When helmets don’t help
Hockey concussions require new attitude, not new headgear, expert says
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Hey there, time traveller!
This article was published 09/03/2010 (4841 days ago), so information in it may no longer be current.
Dr. PAT Bishop just may be a hockey player’s best friend.
His research to improve protective equipment, especially helmets and faceguards, has saved countless players from serious injury.
For example, when the first face shields and cages were introduced to hockey, Bishop’s research revealed most sat too close to the face and not properly on the chin. He warned that the impact of a puck could cave in the shield or even break it.
The result was a new standard that brought the shield or cage safely away from the face.
Today, bigger, stronger, faster hockey players at almost every level, combined with their new-age equipment, have created the sport’s newest concern, a spate of concussions never seen before.
It’s no trifling matter. Concussions are brain injuries, not to be slept off or played through. Though there is rarely structural damage that shows up on an MRI or a CAT scan, they cause one or more symptoms like disorientation, dizziness or nausea.
Helmets, worn properly, protect a player from contusions, skull fractures and other bruising. But as you saw earlier this season when Philadelphia’s Mike Richards smashed his shoulder into the head of Florida’s David Booth, a helmet was no protection from a concussion that caused Booth to miss 45 games.
Surely, a man with Bishop’s insight and dedication to research ought to bring the promise of reducing, maybe even removing entirely, concussions from Canada’s game.
It says something, then, that Bishop doesn’t pin his hopes on equipment.
"There are people working on different helmet-liner systems in laboratory tests," says Bishop, professor emeritus at the University of Waterloo and winner of the 2004 Dr. Tom Pashby Sports Safety Award for his research into catastrophic injury in sport.
"(The test helmets) perform quite well there and offer some opportunity to have the forces acting on the head somewhat reduced but whether it will intervene on concussions or not, I don’t know.
"A hit on the jaw won’t be helped. And if a change in the liner system encourages more beatings to the head, it’s not going to help either."
What is needed is change in players’ behaviour. As an impact biomechanics authority, chairman of the Canadian Standards Association (CSA) committee on equipment for ice hockey, Bishop knows better protective equipment alone will not stem the increase in brain injuries on the ice.
"I really think this is a behaviour issue for which there needs to be a real attitude adjustment on the part of everyone involved… Helmets are very effective against head injury such as skull fractures, but they have very limited capability with respect to brain injury."
On-ice behaviour owes a debt to the improved protective equipment Bishop has had a hand in developing. Young players, those who have always played in protective gear, feel invincible on the ice. Also, too often, parents and coaches are pushing them to be aggressive.
"A lot of that comes from coaching and parental pressure that rewards kids for being aggressive," Bishop says. "There are lots of intangible rewards for the elbow that’s put on a kid’s head. The tacit approval that’s given for that sort of behaviour… is what’s so insidious in our game."
BISHOP knows calling for change to hockey culture is an uphill battle. He has campaigned for an end to head-checking since 1999 when he presented to a Swiss safety conference his research on how helmets don’t protect against concussion when players are hit in the face or jaw.
There is considerable debate about which is the more effective strategy to eliminate such dangerous and life-altering blows in the game: work from the top down by having the NHL lead the way, or work from the bottom up where grassroots levels of hockey initiate the change in thinking?
"I’m not optimistic about top-down," says Bishop. "To be honest, I don’t look at the NHL as being capable of doing anything. These guys have set themselves up as the custodians of hockey in North America. And as far as I’m concerned, we need new custodians.
"The thing that drives me wild is the constant concept that you’re going to change the game if you take head-hitting out. I want to ask them this question — though they don’t want to listen to me because I’m a university professor who only coached for 30 years (including) intercollegiate hockey — when did head-hitting become a fundamental part of the game and why is it allowed?"
IT’S not allowed in many places anymore. Most levels of amateur hockey have put in place rules to ban or limit contact to the head. Hockey Canada banned such action at all minor levels under its jurisdiction in 2002. Until now, the NHL has stayed away from such action but the league has begun, however slowly with its discussion of rules alterations, to follow suit this week.
"This should be easy — you hit someone in the head, you forfeit the right to play for a while," Dr. Bishop says.
"The NHL doesn’t have the will… The custodians of the game, as far as I’m concerned, have to be the minor hockey associations and Hockey Canada and the major junior leagues. I give those guys a lot of credit for the way they’ve stepped in and suspended guys for a long time for those activities."
One suggestion being kicked around at the grassroots is to change the language of hockey.
"We say, ‘good hit,’ " Bishop explained. "I’m not sure when hitting became part of the game. I know bodychecking has always been part of the game.
"If you try to get people to say bodychecking instead of hitting, there’s a different connotation."
THERE is widespread opinion on helmets’ ability to stop or reduce concussions. Some products are even marketed with such claims.
A good many of those opinions are wrong if they don’t fall in line with this piece of knowledge shared by Bishop, but not him alone:
"Regardless of what you hear or what you read, there is no such thing as a concussion helmet."
Nevertheless, the search for better equipment, including helmets, will continue, but that alone won’t solve hockey’s concussion crisis.
"The NFL did a large study in early 2000," Bishop says. "Riddell had built a different football helmet, one that was supposed to intervene on concussions… Concussions (with) old helmets and new helmets are identical. They haven’t done anything on cutting concussions and the reason is that the concussion is a different problem.
"It’s a problem of rotational head acceleration that cannot be addressed through conventional helmets that we have."
A helmet does not eliminate the force delivered to the head, nor does it stop the brain from sloshing around inside the skull. When the blow is from the side and causes the head to twist or spin, experts fear the damage of the concussion may be greater still.
If better protective equipment isn’t the answer, is turning back the clock to a time when equipment was less protective and players were more respectful of fellow players?
Dr. Bishop isn’t going there, either.
"I’m not sure we want to go backwards, in other words, make the equipment what it was 20 or 30 years ago," he says, referring to old shoulder and elbow pads that were just foam or soft plastic or cardboard. "I know Guy Lafleur and Wayne Gretzky hardly wore anything for shoulder or elbow pads. That’s fine and dandy but we’re not just talking about pros here. We’re also talking about kids.
"Some of the equipment, I won’t say it’s over-designed, but it’s a little big for them. The tendency among parents is to buy it somewhat oversized for kids to grow into."
Not only does the wrong size of equipment not protect properly, if it’s too big, it’s just a bigger weapon than it needs to be.
In the case of hockey at more mature levels, especially the pro game, the equipment can and is used for more than protection.
"It’s somewhat over designed," Bishop told the recent Hockey Canada concussions conference, referring specifically to elbow and shoulder pads. "Over designed in the sense, what’s the shoulder and elbow pad really intended to protect? It’s supposed to protect the wearer from falls or striking hard objects like the boards or ice."
That protection is important when seamless glass is used because those boards and panes of glass have little give. And the improved shoulder pads work because there are now fewer broken collarbones. But the gear ends up being used for more than just protection.
"This gives the player the opportunity to use the shoulder and elbow pad as a weapon," Bishop says. "I don’t think that was ever the intention of the manufacturers… And how they think they’re going to add a few millimetres of padding and prevent concussions, it’s just crazy. What we have to do is to stop hitting people in the head with elbows.
Early findings of a comprehensive exploration into concussions in football reveal frightening realities.
Malcolm Gladwell’s recent essay in the New Yorker highlighted the levels of chemicals associated with dementia discovered during autopsies of NFL players’ brains. Those protein deposits were not only not hard to find, they appeared with regularity in the samples of concussed former players.
Can those findings be applied to the NHL? The suspicion now is that the recent case of former tough guy Reggie Fleming, who was found to have chronic traumatic encephalopathy after his death last July, isn’t likely just a one-off.
Chronic traumatic encephalopathy is a condition similar to dementia pugilistica, also known as "punch-drunk syndrome" found in boxers who have had too many blows to the head.
The start of that kind of research, that puts the long-term brain damage of boxers into the same discussion as hockey players ought to be cause for alarm.
"This is just the tip of the iceberg," says Bishop. "We’re going to find out that this is a pretty vicious game, the way it’s played."
Bishop hopes that will be on the minds of NHL executives when they consider their players’ future at this week’s meetings.
"I would like to see some leadership there but the fact that the GMs are at least going to talk about it again is hopeful," Bishop says. "It remains to be seen how far they will go and what they will do to initiate change."