Monday, 7 February 2011

Head Derails Career

It's tough to sit here and not be concerned about Marc Savard's long-term health after it was announced today that his season was over thanks to another concussion. This one was suffered on a devastating hit by former teammate Matt Hunwick as the Bruins and Avalanche clashed on January 22. This concussion was the second major head injury the shifty centerman has suffered within the last year after taking a major blow to the head from Pittsburgh's Matt Cooke ten months ago. For all intents and purposes, it might be time for Marc Savard to look to a future outside of hockey because I'm not sure his brain can sustain another major jolt without returning some sort of unrepairable injury.

The first thing I think we should do is look at what a concussion is and how it is caused. This is vital in knowing what we're dealing with in terms of how concussions are caused and how they can be prevented.

Jamie Hyneman explored this very subject on an episode of Mythbusters (yes, watching Mythbusters is a guilty pleasure of mine). He spoke to Dr. Wade Smith, the director of neuroscience at University of California-San Francisco, about concussions on an episode entitled "Concussion Confidential".

JH: So what exactly happens in a concussion?

WS: A concussion is when you transfer a force - external - through the skull to the brain. Think of the skull as a box, and you've got the brain inside that has the consistency of jello. When a concussion occurs and force is delivered to the skull itself, the skull moves relative to the brain. The brain stays in one place, and the skull moves against it. That can bruise the brain that's hitting the skull, and it can actually damage the brain opposite that.
Scary stuff, no?

Now, no one I've seen has come right out and called a concussion "brain damage" in the sense of what we imagine brain damage to be, but that's essentially what it is. The issue is that these bruises cannot be seen by the naked eye like a bruise on your arm or leg. And because the brain is a fairly important organ in the human body, the impact of a bruise on the brain can result in long-lasting problems from the sufferer.

Today, on, NHL Commissioner Gary Bettman and Dr. Reuben Echemendia, head of the NHL/NHLPA Concussion Working Group, sat down to answer some of the frequently-asked questions about concussions in the NHL. While this seems more like a PR-move than anything else, I am impressed with Dr. Echemendia's responses, although I'm sure they remain fairly scripted as a way to prevent any spin being put on them.

"We've done a lot of work to take a look at how our testing instruments function with our players across a number of different language groups, across a number of educational groups, and how well our tests are picking up these injuries when we examine the players post-injury," Dr. Echemendia told We've also begun to understand in greater detail how the concussions are being caused in the NHL and using video analyses, for example, that have led us to provide data to the League that has subsequently led to rule changes."

I was puzzled about Gary Bettman's next statement, though.
"Since the implementation of Rule 48 last March... we've seen a decrease in concussions and man-games lost resulting from blind-side hits to head. In addition, we have seen a decrease in concussions caused by hits involving the head that are deemed legal in our game."
Really? So you go from not tracking them to improve the detection of concussions, yet the number of concussions is decreasing? Why is the NHL the only sport on the planet where concussions are decreasing despite piles of evidence to suggest otherwise? However, Bettman contradicts himself one statement later!
"What I'm about to say is based on very preliminary data so you can't hold me to it down the road with precision, because we have to make sure it bears out. But I do want to emphasize what appear to be preliminary trends. For the 2010-11 regular season, concussions are up. Again, I want to emphasize it's preliminary.

"The increase in concussions appears to be in the area of accidental or inadvertent situations as most did not involve any contact whatsoever with the victim's head by an opponent. I'm not saying no concussions came from hits to the head, but it appears the increase is coming from somewhere else."
So accidental or inadvertent contact resulting in a concussion is different than intentional contact resulting in a concussion? Are you kidding me, Mr. Bettman?

Let me be very clear here: an injury is an injury regardless of how it happens. Therefore, a concussion should be tracked as a concussion, and not how it is caused. No one plans on getting hurt while playing the game, but it happens. That's just a fact of life when playing a contact sport.

According to the Center for Disease Control, the fourth biggest killer in the United States are accidents. Accidents result in nearly 37 people killed annually between the ages of 24 and 35 which, not surprisingly, is the demographic that hockey wants to own. Accidental deaths get the same weight as deaths due to diseases of the heart, malignant neoplasms, suicides, and homicides because the end result is all the same: someone died. No death is ranked better or worse, so why does the NHL differentiate between two causes of brain injuries when the end result in both cases is brain injury?

Dr. Echemendia didn't answer either of the questions that Mr. Bettman responded to, but he did weigh in on helmets. It appears as though there are no helmets that will effectively protect against concussions as this time, and Dr. Echemendia addressed that point.
"I absolutely agree with that. Given our current technology, there's nothing out there that is going to prevent a concussion, because in order to prevent a concussion, a helmet has to be able to absorb a significant amount of the blow as opposed to translating the force of that blow. The current polycarbonate shells that we have, those hard shells, they tend to just transfer the blow. They tend not to absorb the blow. And they do that for a very good reason, and that is the helmets that we have are very good at preventing what they're designed to prevent, and that is, as you say, depressed skull fractures, lacerations, significant head injuries. They were never designed to protect against concussion.

"As a matter of fact, there was some concern among the biomechanists that if we tried to make a helmet that prevents concussion; we may be going in the other direction and see an increase in skull fractures and these other types of injuries. So it's a complicated issue."
He also refuted claims that mouthguards help to prevent concussions. Some mouthguards make this claim, but Dr. Echemendia feels that this claim might not be so valid.
"There are no clinical data to suggest that mouth guards protect against concussion. They do a very good job at protecting against dental injury, and good mouth guards should be worn for that reason. But there's no indication right now that they're effective at preventing concussion."
So let's review: concussions are up in the NHL, Mr. Bettman says they are trending down, there are no proven pieces of equipment that prevent concussions, yet we're supposed to believe that the NHL doesn't have a concussion problem.

Is anyone feeling a little wool over their eyes?

Look, I wish nothing but the best for Marc Savard, but you have to wonder why the Bruins centerman is already talking about coming back to play hockey again. I get that there might be a macho aspect to his talk, but I was blown away by the following comment during his press conference:
"I'm obviously going to get more medial tests done and then I'll be able to make a clearer decision on what my future is but, right now, I'm hoping to continue at some point again," Savard said.
I'm not a doctor, nor do I play one on TV, but the best medical advice I can offer to you, Mr. Savard, is to take the next 12-18 months off, let your brain heal, and then see where you stand. As Dr. Smith said to Mr. Hyneman, your brain is the consistency of jello, so it probably doesn't take to being smashed against the inside of your skull very well. Since you had a major brain injury in the last calendar year, maybe it's time you give your head some rest and let your brain make itself right.

I'd say "give your head a shake", but I don't want to be responsible for any additional damage to your gray matter.

As for Mr. Bettman, how long will this charade about concussions in the NHL continue?

Until next time, keep your sticks on the ice!

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