Helmets, gloves, and sticks litter the ice after being discarded by the winning team during their end-of-game celebrations. (Photo by Peter Power/The Globe and Mail)Peter Power/The Globe and Mail
Bobby Hull's false teeth may be one of the strangest items coveted by memorabilia collectors wanting insight into the lives of hockey heroes. Charles Tator is after something far more intimate: their brains.
The neurosurgeon is leading a team of researchers at Toronto Western Hospital who are asking NHL and other competitive hockey players to donate their brains after their deaths for a new research project aimed at understanding the long-term effects of concussions.
Researchers at the new Krembil Neuroscience Centre sports concussion project will be the first in Canada to search the brains of dead hockey players for the same signs of severe damage recently discovered in the brains of American football players, and normally associated with boxers.
Their work is part of a revolution in the scientific understanding of concussions. In recent years, researchers have gained critical new insights into how the injuries affect athletes' brains, both in the immediate aftermath of a hit - and possibly long after they've retired from the sport.
It is sobering science that is affecting not just professional athletes.
Researchers in the Toronto area are now following minor hockey teams and doing brain scans of kids who suffer concussions. They want to determine if the guidelines for treating children should be different from those for adults. In North Carolina, scientists are trying to understand why college-age females who play hockey experience more concussions than their male counterparts, and whether younger girls are also more vulnerable.
At Boston University, neurologist Ann McKee and her colleagues are analyzing a brain of a deceased National Hockey League player in a study that is raising the disturbing prospect of a link between sports that are hard on the head and an Alzheimer's-like condition associated with personality changes and dementia.
They are looking for a highly unusual buildup of a protein that clogs and kills the brain cells of people with Alzheimer's disease. A distinctive pattern of damage has been found in the brains of former athletes who played sports in which they experienced frequent blows to the head.
Dr. McKee wants to see at least 50 cases before she draws any firm conclusions, and so far has analyzed 17 brains of former athletes. She has several more she is still working on, including the brain of the former NHL player. Most of the brains come from athletes who had been retired for some time, but one was from an 18-year-old who had played football and showed the same characteristic damage.
That case startled researchers who study concussions.
"It is scary," says Kevin Guskiewicz, who runs the sports concussion research program at the University of North Carolina.
There is very little data on how concussions affect children, say University of Toronto's Michelle Keightley and her colleague, Nick Reed. They are working with 10 Toronto-area hockey teams, both girls and boys from the ages of 10 to 14. They are doing baseline brain scans of the players, and will do another one with any children who get a concussion.
Two of the teams are wearing sensors in their helmets this season. This allows researchers to track the number, magnitude and location of any head impacts.
It is a similar approach used by Dr. Guskiewicz in North Carolina, who has found that teenagers playing minor hockey regularly take hits to the head that are as hard as those experienced by college football linemen.
He and his colleagues put sensors inside the helmets of 13- to 15-year-old hockey players, and compared the results with the university football team he monitored in the same way.
Data from thousands of hits measured on the ice and gridiron revealed the force of the head shots were similar. The collegiate football players were bigger and stronger than the minor hockey players, but they didn't move as fast.
Hockey can be as hard on the head as football, Dr. Guskiewicz says. His work with the college football players also suggests that it may not be just the highlight-reel hits that are dangerous: Small hits after a couple of big ones can also trigger concussions.
Research with university athletes in Montreal shows a concussion can temporarily change the way the brain works, at least on the memory tasks the volunteers were given. Some areas showed less activation, says Karen Johnston, a neurosurgeon and director of the sport concussion clinic at Toronto Rehab. Other areas showed more activity, as though they were temporarily taking over for circuitry affected by the injury.
But after seven to 10 days recovery, the patterns of activity returned to normal, Dr. Johnston says.
Dr. Keightley wants to know whether the same is true for children. Do they need more time to recover, or less time? There is a sense among researchers that concussions may be more dangerous in children than in adults, perhaps because the brain is developing so rapidly.
"We picked this age, 10-14, because it is when they are at the start in their peak growth spurt, when there is so much going on," she says.
Jason Mihalik, a Canadian who works with Dr. Guskiewicz in North Carolina, says the biggest problem isn't that kids are getting concussions, but that they aren't reporting them. Coaches, athletes and parents need to know what a concussion is and what the signs are, he says. Getting a concussion makes you more vulnerable for suffering a second one, and the risk of a third increases exponentially once you've had two.
But in the hockey sphere, and the NHL in particular, dealing with concussions is as much a cultural issue as it is a health question.
"We play a physical game, a tough game, there's contact in it, and I think that's how it has to be, you don't want to take the hitting aspect out of it," says Montreal Canadiens defenceman Josh Gorges, who had to be helped off the ice last season after being elbowed in the head by former L.A. Kings defenceman Denis Gauthier.
Chris Nowinski, a former college football player and professional wrestler who still suffers from the many concussions he experienced in his career, says education and more research is key. Through a group called the Sports Legacy Institute, which is part of the Boston project, he tracks down the families of athletes who have died and asks them to donate the brain of the deceased to science. The brains go to Dr. McKee.
Over 250 current or retired athletes - including 50 NFL players and 12 hockey players - have pledged to donate their brains, including Keith Primeau, who retired from the NHL in 2006 due to post-concussion syndrome.
"I know that I've damaged my brain," Mr. Primeau said in an interview. "What it really boiled down to was the inherent value of what my brain had to offer to science. And for me that was overwhelming."
Dr. Tator says Krembil Neuroscience Centre's sports concussion project aims to see whether the Boston findings can be supported by another independent group. He emphasized that more brains must be analyzed before researchers can draw concrete conclusions about the long-term effects of multiple concussions, and whether some combination of genetic or environmental factors plays a role.
Along with neuropathologist Lili-Naz Hazrati and neurologist Richard Wennberg, he is looking for men and women who have had at least one concussion in their athletic career. They expect to attract mostly hockey players because of the sport's popularity in Canada, but welcome athletes from other contact sports.
Their first volunteer is Jeff Potter, a 45-year-old Toronto man who suffered several severe concussions playing professional roller hockey and in his regular men's league.
"I'm not the NHL guy that's taken so many hits it's ridiculous," he said. "But I've taken more than the average person should've. And if the average person's brain is damaged beyond what it should be … and someone else can benefit, then it's all that really matters."
With reports from David Shoalts, Allan Maki, Sean Gordon, Matthew Sekeres, Eric Duhatschek and James Mirtle