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A head-scratcher for NHL

Many concussions come on legal hits, leaving league with vexing problem

Pittsburgh superstar Sidney Crosby hasn’t played since Jan. 5 because of a concussion. Pittsburgh superstar Sidney Crosby hasn’t played since Jan. 5 because of a concussion. (Gene Puskar/Associated Press)
By John Powers
Globe Staff / February 24, 2011

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Brian Burke remembers how hockey dealt with concussions when he was playing in the minors in the late 1970s.

“Coming back to the bench after you got your bell rung, you puked, you missed one shift, you waited until the cobwebs cleared, then the trainer gave you one of those little ammonia sniffers,’’ says the Maple Leafs president/general manager. “And you went back out.’’

Now, with the number of head injuries on the rise and the game’s best player on the shelf indefinitely, concussions have become what Burke calls the “issue du jour,’’ with more than 60 NHL players reportedly diagnosed already this season. Though the league has banned the most vicious head shots, legitimate checks and accidental collisions have increased the number of injuries.

Pittsburgh superstar Sidney Crosby, who hasn’t played since Jan. 5 after receiving head blows in successive games, was hit inadvertently in the jaw by Washington’s David Steckel, who was dashing for the puck, and then checked legally by Tampa Bay’s Victor Hedman, who pushed Crosby’s face into the boards from behind.

Thus the dilemma for the game’s guardians: How do they keep players from getting their brains scrambled without removing much of what makes hockey hockey?

“There is a reluctance to change the essence of the game,’’ says Bill Daly, the NHL’s deputy commissioner. “The physicality of the game is one of its greatest attractions.’’

The league made a huge change last year when it created Rule 48 to eliminate blind-side and lateral hits in which the head either is targeted or is the principal point of contact. The penalty is stiff: a five-minute major and an automatic game misconduct, with the offender also missing the next game if the referee deems the hit was meant to injure.

“I think that’s a huge step forward for ice hockey,’’ says Dr. Robert Cantu, the neurosurgeon who consulted with the Bruins after Patrice Bergeron and Marc Savard both were put out of commission. “The [first] hit that put Savard out now is illegal.’’

Yet most of the hits that cause concussions — the head-on “north-south’’ shot and the shoulder check — are within the sport’s rules and traditions, and there’s little appetite to ban them.

“Hitting is a big part of my game, and you want to do whatever you can to keep that physicality in the game,’’ says Bruins forward Milan Lucic, who is both the club’s top goal scorer and its trademark thumper. “It is a tough sport and it’s inevitable that concussions and injuries are going to happen.’’

Tricky balancing act Unlike most contact sports, hockey is played in an enclosed space with rigid wooden dashers, glass barriers, and a slippery playing surface that is pavement-hard.

“It’s an inherently unsafe workplace,’’ observes Burke.

Since the workers themselves are significantly taller, heavier, and faster than they were half a century ago, the concussions are more frequent and serious.

“It’s speed,’’ says Cantu, who is chief of neurosurgery service at Emerson Hospital and a professor at Boston University’s School of Medicine. “The guys are big and strong and they hit with great velocity.’’

Despite the rising concerns, hockey players still are less susceptible to concussions than their football counterparts.

“They’re both collision sports, but in football every single day there are subconcussive hits,’’ says Dr. Ann McKee, a BU associate professor who directs the neuropathology service for the New England Veterans Administration medical centers. “Hockey doesn’t have those.’’

Still, the punishing give-and-take of the game has been part of the professional DNA since the NHL was founded nearly a century ago, and hard-nosed teams such as the Big Bad Bruins and the Broad Street Bullies of the 1970s were both feared and admired for their muscularity.

“We’re on record and we’ve said repeatedly that it’s important to maintain the fundamental nature of the sport, which is its physical aspect,’’ says Daly.

But with Savard sidelined for the remainder of the season after sustaining a second concussion last month and Crosby’s return date unclear, there has been renewed focus on the balancing act between keeping players reasonably safe and turning the game into an all-skate.

“We’re ending careers far too early,’’ says Paul Kelly, the former executive director of the NHL Players Association who now holds that post with College Hockey Inc. “There are dozens of guys who could have and should have played five to 10 more years, but their careers were cut short by hits to the head.’’

The concern about head injuries is not new. The NHL was the first professional league to form a working group for the study of concussions, the first to mandate neuropsychological baseline testing, and the first to develop diagnosis and return-to-play protocols. Players suspected of having been concussed are evaluated on the bench by either the team trainer or physician and, if so diagnosed, are kept out of action until they are deemed symptom-free.

Equipment challenges Reducing the number and severity of concussions is a complex undertaking. Suggestions have included enlarging the playing surface, modifying the rink confines, softening the equipment, and changing the rules, but all of them come with tradeoffs.

Expanding the ice from the standard 200-by-85 feet to the international 200-by-98 size would require removing hundreds of prime seats at a time when foreign rinks are downsizing to the North American standard.

Because some concussions result from the player’s head bouncing off the glass, the NHL has been switching from the rigid seamless style back to the original design, with individual panes that are more forgiving.

Since most concussions, though, result from open-ice collisions, the conversation has been more about equipment — specifically helmets and shoulder and elbow pads.

Mark Messier, the Hall of Famer who played 25 years in the league, has developed the M11 helmet that compresses to spread out the impact from a blow and then resets. But Messier and neurologists agree that no helmet can keep the brain from being bounced around by a direct blow.

“Helmets are made to prevent skull fractures and brain hemorrhages, not concussions,’’ says Cantu, who is co-director of BU’s Center for the Study of Traumatic Encephalopathy.

The NHL didn’t require helmets until 1979 and grandfathered helmetless players who were already in the league.

“There wasn’t a whole lot of headhunting back then,’’ recalls Rick Middleton, who played for the Bruins for a dozen years and didn’t wear a helmet until his final three seasons. “Call it respect or fear of retribution. But when the game went to all helmets, the hitting definitely got higher. Guys would come and hit you under the chin.’’

Equipment designed to prevent injuries to the wearer is being used as a weapon.

“If you put bigger shoulder pads on, the players go in harder,’’ says Burke. “If you put bigger helmets on, they go in head-first.’’

A video analysis of 260 reported concussions over four seasons that was performed last year by Toronto neuropsychologist Dr. Paul Comper concluded that 60 percent resulted from a shoulder check.

Making the pads less armorlike likely would lower that number.

“I feel strongly about looking at the shoulder and elbow pads,’’ says Bruins general manager Peter Chiarelli. “They’ve done a good job in making them softer, but I think you have to get them even softer and smaller.’’

Even then, there’s only so much cushion that can be provided in a collision with a defenseman who stands 6 feet 9 inches and weighs 255 pounds.

“The answer will never be technology,’’ says McKee, a CSTE co-director.

Hesitant to change rules Tweaking the rules produces countermeasures as players find ways to adapt to restrictions. When the NHL began enforcing obstruction penalties to cut down on the clutching, grabbing, and hooking that was bogging down the game, defenders put more emphasis on playing the body. Comper’s analysis found that only a quarter of the concussed players had the puck when they were hit and that nearly half of them had just released it.

“When you get the puck and you know you’re going to be targeted, you’re braced because you know the hit is coming,’’ says Cantu. “Once you’ve passed it, your antennae aren’t quite as heightened.’’

While banning north-south head shots clearly would reduce the number of concussions, it also would skew the time-tested equilibrium between offense and defense. As long as a player can see who’s coming at him, he’s fair game.

“From the time you’re 8 years old, you’re taught to keep your head up, and that if you get labeled, it’s your fault,’’ says Kings general manager Dean Lombardi.

Even after he has released the puck, the offensive player has to expect to be taken out of the equation.

“Ever since I’ve been involved in the sport, you’ve been taught to finish your check,’’ says Chiarelli. “If you don’t, the guy knows you’re not finishing the check, so he has that much more freedom.’’

Any change to the rulebook changes the game, which is why both management and players tend to react hesitantly to proposed alterations. While the general managers will deal with the concussion issue at their meeting next month and likely will talk about north-south hits, their sense is that Rule 48 should be given more time to work before more changes are made.

“Whenever you’re going to change a playing rule and people don’t have a degree of confidence in what the result will be, they’re going to be cautious about it,’’ says Donald Fehr, executive director of the NHL Players Association. “The uncertainty is one of the reasons for the caution.’’

There is universal agreement that Rule 48 was necessary and that cheap shots to the head clearly diminished this season with only six penalties (four suspensions and two fines) assessed under the rule and players are more mindful about how they play the body.

“Definitely, guys are thinking a bit more,’’ says Lucic. “If you look at tapes of games where those hits could have happened, guys let up this year. So you can see somewhat of an improvement when it comes to that.’’

But the NHL has never been an ice ballet, not since the Montreal Wanderers and Toronto Arenas first had at each other in 1917. Hockey is by its nature a concussive game, and the risks are obvious to everyone who pulls on a sweater.

“I say to people, these guys are all volunteers,’’ says Burke. “There’s no one out there who was conscripted. They signed on for a game that’s dangerous at times. We have to make it as safe as we can while preserving the fabric of the game.’’

John Powers can be reached at jpowers@globe.com.

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