Moron (6 page)

People at the highest levels of minor hockey have said to me, “Body checking is part of our game, it’s the way it should be, and it’s the way it’s always been.” They have said, “It’s the game of
hockey
– of course kids are going to get hurt! It’s just part of the game!”

No. It doesn’t have to be that way. You are wrong. That’s the kind of logic that made people think that “buckling up” in a car wasn’t “cool.” Unfor­tunately, if you don’t wear a seat belt, you might just get thrown through the front windshield of your car.

Take off the
Moron Helmet
. Everything will start making a lot more sense.

_________________

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Study also includes Dr. Carolyn Emery’s colleagues: Jian Kang, PhD, Ian Shrier, MD, PhD, Claude Goulet, PhD, Brent E. Hagel, PhD, Brian W. Benson, MD, PhD, Alberto Nettel-Aguirre, PhD, Jenelle R. McAllister, MSc, Gavin M. Hamilton, MSc, Willem H. Meeuwisse, MD, PhD.

Chapter Three

CONCUSSIONS

A
16-year-old boy in a high level Midget game was crossing the rink, mid-ice, going into the zone with the puck. He had his head down. He was body checked by a defender square in the chest, but with such force it knocked him over. His helmet bounced on the ice with a thud.

A hockey helmet is designed to protect the skull. It’s not there to protect the brain. So, when you think about this teenager whose head bounced on the ice, the helmet did a perfect job. It protected his skull. There was no blood, the skull wasn’t cracked, and it seemed that all injury had been averted. But that player had an internal injury.

This young man shared with me after his game that he had no knowledge of the next three shifts that he played. No knowledge at all.

So, when this 16-year-old, playing a game that he loves, went to the bench after his gigantic hit on the ice, he mumbled to the other players, “Oh yeah, I took a big hit on my head.” The kid’s head had rebounded off the ice like a marble, and yet he started on each of the next three shifts. Every­one thought everything was fine.

Only at the end of the game, did the kid say to his father, “My head’s still sore.” At that point, his dad decided to take him to the hospital. Fortunate­ly, he was diagnosed, and sat out numerous games after that. His parents were smart, and said, “Hey, you’re going to be benched; you’re not going to play for a while.”

Doctors now say that, after a concussion, it’s not good enough just to refrain from playing hockey or other physical activity. People also shouldn’t play things like X-Box or other video games that stimulate the brain in any way.

This 16-year-old can only handle another two concussions if in fact he hasn’t already had some, according to several studies. We still don’t know the long-term implications. Where does he go if he has had another concussion or two, and what will happen to his cognitive learning abilities as time goes on? What will happen to the wellness of his brain as it relates to that?

When I was a kid, if you had a concussion, Mom or Dad might come in, check you every hour or two at night in order to make sure that you were only sleeping, weren’t vomiting, and hadn’t gone into a coma.

Medicine has advanced by leaps and bounds over the decades since then, but unfortunately, the safe­ty of the game has not. In other words, we’re still allowing body checking, and one of the major out­comes of a body check is a concussion in minor sports. In addition to that, we’re still having con­versations on the bench that sound just like what I heard as a kid: “Oh, you just got your bell rung. Don’t worry about it – it should be okay!”

The problem with a concussion is that kids don’t tell you. Players don’t tell you. It’s never even dis­cussed. 90 percent of concussions go undetected, and new evidence suggests that the healing time is longer for youths than adults. Add to that the little understood issue of longer-term symptoms that crop up in adults in their 40’s and 50’s, and you have a potential time bomb.

A concussion is a quiet kind of injury that is not like a broken arm where the bone's sticking out of the jersey, or you can’t move your arm and there’s blood all over the place so we've got to get you to the hospital. Who’s to know, if the player doesn’t tell you how they are feeling?

After a concussion happens, you can’t see inside the head, there’s no visible trauma on the outside of the head, the helmet’s not cracked, the player got up after getting hit – he might have shaken his head a couple of times and the coach or trainer might have turned to the player and said, “Hey, are you okay?” Or, if a player is lucky enough to have a trainer on the bench, the trainer might have actually looked in his eyes and not seen the pupils dilating, and since the kid isn’t vomiting on the bench, the trainer sends him back out to play, even though he might be concussed.

Then the player gets concussed again and again and again, and there’s all kinds of evidence again that the repetitive aspect of concussions is expo­nential.

When I was a kid, we didn’t understand the long-term implications of bruising of the brain. A con­cussion is something like having a bruise on your arm, but you can’t see it because you are wearing a leather jacket over it all the time. In the case of the brain, you never know. You have that big thing called a skull surrounding it, thank goodness, but then it’s very difficult to see when you’ve been concussed.

The following is a great guide written by the MediResource clinical team about concussions (reprinted here with permission).

8 things you should know about concussion

1. What is a concussion?

A concussion is a brain injury that can temporarily alter the way the brain functions. When jarred or shaken, the soft tissue of the brain can move around inside the skull and knock into the hard bone. Bruising, torn blood vessels, and nerve dam­age can result.

2. What causes a concussion?

A concussion is often caused by a blow to the head. A person might suffer a concussion due to a fall, in­juries resulting from a car accident, or any number of types of impact injuries, like a hard tackle in football or a high-hit or body-check in hockey.

3. What are the symptoms of a concussion?

Concussion symptoms range from unconsciousness to no outward symptoms at all. The most common immediate symptoms include confusion, dizziness, amnesia, ringing in the ears, and headache. Speech may be slurred, and the person may vomit or feel nauseated or fatigued. Over the course of hours or days, other symptoms may emerge: memory or concentration problems, sleep disturbances, changes in mood, and sensitivity to light and to sound. In many cases, the symptoms of concussion resolve after treatment and rest.

4. Do a child's symptoms of concussion dif­fer from an adult's?

A very young child may not be able to explain their symptoms, so adults should watch for signs of listlessness, unsteadiness, or changes in a child's mood or patterns of eating or sleeping. A child should be closely monitored during the hours and days following a concussion. Ask a health care pro­vider for more information about the signs to watch for and any special instructions to protect your child during recovery.

5. What should you do if you suspect a con­cussion?

Seek immediate medical attention for a person who has lost consciousness, is vomiting or having seizures, or is showing signs of obvious mental dif­ficulty. If a person does not lose consciousness, a "better safe than sorry" approach is prudent, since how a head trauma will progress is impossible to predict. Children are especially vulnerable to head injury, so seek medical attention for anything be­yond a light bump on the head. A person suspect­ed of having a concussion should never be given aspirin, ibuprofen, or other non-steroidal anti-inflammatory medications, as this can increase the risk of bleeding.

6. How is a concussion treated?

The doctor will examine the person to assess their symptoms, checking pupil size and asking ques­tions to determine extent of confusion and memory loss. Further testing may be ordered, such as a CT scan, EEG, or MRI. Depending on the severity of the concussion, a patient may be told to rest (in­cluding rest from the computer or video games) and given medication to deal with headaches or pain. Once the symptoms of concussion have re­solved, you can slowly ease back into activities as directed by your doctor.

7. Are there any complications of a concus­sion?

Symptoms of concussion may linger for months or longer after injuries have healed. In post­concussion syndrome, a person may continue to experience headaches, dizziness, fatigue, and changes in mood, sleep, and memory. Repeated concussions may lead to permanent neurological damage.

8. How can a concussion be prevented?

A concussion most often happens by accident, and not all causes can be prevented. To reduce your risk, protect yourself and your family from the most common dangers. Wear a seat belt whenever you ride in a car. Strap children in to age- and size-appropriate safety seats. Wear protective gear whenever engaged in sports or active pursuits that pose injury risks (skating, bicycling, horseback rid­ing, etc.) Wear sensible shoes to prevent slips and falls.

Everything goes back to respect. When players have an opportunity to perform a big open-ice body check, they should consciously ease up. You don’t need to do it. There’s no benefit other than stoking the moronic yells, screams, and cheers from people in the stands.

From a player’s perspective, it’s important to al­ways play with respect. Play with the attitude that you will never go out there and hurt someone. Why would you want to see somebody’s head bouncing off the ice?

In terms of the player who is hurt, we need to re­define what “toughness” is. Being tough doesn’t have to mean “sucking it up” and not telling peo­ple when we’re hurt. When you’re hurt in a game of hockey, whether your shoulder is hurt, or your knee is acting up, or in this case, you had a brain injury, you need to stand up and make sure that people are aware of that.

I get most sensitive when I talk about kids, because we need to educate them that it’s important for them to share their feelings with parents, coaches and volunteers. It’s important to tell the coach, “I don’t remember playing my last three shifts,” or, “I can see spots, my head is sore, I’m feeling dizzy, I feel nauseated.” These are the things that are very important, if a child is to continue playing hockey for a lifetime. Every volunteer, including coaches, parents and officials, has a responsibility to teach our children the proper behaviour – and that includes talking about their injuries in an open and honest way.

Look, this is pretty simple. Johnny’s head bounces on the ice. Even though he gets back up and seems relatively normal, the coach should openly and honestly ask him whether everything is okay. Then, even if Johnny says he is okay, the coach should probably make the determination that Johnny won’t play the rest of the game – just to be sure.

At the end of that game, the coach should go to Johnny’s mother and father, and say, “Look, you probably notice little Johnny was sitting out during the game because he hit his head really hard. I think it’s important that you get him to the hospi­tal to be evaluated.”

Hockey Canada has done a good job of making sure that this kind of information is available to coaches and parents, but the underlying culture still discourages kids from reporting when they have been injured.

Most importantly, parents need to take a larger role in Johnny’s well-being, and when he hits his head on the ice, they need to ask him if he’s all right. It’s better to be safe than sorry, and if you think that Johnny might have the risk of any kind of brain trauma, professional assessment is a must.

Hockey is dangerous in many ways, and concus­sions have been part of the game for a long time. Having said that, parents, players, and coaches all need to take the responsibility of monitoring play­er’s well-being. So, what do we do when concus­sions happen?

The worst thing to do is nothing. If Johnny gets a concussion and doesn’t talk about it, that is proba­bly the worst-case scenario. So, we need to make sure that we utilize our communication skills as coaches, volunteers, and parents, and we need to be more attentive while talking with Johnny, work­ing hard to understanding the severity of his po­tential injury. If we don’t know how bad the con­cussion is, or what the consequences might be, we need to keep in mind that this is a fun game, and these are young kids. We let Johnny sit out for a game or two, so that we can monitor him and see how he’s doing. Even if he’s a great player, we shouldn’t risk putting him out on the ice, because it could cause drastic complications in his life. The only cure for concussion is total elimination of the activity for a period of time.

I have a friend who’s an ex NHL player, and to­day, he admits that he “messed up” his head as a result of all the concussions he suffered throughout his minor and pro career. More players are com­ing out into the public with their stories of brain damage every day. Do we want our kids to tell that same story?