Concussions: the untold story

By Cathy Gulli - Thursday, May 19, 2011 at 6:00 AM - 15 Comments

Photograph by George Widman/AP

Before there was Sidney Crosby, there was Eric Lindros. Both were hockey prodigies as young teenagers. Both were drafted first overall into the NHL. Both won the league MVP in their early 20s, both were captain of Team Canada at the Olympics, and both were hailed as the next Wayne Gretzky or Mario Lemieux. And then, in a fraction of a second, both fell victim to devastating concussions. The toll on Crosby, who has been sidelined since January, remains to be seen. But most fans know that Lindros was never the same after a series of blows to the head—at least eight by the time he retired in 2007. What few know, however—what he’s never talked about publicly before—is the psychological and emotional toll of those concussions.

That a Herculean hockey legend such as Lindros (he is six foot four and 255 lb.) is speaking out with disarming candour about the panic and desolation that he has endured is unprecedented. “You’re in a pretty rough-and-tumble environment with this sport. Talking about these things—you don’t talk about these things,” says Lindros. So while he was playing in the NHL, Lindros mostly kept his game face on. “You got to understand, you want to wake up in the morning and you want to look at yourself and say, ‘I’ve got the perfect engine to accomplish what I need to in this game tonight.’ You are not going to look in the mirror and say, ‘Boy, I’m depressed.’ ”

But there were signs that the concussions had transformed him, both as a man and a hockey player, for the worse. “I was extremely sarcastic. I was real short. I didn’t have patience for people,” says Lindros, 38. That rudeness mutated once he stepped on the ice into fear that the next concussion was just one hit away. “That’s why I played wing my last few years,” he explains of changing positions late in his career. “I hated cutting through the middle. I was avoiding parting the Red Sea.” Off the ice, Lindros developed a paralyzing sense of dread at the very thought of public speaking or of being in a crowd—once routine activities for the sports superstar. “I hated, absolutely hated, that. I’d avoid those scenarios. I didn’t like airports. I didn’t like galas. It would stress me out.”

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What really happened to Max Pacioretty?

By Cathy Gulli - Friday, April 1, 2011 at 11:00 AM - 5 Comments

Shaun Best/Reuters; Andrew Post/Neurotrauma Impact Science Laboratory/University of Ottawa

By now, the stomach-churning footage of Max Pacioretty of the Montreal Canadiens slamming headfirst into a post during an NHL game on March 8 is well-known. The hit, delivered by Zdeno Chara of the Boston Bruins, happened in less than a second, but it took several unnerving minutes for medical personnel and teammates to carry an unconscious Pacioretty off the ice. Doctors later diagnosed him with a concussion and a fractured vertebra, from which he is still recovering. Considering the powerful collision, it’s stunning that the 22-year-old wasn’t hurt worse or even killed, as many fans and players feared that night.

But to truly marvel at the dangerous blow that Pacioretty survived, one must watch a precise five-second black and white video just created by scientists at the University of Ottawa. Led by Blaine Hoshizaki, director of the elite Neurotrauma Impact Science Laboratory, researchers have reconstructed a hit similar to the Pacioretty-Chara one. The footage shows a dummy head wearing a helmet similar to the one Pacioretty uses. A metal rod covered in two-inch foam mimics the padded stanchion that Pacioretty struck. An air compressor unleashes the rod on the head form, which is pummelled at the exact same speed and location as when Pacioretty rammed into the post. The impact launches the dummy into a sideways extension—the neck stretches until it’s perpendicular to the rod, before the head form snaps back and slightly rotates.

WATCH THE RECONSTRUCTION

Witnessing the hit recreated in the isolation of a lab makes it all the more disturbing to watch. But for Hoshizaki, the goal is scientific. His team is determined to understand the relationship between brain injuries such as concussions, helmet performance, and the risky hits that hockey players give and take during a game—and to find out whether equipment should be improved or whether certain hits should be banned in the future.

YOUTUBE; Andrew Post/Neurotrauma Impact Science Laboratory/University of Ottawa

The Pacioretty-Chara reconstruction confirms that hockey helmets excel at preventing catastrophic brain injuries such as skull fractures and subdural hematomas, which are caused by “linear acceleration” (which happens when players fall and hit the ice or receive an impact directly through their centre of mass). On the other hand, it also demonstrates that helmets are not built to prevent mild traumatic brain injuries such as concussions, which are caused primarily by “angular acceleration” (a rotational impact such as when a boxer throws a hook punch to the side of an opponent’s head).

What’s more, this reconstruction explains why Pacioretty will probably recover from his concussion faster than superstar Sidney Crosby of the Pittsburgh Penguins, who has been sidelined since Jan. 5. As Maclean’s recently reported, Hoshizaki’s team has reconstructed the first of two hits to the head that preceded Crosby’s concussion diagnosis. That hit occurred on New Year’s Day, when David Steckel (then of the Washington Capitals, now playing for the New Jersey Devils) collided with Crosby—shoulder to the left side of the head—and sent him flipping through the air and crashing onto the ice.

By comparing the two reconstructions, especially the 3-D brain models generated by sensors inside the dummy, Hoshizaki’s team can see the different risk of brain tissue damage each player might have experienced. The results are as fascinating as they are perplexing: the brain model from the Crosby reconstruction shows a rainbow of tissue stress, while the brain model from the Pacioretty reconstruction is mostly blue, representing less risk of tissue damage.

Hoshizaki suggests that although the Pacioretty-Chara hit happened at a higher speed than the Crosby-Steckel one (36 km/h versus 27 km/h), and even though Pacioretty was knocked out, the angular acceleration lasted longer in the case of Crosby than Pacioretty (20 milliseconds compared to seven milliseconds, respectively). Since angular acceleration is so closely connected to the risk of concussion, that might explain why the brain model generated by the Crosby-Steckel reconstruction indicates so much more tissue stress. As well, the researchers hypothesize that the location of the impact on each player’s head may explain why the tissue damage varies. Hoshizaki says that the front of the brain, such as where Pacioretty was hit, may be more robust than the sides, which is where Crosby was struck.

Going forward, Hoshizaki’s team are working toward mapping which parts of the brain are most vulnerable to hits to the head. Meanwhile, fans await the return of Pacioretty and Crosby—whenever that might be.

Reporter Cathy Gulli on Sidney Crosby's concussion

By macleans.ca - Thursday, February 17, 2011 at 3:57 PM - 2 Comments

Shot and edited by Tom Henheffer
Produced by Claire Ward

Read about Sidney Crosby’s concussion in ‘Hits to the head: Scientists explain Sidney Crosby’s concussion’, in the February 28 issue of Maclean’s

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Hit to the head: a similar one to Sidney Crosby’s (reconstruction) (VIDEO)
Reporter Cathy Gulli explains the seriousness of concussions in sports (VIDEO)
The damage done by concussions

Hits to the head: Scientists explain Sidney Crosby’s concussion

By Cathy Gulli and Charlie Gillis - Thursday, February 17, 2011 at 4:00 AM - 20 Comments

Neurotrauma impact lab: University of Ottawa scientists reconstruct hits to the head, including ones from pro hockey, to better understand concussions. Photographs By Blair Gable.

Inside a white cement-block science lab at the University of Ottawa, two young researchers cover a beige crash-test dummy head with a black nylon stocking. It’s supposed to mimic the tousled hair of Pittsburgh Penguins superstar Sidney Crosby, who’s been knocked out of the game since early January because of two massive, back-to-back blows to the head. Here, at the elite Neurotrauma Impact Science Laboratory, researchers led by Blaine Hoshizaki are reconstructing a hit similar to Crosby’s first one to establish the relationship between helmet performance and how concussions occur. That nylon stocking, however out of place it seems, makes sliding a helmet on and off the sticky urethane and aluminum head form easier.

Guided by a laser, they position the dummy inside a Plexiglas cage so that a thick metal rod with a hard, white plastic nib is aimed at its left side—precisely the spot where the cold shoulder of David Steckel of the Washington Capitals hit Crosby during a game on New Year’s Day. Everyone nearby in the hangar-like space puts on heavy-duty earphones and steps behind yellow and black danger tape on the floor. With one press of a red button, a calculated reconstruction of the hit similar to the now infamous Crosby-Steckel one is under way.

Beep! Beep! Beep! A shrill, pulsating tone precedes a bursting whoosh as an air compressor drives the rod into the head form at the exact same speed (27 km/h) and angle as when Steckel’s 217-lb. body collided with Crosby’s head. The crash hurls the head form along a monorail track while it flops back and forth on a dummy neck. However hard the hit looked on the ice, seeing it in the isolation of the lab is disturbing—much like the unsettling feeling one gets from watching footage of crash-test dummies flailing in car accident re-enactments. It’s the distinct surprise that anyone survives these events.

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Hit to the head: a similar one to Sidney Crosby’s (reconstruction)

By Cathy Gulli - Wednesday, February 16, 2011 at 10:30 PM - 5 Comments

This video displays a reconstruction of a hit similar to the one Pittsburgh Penguin Sidney Crosby experienced during a game on Jan. 1 from David Steckel of the Washington Capitals, as conducted at the Neurotrauma Impact Science Laboratory, University of Ottawa.

Scientists led by Blaine Hoshizaki replicated the speed, angle and location of the impact to understand the relationship between head trauma, helmet performance and concussions.

Source for black/white footage: Neurotrauma Impact Science Laboratory, University of Ottawa.
Source for colour footage: Cathy Gulli, Maclean’s

Read about Sidney Crosby’s concussion in ‘Hits to the head: Scientists explain Sidney Crosby’s concussion’, in the February 28 issue of Maclean’s

RELATED:
Reporter Cathy Gulli explains the seriousness of concussions in sports (VIDEO)
The damage done by concussions

The damage done by concussions

By Cathy Gulli - Friday, February 4, 2011 at 9:00 AM - 106 Comments

Brian Babineau / NHL / Getty Images

Until a month ago, there was nothing typical about Sidney Crosby. At 23, the Pittsburgh Penguins captain had already won the Stanley Cup, an Olympic gold medal, and the praise of Wayne Gretzky, who raved in December: “He’s the real deal. He’s the best player in the game.” Crosby had been on a 25-game scoring streak, amassing goals at a faster rate than ever before in his career—and the longest run since Mats Sundin’s 30-game tear almost 20 years ago.

Crosby’s streak came to a crashing end, however, when he was diagnosed with a concussion in early January—having endured two massive blows only a few days apart. The first time, Crosby took the cold, hard shoulder of Washington Capitals winger David Steckel to the side of his head. The velocity of the hit snapped his neck back, and spun him in the air for a full rotation. His 200-lb. body thudded onto the ice, and as Crosby hunched over, his mouthguard slipped out. Eventually, he skated to the bench, bent over. Despite a sore neck, Crosby shrugged off the pain, and played in the next game.

That’s when a crushing check by Victor Hedman of the Tampa Bay Lightning slammed Crosby’s head against the boards. The collision happened so fast that startled fans on the other side of the Plexiglas jerked back in their seats as if Crosby might come hurtling right into their laps. Instead, he melted onto the ice and doubled over. When his face was finally visible, the grimace said it all. ‘Sid the Kid’ was done. Suddenly and spectacularly, Sidney Crosby went from being the golden boy of hockey to just one more pro athlete incapacitated with a concussion.

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Off-key in the NHL headshot chorus

By Colby Cosh - Thursday, March 11, 2010 at 6:08 AM - 24 Comments

A memo to those who are concerned with (hitherto) legal checks to the head in the NHL: I sure hope you’re not just fighting physics. Because you’ll lose.

I see nothing wrong with the proposed new rule against blind-side hits to the head. I’d be willing to take it even further, and adopt an easy-to-apply strict-liability standard; if you hit somebody in a way that induces unconsciousness, or causes a concussion, you sit out the next n games. This would spare us from adopting hard-to-apply rules whose enforcement might ebb and crest, vary between personalities, and differ between leagues and regions. (It would occasionally lead, like all strict-liability rules, to unfair-seeming results and punishments for actions that didn’t look unjust or vicious aside from the outcome. But almost anything is better, at least to my mind, than a rule defined by excessively complex language, taught by means of intuitive references to a mass of individual cases, and left to evolve so that everybody thinks he knows the offence when he sees it.)

Ultimately, we are going to have collisions, and concussions, in the game of hockey, and the general quality of thinking about them is pathetically weak. Almost every columnist is quick to assail the disciplinary and managerial guardians of the game for lacking his own up-to-the-minute moral sensitivities; none stops to consider how unintended changes to the game, fundamental physical factors, may have increased the incidence and severity of closed head injuries. We routinely speak and act as if the rules are the only thing in hockey that humans have control over.

It’s sometimes observed, for example, that the players are bigger and the game faster than 20 or 30 years ago. But nobody ever sorts out the relative importance of these effects; a player whose mass is 5% bigger has 5% more kinetic energy in open ice, but if his velocity is increased 5%, the energy varies according to the square, and thus increases by more than 10%. If you watch early ’80s hockey, what immediately strikes you, once you get past the sheer horribleness of the goaltending, is the relative slowness of the game. There’s no one reason for this: plenty of things have changed just a little bit, from the quality of icemaking to skate technology to the way skaters are trained. And the change isn’t that extreme, or else Chris Chelios, who actually played early ’80s hockey in the early ’80s, would be unable to draw a paycheque in his weak-bladder years. Still, it’s a factor with exponential weight.

No one wants to consider deliberately slowing down the game, but we should at least consider that its speed is part of the problem, and a part we can’t ignore if we want to address collisions at the fundamental level of imparted energy. Otherwise, as the game continues to get faster, we’ll constantly be playing catch-up with rule changes. The speed is there in the game for pure entertainment purposes, just as much as the bodychecking is. It is, without any possible question, part of the game’s danger; more speed means more and worse injuries, all other things being equal. If you won’t consider steps to slow things down, you are in exactly, EXACTLY the same ethical position as somebody who refuses to consider changes to bodychecking doctrine. Hope I didn’t just put a bullet in the head of your high horse.

Another immediately noticeable thing about early ’80s hockey, of course, is the less ridiculous padding. Armour initially introduced to prevent injuries has pretty clearly become weaponized. And the role of helmets in preventing some hypothetical background rate of concussions is poorly understood. The concussions have, by the best measurements we can make, increased as helmets became common and then mandatory.

We can’t do without helmets, since they demonstrably prevent catastrophic and immediately life-threatening head trauma from pucks, falls, and checks. But if players feel more comfortable throwing Cooke-style shoulders to the head now, it’s probably, in part, because everyone wears a helmet. We know that no change to helmet design has ever been shown to reduce concussions. We know that the forces that cause most concussions are rotational, as helmet expert Pat Bishop recently pointed out; and it’s conceivable that, on the whole, helmets worsen the specific problem of concussion by adding more angular momentum to rotational blows [UPDATE: but see commenter Gaunilon's objection to this bit]. The increase in concussions may be part of the price we are paying for the absolute elimination of skull fractures from the pro game.

If so, it’s almost certainly a price worth paying. And, please, spare me the citations of brain-injury data from American football. NFL players are taught to use their helmeted heads as weapons, and linemen are subjected to brain injuries on nearly every snap of a game; that was a major point of the admittedly compelling Malcolm Gladwell article you’re all so impressed with yourselves for having read. (I’ll leave aside the possibility that Gladwell is overselling the findings of some scientists he got all excited about hanging out with, and since it’s Gladwell, by “possibility” I mean “extreme likelihood you could happily bet your house on”.) There’s no analogue to this brutal, repetitive activity in hockey, and no research to justify comparison with the NFL’s problem. Hockey has to solve hockey’s problems, and only hockey’s. Full stop.