When the face of the game is incapacitated by a concussion, the entire NHL feels his pain.
Next week, when the NHL's general managers hold their annual meeting, one of the main topics will be the league's rise in concussions this season and whether the league can do more to protect players. Penguins GM Ray Shero says the group should at the very least discuss whether it is time to consider penalizing all hits to the head, even accidental ones.
Before this season, the NHL enacted Rule 48, eliminating blindside blows to the head.
That was a big step, and there is considerable opposition to taking the next step.
"On one side, you could say the game is getting too soft," Washington Capitals forward Mike Knuble says. "On the other, we have to protect the players."
That is the central tension in an ongoing debate over concussions in contact sports that flared up over the past year. Much of the national conversation has centered on football, but hockey moved squarely into the debate with Crosby out since Jan. 5, Boston Bruins center Marc Savard shut down for the season and New York Islanders forward Trevor Gillies twice suspended for head-hunting from behind, plus the news that former NHL enforcer Bob Probert had a degenerative brain disease.
Bill Daly, the NHL's deputy commissioner, says Rule 48 appears to be working but concussions are up this season. There have been as many concussions this season — with a month to go — as all of last season, he says.
"The concussions resulting from hits to head, whether you categorize them as legal or illegal, are actually down," he says. "What we can say about the data is that (Rule 48) has changed behavior. Beyond the blindside hits, it looks like we are getting less shoulder-to-head hits north-south."
Even so, the NHL is experiencing more concussions through accidental contact, such as the Crosby-David Steckel collision, and secondary contact, such as a player hitting his head on the ice or boards after a legal check.
"Most of those things there isn't much we can do to legislate against, unless we took hitting out of the game altogether, which I don't think you will see that in your lifetime," Daly says.
NHL leads way
The NHL has been at the forefront of the issue of concussions in sports; it formed a Concussion Working Group in 1997 and mandated neuropsychological testing to establish a baseline for players. That working group met during the All-Star break in Raleigh, N.C., in January and recommended a new policy for players suspected of suffering a concussion during a game. The policy is not complete but will be in place by the end of the regular season.
"The protocol now calls for players with obvious symptoms to be evaluated away from the bench and action," Daly says. "The tweak we are making to that is put in specific criteria that trainers and health professionals should look to. If a player meets any of those criteria, it becomes mandatory for the player to be pulled off the bench and evaluated in the dressing room."
The names of players with concussions have been noteworthy this season, including Crosby and Savard. The Nashville Predators signed Matthew Lombardi to be their top center this season, but he has been out since being hurt in the second game of the season.
Last week came another twist with word that Probert, a former NHL enforcer who died at 45 last summer, had a degenerative brain disease. Boston University researchers discovered 13 of 14 football players who left their brains to science showed signs of chronic traumatic encephalopathy (CTE). The brains of two hockey players also showed signs of CTE; Reggie Fleming, an enforcer in the 1960s, is the other.
"We do know it is critical for people to rest and recover from concussions or they will potentially continue to have symptoms from the concussion, something called post-concussion syndrome," says Robert Stern, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University's School of Medicine. "But what we don't know yet is the link between returning to play too quickly after a concussion and subsequent development of CTE."
Primeau is among 350 athletes who have pledged their brains to the center. He had four documented concussions during his career but thinks the real figure is "north of 10," including undiagnosed ones early in his career. He still gets lightheaded and dizzy when he exerts energy, five years after he retired. Only very recently has that begun to subside.
"This is real," he says. "Players may sit in a room and listen about post-concussion and think, 'I feel really bad for them, but that's not me.' I'm here to tell you that it can be you."
What must Crosby be feeling these days? Primeau describes how life after a concussion feels: "Headaches, head pressure, stiffness in the neck."
And what must Crosby be thinking? "You aren't thinking long term," Primeau says. "You are thinking about the moment. It's extremely difficult and frustrating, because you are waiting every day to feel better."
Concussions and the impact of Rule 48 will be first on the agenda when the general managers meet starting Monday in Boca Raton, Fla. — but not just because of Crosby, Daly says.
"Anytime a newsworthy event brings more attention to an important thing, it's a good thing," Daly says. "But I don't think within our ranks we are treating this issue any differently because Sidney Crosby has been out two months."
What price safety?
Crosby, at 23, has won a Stanley Cup with the Penguins and scored the gold medal-winning goal for Canada in the 2010 Olympics. He was playing in the NHL's marquee regular-season game — the Winter Classic, outdoors on New Year's Day — when Steckel, then with the Washington Capitals, accidentally hit him from behind.
Crosby appeared dazed but played the remainder of the game and appeared to be fine when he addressed the news media after the game. Four days later, he was checked into the boards by Tampa Bay Lightning defenseman Victor Hedman. This second hit did not look nearly as hard as the first, but the Penguins sent him home when he had symptoms the next day. Crosby has not played since.
"He wasn't healed from the first one, and that's why the damage was greater from the second one," says Hall of Famer Pat LaFontaine, speaking from the experience of his oft-concussed career. "When you get hit again a short period of time after you've been concussed, that's when the exponential damage comes in."
Steckel's blindside hit on Crosby was deemed accidental by the NHL, but LaFontaine says even accidental hits to the head should be penalized.
"I've been saying for years that there should be no tolerance," he says. "If we lift our stick and hit a guy in the face, it's a penalty whether it was by accident or on purpose. Hits to the head should be no different."
Capitals defenseman Karl Alzner says if accidental hits were outlawed, the game would lose spontaneity as players slowed down.
"That would change the whole dynamic," he says. "The game happens so fast, and you don't want to take away from that."
Toronto Maple Leafs general manager Brian Burke thinks eliminating straight-on blows to the head would also change hockey for the worse, even though international and collegiate hockey do not allow such blows.
"We are a contact sport, and we are going to have injuries and we are going to have concussions," Burke says. "Our job is to make it as safe as we can without changing the fabric of the game.
"All of these players are volunteers. No one was conscripted."
Capitals forward Matt Hendricks notes that, as players get bigger and faster, the danger of the sorts of collisions that lead to concussions increases.
"We don't want to end careers," Hendricks says. "It's a fine line. Straight-on hits, you should be able to see them coming."
Or as the Caps' Knuble puts it: "Is a puck carrier never going to be at fault for coming through with their head down? No one can touch you, almost, when skating with your head down?"
For all of that, Capitals coach Bruce Boudreau thinks maybe the time has come to phase out all blows to the head.
"I like seeing the straight-on hits," he says. "It's easy for me, because I'm not out there anymore. But at the same time I'm down there close enough to the play to see how big and fast these guys are and knowing how dangerous this thing could be in the long haul.
"You're never going to want to take the hitting out of hockey. But at some point the hitting to the head has got to stop, I think."
Facing future
Probert had hundreds of fights in his career. Researchers can't rule out that repeated blows to the head caused his CTE. Even so, Anaheim Ducks forward George Parros thinks the threat of fights keeps the game safer.
"If you took fighting out of the game," he says, "you would see more blows to the head, because there would be no price paid for doing that."
Mathieu Schneider, special assistant to the NHL Players Association's executive director, had a few concussions when he played from 1987-88 to last season.
"I find myself asking, would I have changed anything had I known what I know today?" he says. "Honestly, I don't know."
Today's players worry about the dangers of their sport, and for good reason.
"If you play in the league long enough, you play with guys who you hear later on are damaged," says Knuble, who has had one concussion in his career. "I can think of two or three guys who I played with who have brain damage. Will you notice it now? No, but who knows if it will contribute to dementia down the line? It's hard to say."
LaFontaine, who retired in 1998, says he feels fine these days. He also feels lucky.
"I'm all for a physical game played with intensity at a high level," he says. "But if you hit a player in the head, you have to be held accountable.
"I remember a few years ago, I said, 'What is it going to take — a Sidney Crosby or an Alex Ovechkin out of our game for us to finally wake up?' I think maybe we are finally waking up. I hope so, anyway."
Stronger hockey pads could be double-edged sword
Today's modern hockey equipment, constantly upgraded to protect wearers, might be hurting players, too. That's an idea that could receive more play as the NHL and NHL Players Association work together to reduce injuries.
"Even when you graze guys with shoulder pads, it's dangerous," Pittsburgh Penguins general manager Ray Shero says.
Bigger, stronger shoulder pads can be weapon-like when they strike an opponent.
"If you ask some ex-players, they believe it's so protective it's almost encouraging those type of hits," says Bill Daly, the NHL's deputy commissioner.
Shero says, "Maybe guys wouldn't run as much on the ice if they didn't have all of that equipment on."
Former NHL player Mathieu Schneider, special assistant to NHLPA executive director Donald Fehr, says it's a complicated issue. "Most of the players have grown up with the equipment they have now," Schneider says.
The NHL has made recent adjustments, requiring elbow and shoulder pads to have a softer cushion on the outside. Players also are required to tighten their chin straps so their helmets don't fly off.
"Players are now stronger and quicker," says Alain Hache, a physics professor at the University of Moncton in New Brunswick. "A 10% increase in velocity increases the blow by 20%. When it comes to head blows, there's a limited amount of protection you can receive from a half-inch of padding inside the helmet."
As a rule, players don't like to switch equipment for the same reason craftsmen prefer their own tools: comfort.
"If you go back to the 1980s, we had issues in baseball as whether to require batting helmets and then whether to require one earflap or two," Fehr said. "That was in a sport that doesn't have the some propensity for injury that this one has. … The players have their own comfort level with the way the game is played."
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