How was Sid­ney Crosby cleared so quickly?

The Hamilton Spectator - - SPORTS - A.J. PEREZ USA To­day Sports

Sid­ney Crosby went 320 days be­tween games af­ter his most sig­nif­i­cant con­cus­sion — suf­fered in Jan­uary 2011.

The Pittsburgh Pen­guins cap­tain was out all of five days — and just one game — with his most re­cent as he skated more than 19 min­utes in a 4-2 loss to the Wash­ing­ton Cap­i­tals in Game 5 of their Eastern Con­fer­ence semi­fi­nal se­ries at Ver­i­zon Cen­ter on Satur­day night.

“You just want to be back out there,” said Crosby, who had the sec­ondary as­sist on Phil Kes­sel’s sec­ond pe­riod power-play goal.

“I think you just go with the flow. You try to elim­i­nate ex­pec­ta­tions as far as when you think you’re com­ing back. Play­offs, you want to be in the lineup.”

Like other sports, the NHL’s con­cus­sion pro­to­col states “there is no manda­tory pe­riod of time that a player must be with­held from play fol­low­ing a con­cus­sion.”

Crosby took part in a full-con­tact prac­tice on Fri­day and was cleared to play Satur­day.

Team­mate Conor Sheary was also back in the lineup af­ter he was con­cussed in Game 3.

“The guide­line is to treat every con­cus­sion on its own mer­its,” Chris Nowin­ski, ex­ec­u­tive di­rec­tor of the Con­cus­sion Legacy Foun­da­tion, told USA To­day.

“Each one is dif­fer­ent. It’s not im­pos­si­ble to pass the pro­to­col within five days. That doesn’t mean it’s a great idea. It doesn’t mean this isn’t a cal­cu­lated risk.”

Re­search has shown that clin­i­cal re­cov­ery — when some­body no longer shows con­cus­sion-like symp­toms — doesn’t al­ways mean the brain has fully healed.

Other stud­ies have shown there is an in­creased cere­bral vul­ner­a­bil­ity (ICV) in the days af­ter an ini­tial con­cus­sion that could lead to se­ri­ous health con­se­quences if a per­son in­curs an­other brain in­jury soon there­after.

The NCAA and De­part­ment of De­fense cre­ated the Con­cus­sion As­sess­ment, Re­search and Ed­u­ca­tion Con­sor­tium (CARE), and the con­sor­tium stud­ied 1,200 con­cus­sions among ser­vice academy cadets and stu­dent ath­letes over a three-year pe­riod.

In a study pub­lished in the Sports Medicine jour­nal in March, the au­thors pointed out the “win­dow of cere­bral vul­ner­a­bil­ity may ex­tend beyond the point of clin­i­cal re­cov­ery, leav­ing the brain phys­i­o­log­i­cally com­pro­mised and stu­dent ath­letes at height­ened risk of repet­i­tive in­jury.”

The study also stated the cur­rent con­cus­sion di­ag­nos­tic tools—like the ones used to clear ath­letes— may be un­able to re­li­ably de­tect the of­ten sub­tle signs that some­body hasn’t fully re­cov­ered.

The NHL’s pro­to­col man­dates three things that have to hap­pen be­fore a con­cussed player is al­lowed to re­turn:

There is com­plete re­cov­ery of con­cus­sion-re­lated symp­toms at rest.

There is no emer­gence of con­cus­sion-re­lated symp­toms at ex­er­tion lev­els re­quired for com­pet­i­tive play.

The player has been judged by the team physi­cian to have re­turned to his neu­rocog­ni­tive base­line test lev­els fol­low­ing an eval­u­a­tion by the club’s con­sult­ing neu­ropsy­chol­o­gist.

Re­searchers are ex­plor­ing blood biomarker and brain imag­ing tests to bet­ter di­ag­nose con­cus­sions and gauge when the brain has fully re­cov­ered. Un­til those be­come ap­proved for clin­i­cal use, ath­letes are taken through mem­ory retrieval, bal­ance and an in­ven­tory of phys­i­cal symp­toms to as­sess re­cov­ery.

“It’s come a long way,” Crosby said when asked how con­cus­sions are han­dled com­pared when he came into the league as a rookie more than a decade ago.

“Year af­ter year, ev­ery­one is try­ing to be more aware and they’re tricky things. I think (it’s) just been the process for ev­ery­body. It’s changed a lot.”

Half the ques­tions Crosby an­swered af­ter his team failed to elim­i­nate the Cap­i­tals dealt with his lat­est con­cus­sion.

Nowin­ski said the Pen­guins and the NHL — which is in the midst of a class-ac­tion con­cus­sion law­suit filed by for­mer play­ers — would have faced far more had Crosby been con­cussed again.

“If he took a bump to the head and gets knocked un­con­scious, the de­ci­sion to al­low him to play would be scru­ti­nized for ages,” Nowin­ski said.

CAROLYN KASTER, THE AS­SO­CI­ATED PRESS

Sid­ney Crosby is checked into the boards by Wash­ing­ton Cap­i­tals’ Matt Niska­nen in Game 5 on Satur­day.

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