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NHL's problem with concussions goes far beyond Crosby

| Sunday, Jan. 29, 2012

OTTAWA -- Hockey purists have taken to inventing reasons not to watch the NHL All-Star Game, yet there is a curious reason to pay attention to the exhibition today at Scotiabank Place.

"There is not hitting in a game like this," said Toronto Maple Leafs defenseman Dion Phaneuf.

That does not guarantee the players won't sustain an injury, specifically a concussion, but it's the closest the NHL can come to ensuring player safety.

There certainly was no guarantee in the season's first half.

Seventy-two players missed at least one game because of a concussion or concussion-like symptoms. That's an average of 2.4 players for each of the NHL's 30 clubs, which have 23-man rosters.

The problem has grown bigger than Penguins center Sidney Crosby, the face of the NHL who has played in only eight games since Jan. 6, 2011, because of lingering concussion symptoms.

League and NHL Players Association officials met Friday for a concussion summit that is held at least three times a year, said Mathieu Schneider, a 20-year veteran who serves as a special assistant to NHLPA executive director Donald Fehr.

"Concerned is a good word to use," Schneider said, describing players' feelings. "When you see guys like Sidney with his struggles, obviously, but also Chris Pronger being shut down for the year -- a guy who is big, tough as they come, and had great awareness on the ice -- that sends a message."

Concussions are "the hot-button issue in our league right now," Penguins general manager Ray Shero said.

It's an issue that could have a profound impact on rules of the game, how hockey is played at the highest level, and how players are treated and seek treatment.

Game changes

The issue of brain trauma is unlikely to take up much space at the negotiating table when the NHL and NHLPA go to work on a new CBA this summer. The current CBA expires in September, and while there is no guarantee the sides will avoid a work stoppage, players are not dissatisfied with the way owners have adjusted protocol for concussion management.

A majority of All-Stars here this week, especially veterans such as Philadelphia Flyers defenseman Kimmo Timonen and Calgary Flames winger Jarome Iginla, said they support suspensions for illegal hits that first-year NHL discipline czar Brendan Shanahan has dished out.

There is mounting evidence, medical experts say, that incidental contact can cause a concussion as much as a high-impact leaping check such as the one that drew a three-game suspension for high-profile Washington Capitals winger Alex Ovechkin. The careless hits -- and the blindside shots -- cannot be part of the NHL going forward, Iginla said.

"Fourteen, 15 years ago when I started, you weren't allowed to elbow, obviously, but if your shoulder hit (an opponent's) head, you didn't think much of it and you finished your check," Iginla said, adding he is in favor of Rule 48, known as the "headshot rule."

"Now there is a little bit different way to hit, and there is a learning curve, and we aren't always going to agree with the suspension or penalties, but for the most part we'll adjust."

When Iginla made his debut in 1996, the center red line was in play. The line remains painted on rinks but was "removed" from play after the 2005-06 work stoppage in an effort to return speed to a game that during the previous decade had fallen victim to neutral-zone trapping and clutching and grabbing.

Timonen conceded it might be necessary to reincorporate the red line in today's era of faster, stronger players. However, he said, "I don't know if the league wants to do that right now."

Shero, an outspoken but minority proponent for eliminating head shots, said teams were updated on the concussion issue at a Board of Governors meeting Saturday.

"We've talked about the red line and maybe going back," Shero said. "The end zones are bigger, obviously, and ... when the (behind-the-net) trapezoid was put in, I thought it was a great idea. I'm not so sure anymore. Some of these defensemen that go back for soft chips, it's almost like a punt returner in football that calls for a fair catch and gets steamrolled anyway.

"Maybe we can look at (allowing goalies to play the puck outside the trapezoid) again as well, having them help these defensemen set up some of these pucks and stop some of these hard hits behind the net."

The general managers meet in March for an annual rules discussion. "We'll see if some of these things get brought up," Shero said.

Players' options

During the fall, NHLPA officials toured the league's cities and discussed a variety of topics with its members. Concussions were a priority, Schneider said. That followed a joint effort by the NHL and NHLPA last spring to develop a new in-game concussion protocol, which players lauded.

No player showing symptoms can return to game action before he is taken to a dark room and evaluated by a team physician -- though noted neurosurgeon and concussion expert Dr. Julian Bailes said few professional teams' physicians are neurological experts.

Penguins physician Dr. Charles Burke, an orthopedic surgeon, directs players with symptoms to the UPMC Sports Medicine Concussion Clinic, headed by Micky Collins, a clinical psychologist with neurological training.

During the NHLPA's fall tour, players expressed frustration over the widely held belief that the best concussion treatment is rest -- an opinion Collins shared with the Tribune-Review this summer.

"Guys don't like to hear from doctors, 'Just sit in a dark room and wait till it goes away,' " Schneider said. "They want to be more proactive. I think you'll see more and more proactive treatments, getting guys to be a little more active and aggressive in the process."

Crosby, per his option under the collective bargaining agreement, has sought alternate-opinion treatment from Ted Carrick, an Atlanta-based chiropractor who specialized in neurological issues, and most recently from Dr. Robert S. Bray, a neurological spine surgeon in California.

There was stark contrast in the recovery regimens offered by Collins (rest) and Carrick (activity), though Bailes said there is no conclusive research to position one ahead of the other.

Pronger, known as a hard-edged, big-hitting defenseman throughout 16 NHL seasons, sought a second opinion from Dr. Joseph Maroon, a UPMC neurosurgeon who has worked as a Steelers physician, after being treated by the Flyers' medical team. Maroon diagnosed Pronger with a concussion and shut him down for the season.

"We are all working on different ways to look at it," said Bailes, who has worked with college and NFL players regarding brain-injury matters. "My sense is that (athletes) want to be more involved, and the majority of them don't want to take a passive approach anymore."

Equipment standards

There is an elephant in NHL dressing rooms but one acknowledged by equipment managers and trainers: Most players would rather risk head trauma than wearing unsightly equipment.

This is nothing new in hockey. The NHL had to mandate that players wear helmets, which officials with equipment manufacturer Bauer Performance Sports said originally were designed to prevent skull fractures, not brain damage.

"The aesthetic part is an inescapable part of product development," said Ken Covo, senior director of research and development for Bauer. "By experience, and not just with our brand but others as well, (the industry has) come up with helmets that had various safety features but that looked so different they just weren't accepted by the player."

Bauer unveiled a new helmet Friday. Already worn by current stars such as Flyers center Claude Giroux and Tampa Bay center Steven Stamkos, the Re-Akt helmet is touted as the first to "specifically manage rotational impact forces," which many medical experts believe do the most damage to the brain. At a news conference, Giroux and Stamkos mentioned multiple times that the helmet was "good looking."

Covo said a "data-gathering sensor," such as the Shockbox from Ottawa-based Impakt Protective, could be implanted in NHL helmets starting next season. Some junior clubs already use the device.

Relying on technology he helped develop for Army helmet sensors, Impakt Protective CEO Danny Crossman said the Shockbox measures impact of head contact and delivers that information to a smartphone or tablet that can be accessed by team trainers and medical personnel.

"The sensor can show a timeframe for what the biorhythms were, but it still helps to have somebody on the bench notice that a player is acting off," Crossman said. "The actual diagnosis of a concussion is separate, but this can give a doctor some valuable data."

Players' responsibility

San Jose Sharks forward Logan Couture, an All-Star in his third season, said he has switched mouth guards to a brand that fared better in concussion-prevention testing. He had a concussion as a junior player with the Ottawa 67's.

"They're not fun to deal with," he said. "You've got to protect yourself.

"We need to have more respect for one another on the ice. Some hits don't need to happen. We need to be honest with our teammates if we notice something."

Schneider relayed a story from the Friday concussion meeting. An Ottawa Senators trainer said that, for the first time in his career, a player asked him during a game to check on a teammate who did not "look right," Schneider said.

"One of the things we stressed on the fall tour was that guys who have never had a concussion don't really know what it feels like," Schneider said. "We said to the players, 'If teammates looking after one another and telling the trainer doesn't help, well, not a lot else can be done."

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