Even in death, Reggie Fleming's brain is sending messages.
Researchers at the Boston University School of Medicine have determined the former NHL player, who endured multiple concussions during his career, suffered from degenerative brain disease at the time of his death. This marks the first time a hockey player has been diagnosed with chronic traumatic encephalopathy (CTE) and adds to the growing concern about the long-term effect of concussions in hockey and the price exacted by the game's physical nature.
Dr. Ann McKee at the Center for the Study of Traumatic Encephalopathy at Boston University, examined Fleming's brain tissue following his death July 11 at 73. Fleming played 13 seasons in the NHL for six teams and suffered approximately 20 concussions, his family said. He was an edgy competitor who didn't wear a helmet (from 1959 to 1971) and played with little regard for his body.
Fleming also suffered from strokes and a heart attack in his later years but his brain tissue showed "typical CTE pathology," according to McKee.
"The changes in [Fleming's]brain were very similar to the changes we've found in football players and [five]boxers," McKee said. "This case also points out that individuals who suffer from CTE are often misdiagnosed during life and may be told that they are suffering from a psychiatric disorder, such as bipolar disease, or later in life, from Alzheimer's disease."
McKee takes thin slices of brain and applies a brown stain that indicates a protein called tau. High levels of tau are found in people with Alzheimer's disease. Usually, a microscope is needed to detect the presence of tau.
But McKee said the build-up was so severe in the brains of the football players she examined that "the changes can be detected on the slides with the naked eye. … You never see this profound build-up in this distinctive pattern unless there is a history of repetitive head trauma."
When Fleming played in the NHL, the equipment was of poorer quality and team trainers and physicians were not as informed as they are now. Yet the image of current NHL players left sprawled on the ice or being carted off on a stretcher after taking a hit to the head is fast becoming regular viewing.
Vancouver Canucks forward Ryan Johnson was involved in one of the NHL's scarier scenes this season. The 33-year-old was skating full speed when he fell into the end boards at GM Place during an Oct. 28 game against the Detroit Red Wings.
Johnson suffered a concussion and was taken off the ice on a stretcher. He remembers waking up and being hovered over by "eight different doctors and medics telling me not to move." Johnson was lucky; the postconcussion symptoms (headaches and fogginess) lasted only five days. When former Tampa Bay Lightning forward Brian Bradley had his concussion during the 1997-98 season, it ended his career.
"You're just really irritable," Bradley said of the physical and emotional toll. "Noise and movement bother you. You try and do a light bike ride and you feel like your head is going to explode. In my case, if I came back and got hit again, I could be in a wheelchair or a coma for the rest of my life."
Loss of consciousness is one sign of a concussion, but there are many other symptons.
NHL deputy commissioner Bill Daly said the league "only recently became aware of the [Boston University]report" and "won't have any comment until we have had a chance to read and digest it."
The NHL's board of governors spent part of its annual meetings this week hearing reports on head shots and concussions. One study showed how the nature of hitting has changed over the last four decades while another detailed how the league has handled concussions since 1997. This season, the NHL has officially acknowledged more than 10 concussions. Unofficially, there are reports that number is more than double.
Several governors said the NHL is among the leaders in professional sports when it comes to dealing with concussions. They said the work, which includes looking at equipment changes such as better helmets, will continue.
"With the research and amount of time being spent on it, I think they're doing everything they possibly can," New Jersey Devils president and general manager Lou Lamoriello said. "With the number of hits we have, 60,000 or something [a season]… It's so astronomical we have to be careful for the game."
The NHL has been criticized because a growing number of players have received serious head injuries due to body-checks that are legal by NHL rules, a side effect of the 2005-06 rule changes designed to speed up the game. At the last general managers' meetings in November, the league formed a committee to study whether those hits should be illegal. Most GMs expect a rule proposal concerning blindside hits come March.
"I think you'll see something tangible coming out of the meeting in Florida," San Jose Sharks GM Doug Wilson said. "I don't consider us a reactive league but we realize the game is played at a different pace."
Chris Nowinski cited the Fleming case as a tell-tale moment in the study of concussions in hockey. A former college football player and professional wrestler who suffered his share, Nowinski co-founded the Sports Legacy Institute and tracks down the families of athletes who have died and asks them to donate the brain of the deceased to science. So far, 120 athletes have agreed to the idea.
"The NHL was on the right track with baseline [neurological]testing," said Nowinski, who recently testified before the U.S. House of Representatives Judiciary Committee on football brain trauma. "But the ex-[hockey]players I've met are telling me it's not where it needs to be in light of the evidence coming out. Hits to the head are still happening that shouldn't."
Fleming's son Chris, a filmmaker, can vividly recall his father's erratic behaviour, from the emotional outbursts in his 40s to Fleming's later problems with drinking and gambling. In his final years, the former NHL tough guy suffered from a severe lack of concentration, memory impairment and, ultimately, full dementia.
"[The CTE]had something to do with his strokes," Fleming said of his father. "It had to do with other parts of his body shutting down. It had to do with the Parkinson's disease that he got as well. It's a shame because we all love the sport, but there are repercussions from it."
With reports from Matthew Sekeres, David Shoalts, Sean Gordon, Anne McIlroy
Head injuries in hockey
- The proof: NHLer's condition linked to concussions at time of death
- The man: Reggie Fleming's story
- Video: Reggie Fleming interview
- Usual Suspects: Fleming's diagnosis should serve as wakeup call
- Brain damage: Building a better helmet
- Staring early: Minor hockey gets serious about safety
- Graphic: Anatomy of a concussion