With blades about to hit the ice for the start of NHL training camps Saturday, the issue of concussions in hockey is top of mind for a group of doctors, researchers and players who want to educate the public about the potential long-term effects of the brain injury.
A public meeting being held Saturday at Toronto's St. Michael's Hospital will also look at the situations under which concussions occur and how they can be prevented, with a focus on teaching young players about the dangers of head trauma and how to better protect themselves.
"There's still an attitude out there that brain injury is like a broken arm," said neurosurgeon Dr. Michael Cusimano, who helped organize the conference. "We take our brains for granted, and we need to have people realize that you can't take your brain for granted."
Michael Hutchison, a post-doctoral fellow in injury prevention at St. Mike's, will present findings from a study of almost 200 concussions that occurred among NHL players from the start of the 2007 season to mid-season 2010.
By analyzing video clips of incidents that led to those brain injuries, Hutchison found that, not surprisingly, most are caused by direct hits to the head involving actions by other players — predominantly head shots with a shoulder, elbow or gloves. About one in 10 were the result of fights.
The study also showed that forwards incurred more concussions than defencemen and goalies, likely because there are more of them on the ice and "because they have the puck more often," he said, noting that brain-rattling blows often occurred during breakaways or a rush to the net.
He found that concussion-causing checks taken by forwards could took place anywhere on the rink. "They were not all violent activities at centre ice. They occurred in many places around the ice — in the middle, along the boards."
Defencemen, however, were "more likely to get injured in the defensive zone, which would make logical sense because that's most often the point where they have the puck," he said.
The research also showed that more concussions were sustained in the first period than the other two periods, an intriguing finding that Hutchison said is contrary to other hockey-related injuries, which tend to occur the longer play goes on.
"Generally athletic injuries have been thought to be sustained later on in the game when people are tired and fatigued," he said. "And this was a situation where most of the concussions occurred in the first period."
He speculated that high adrenaline and energy levels in the 20 minutes that follow the initial drop of the puck may lead to more contact between players, as may a team's strategy to set the tone with aggressive forechecking.
Hutchison, who coaches minor hockey and is assistant coach for the University of Toronto's varsity men's hockey team, also found there weren't a lot of penalties called on the NHL hits that caused concussions.
"So there weren't any repercussions on the ice at the time for actions resulting in concussions. So there was a possibility that if a rule were to be put in place, that behaviour would likely go down."
A lack of penalty-calling has been an issue for Karolina Urban, captain of the University of Toronto's women's Varsity Blues hockey team, who suffered three concussions over three seasons while playing forward.
The first, from a direct hit to the head, eventually took her out of the game for six weeks, although she initially went right back on the ice. "I was young and I didn't really understand what concussions were and what could happen if I got another one ... I went back out next shift and I kept playing.
"On none of my three concussions was there a penalty," she said, adding that her team had the highest rate of concussions last year — 11 — of any sports team at the university, plus about 20 other injuries.
Urban, 21 and in her final year of a physical education program, will be a featured speaker at the concussion conference. She said she will stress that young players of both sexes need to be educated about concussions and what they can do to avoid the hits that cause them.
And young players also need to realize what the experts have long been preaching — that multiple concussions can have life-long effects, including mood disorders like depression and cognitive deficits that can impede learning. Over time, dementia and other neurological conditions may also develop.
If she does get plowed and takes a head hit, Urban said she will leave the ice immediately, even though she won't want to let her team down.
"Now that I know more about concussions, there's no way I would go back out there and risk my future."
Conference speaker Rob Zamuner, a player representative for the National Hockey League Players' Association, said concussions in the sport have become a hot topic — and that's a good thing, resulting in rule changes by the league aimed at preventing the brain injury.
"It's a serious issue," said Zamuner, who suffered at least two concussions before retiring from the NHL in 2004-05. The former forward with the Tampa Bay Lightning, Ottawa Senators and Boston Bruins is also a member of the NHL-NHLPA concussion working group.
"I think the great thing about this is we're talking about it and we're having these discussions and we have to push forward to see how we can make the game better and safer for everybody involved."
But Cusimano said the NHL needs to step up its game even more when it comes to concussion prevention. A good portion of the conference will be exchanging ideas about how players, parents, coaches and governing bodies for hockey leagues covering all ages can contribute to that process, starting with the education of young players.
"We know that half a million kids are registered in hockey a year across Canada and it's the national sport and it's part of the Canadian fabric," he said. "And it's part of a strategy to keep kids active.
"So there's lots of reasons to keep it and the game's a great game. But we're coming to realize some of the problems and we need regular everyday people to come up with solutions and maybe share those solutions with the broader public.
"I think if we depend solely on the elite leagues that have different motivations, we're not really going to accomplish that. It has to come from the grassroots."