The issue of fighting in hockey, especially in major junior leagues and below, and whether it’s time for it to go away isn’t going to leave us any time soon.
In fact, there are those in the medical profession who wonder if government agencies will at some point have to get involved to bring the fighting to an end.
Here’s a letter from one of those medical professionals, a hockey mom who lives in B.C., and who deals a lot with Alzheimer’s patients.
(NOTE: The numbers in parentheses refer to notes that are referenced at the end of the letter.)
———
I believe it is time for the medical community to consider the evidence that we have and to act to pressurize this government to protect our children who play hockey.
Last year, the Western Hockey League, a junior league that has players aged 15-20, reported 100 concussions. A prospective study of concussions in junior hockey in Ontario (1) showed that concussions are under-reported in junior hockey, suggesting that this number is probably a lot higher. This study also found that 25 per cent of concussions were caused by fights.
We now have neuropathologic evidence of an early onset dementia (Chronic Traumatic Encephalopathy — CTE) in two NHL enforcers — Bob Probert and Reggie Fleming.
Clinically Chronic Traumatic Encephalopathy is characterized by memory disturbances, mood disorders, behavioural and personality changes, parkinsonism, and speech and gait abnormalities.
Dr. Ann C. McKee (2) reviewed 47 cases of neuropathologically verified CTE in the literature showing atrophy and neurofibrillary tangles in a characteristic pattern. Ninety per cent of cases in the review were in athletes — 85 per cent were boxers, 11 per cent were football players, one was a professional wrestler, and one a soccer player. They began their sporting activities between 11 and 19 years of age. They first had clinical symptoms between the ages of 25 to 76 years.
Of the football players, two committed suicide and two died in traumatic circumstances. A recent report in The Globe and Mail of brain pathology of four deceased CFL players reveals CTE in two and Parkinson’s disease and ALS in the other two (3).
In the hockey world people are shocked by the recent deaths of five young “enforcers.”
Probert, 45, died of a heart attack, but was found to have CTE.
Derek Boogaard, 28, died of an overdose after struggling with chronic pain and memory loss.
Barry Potomski, 38, died of a heart attack.
Rick Rypien, 27, died last month, presumed from suicide.
On Wednesday, the apparent suicide death of Wade Belak, 28, another enforcer, was reported.
The neuropathology is not yet available on the last four men, although researchers are in the process of examining Boogard’s brain.
Boogaard's challenges of substance abuse, memory lapses and depression are highly suggestive of the clinical histories of other athletes with documented CTE. Some NHL enforcers are coming forward to talk about their experiences of impaired memory and chronic headaches, disability and struggles with substance abuse. Marty McSorley is quoted as saying: “Then there are times when I'll walk into a room and I'll stand there and go 'Why am I here again?' — and you just don't know.” (4).
These are the facts we know.
What we don't know is how many concussions are required to cause CTE. We don't know if a young brain is more vulnerable. We don't know if seven concussions in a WHL career will be enough to set in place the cascade of damage that causes CTE.
I believe we don't need to know those facts to act and to push the provincial government to ban fighting in junior and recreational hockey and create increased accountability from the hockey system for head trauma to young athletes. This is a preventable dementia and we need to do what is necessary to prevent it.
The WHL has put in place new rules regarding hits to the head (and has moved to soften shoulder and elbow pads) and that is excellent news. However, there is no movement on banning fights. There is no way of knowing whether fighting or other causes of head trauma pose the bigger risk and I don't think it matters. We do know that the hockey players who have suffered most from this disease were enforcers and that 25 per cent of concussions in Jumior hockey are caused by fights. Fighting is gratuitous and preventable and the coaches and the referees, the fans, the parents and the whole WHL system are accountable for it.
Why is the provincial government not calling in child protection services to disallow adults from sending children out to fight against each other for the entertainment of a crowd?
Surely we need to step up and protect these children? Particularly as we are now aware of a very real risk of long-term devastating damage.
I am a hockey mom — I love the game, I love the kids who play it and I have loved my involvement with junior hockey. We owe it to all of our kids to ensure that they are safe when they go out on the rink.
———
(1) Echlin PS Neurosurg Focus. 2010 Nov;29(5) A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates.
(2) Ann C. McKee, MD, J Neuropathol Exp Neurol. 2009 July; 68(7): 709-735. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury
(3) Allan Maki, Globe and Mail, Tuesday, July 26, 2011 Donated brains of two former CFLers show signs of disease
(4) Globe and Mail March 2011 Young players poorly protected, Marty McSorley says.
gdrinnan@kamloopsnews.ca
gdrinnan.blogspot.com
Taking Note on Twitter
Showing posts with label Reggie Fleming. Show all posts
Showing posts with label Reggie Fleming. Show all posts
Thursday, September 1, 2011
Thursday, March 24, 2011
Concussions, CTE mean it's time for fighting to go
The time has come to rid major junior hockey of fighting.
There. I said it.
And you know what?
It doesn’t feel half bad. In fact, it feels pretty good.
Having been around the WHL for more than 30 years, I have long been a drinker of the Kool-Aid. When hockey people would say that fighting is an integral part of the game, that a fight could swing a game’s momentum one way or the other, that players rarely got injured in a fight, I would nod my head in agreement.
Fighting, the hockey lifers will tell you, has always been part of the game.
And it has been. Just like the centre-ice red line. And goaltenders handling the puck without restrictions. And obstruction. And one referee.
But now it’s time for fighting to go.
Why?
Because the time has come for the WHL to rid its game of headshots. It has to do this because it is imperative that it do more to protect its young players from concussions.
And it would be hypocritical to invoke a ban on headshots and not take fighting out of the game.
How can you ban headshots while saying it’s OK for two players to stand there and punch each other in the face?
My thinking started to change about the time that researchers at the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine revealed that an examination of the brain of former NHLer Reggie Fleming, a disturber in the 1960s who died in 2009, showed indications of chronic traumatic encephalopathy (CTE).
Then, in the last while, the same researchers found CTE in the brain of former NHL enforcer Bob Probert.
That, along with some on-ice happenings, has made headshots and concussions the hot-button topic in and around hockey at all levels.
Also influencing my thinking were incidents involving Sidney Crosby and Killian Hutt, Zdeno Chara on Max Pacioretty, Matt Cooke on Marc Savard and on and on.
And then came an email from the mother of a WHL player. She expressed concern over the number of concussions and head injuries in the WHL this season, a figure that now has reached at least 100. This wasn’t your ordinary email, because it came from a professional who provided documentation, some of it frightening, to every statement she made.
It is most obvious that, while the study of concussions and their long-term effects is in its infancy, head injuries no longer can be looked at in the short term. Studies that have been done contain too many words and phrases like “ongoing impairment” and “recurrent or cumulative damage” and “chronic neurocognitive impairment” and “early onset of dementia.”
During the 2009-10 season, a group of medical professionals, including Dr. Charles Tator, who is considered Canada’s pre-eminent expert on sport concussions, put together the Hockey Concussion Education Project, a study involving “67 male fourth-tier ice hockey players from two teams.”
Physicians involved attended 52 regular-season games involving junior-aged players and observed 21 concussions to 17 players. “A concussion was diagnosed in 19 (36.5 per cent) of 52 observed games,” the resulting report reads.
It is interesting, too, that “no concussions that occurred in practices were reported by either team during the study. Previous sport concussion studies demonstrated that concussion predominantly occurs in game situations.”
The professionals involved in this study, however, ran into some problems.
As they reported: “Complaints by coaches, players and parents concerning the inconvenience of multiple physician visits for serial testing and evaluation were common. The reluctance to report concussion symptoms and to follow such protocols likely results from certain cultural factors such as athletes asserting their masculinity by playing through the discomfort of an injury, and the belief that winning is more important than the athlete’s long-term health.”
The report summarized that “the incidence of concussion in fourth-tier junior ice hockey players was significantly greater than has previously been reported in the literature for this age group.”
Another report — this one by Drs. Jeffrey S. Kutcher, Christopher C. Giza and Anthony G. Alessi, titled simply Sports Concussion — concludes with this:
“Increasing animal and human data suggest that the developing brain’s reaction to concussive injury is distinct from the mature brain, and that age-specific clinical guidelines for concussion management be developed, with perhaps a more conservative approach to assessment and recovery.”
You don’t have to look very hard to find warning signs and lots of them.
According to one study involving U.S. college football players, those who suffered one concussion “were 3.4 times more likely than uninjured teammates to sustain a subsequent concussion during the same season.”
And then there is this from a study titled Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma:
“A minority of cases with neuropathologically documented CTE developed dementia before death; the relative infrequency of dementia in individuals with CTE may be due in part to many individuals with CTE having committed suicide or died from accidents or drug overdoses at an early age.”
Unfortunately, the only way to diagnose CTE is through the examination of a brain, although efforts are being made, according to this report, “to identify biomarkers to detect the disease and monitor its progression and to develop therapies to slow or reverse its course.”
In the meantime, the WHL, indeed all of hockey, owes it to the athletes to do more to protect them from themselves.
“It is widely accepted that the symptomatic effects of up to 90 per cent of concussions are short-lived, lasting only seven to 10 days,” reads the report titled Sports Concussion. “This viewpoint puts sports concussion in the light of being a transient phenomenon with little or no long-lasting effects. There is increasing concern, however, that this may not be the case.”
It is imperative, then, that the WHL and other junior hockey leagues err on the side of caution and work harder to get headshots — and fighting — out of the game. According to hockeyfights.com, there were more than 800 fights in the WHL’s 792 regular-season games in 2010-11.
The adults charged with the care of these players must do all they can to protect their charges.
It is becoming more and more evident that the cost of not doing so is far too high.
(Gregg Drinnan is sports editor of The Daily News. He is at gdrinnan@kamloopsnews.ca, gdrinnan.blogspot.com and twitter.com/gdrinnan.)
There. I said it.
And you know what?
It doesn’t feel half bad. In fact, it feels pretty good.
Having been around the WHL for more than 30 years, I have long been a drinker of the Kool-Aid. When hockey people would say that fighting is an integral part of the game, that a fight could swing a game’s momentum one way or the other, that players rarely got injured in a fight, I would nod my head in agreement.
Fighting, the hockey lifers will tell you, has always been part of the game.
And it has been. Just like the centre-ice red line. And goaltenders handling the puck without restrictions. And obstruction. And one referee.
But now it’s time for fighting to go.
Why?
Because the time has come for the WHL to rid its game of headshots. It has to do this because it is imperative that it do more to protect its young players from concussions.
And it would be hypocritical to invoke a ban on headshots and not take fighting out of the game.
How can you ban headshots while saying it’s OK for two players to stand there and punch each other in the face?
My thinking started to change about the time that researchers at the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine revealed that an examination of the brain of former NHLer Reggie Fleming, a disturber in the 1960s who died in 2009, showed indications of chronic traumatic encephalopathy (CTE).
Then, in the last while, the same researchers found CTE in the brain of former NHL enforcer Bob Probert.
That, along with some on-ice happenings, has made headshots and concussions the hot-button topic in and around hockey at all levels.
Also influencing my thinking were incidents involving Sidney Crosby and Killian Hutt, Zdeno Chara on Max Pacioretty, Matt Cooke on Marc Savard and on and on.
And then came an email from the mother of a WHL player. She expressed concern over the number of concussions and head injuries in the WHL this season, a figure that now has reached at least 100. This wasn’t your ordinary email, because it came from a professional who provided documentation, some of it frightening, to every statement she made.
It is most obvious that, while the study of concussions and their long-term effects is in its infancy, head injuries no longer can be looked at in the short term. Studies that have been done contain too many words and phrases like “ongoing impairment” and “recurrent or cumulative damage” and “chronic neurocognitive impairment” and “early onset of dementia.”
During the 2009-10 season, a group of medical professionals, including Dr. Charles Tator, who is considered Canada’s pre-eminent expert on sport concussions, put together the Hockey Concussion Education Project, a study involving “67 male fourth-tier ice hockey players from two teams.”
Physicians involved attended 52 regular-season games involving junior-aged players and observed 21 concussions to 17 players. “A concussion was diagnosed in 19 (36.5 per cent) of 52 observed games,” the resulting report reads.
It is interesting, too, that “no concussions that occurred in practices were reported by either team during the study. Previous sport concussion studies demonstrated that concussion predominantly occurs in game situations.”
The professionals involved in this study, however, ran into some problems.
As they reported: “Complaints by coaches, players and parents concerning the inconvenience of multiple physician visits for serial testing and evaluation were common. The reluctance to report concussion symptoms and to follow such protocols likely results from certain cultural factors such as athletes asserting their masculinity by playing through the discomfort of an injury, and the belief that winning is more important than the athlete’s long-term health.”
The report summarized that “the incidence of concussion in fourth-tier junior ice hockey players was significantly greater than has previously been reported in the literature for this age group.”
Another report — this one by Drs. Jeffrey S. Kutcher, Christopher C. Giza and Anthony G. Alessi, titled simply Sports Concussion — concludes with this:
“Increasing animal and human data suggest that the developing brain’s reaction to concussive injury is distinct from the mature brain, and that age-specific clinical guidelines for concussion management be developed, with perhaps a more conservative approach to assessment and recovery.”
You don’t have to look very hard to find warning signs and lots of them.
According to one study involving U.S. college football players, those who suffered one concussion “were 3.4 times more likely than uninjured teammates to sustain a subsequent concussion during the same season.”
And then there is this from a study titled Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma:
“A minority of cases with neuropathologically documented CTE developed dementia before death; the relative infrequency of dementia in individuals with CTE may be due in part to many individuals with CTE having committed suicide or died from accidents or drug overdoses at an early age.”
Unfortunately, the only way to diagnose CTE is through the examination of a brain, although efforts are being made, according to this report, “to identify biomarkers to detect the disease and monitor its progression and to develop therapies to slow or reverse its course.”
In the meantime, the WHL, indeed all of hockey, owes it to the athletes to do more to protect them from themselves.
“It is widely accepted that the symptomatic effects of up to 90 per cent of concussions are short-lived, lasting only seven to 10 days,” reads the report titled Sports Concussion. “This viewpoint puts sports concussion in the light of being a transient phenomenon with little or no long-lasting effects. There is increasing concern, however, that this may not be the case.”
It is imperative, then, that the WHL and other junior hockey leagues err on the side of caution and work harder to get headshots — and fighting — out of the game. According to hockeyfights.com, there were more than 800 fights in the WHL’s 792 regular-season games in 2010-11.
The adults charged with the care of these players must do all they can to protect their charges.
It is becoming more and more evident that the cost of not doing so is far too high.
(Gregg Drinnan is sports editor of The Daily News. He is at gdrinnan@kamloopsnews.ca, gdrinnan.blogspot.com and twitter.com/gdrinnan.)
Posts
