Rules of Engagement

Jury still out on whether rule change has reduced NHL concussions

/ Author:  / Reviewed by: Joseph V. Madia, MD

For even the most casual observer, it's clear that ice hockey is a rough sport. Players fly down the ice at close to 35 miles per hour delivering bone-crunching hits to each other, often directly into the boards and glass that surround the rink. Hard vulcanized rubber is launched from their sticks at speeds that approach that of a major league fastball, often times even faster. All while wearing small shoulder pads and loose fitting helmets that aren't required to have facemasks.

Oh, and occasionally, a bare knuckle fistfight breaks out.

So there's no doubt it's a tough sport for tough guys. Yet the discussion about the risk of concussion and head injury in sports seems to center around American football. Perhaps that's not surprising, as the NFL and NCAA college football routinely dominate American television ratings, and NHL hockey has struggled to find an American television audience since it's peak of popularity when Wayne Gretzky and Mario Lemieux were streaking down the ice. But in Canada, the sport is still the national obsession, and there's no shortage of youth players in Canada and the U.S., as well as thousands of professional players in the juniors, minors, and pro leagues worldwide who are putting their heads and minds at potential risk.

Just as in football, concussions are a routine injury in professional hockey. Also like in football, it was long thought of as something of little consequence, where 'tough' players would either play through it, or keep the presence of concussion symptoms to themselves so they could continue playing. Perhaps with the increased knowledge of the long term risks of repeated concussions and the acute risks of playing before symptoms have had a chance to resolve have brought attention to the problem in hockey, as in the cases of Marc Savard and Pierre-Marc Bouchard.

Savard, a center for the Boston Bruins, only recently returned to play in December 2010 after being sidelined by concussion symptoms for over 9 months. During a game against the Pittsburgh Penguins on March 7, 2010, he was checked hard by Penguin Matt Cooke. What he thought was a “routine” injury that he would recover from as he had from two previous concussions, quickly turned into post-concussion depression and post-concussive syndrome, sidelining him with depression, fatigue, and isolating himself in his home in the dark.

Bouchard, a left winger for the Minnesota Wild, returned after missing 104 games due to concussion-related symptoms, an injury that plagued him since October of 2009. Only recently has he been cleared of post-concussive symptoms, including “pressure in the head,” according to Bouchard.

The cases of these two players, especially Savard, as well as public pressure and the emerging science, led the NHL to tighten up rules regarding the types of hits that can be delivered, as well as new rules on when players can be cleared to return to action. Over the summer the NHL instituted Rule 48, which allows game referees to call a minor or major penalty on any "lateral, back pressure or blindside hit" where the primary point of contact is the player's head. All of those penalties called under Rule 48 will also be automatically reviewed for additional discipline in the form of suspensions or fines.

Has Rule 48 had an impact? Numbers-wise, no. In a recent press conference, NHL neuropsychologist Dr. Ruben Echemendia reported that as of December 1, 2010, there have been 33 concussions reported in the current NHL season...exactly the same number that was reported during the previous year. Although just because the numbers are the same, Echemendia is quick to point out that it doesn't mean the rule change has been ineffective.

It's premature," said Dr. Echemendia. "We need to very carefully follow the concussions this year and next year and see to what extent the rule changes have or have not had a change in behavior. We don't know exactly what's causing the concussions to be at the level that they are at this point in time."

The number of concussions appearing to be the same despite the rule change could be for good reasons: increased awareness and better reporting. Perhaps the message is getting across to players that even though the culture of the sport is telling them to power through it and keep playing, it's in the best interests of their long term health to be honest about concussive symptoms.

"It could be that we are making inroads in terms of our ability to communicate to players that they need to report their symptoms, that this is a serious injury and there's increased awareness and identification of the injury...The earlier they tell us what's going on for them, the less time loss they're going to have and the better off they're going to be down the road” said Dr. Echemendia.

Reviewed by: 
Review Date: 
December 9, 2010