Mirroring a trend that has been seen among participants in American football, a recent report in the journal Neurosurgical Focus indicates that the number of concussions in the junior and high school ranks of ice hockey is vastly under-reported compared to the professional ranks.
Dr. Paul Sean Echlin and his colleagues at the Hockey Concussion Education Program followed 67 male ice hockey players aged 16-21 during the 2009-2010 season. All the players were members of two fourth-tier junior teams in Ontario. They found that the concussion rate for junior hockey players was three times larger than previously believed, and over seven times larger than the rate in NCAA Division I ice hockey. Alarmingly, the study also commented on widespread pressure from coaches, management, and parents to ignore or disregard a concussion diagnosis and return to the ice as quickly as possible.
Over the course of the study, concussions were assessed by one independent physician and by another one to three non-physician observers. At the beginning of the season, players had baseline assessments using the Sideline Concussion Assessment Test (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT).
Highlights from the research are were:
- Seventeen players accounted for 21 reported concussions over the 52 observed games, which equals out to 21.5 concussions per 1,000 man-games.
- Five of the 17 players (29%) who suffered a concussion suffered a second concussion during the course of the study.
- Fifteen of the 17 players (88%) who were diagnosed with a concussion admitted to having suffered a previous concussion at some point in their playing career.
- The average length of time a player missed from suffering a concussion was 12.8 days.
- Likelihood of sustaining a concussion increased as the game progressed, with 14% coming in the first period, 29%in the second period, and 57% of diagnosed concussions occurred in the third period.
- Five of the 21 concussions came directly after the participants were involved in an on-ice fight.
- Seventy-one percent of the concussions were suffered by the forward position, and 29% suffered by defensemen. No goalies were involved.
- Most alarmingly, two of the seventeen players who suffered a concussion during the study admitted that they had covered up another concussion during the season in order to keep playing.
Also of note was that during the study, the general manager of one of the teams being monitored stopped his team from participating in the study at the halfway point of the season because he objected to in-game monitoring. Interestingly, the two teams sustained similar amounts of concussions during the first half of the season (eight vs. six), and after the study team was not permitted to monitor team that pulled out, they reported no concussions for the second half of the season, while the monitored team reported six more.
Dr. Charles H. Tator, one of the physicians running the study remarked, “This study showed a disturbing lack of compliance by the athletes to undergo requested neuropsychological evaluations and multiple physician visits, as well as a lack of understanding about the seriousness of concussion. Complaints from players, coaches, and parents about this testing gave further credence to the importance of raising awareness about the serious long-term implications of concussions through education, which does appear to be beneficial according to our findings.”
Dr. Echlin continued, “The reluctance to report concussion symptoms may result from cultural factors, as expressed in several of the case studies -- athletes demonstrate perceived toughness to their parents, coaches, teammates and peers by playing through an injury; and the belief of the athlete that he or she is invincible, so winning overrides any consideration of the effect of the injury upon long-term health.”
The National Hockey League made news recently when it instituted Rule 48, which allows for game officials to assess harsher penalties for on-ice hits deemed to have had the opposing players head as the primary target, with additional penalties to follow. To date, the new rule has not decreased the number of concussions seen during this NHL season. Similarly, the National Football League broke precedent and instituted mid-season rule changes that allow for penalties, fines, and even suspensions for players who administer helmet-to-helmet hits.