Research finds more concussions
MDS directly observing games find head trauma has been underreported
Brain-rattling concussions among both elite male and female hockey players appear to be much more common than reported, suggests a study in which sports medicine doctors were behind the bench observing a season’s worth of games.
The study, which followed players on two university teams in the 20112012 season, found an incidence of concussions three times higher in males and more than five times higher in females than most previous research had found.
Surprisingly, perhaps, the rate of concussion among women playing university-level hockey in Canada was roughly twice that of their male counterparts.
Five of the 25 male players and six of the 20 females sustained concussions during the season. One of them experienced a second brain trauma in a subsequent game.
“Those are all significant (findings) to say, ‘Look, it’s important to understand that we’re not reporting this correctly,’ ” said Dr. Paul Echlin, a sports medicine specialist who oversaw the studies.
Almost 70 per cent of hits that caused a concussion were to a player’s head; more than 80 per cent of those knocks were deliberate versus incidental, the observers found.
Concussion is a traumatic brain injury that typically results from a blow to the head. Symptoms include headache, confusion, memory loss, dizziness and nausea or vomiting.
Depending on the severity, symptoms can last for days, weeks or months. Concentration and the ability to remember may be im- paired. The person can be irritable or depressed and may experience marked personality changes. Sensitivity to light and noise, along with disturbed sleep, are also common.
The brain can be permanently damaged by repeated concussions.
Getting coaches and trainers to recognize when a player may have suffered a concussion and needs to be pulled from the ice for assessment — and possibly from further play for a time — continues to be a huge challenge, said Echlin, who works with injured athletes at the Elliott Sports Medicine Clinic in Burlington, Ont. “Once you start removing players and testing them, then it becomes oppositional,” he said, noting there was “huge pushback” during the study, in which physicians observed 55 regular- and post-season games played by the varsity squads. As one physician-observer reported: “I had negative feedback from the coach, who thought that the study was a waste of money . . . he didn’t want his players to get assessed in fear that they would be declared as concussed and advised not to play . . . the players didn’t want to be declared as concussed since it would limit their playing time.” In one incident, a player diagnosed with a minor concussion in the second period was back on the ice for the third. At the end of the game, she was still feeling “iffy.” The study doctor advised she be excluded from upcoming games to give her brain time to heal, Echlin writes in an editorial overview of three linked studies published in the journal Neurosurgical Focus.
While the coach acknowledged the symptoms were concerning, she challenged the doctor’s authority to make the call — even though her own playing career had been ended by multiple concussions.
“Players and coaches often downplay the symptoms in an effort to get the athlete back into action,” said one physician-observer. “It relates to the culture of hockey.”
Echlin agreed, saying sports culture encourages the idea that “if you can’t see it, it doesn’t exist. And it’s win at all costs.”
The linked studies, which involved Canadian and U.S. researchers, used standard neuropsychological tests to assess players for memory and other cognitive deficits indicating concussion. But they also added post-season MRI scanning.
One study involving researchers at the University of Montreal found metabolic changes in both those with concussions as well as those without diagnosed brain trauma.
The finding suggests that instances of sub-concussive damage can add up over a season and lead to alterations in brain function.
In another study using advanced MRI data from just the male players, researchers at Harvard University found changes in the white matter of the brain. White matter consists of nerve tissues that transport neural messages, or impulses, between different regions.
Players with a diagnosed concussion had the most pronounced changes in their white matter, which included a thinning of the myelin sheath around nerve fibres.
But Dr. Inga Koerte said they saw alterations in players without a diagnosed concussion, which suggests athletes playing contact sports are piling up traumatic brain injuries bit by bit over the season.
“So you don’t need a concussion to develop white matter changes.”