ALLENTOWN, Pa. — Those were the instructions given to the Edmonton Oilers skater Shaun Van Allen after suffering from post-concussion amnesia. This humorous statement is highly indicative of the way most approach getting your “bell rung.” Due to the competitive nature and instinct of the hockey player, the usual response is; “I am OK to play.” Would any player aspiring to reach the NHL respond; “yes coach, that did really hurt; I wish not to play?”
Often times a healthcare provider with limited neurology background is called upon to medically clear a player after a concussion. Many times the player states he is fine and a recent review of the medical literature reveals extremely inconsistent recommendations to medically clear his return to the ice.
The concussion is defined as mild brain trauma or injury. It is the most common type of traumatic brain injury suffered in hockey. In a 2003 Canadian Medical Association Journal article, it was reported that each season, 10%–12% of minor league hockey players 9–17 years old who are injured report a head injury, most commonly a concussion. These head injuries results in a temporary loss of brain function . Diagnosis is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia (usually less than 24 hours).
The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient’s condition. Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury. The biggest problem today is inconsistent follow-up once players move from team to team or switch leagues.
Very few players will volunteer medical information to new coaches and trainers. Most perceive injury reports as negative information that will hurt their prospects of promotion. Although never appearing on a scouting report, players identify the label injury-prone, with damaged goods. If only they could be made aware of the cumulative effect of these concussions.
The brain is governed by a complex wiring system of nerves (neurons) and tissues (gray and white matter) which integrate the pathways of thoughts, reflexes and bodily function. The central nervous system is very similar to electrical wiring systems of our homes. A lightning bolt overloads the circuit and leads to a blackout. A blow to the head damages our central nervous system in a similar mechanism of action.
Once a neuron is damaged, it can no longer fire over established pathways. The white and gray matter atrophies like any other unused tissue or organ. Multiple lightning bolts to the brain damage these complex pathways in a variety of cognitive impairments. Depression, agitation, uncontrollable violent behavior, attention deficit disorder and early onset Alzheimer disease are just several of the complications of repeated concussions.
A consistency needs to be established in the minor leagues with neurologic assessments of injured players. Mandatory medical seminars and certifications are needed to establish diagnosis and treatment guidelines for players suffering any brain trauma. My hope is that within a reasonable degree of certainty, health care providers can refer to the same protocols to diagnose, treat and medically clear players for competition. More importantly is to know when it is right to not let them play.
John R. Manzella DO, MBA is a practicing physician in Pennsylvania. Board certified in Pediatrics as well as Internal Medicine. Dr. Manzella can be reached with questions or comments at jmanzellajrd347@pol.net
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