Doctors and minor hockey players are calling for changes to rules and attitudes as evidence shows that concussions are taking an even greater toll on players than researchers had realized.
A Canadian study, published in the November issue of the journal Neurosurg Focus, found the injuries are seven times more common than previously reported for players in their late teens and early 20s and that many of those most closely involved with the sport aren't taking the injuries seriously.
The study, which followed two unnamed male junior hockey teams for 52 matches, shows that 17 of the 67 players suffered concussions, more than a quarter of them more than once. About 80 per cent were the consequence of deliberate hits.
"These numbers are my patients," said Paul Echlin, a London, Ont.-based sports medicine physician and lead author of the study. "They're human beings and should be respected as such … Why are we exposing young athletes to danger and not asking the questions? It's everyone's responsibility."
The effects of concussions, which typically involve an injury when the brain is shaken inside the skull, can be debilitating, ranging from mood swings to memory loss to the splitting headaches Krishan Kaushal knows all too well.
The 20-year-old hasn't skated since February, when a pair of head shots ended his season with the Alberta Junior Hockey League Calgary Canucks and put his dream of playing pro hockey in peril. In the months that followed, he was beset by episodes of intense head pain that built in pressure until his skull felt as if it was being squeezed in a vice.
Once thought by his coach to be on his way to a college scholarship, Mr. Kaushal has instead spent the past few months nursing his injuries.
"This summer I did nothing. The headaches were so bad I sat in dark places in the basement. I was sensitive to light and music," he explained.
The medical community is taking increasing notice of the problem faced by players like Mr. Kaushal - a problem believed to extend to all contact sports - and calling for swift action.
On Monday, a position statement issued by the American Academy of Neurology called for any athlete who had a concussion - or even a suspected concussion - to be taken off the field and not allowed back until assessed by a qualified doctor.
The same day, the magazine Sports Illustrated released a special issue that discussed the frequent occurrence of the injury among National Football League players and took a frightening look at the effects of head hits on players from minor-league football on up.
The researchers behind the Canadian study hope to do an evaluation next year of women's hockey, which, they say, has a surprising number of concussions, despite non-contact rules.
What is needed, experts say, is a multi-pronged approach to battling the problem, with changes in everything from equipment to regulations designed to make the sport safer.
American concussions expert Robert Cantu said helmets do a good job protecting against skull fractures, "but they're not being made to a standard to prevent concussion and they probably never will be able to prevent all of them."
"I think helmets are a pretty minor part of the total solution. … I really think education and rule changes is where you're going to get the greatest amount of good occurring."
The Canadian study found a deficit on the education side, with some players, coaches and parents involved in the study resisting doctors' evaluations.
One of the two teams pulled out after an executive wanted to stop the study's doctors from examining players for concussions during games. What is more, five of the 17 players who had the head injuries refused further examinations by the study's doctors, while two of them were also found to have deceived family doctors to get notes saying they could still play.
Ignoring such an injury is familiar to former goalie Brad Madigan of Oakville, Ont. Two years ago, he was knocked unconscious when an opposing forward slammed into him after he made a save. After a break in the dressing room, he returned to the ice and finished the game.
"It's a culture, it's a mentality to suck it up," said his father, Kevin Madigan. "Unfortunately, it has consequences."
Those consequences caught up with the younger Mr. Madigan when he started business courses at Wilfrid Laurier University. He began forgetting his shifts at his part-time job and began having random nausea attacks at school. Doctors realized he had been having the effects for years: He had lost peripheral vision, skipped dinner before games, suffered migraine headaches and became sensitive to light and sound.
"I'd been playing through concussions, though I didn't know it. It's what you did in hockey, play hurt," he said, adding that twice he had to take time off school to recuperate.