The way a clearly dazed NHL player was handled during a game Tuesday has intensified the debate surrounding hits to the head, with the league's rules and mores under fire and parents expressing increased concern about the dangers of the sport.
While the Toronto Maple Leafs insist they did not risk Mikhail Grabovski's health when he was allowed to continue playing after two blows to the head, concussion experts raised questions Wednesday about the NHL's protocol.
"When I see injuries that occur when players sustain heavy hits to the head or body and have signs that are externally exhibited – signs of the inability to co-ordinate, slowness to get up – those guys have to be evaluated medically, not just tapped on the shoulder, asked if they are okay and they say they're good to go," said Paul Echlin, a sports medicine physician from London, Ont., who studies concussions. "That is antiquated."
Mr. Grabovski was hailed as a hero when he came back from two hits from 6-foot-9 Boston Bruins defenceman Zdeno Chara to score the winning goal in the last minute Tuesday night as the Leafs defeated the Bruins in Boston. Video replays of the second hit show Mr. Grabovski falling to the ice, struggling to get up, falling a second time, then stumbling to the bench.
But the incident also gave new impetus to the debate on concussions, which continues to rage as the National Hockey League's biggest star, Sidney Crosby, and many other players are sidelined with head injuries. The NHL's general managers plan to study all aspects of concussions and head shots next month at their annual meetings.
But meanwhile, the NHL incidents have left Canadian hockey parents wrestling with questions on the home front.
"We talk about head injuries and how the head is so fragile and you can't take risks with it, and how important it is not to hit people from behind," said Theresa Dostaler, a Belleville, Ont.-area mother of three with two sons playing hockey. "It's good for having conversations. But it also makes them leery. They understand it could be career-ending."
The questions surrounding Mr. Grabovski are whether the Leafs should have pulled him from the game after either hit, and whether the NHL's concussion protocol is adequate. Mr. Grabovski said he was fine after the game and was in the lineup on Wednesday night against the Buffalo Sabres.
An NHL spokesman said the league is "comfortable" with its present protocol, although he added "it is constantly being reviewed."
While the group of doctors who make up the joint NHL-NHLPA working group on concussions is expected to recommend that any player suspected of sustaining a concussion undergo an exam in the dressing room by a doctor starting next season, at present a player can be cleared to return to play by his team's athletic trainer.
The current protocol says, "A player suspected of having sustained a concussion should be initially evaluated by the team's athletic trainer and/or team physician at the bench. If a concussion is suspected the player should be removed from the playing environment …"
Since the Leafs were the visiting team on Tuesday night, they did not have a team physician with them. But Leafs general manager Brian Burke said Mr. Grabovski was examined and questioned at the bench by trainer Andy Playter, who determined he did not suffer a concussion.
"[Mr. Playter] went right to Grabbo [Mr. Grabovski] and said, 'How are you?' He had total recall, he said the puck hit the crossbar, like total recall on the situation. No blackout, no loss of memory, no dizziness, no nausea," Mr. Burke told Toronto radio station Sportsnet The Fan 590. "And so the trainer said to him, 'Are you good to go?' and he said, yeah he got it in the jaw. He said he just got it in the jaw and was disoriented. No symptoms."
The Maple Leafs refused to make Mr. Playter available for comment.
While players often show symptoms in the days following a suspected concussion, Mr. Burke said Mr. Grabovski was symptom-free on Wednesday. But both Dr. Echlin and Charles Tator, a neurosurgeon at Toronto Western Hospital who worked with Dr. Echlin on a major study of concussions, said the NHL needs to change its protocol because trainers are not qualified to diagnose concussions.
"From my point of view and the work I've done, you have to have at least a 15-minute medical evaluation, not one by a therapist," Dr. Echlin said. "A therapist can identify a probable medical problem but can't diagnose it."
Dr. Tator pointed out that athletes often give misleading answers due to their desire to get back on the ice. Sometimes there is also a language barrier: Mr. Grabovski is from Minsk, Belarus, with an uncertain grasp of English.
"It is not an easy diagnosis to make," Dr. Tator said. "The co-operation of the person who is suspected of having a concussion is very important. If there is a combination of a language problem and he is so keen to get back and get more goals, then [the player] can actually fudge it."
Former NHL player Keith Primeau, who was forced to retired from the NHL in 2005 at the age of 33 after his fourth concussion, said it is common for players to lie about their symptoms to get back on the ice. Mr. Primeau, who now works to educate young players about concussions through his non-profit group Play It Cool, said he was often in the same situation.
"I lived it," he said. "It doesn't make it right. I applaud his courage, I think we all applaud his courage, but at the same time there has to be greater awareness to the situation. In that moment, 100 per cent of the pressure is placed on the individual by themselves. It is their desire and their intent to get back out and play."
In Toronto, Dan Collison says all eyes were on Mr. Grabovski as he took the two heavy blows, but the game highlighted the complex tangle of issues parents face.
"Any parent that has a child in hockey has to think about potential injuries," said Mr. Collison, adding that his two boys have had their share of head hits and broken bones. But cases like Mr. Crosby's may not be enduring teachable moments, despite parents' best intentions.
"Boys will be boys, unfortunately," he said. "Being one myself, you kind of take it as, that's the way it is. As an adult, you take it more seriously. Look at the Lindros brothers [Eric and Brett], both careers cut short due to it. But that doesn't weigh in on the kids themselves."
With reports from James Mirtle and Tralee Pearce