NHL in denial on head injuries, neurologist says
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.”