NHL in de­nial on head in­juries, neu­rol­o­gist says

Ottawa Citizen - - SPORTS - MIKE BEAMISH mbeamish@post­media.com Twit­ter.com/sixbeam­ers

He grew up in Brain­tree, Mass., in a house next to the home of then-Bos­ton Bru­ins’ sniper Phil Es­pos­ito, played hockey at Thayer Academy, the prep school that launched Jeremy Roenick and Tony Amonte to­ward the Na­tional Hockey League, and went on to study medicine at Bos­ton Univer­sity with a spe­cial in­ter­est in brain func­tion.

“What got me into neurology is that my fa­ther had a stroke in my sopho­more year in col­lege,” says Dr. Frank Conidi, ex­plain­ing his fas­ci­na­tion with grey mat­ter at the 68th Amer­i­can Academy of Neurology con­ven­tion in Van­cou­ver. “It was a dif­fi­cult time, I was an only child, I lived at home and I wanted to take care of the man who had been there for me.”

Now chief of the Florida Cen­tre for Headache and Sports Neurology, head of the Florida high school ath­letic con­cus­sion com­mit­tee and team neu­rol­o­gist for the NHL’s Florida Pan­thers, Conidi was in Van­cou­ver this week to present a pa­per adding more weight to the link be­tween foot­ball and trau­matic brain in­jury.

But hockey, his first love, doesn’t get off the hook.

Conidi sug­gests that the NHL is suf­fer­ing from a form of de­nial when it comes to TBI. “The NHL’s con­cus­sion com­mit­tee doesn’t have a sin­gle neu­rol­o­gist on it,” he said in an in­ter­view with the Van­cou­ver Sun. “Think about that. It (TBI) might be a prob­lem in hockey as well.”

Although the NFL fought and tried to cover up the mount­ing ev­i­dence of chronic brain dis­ease in mod­ern foot­ball, the league now has pro­to­cols in place in which a con­cussed player must past muster from a team physi­cian and two in­de­pen­dent neu­rol­o­gists be­fore be­ing al­lowed to re­turn to play.

What will it take for the NHL to re­spond the same way?

“I don’t see ev­ery con­cus­sion with the Pan­thers,” Conidi ad­mits. “Of­ten­times, it’s the team doc­tor or the trainer who makes the ath­letes go back. That’s a lit­tle bit con­cern­ing for me.

“It’s go­ing to change. They know it. We know it. The NFL was the first. At­tor­neys are go­ing to start go­ing af­ter the NHL to make it change. It’s a mat­ter of time.”

He adds: “Hockey has the high­est in­ci­dence of con­cus­sion per par­tic­i­pant, at any level. Look at the physics: force equals mass times ac­cel­er­a­tion. You’ve got higher mass now, higher ac­cel­er­a­tion in mod­ern hockey. Th­ese guys are get­ting banged at a much higher rate.”

Based on an ini­tial study of 40 NFL re­tired play­ers (it has since grown to 80 to 100), Conidi added one of the strong­est links yet be­tween foot­ball and de­gen­er­a­tive brain dis­ease. He re­ported that 42.5 per cent of play­ers in his study showed ev­i­dence of brain ab­nor­mal­i­ties. The me­dian age was 35.85 years. Most had re­tired within the past five years.

All were play­ers who ar­rived at his door as pa­tients, ex­pe­ri­enc­ing de­pres­sion, anx­i­ety, sleep dis­or­ders, at­ten­tion prob­lems, and deficits in ex­ec­u­tive func­tion (54 per cent) and learn­ing mem­ory (45.9 per cent).

He used con­ven­tional neu­roimag­ing tools (MRI) as well as an ad­vanced tech­nique known as the Dif­fu­sion Ten­sor MRI (DTI), which maps the func­tion­ing of white mat­ter, the wiring in the brain. Seven­teen play­ers (42.5 per cent) showed ev­i­dence of trau­matic brain in­jury on the DTI. Twelve (30 per cent) showed signs of in­jury on the con­ven­tional MRI.

“It shocked me,” Conidi said. “In the gen­eral pop­u­la­tion, the meta anal­y­sis (a com­pi­la­tion of nu­mer­ous stud­ies) is 12 to 16 per cent (ev­i­dence of trau­matic brain in­jury). We’re look­ing at three times that rate in foot­ball.”

In­ter­est­ingly, Conidi de­duced that the num­ber of con­cus­sions a player had was not nec­es­sar­ily linked to the ex­tent of brain dam­age. Twelve (30 per cent) had ex­pe­ri­enced nu­mer­ous sub-con­cus­sive hits, ev­i­dence that brain changes can oc­cur even with­out the tell­tale signs of a con­cus­sion.

“What we found is that the high­im­pact play­ers — the bangers, of­fen­sive line, de­fen­sive line, run­ning backs, those who took the repet­i­tive hits — had the high­est rate of imag­ing,” he said. “There was no cor­re­la­tion be­tween hav­ing a pos­i­tive MRI and the num­ber of con­cus­sions.”

It’s a dis­turb­ing re­al­ity that the dam­age be­gins at the com­mu­nity foot­ball, high school and col­lege level and ac­cu­mu­lates over time. That con­clu­sion means start­ing to limit full con­tact in prac­tice — or ban­ning it al­to­gether — clas­si­fy­ing foot­ball leagues into weight and size cat­e­gories, as in wrestling, or in­tro­duc­ing play­ers to tackle foot­ball at a more ad­vanced age.

“We don’t have ob­jec­tive ev­i­dence that play­ing pro­fes­sional foot­ball causes you to have ab­nor­mal MRI find­ings,” Conidi says. “We don’t make the claim that play­ing in the NFL in­creases the risk of brain in­jury. We can’t. Th­ese guys have played the game since kids. It’s more of a long-term process.

“Par­ents are afraid. Pop Warner num­bers are down. You see NFL play­ers re­tir­ing over head in­juries. Foot­ball is not go­ing any­where. But the way it’s played might have to change a bit.”


Dr. Frank Conidi, right, with his as­so­ciate Dr. Ed Pegg, is a Florida neu­rol­o­gist whose study found that 42 per cent of for­mer NFL play­ers suf­fer from some form of brain dam­age.

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