Heading for trouble: A concussion can mean it's safest to hang up the skates

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Today is Tim Campbell’s first instalment of a four-part series dealing with concussions and their consequences.

Jamie Heward takes a lot less for granted than he used to.

It's a self-imposed side-effect from having suffered as many as 20 concussions, some from hockey, some from normal kid activities and falls, up to the end of his NHL career at age 37.

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Alexander Ovechkin slams Jamie Heward into the boards and Heward crumples to the ice (opposite page). Ovechkin looks on (left) as Heward is attended to and carried off the ice. ( ROGER L. WOLLENBERG / UPI ARCHIVES)

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(MCT)

The last, when he was hit from behind by reckless superstar Alexander Ovechkin of the Washington Capitals, knocking his head hard and awkwardly into the glass on Jan. 1, 2009, was one too many for the Tampa Bay Lightning player.

Heward was unconscious for a minute. He was then carried off the Washington ice on a stretcher. To this day, he remembers little about the events before and after that hit.

"All my symptoms from before came back," the Regina native says.

Those included feeling like he was floating in space, not remembering his wife's name, not remembering where he was. There was even a time when he went golfing on a summer day and an hour after returning home, couldn't remember playing any golf and denied he had.

After the hit by Ovechkin -- one Heward still says he has trouble watching -- he couldn't remember flying home to Tampa after the game. He does remember staying in bed in his dark hotel room for days on end after that, ordering room service and then resuming sleeping in that dark brain fog that concussions can cause.

When he was finally up and about after nearly a week, he tried to point himself to a return to the Lightning's lineup, but knew there was trouble.

"HD TVs, everybody loves them today, but I couldn't watch them," Heward says. "I couldn't even watch a game from up top (the press box), just couldn't concentrate."

Heward, like most injured players, turned his thoughts to his job.

"My first reaction was, 'I'm not going to get paid. Somebody's going to take my job.' At times, professional hockey players, they're their own worst enemies."

Heward admitted that he started telling the Lightning trainers he was feeling fine, that he was better, that he, in fact, was having "great days." He was caught more than once in the deception.

That short-circuited his progress through a strict set of steps NHL players and other athletes must pass in order to return to play. Those protocols include monitoring of symptoms and actual testing of mental sharpness and comparing the results to a baseline test completed when the player was fine.

"No matter what kind of injury it is, you always feel you're letting the team and yourself down," Heward says. "It's a kind of withdrawal, that this is all I've ever done, this is all I want to do and now I can't do it.

"It's good to be part of the team, but as soon as they put on their skates, you're left all by yourself sitting in the training room. It's a sense of emptiness. Why am I not better? I should be better. I'm going to tell them I'm better so I can get back on the ice."

Heward's symptoms last season did not abate until May.

"I was OK after six months in the doctor's eyes," he says. "But not in my eyes. I still have symptoms."

After 394 NHL games, Heward is now spending some of his time working with minor hockey teams in Regina and sharing the message about concussion education and prevention where he can.

"The (return-to-play) protocols may have ended my career but might have saved my life," Heward says. "I want to remember my kids, my wife."

When the brain rattles around in a skull, there is bruising and tearing. This damage is a concussion, whether or not consciousness is lost.

The sudden force could be from a fall, a car accident or innocent horseplay. In hockey, it's often from the boards, the ice or the shoulder, elbow or fist of an opponent. The NHL has past data that shows that 42 per cent of concussions come from head contact with boards, glass or ice; 40 per cent come from an elbow, forearm or shoulder to the head; 12 per cent come from fighting and six per cent come from a puck or stick to the head.

Statistics, incidents like Heward's and an injury that's damaging its elite workforce will be like stars aligning early next week when NHL GM's meet in Florida. The top of their agenda will be how they might revise rules to outlaw some of the dangerous contact to the head.

In the real world, the understanding of concussions is constantly improving -- welcome news, given that trauma is the leading cause of death among Canadians under 44, and that of those trauma deaths, head trauma is No. 1 on the list.

"Imagine if concussions had received all the attention that H1N1 received," says Toronto neurosurgeon Dr. Charles Tator, one of Canada's top concussion experts. "Far fewer people are going to die from H1N1."

Dr. Tator also said that his research leads him to believe that as many as 20 per cent of the players on any hockey team (early teens to the NHL) suffer from concussion in a given season.

To be diagnosed with a concussion, a loss of consciousness is no longer necessary. Instead, any one of a long list of symptoms (dizziness, confusion, headaches, seeing stars or lights, nausea, etc.) after a blow to the head probably means a concussion. And symptoms aren't always immediate.

But even a blow to the head isn't required; it could be force applied to other parts of the body that causes the head to move in a whiplash-like manner.

Concussions are also no longer graded; they are gauged by the duration and severity of symptoms. And medical experts no longer like the term "mild concussion," because the word "mild" does not go well with brain injury.

In sports, the study of concussion has led to many discoveries.

One of the most important is the risk of second-impact syndrome, which can occur if there is a second concussion while a person still has symptoms from an earlier one.

In this case, there is high risk of brain-swelling and even death.

And that's why a protocol of careful steps has been developed for athletes to return to play after a concussion. Once symptom-free, they may gradually ramp up their activity, but always with at least a day in between the steps to make sure they are free from symptoms.

Experts are now also recommending that anyone with a concussion should not just sleep it off, but see a medical doctor.

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All Jason Smith ever wanted for Christmas was hockey.

It became a family tradition -- and inside joke -- that there were always skates, sticks, gloves and tournament trips for him under their tree.

What he also got that he didn't ask for was a concussion.

As a draft pick of his hometown Calgary Flames in 1993, he was a big defenceman with an NHL dream and a future ahead of him, playing at Princeton University in New Jersey.

The first check to his head came during Flames' training camp in 1996, when an elbow knocked him cold. He described the sensation as large gates on either side, closing down his vision from the periphery to the centre with an echoing, whomping sound.

The second concussion came later that year during a game for the Flames' farm team in Saint John, N.B., a hit far less severe but with the same effect. He told nobody, though when he couldn't see, the team's assistant coach just told him to sit on the end of the bench.

A third occurred a short time later playing in the ECHL, from a routine shoulder check with very little force. Some symptoms went away more slowly, to the point where, "I had a Princeton degree and I couldn't hand-write a letter to my agent," Smith said of his "dark" days right after this third concussion in six months.

Nor could he count past 97 when asked to count by threes backward from 100.

He returned to Calgary to consult the Flames medical team and was told, in no uncertain language, that he should quit hockey for the sake of his brain.

He did not like the advice, given his lifelong Christmas list, but he followed it.

"I'm glad somebody was there to make that decision for me," Smith says.

Instead of continuing to put his brain at risk in hockey, Smith, the Princeton grad, became a successful sports orthopedic surgeon who has worked for such teams as the Washington Redskins, Toronto Maple Leafs and Toronto Blue Jays.

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Concussion in hockey is pervasive and it's constantly ruining careers.

The risks of repeated concussions have only come into focus in recent years, and still much isn't known. But medical experts and researchers have seen evidence that depression, cognitive deficit, behaviour changes, epilepsy, dementia and even Alzheimer's disease could be in play.

Dementia pugilistica is a form of brain damage known to be suffered by boxers, but a similar condition, known as chronic traumatic encephalopathy, has recently been seen in studies of football players. The condition, marked by unusual protein deposits in damaged areas of the brain, was also found in former NHL tough guy Reggie Fleming in a study released by a Boston University research team last summer. It was a finding that raised alarm in hockey medical circles.

The NHL has lost dozens of players to career-ending concussions.

Among the more prominent have been Keith Primeau, who will donate his brain to the Boston University study, Eric Lindros, Pat LaFontaine, Jeff Beukeboom and former U.S. Olympic goalie Mike Richter.

Manitoba Moose defenceman Michael Funk has suffered four concussions in the last 18 months, the most recent in early November. He's been finally having some better days recently, but is still experiencing symptoms, mainly headaches.

"Watching TV, I can tell within minutes if it's going to set one off," Funk says. "Then I'd have to back to my dark room and lay down." Funk's Moose season is over and he says this week he'll soon have some serious thinking to do about his hockey future.

Morden product Chay Genoway, the talented captain of the University of North Dakota Fighting Sioux men's team, was felled by a hit from behind that concussed him early in the season. It was a huge blow to his team and he hasn't skated since.

Winnipegger Jason Botterill, once a world junior hero, had his career cut short by concussion in 2004. He's now the assistant GM of the Pittsburgh Penguins.

And former University of Manitoba skater Stu Grimson's career ended too early in late 2001 while with the Nashville Predators. After a stint with the NHLPA, he's now an attorney practising in the Nashville area.

tim.campbell@freepress.mb.ca

What is a concussion?

A concussion is a common form of brain injury, and can be caused by a direct or indirect hit to the head or body where the brain suddenly shifts or shakes inside the skull and can knock against the skull's bony surface. This causes a change in brain function, which results in a variety of symptoms. With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans often appear normal.

(Source: ThinkFirst.ca)

Symptoms

(only one of these symptoms is required for a concussion diagnosis)

Nausea, vomiting

Dizziness

Confusion

Fatigue

Light-headedness

Headaches

Seeing bright lights or stars

Irritability

Feeling stunned

Depression

Signs

of a concussion

Inappropriate behaviour

Decreased work or play ability

Cognitive and memory dysfunction

Sleep disturbances

Vacant stare

Poor balance, co-ordination

Slow or slurred speech

To learn more about concussion and injury prevention: www.thinkfirst.ca

Republished from the Winnipeg Free Press print edition March 6, 2010 D2