Matt Eagles is soon to graduate from Memorial University's medical school, and is headed to a Neurosurgery Residency program at the University of Calgary; he is a former Major Junior and University hockey player and a founding member of Concussion-U
On Monday May 1, 2017, the Pittsburgh Penguins entered their second-round playoff game against the Washington Capitals with a tight 2-0 grip on their best-of-7 playoff series. An important reason for this was the play of their star captain: Sidney Crosby.
Through 2 games in the series, Crosby had scored 2 goals and added 2 assists. He was, as he had been for much of the preceding year, playing at a level higher than anyone else in the sport of hockey. However, in the first period of game three, the fortunes of the Pengiuns and their superstar appeared to change when he was cross-checked in the face by the Washington Capitals’ Matt Niskanen.
Crosby lay on the ice for several minutes, and was eventually helped up by his teammates before skating off the ice under his own power. It was a scary scene for Penguins fans, and hockey fans in general for that matter, as Crosby has a long and storied history of concussions. One could argue that Crosby is the greatest athlete of all time to miss a significant portion of his career due to sport related concussion (SRC) and, recently, concussion expert Dr. Charles Tator suggested that if Crosby was an amateur athlete, he would be advised to stop playing hockey.
SRC has become a popular topic in both the lay press and academia, due, in large part to injuries to players such as Crosby, as well as concern over the possible long-term health implications of repeated concussions. The most recent International Conference on Concussion in Sport took place in Berlin in October of 2016. This meeting brought together world experts in concussion, and culminated in the release of an updated “Consensus statement on concussion in sport”.
This statement, authored by the Concussion in Sport Group (CISG), provides an overview of the most updated, evidence based recommendations surrounding SRC. The authors make sure to mention that the statement “is not intended as a clinical practice guideline or legal standard of care, and should not be interpreted as such.” However, it represents the opinions of the world leaders in concussion research, and is backed up by the joint release of 12 systematic reviews.
One of the most important aspects of the management of SRC is deciding when the athlete can return to sport. In the updated “Consensus Statement”, the authors propose a graduated return-to-play protocol, that consists of 6 steps. Each step in the protocol is to take a minimum of 1 full day, meaning that it should take an athlete a minimum of 1 week to return to sport once they are symptom free at rest.
Surprisingly, Crosby returned to action on May 7, 2017, a mere 5 days after his second concussion of the season (he missed the first 6 games of the regular season recovering from another concussion). While this might be cheered by his fans, it should be a cause for concern in the medical profession.
Sidney Crosby is arguably the most popular hockey player on the planet, and may be the most recognizable Canadian athlete. He is the face of the NHL and countless youth look up to him. Aside from his athletic prowess, he is typically viewed as a genuine role model for aspiring hockey players, being respectful, articulate, and a tremendous ambassador for the game of hockey.
How, then, is his expedited return from his most recent concussion to be viewed by his millions of admirers? Will they feel as though that they can follow his example and return without going through the proper return-to-play steps? These questions must now be addressed by healthcare providers when discussing SRC with players, parents, and coaches of minor sports. Perhaps it is reasonable to have a double-standard for concussion recovery when comparing an athlete of Sidney Crosby’s stature and a minor hockey player. He is making millions of dollars per season, while fewer than 0.1% of young athletes will ever make their living through sport. On the other hand, perhaps the only way to get those minor hockey players to take SRC seriously is to see their heroes taking them seriously. While it is understandable that Crosby would want to return to action as quickly as possible, his team’s medical staff should have been mindful of the effect his hasty return might have on young competitors, not to mention his own long-term health. If they were, and they provided medical clearance anyway, it provides further proof that leagues such as the NHL are more interested in the short-term success and financial gains from having their biggest names in action, than they are the safety of millions of young athletes who look up to those stars.