suffered a career-ending concussion in 1995, support some initiative but with reservations. “I don’t think there has been anything landmark done by the league or the players’ association,” says Brett Lindros, “to attack this issue and get ahead of it.”
The number of concussions has remained steady—a little above 100 a year—in the 4V2 years that the league has been collecting data for Burke’s study. While many head injuries result from open-ice hits, the injury analysis panel is also looking at other possible contributing factors. The ultra-sturdy elbow pads now in use may be one culprit. Another could be the seamless “glass”—actually an acrylic— used in many arenas. It gives fans an unobstructed view of the game, but players find it less forgiving than the Plexiglas still in use in some rinks, and the boards that support
the new glass are particularly rigid.
One more cause of concern is the larger size and, some argue, more boorish behaviour of current players. “If you go back 20 or 30 years ago, you didn’t see guys coming at the other guy’s head with their elbows,” says Dr. Willem Meeuwisse, team physician for the Calgary Flames. Some players pay little heed to safety, leaving chin straps too loose to keep their helmets on in a hit. The league, says Brett Lindros, should enforce safe practices. “If guys don’t tighten
their chin straps,” he says, “they might as well not wear helmets.”
Doctors agree that athletes should never return to their sport while still showing symptoms of a concussion. And even a rehabilitated player risks greater symptoms from subsequent hits, Johnston says. NHL old-timers she has examined would
head straight back out to play after getting concussed, then feel disoriented for hours. Some, she says, now have to deal with continuous headaches.
Still, the pressures to play remain part of the game. Zubrus returned to the Canadiens lineup on Feb. 6 feeling slighdy off his pace. After three concussions, he concedes, “of course you’re afraid to get another one.” But it’s not something he dwells on. “As a forward, I need to go into the corners,” Zubrus says. “I need to battle.” ES]
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