Head in the game: Changing concussion culture in minor hockey

The story of concussions in hockey doesn’t start with Sidney Crosby. And thankfully, reaction to the NHL star’s career-pausing injury suggests it won’t end with him, either.

But when arguably the best player in the game, at the peak of his abilities, missed an entire calendar year in 2011-12 due to recurring symptoms from a pair of on-ice concussions, people took notice.

Crosby’s story was all too familiar to Michael Bruni (LLB’77), chair of the board of Hockey Canada, the country’s national governing body covering all levels of the sport. Like many who’ve grown up around the game of hockey, he’s seen first-hand the devastating effects that head injuries can have on the lives of young players.

“Concussions hit home to me,” says the lawyer, who became the organization’s chair in June 2011. “My oldest son, Jesse, who was a very good hockey player, had his university hockey career ended after several concussions. He’s 30 now, and still sees the effects from time to time. There’s no question that the impact that concussions can have on our players’ lives is one of the most critical concerns in the game right now."

Love for the game

Bruni’s experience in minor hockey stretches across more than 30 years. He started volunteering the way most parents do: as a way to contribute to his kids’ pastime. (Bruni and his wife Janice, who graduated from Dal law the same year, have three sons and a daughter.) As the years went by, though, his involvement became as much about keeping the game both fun and safe for the next generation of young players.

“It’s about respect for each other, respect for yourself and your well-being, and respect for the game,” he explains. “It has to be seamless. If you approach life with an attitude of respect, it shouldn’t change when you go on the ice.”

Whether it’s about helping reform Hockey Canada’s governance structure, or working with staff and management on national education initiatives, Bruni sees himself as a steward for cultural change in his role as chair. “You want to evolve from an attitude to a culture to a paradigm. It’s staying relevant through the courage to change. That’s what motivated me at the outset, and it still motivates me today.”

At times, this work is a challenge. The hours are certainly long: Bruni says that his Hockey Canada post is akin to a second full-time job, alongside his work with the Energy Resources Conservation Board of Alberta. But it’s more that enacting change in a large, multifaceted organization like Hockey Canada isn’t easy, even on an issue as important as head injuries.

“We’ve made great progress, and we have to keep pushing along that route,” he says. “But we’re working to change behaviours in parents who send their kids back too soon, or coaches struggling to identify when kids are actually hurt. There’s a lot of education we have to keep imparting.”

Understanding the science

Education and awareness of concussions have come a long way from the idea that “getting your bell rung” is just part of the game. It’s advanced to such a point that experts like Dr. Kevin Gordon, a pediatric neurologist with Dalhousie and the IWK Health Centre, say the long-term data about the prevalence of head injuries is increasingly unreliable.

“It’s an open question as to how many concussions are out there, because it’s clear that they’ve been grossly underreported for decades,” he says. “A reported concussion 10 years ago is not the same as a reported concussion today. Many of them would never have seen the light of day back then.”

Complicating matters further is that, despite advances in scientific knowledge, we still don’t really know all that much about what goes on in the brain when a concussion occurs.

“I would say that 90 per cent of the brain, we don’t understand at all,” says Dr. Stan Kutcher, Dal psychiatrist and the Sun Life Financial Chair in Adolescent Mental Health. He’s encountered concussions as both a mental health clinician and as a minor hockey and soccer coach. (He’s also suffered three sport-related concussions himself through the years, one of which was serious enough to warrant a hospital stay for several days.)

“The outcome of concussion depends on where in the brain the injury occurs, what connectivities it impairs, plus where the brain is in its own growth and development,” he explains. “That’s why concussions that occur in young people may have more profound impacts than concussions that occur in someone my age, because it can affect the long-term development of the brain.”

For the vast majority of individuals, somewhere around 80-85 per cent, concussions are benign and self-limited if treated properly, says Dr. Gordon. “In the remainder of cases, some can have longer effects and for a small subset, they can be life-changing.”

The most common symptoms of a concussion are headaches, blurred vision and dizziness/nausea. In cases where a significant brain injury may have occurred, the effects can range from major cognitive difficulties and trouble sleeping, to serious depression and other mental health issues.

The greatest risk may well be in a second injury, when a player who hasn’t fully recovered through cognitive and physical rest returns to play too quickly and takes another hit. That’s what happened in Sidney Crosby’s case, and it’s why keeping players from getting back onto the ice before they’ve healed is a top priority in preventing head injuries.

A question of respect

Thankfully, for the most part, the days of “sucking it up” are over. Across the country, minor hockey organizations are adopting strict standards to remove players upon suspicion of a concussion and to keep them from returning to play until approved by a physician.

That process isn’t without its problems – placing burdens on family clinics, for one – but it’s a big step forward.

Dr. Gordon says that he sees hockey culture changing left, right and centre – and he’d know. In 2006-07, he blew the whistle on the prevalence of a locker room game called “Helmets and Gloves” with a paper outlining how a lack of supervision was enabling off-ice boxing contests, leading to concussions and head injuries. Today, with that activity appearing to be in decline, he’s noticed that players, coaches and parents are all much more conscious about head injuries on the ice as well.

“My practice was a disaster when Sidney was out,” he says. “I was pretty much doing full-time concussion management . . . we actually began seeing kids come in where the diagnosis didn’t end up being a concussion. That was extremely rare before Sidney’s injury.”

Dr. Kutcher and his team have published a pair of brain injury guides – one for youth and one for parents, coaches and educators – that are available for free online, and are making their way across the country thanks to sponsorships.

As for Bruni and Hockey Canada, they’ve been at the forefront of this movement. The national body has a zero-tolerance rule on the ice, where even accidental hits to the head result in penalties. It has been diligent about responding to the latest concussion research and last October launched the free Hockey Canada Concussion Awareness app for iPhone/iPad, Blackberry and Android devices, providing players, coaches and parents with easy-to-use information at their fingertips.

There’s still plenty to be done, but Bruni hopes that his message of respect is resonating.

“Hockey is a contact game, and there are some accidents that happen,” he says. “But I think fundamentally, if respect permeates the game, and if we keep safety as a priority, we’ll continue to make major improvements and help keep the game both fun and safe.”

From the Winter 2013 issue of Dalhousie magazine.