Senators Article: Hockey players face unknowns after suffering 'invisible injury'
March 23, 2004

Posted by: Bob Howard
Credit: Scott Lauber of Press Connects.com

Hockey players face unknowns after suffering 'invisible injury'

Testing reveals little about a concussion's long-term effects

BY SCOTT LAUBER

Press & Sun-Bulletin

BINGHAMTON -- Brad Tapper scored two goals in the first period Feb. 6 against the Hershey Bears. Before the second period had ended, he couldn't remember either of them.

"All I know is I was in a hospital bed and (assistant athletic trainer) Brian Maddox turned on the TV, and I saw myself on the news," Tapper said. "That's how I knew (about the goals). It was like they were erased from my head."

Erased by a vicious check from behind by Bears winger Shane Willis, whose elbow caught Tapper in the back of his head, knocking him out cold for almost a minute. When he woke up, he did not know the date nor the city in which he was playing.

Tapper, a 25-year-old right wing and the Binghamton Senators' most gifted offensive player, could not play again for 11 straight games and 13 of 14 after suffering the third known concussion of his four-year pro career. For three weeks, he struggled to make it through a day without the classic symptoms of post-concussion syndrome -- headaches, nausea and fatigue.

"You're just not yourself," Tapper said. "It feels like your head is three times bigger, and you're irritable. My wife would say something and I would snap at her for no reason."

There are any number of reasons for why concussions, traumatic blows that cause impaired brain function, have been on the rise in hockey for a decade.

Players are stronger and faster, so the odds of violent collisions have increased, and with the emphasis on defense, hitting is more prevalent than ever. Also, advances in equipment have sparked a greater sense of invincibility among players rather than making the game safer.

Yet there is still precious little known about the long-term effects of concussions or how they can best be prevented.

"Every sport has its own magnitude of injuries," said Jon Smith, the certified athletic trainer for the Binghamton Whalers and Rangers from 1982-94. "But head and neck injuries are always serious. It just so happens we see a lot of them in hockey."

ON THE RISE

There was a time when players joked about "getting their bell rung" or "being dinged." Those who pulled themselves from a game were branded as "soft," and playing through pain was a badge of honor.

Not anymore.

Injuries, particularly concussions, have become serious business in the NHL. Teams are required to report concussions by phoning a hotline after each game and sending any available video clips to the league office.

According to a recent Canadian Press report, there were 69 NHL concussions in 1995-96. That figure rose to 103 by 1999-2000 and leveled at 94 in each of the last two seasons. Concussions have cut short the careers of several players, including former New York Rangers Nick Kypreos, Jeff Beukeboom and Mike Richter and ex-Rangers and Buffalo Sabres star Pat LaFontaine.

The AHL, the sport's top minor league, does not monitor concussions, and since its teams are not required to publish an injury report, there is no way of knowing how many have occurred. Tapper, winger Alexandre Giroux, defenseman Julien Vauclair and center Serge Payer have each suffered at least one concussion while playing for the Senators this season.

"The game has changed entirely," said Beukeboom, now the assistant coach for the AHL's Toronto Roadrunners. "Coaches are focusing on defense, and that means everyone has to play the body. That means more hits and more hits to the head."

Recently, NHL executives have put their heads together to curb the concussion problem. Since 1996-97, all players under contract to NHL teams have undergone mandatory baseline neuropsychological testing during training camp. If a concussion is suspected, the league requires players get tested again to see if there's a difference in the baseline score.

And in September 2000, the NHL's Injury Analysis Panel --comprised of players, coaches, general managers, league executives, on-ice officials, doctors, trainers and equipment managers -- was formed to track and study head injuries.

"The league has done a lot already, but I would like to see them take it one step further and hand out penalties for any hit to the head," Beukeboom said. "They're already doing that in minor hockey in Canada, and I'd like to see them take that step."

CAUSES AND EFFECTS

Typically, concussions are caused when the brain vibrates inside the skull after any blow or jolt to the head. There are often three classifications of concussions, ranging from the least-serious Grade 1 (momentary confusion, no loss of consciousness) to most-severe Grade 3 (loss of consciousness).

But many concussions go undetected.

Dr. Karen Johnston, a Montreal-based neurosurgeon who treated Richter and Eric Lindros, called concussions "the invisible injury" because they normally don't show up on a brain scan. Johnston suggests a computerized tomography (CT) scan, but even then, the severity isn't usually revealed until the onset of post-concussion syndrome.

"When you deal with concussions, you deal with a lot of unknowns," Smith said. "You've just got to be sure they pass every test before they play, and I even tell athletes to get a second opinion. Have another physician look at you, because with concussions, you just don't know."

Headaches, irritability, anxiety, loss of appetite, sleeplessness, withdrawal, a sensitivity to light and noise, blurred vision, depression and a general inability to perform basic activities are some post-concussion symptoms, and how long a player is out often depends on how long those symptoms linger.

Even then, there's no specific timetable. Most teams require players to be asymptomatic for seven straight days or until they pass the baseline test. Vauclair missed one game, while Payer was out for four and Giroux for six. Rochester Americans wing Michael Ryan hasn't played since Jan. 28 when Senators defenseman Christoph Schubert smashed him into the end boards.

"Everyone reacts differently, probably because everyone's hit is different," Beukeboom said. "It's not like a broken arm where you can put a cast on it and wait six weeks. There's a real mystery to these types of injuries."

More unknown are the long-term problems that may be caused by concussions. Beukeboom, who wasn't free of symptoms for more two years after his last concussion, said he's living a normal life, but the fear is repeated concussions could increase the risk of diseases like Parkinson's.

"For safety sake, you have to take it slow," Tapper said. "You can always replace a knee or a shoulder, but you can't replace your brain, your mental process. This is just a game, and your health and family are more important."