Striving for a breakthrough in sports concussions research

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Wednesday evening, at a dinner staged at the Crowne Plaza Hotel in Colorado Springs, Colo., USA Hockey will honour the best college, junior and female hockey players and goaltenders in the United States – and give a special award to a Canadian.

Charles Tator, CM, MD, PhD, FRCSC FACS, neurosurgeon at Toronto Western Hospital, professor at the University of Toronto, founder of ThinkFirst Canada, will be celebrated and thanked for the decades of work he has done on brain injuries and the mysterious effects of concussion.

There is likely no one who knows more about hockey concussions than Tator, and yet he would be first to admit he knows next to nothing at all.

"We know only the tip of the iceberg," he says. "There remains a huge amount we do not know."

Tator hopes to change that with an ambitious plan to raise, ultimately, $25-million for his Canadian Sports Concussion Project that is under way at the Krembil Neuroscience Centre at Toronto Western. On the Monday following his USA Hockey award, he will meet with a new advisory group – which includes Hockey Hall of Famer Ken Dryden and Boston Bruins star Marc Savard, who is still suffering the effects of concussion – and plans will be laid to turn the project into the leading source for brain injury research in the country, just as Boston University has been leading the way in the United States.

Already Canadian neuroscientists at Western have studied the brains of four deceased former CFL players – two found to have suffered from chronic traumatic encephalopathy (CTE), two without but showing signs of Parkinson's disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) – and have under study two more donated autopsied brains of Canadian football players.

"There will now be a Canadian counterpart to the work being done in Boston," Tator says.

At the moment, he says, "We don't have an accurate way of even diagnosing concussion."

He adds, in words that will surprise many, that, "There is currently zero treatment for concussions" that can be proven effective, apart from time itself. Much of the treatment there is in today's sports medicine is, in his learned opinion, "worthless" and needs to be "discarded."

"Research is sadly lacking," Tator says. "It has been a neglected issue in medical research."

As for the study of brain degeneration, as in the case of CTE, Tator says medical scientists have long been aware of the condition in aging athletes but, "We didn't take it seriously enough. We actually thought it was confined to boxers, but then it appeared in soccer. In European soccer there has been a real concern about the dangers of heading the ball. Several former European stars have come to autopsy and been found to have had this brain degeneration. So it spread from boxing to soccer and then football – and now hockey."

Tator believes, "The time for action is now," and he says there are some "very positive things" happening. Hockey Canada, with its Smart Hockey video, is helping. And he likes what he sees in the Ontario government's Bill 39, which will amend the education act so that schools, school boards and educators have clear directives on what action to take regarding head injuries and possible concussions. He trusts this legislation will stand as a model for other provinces across the country.

Tator also likes what he hears from such junior hockey leaders as Dave Branch, head of the Ontario Hockey League who has been tough on head shots and has spoken out against fighting. He applauds the NHL coming down hard with a 25-game suspension on Raffi Torres of the Phoenix Coyotes for his deliberate hit to the head of Chicago Blackhawks forward Marian Hossa during the Stanley Cup playoffs.

"It does signal that the NHL has moved on this – just not as far as we would like them to," Tator says. "But they're certainly on the right track."

Football, however, has taken even more impressive steps. Tator has no doubt that there is a direct link between action and the threat of class-action lawsuits from former players, but football everywhere is getting "serious about concussion.

"They're putting posters up in the locker rooms of NFL teams that players should report their concussions. Can you imagine that? That's a 180-degree turn that has happened in the last couple of years, going from denial that concussion was a problem to asking players to report their concussions. That's a huge shift. The Americans have taken injury prevention and player safety to heart and are trying to do something about it."

What the Sidney Crosby injury last year did for awareness of "acute concussion," the class-action suits are doing for a better understanding of the spectrum of injury that lies between a single hard hit and long-term brain degeneration. "In between," Tator says, "there are other important aspects, such as postconcussion syndrome, second-impact syndrome, the issue of concussion leading to emotional changes like depression, significant mental illness as a result of repeated concussion,

"If you add up all the positives, it is quite substantial," Tator says. "I continue to be encouraged by all the positives."

At times accused of being a "hockey killer," the 75-year-old Tator was himself a player and remains a great fan of the game, of all games.

"I don't want kids to stop playing collision sports," he says. "I want them to benefit from playing hockey, football, rugby, soccer. They are great sports, but they need to be played safely. In every one of those sports there is a safer way to play. And the people who are administering those sports, and the coaches and the trainers need to be up to speed on how to diagnose concussion, because I am convinced that if concussions are diagnosed promptly and good management advice is given, that the effects of those concussions is minimized, that proper management will keep players playing longer and without suffering the consequences of play.

"I look forward to being able to recommend even more strongly that players keep playing. We obviously still have a long way to go – but it's starting."