On Saturday November 19, 2011 I took the ice for warm-up against the UPEI Panthers. It was just another night at the rink. My routine felt no different than it had for any of the other 300 or so games I played in my Major Junior and University Careers. What I did not know at the time was that this would be the last game of competitive hockey I would ever play.
In the second period, I suffered my third concussion in a ten-month span. I had gone through the recovery process in the past, and I figured that I would be fine in no time. Unfortunately, that wasn’t the case. When I tried to return to the classroom about a week later, I could not focus. If I tried to sit down and read, I would get headaches. By this point in my life I had shifted my dream from playing in the NHL to attending medical school. I quickly realized that my playing days might be numbered, and I sought expert advice. Both physicians and psychologists advised that I should walk away from the game. They said that continuing to play hockey would be putting my brain at risk for long-term impairment. Reluctantly, I heeded their counsel. My hockey career was over. Today I am a second year medical student at Memorial University of Newfoundland and Labrador.
Concussions are difficult injuries for many reasons. Concussion is, to all intents and purposes, an invisible injury. Athletes have no obvious signs of being injured when recovering from a concussion, unlike a broken leg or a dislocated shoulder. To make matters worse, we hockey players are a product of our culture. We are trained from a young age to play through injury, never show weakness, and sacrifice ourselves for the good of the team. How then can someone who looks completely healthy sit out of a game without feeling ashamed? I couldn’t.
My background has given me an appreciation for the burden these injuries put on a player. I did not want to admit to being concussed for fear I would be kept out the lineup. This fear was well founded. Any missed time for a hockey player is an opportunity for someone else to take his or her spot. Understandably, most players care more about what coaches think than the team doctor. If you add parental pressure to the mix, the warnings of the medical profession may not carry that much weight. For this reason, it is important to educate everyone involved in the sport on the dangers of concussions.
Minor hockey coaches are special people. They sacrifice huge amounts of time to teach young boys and girls the value of commitment, team play, and hard work. In many ways, coaches are like physicians. They prescribe team systems and rules, but rely on players to be compliant and buy in. Oftentimes this is good, and players learn how to work together to achieve a common goal. However, coaches are also fiercely protective of the game. They take pride in the way they go about their craft and resist any attempts to change it. It often takes a great deal of persuading for them to collectively change their ways. Many coaches are steeped in the traditions of the game and, for better or worse, look more highly on players who are willing to play through injury. Problems can arise if a coach creates an atmosphere that doesn’t appreciate the dangers associated with concussions. In these situations, players may be encouraged to play after “getting their bell rung”.
Hockey parents are another variable in this equation. Parents undeniably want what is best for their child but sometimes their views can lead to harm. Take the recent decision by Hockey Canada to change the age for body checking from peewee to bantam. Opinions on this were decidedly split. Many parents felt that this would make their children “softer”. Perhaps the most popular argument, and one that took a shot at reason, was that delaying the age before players start body checking will lead to more concussions when they are older. They argued that players would not learn how to take a hit when they are young, and therefore, would be more susceptible to concussions later. Even though physicians have tried to explain that the evidence shows no corresponding increase in concussions amongst older players (when hitting is delayed), they still face fierce opposition from the hockey purists, who label them as outsiders meddling with the game.
As medical professionals, we have a responsibility to continue fighting this public health battle. The question is, “How do we do it and win?” I believe that outreach to players, parents, and coaches holds the key to changing the views of the hockey world. It is not enough to simply collect data and present it at annual meetings. High profile injuries to celebrities such as Sidney Crosby have garnered a great deal of attention, but we cannot trust the media to educate the masses. We need to get into dressing rooms and explain to players why concussions must be taken seriously. We need to have open conversations with parents and coaches about making it ok for players to say they might be concussed. Just like a patient-centered interview, we have to be there to respond to concerns and explain the evidence for what we are suggesting. Not everyone will be open to what we have to say, but if we can help prevent even one player from suffering the same fate as I did, our efforts will be worth it.