The first scientific study to delve into the long-term impacts of concussions specifically among National Hockey League players has yielded some surprising initial results.
The Rotman Research Institute at Toronto's Baycrest Health Sciences is collecting brain images and genetic data and conducting a battery of tests on retired NHL players.
On objective tests of cognitive functions such as memory, attention and processing information, the NHL alumni do about as well as the study's comparison group, and it doesn't matter how many concussions they had during their careers or whether they have the APOE4 allele, a type of gene that has been associated with increased dementia.
"If there was impairment, it was subtle and nobody was significantly cognitively impaired," said Dr. Brian Levine, the study's lead.
Given how much attention there has been lately on the long-term dangers of repeated hits to the head, particularly among football players in the NFL, that's not necessarily what they might have expected to find.
But what's also interesting is that the study's generally positive main finding doesn't jibe with how players say they feel. In subjective questionnaires, they reported high levels of behavioural and emotional problems.
"There's nothing glaringly obvious as far as red flags or anything to panic about (from the testing), so that's good news, because I really don't want to have anything that scares me," said Scott Thornton, who played 17 seasons in the NHL and now runs several businesses in Collingwood, Ont.
Still, he's pretty reserved about these findings — based on the first four years of study — because, despite what the standardized tests say, fine is not how he always feels.
Thornton, a first-round draft pick for the Toronto Maple Leafs in 1989, learned early on that playing through injuries, including the blinding headaches and confusion brought on by concussions, was a good way to earn respect from players, coaches and team management.
Now, a decade removed from his professional hockey career, he's among the group of former NHL players who have volunteered for the Rotman study, hoping to find out if the multiple concussions they sustained while playing hockey have left them with damaged brains and what, if anything, they can do about it now.
Thornton isn't sure how many concussions he had during his career, which started with the Leafs and ended with the Los Angeles Kings.
"Probably seven or eight documented and at least that many undocumented, so, for sure, in the double digits," he said.
He struggles at times to recall words, conversations or the names of past teammates.
"These can be guys I played seven seasons with and I can't think of their names," he said. "I know we all get that at times in life, especially as we age, but I think it's a little more significant than just that. There are times when you have conversations with your wife and kids that you don't even recall. You sit there and swear that you've never heard that conversation before and the whole family kind of laughs. 'There goes Dad again, doesn't remember talking about that.'
"But it gets to a point that you don't like joking about it anymore."
He hears similar stories from other retired players and their families.
"I don't think it's just your typical mid-40s starting to forget things. So, I'm assuming we're not as sharp as we used to be and some of that has to be related to concussions or head trauma," Thornton said.
Interwoven tightly with the ex-players' current experiences are their fears of the future.
"And I have more than a few friends that had a really hard time and still have seizures, and you wonder, why him and not me? Why am I doing better than him?"
Why concussions affect people differently is just one of the many things science still can't answer. That's particularly tough for former players with histories of concussions who want to know what their future may hold.
"A lot of guys are terrified," Levine said of players in the study.
The published paper is based on 33 professional hockey players, 34 to 71 years old, but the number of participants is now over 50 and continuing to grow.
They all want to know how they're doing, but the bigger purpose of the research is to create a broad pool to overcome the inherent difficulties of testing humans. There are very few one-to-one relationships between biology and behaviour. Someone could have half a dozen concussions but have a counteracting positive genetic factor that means they'll suffer less than another person with a similar sport history.
It takes a group study to parse out cause and effect, and it takes time.
Levine and his team are still analyzing the brain imaging data, which will be published in a future paper, but he said they did not find anything troubling, such as lesions on the brain, that could provide clear answers.
For now, they are left with yet more questions.
On the subjective questionnaires, followed up with medical diagnosis, the NHL alumni had elevated rates of psychiatric complaints from depression and mood disorders to alcohol and substance abuse — and those were not related to the number of concussions they suffered.
Fifty-nine per cent of the former players reported problems with depression, anxiety, alcohol and substance abuse — well above the 19 per cent found in the control group. The figure is also higher than medical estimates that 50 per cent of the general population will experience a psychiatric disorder at some point during their lifetime, Levine said.
But what that means, if anything, to the concussion debate is unclear.
It's possible that it is a sign of some brain impairment that hasn't shown up on the other tests, or it could be more lifestyle-related, Levine said.
"One of the possibilities that we entertained is that athletes are special, they have extraordinary abilities, and that may come along with extraordinary challenges. Being a pro athlete in and of itself is a unique position in life, so it comes with unique challenges, especially after retirement."
That's something Bryan Muir, who spent his 15-year career moving between the NHL and the minors, knows all about. He remembers mood swings and throwing up between shifts on the ice after concussions, but refused to admit to any injury that couldn't be seen on an X-ray because he didn't want to be sent down.
"I don't think it's surprising that there's more addiction and depression, just having known what I've gone through on the retirement side," said Muir, who is head of sales for a content marketing platform for financial advisers.
"You've got to imagine something: You played as a kid, you loved this sport and then you were fortunate enough to play this game for 15 years until you're 32 or 35. And, with a flip of a switch, it's turned off and you can't do it anymore," he said.
"I had to go through three different jobs before I found one I wanted, and not everyone has the opportunity and connections I had to be able to get those jobs."
Just as there is more concussion awareness and protocols for player safety today than there were in his early playing days — changes spurred by the experiences of superstars like Eric Lindros and Sidney Crosby — the National Hockey League Players' Association is now doing more to help men cope with retirement from the game, Muir said.
But the life of a professional athlete is rarely an easy one to leave behind.
"I know what I miss about hockey: I miss the pain, I miss the battling, I miss the camaraderie of the guys. There is a sense of addiction to that battling and warrior mentality. I really did enjoy that," Muir said.
"Now, I've been getting a short temper … and I don't know if that's a lack of an outlet or it's a physical or chemical thing. It's hard for me to say that it's because of my NHL career — I got hit in the head and had (multiple) concussions — that now I'm snapping," he said. "I don't know, and that's why this study is so great."
Muir and Thornton hope that over the long term, Levine's work will produce some answers for them and for others.
"What happens when you retire is that you're, quite often, just gone — you don't have access to team doctors or the stuff you had before," Thornton said. "You're just forgotten about, and a lot of us are trying to be proactive (about our health), but it's very difficult to get information, probably in light of the ongoing lawsuits."
Any new concussion research lands smack in the middle of a very polarized, public debate about safety in sport, from children in soccer all the way up to highly paid professionals in contact sports.
More than 100 former NHL players are currently suing the league, alleging it put profits before safety and failed to protect them from head injuries. The league has maintained that it did what it could and science did not demand more measures.
Although many people in the concussion debate, layman and expert alike, have firm views on one side or the other, that's not Levine. He wants science to speak, and when the picture isn't clear or complete, he says so.
"There are sides to the debate and people will probably find support for whatever side they're on in our study, but our study is one study. It's not going to settle any arguments," he said.
But as an objective, long-term study dedicated to finding biomarkers that may be able to explain why some athletes with a history of concussions suffer badly and others don't, it is vital scientific research, said neurosurgeon Dr. Charles Tator, who runs the Canadian Sports Concussion Project.
If there's a way to predict bad outcomes, there may, eventually, be a way to prevent them.
"Unfortunately, we're at the beginning of concussion research," Tator said.
"Longitudinal followup is essential so we can connect the dots. Let's hope the players keep showing up."
Muir's followup testing takes place next year.
"I'm excited to stay in this study and, hopefully, understand how (a history of concussions) affects us later," he said. "That's really the goal of this thing, and only time will tell."
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