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Former NHLer Keith Primeau seen here in action during the 2003 Eastern Conference Finals with Philadelphia says it is common for players to go back into games after suffering a concussion. (Photo By Dave Sandford/Getty Images/NHLI) (Dave Sandford/2003 Getty Images)
Former NHLer Keith Primeau seen here in action during the 2003 Eastern Conference Finals with Philadelphia says it is common for players to go back into games after suffering a concussion. (Photo By Dave Sandford/Getty Images/NHLI) (Dave Sandford/2003 Getty Images)

Hockey still searching for a concussion code Add to ...

The Toronto Maple Leafs handling of Mikhail Grabovski in Tuesday night's game at Boston once again brought into question the National Hockey League's concussion protocol .



After being hit by the 6-foot-9 Boston Bruins defenceman Zdeno Chara, Grabovski fell to the ice, struggled to get up, collapsed, got back on his skates, staggered backward, recovered and struggled to get to the bench. The scene appeared disturbingly reminiscent of Pittsburgh captain Sidney Crosby's struggles after being hit by Washington's David Steckel in the Winter Classic on New Year's Day. When Crosby succumbed to concussion five days later, after again being hit in the head on Jan. 5, he triggered a now raging debate about the league's ability to recognize and react to concussions.

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Grabovski took two hits to the head on checks by Chara in Tuesday's game. After the second hit, he was administered smelling salts and allowed to take his next shift. He would go on to score the winning goal later in the third period.



"When I see injuries that occur when players sustain heavy hits to the head or body and have signs that are externally exhibited, signs of the inability to co-ordinate, slowness to get up, those guys have to be evaluated medically, not just tapped on the shoulder, asked if they are okay and they say they're good to go," said Dr. Paul Echlin, a sports medicine physician from London, Ont., who studies concussions. "That is antiquated."



In Boston, the Maple Leafs did not have a team physician with them. Leafs general manager Brian Burke said Grabovski was examined and questioned at the bench by trainer Andy Playter, who determined he did not suffer a concussion.



"[Playter]went right to Grabbo [Grabovski]and said, 'How are you?' He had total recall, he said the puck hit the crossbar, like total recall on the situation. No blackout, no loss of memory, no dizziness, no nausea," Burke told Toronto radio station Sportsnet the Fan 590. "And so the trainer said to him, 'Are you good to go?' and he said, yeah, he got it in the jaw. He said he just got it in the jaw and was disoriented. No symptoms."



The Maple Leafs refused to make either Player or Grabovski available for comment prior to their game in Buffalo on Wednesday night.



Former NHL player Keith Primeau, who was forced to retired from the NHL in 2005 at the age of 33 after his fourth concussion, said it is common for players to lie about their symptoms in order to get back on the ice. Primeau, who now works to educate young players about concussions through his non-profit group Play It Cool, said he was often in the same situation.



"I lived it," he said. "It doesn't make it right. I applaud his courage, I think we all applaud his courage, but at the same time there has to be greater awareness to the situation.



"In that moment, 100 per cent of the pressure is placed on the individual by themselves. It is their desire and their intent to get back out and play."



Primeau said he was surprised Grabovski was allowed to play after the first hit and the fact he did not miss a shift after the second hit made him "even more unsettled." This was echoed by Dr. Richard Wennberg, a neurologist and concussion expert at the University of Toronto, who studied video of both hits. He is also a consultant to the NHL Players' Association.



Dr. Wennberg said he could not criticize the immediate actions of the Leaf trainers because their view from the bench was not as good as a television close-up complete with replays. But he thought Grabovski should not have been allowed to continue playing.



"It was heroic in a sense, but it flies in the face of modern medical recommendations to be cautious," Dr. Wennberg said. "By medical definition, if someone can't get up off the ice after a hit because their balance is off, that is a concussion."



An NHL spokesman said the league is "comfortable" with its present protocol, although he added "it is constantly being reviewed."



A joint NHL-NHL Players Association working group on concussions is expected to recommend that any player who is suspected of sustaining a concussion undergo an exam in the dressing room by a doctor. That policy could be in place by the beginning of next season. At present, a player can be cleared to return to play by his team's athletic trainer. The current protocol says, "A player suspected of having sustained a concussion should be initially evaluated by the team's athletic trainer and/or team physician at the bench. If a concussion is suspected the player should be removed from the playing environment …"



At the All-Star Game recently, NHL commissioner Gary Bettman admitted the concussion rate is rising from last season but wouldn't specify numbers. Currently, there are at least 16 players sidelined by concussion including Marc Savard of Boston, who is out for the year after suffering his second head trauma in as many seasons.



On occasion the symptoms of concussion do not become obvious immediately. After being hit by Victor Hedman of Tampa Bay on Jan. 5, Crosby flew with the team to Montreal for a Jan. 6 game, only to return to Pittsburgh on a charter flight that morning. He hasn't played since.



Grabovski was symptom-free on Wednesday, Burke said.



Both Dr. Echlin and Dr. Charles Tator, a neurosurgeon at Toronto Western Hospital who worked with Dr. Echlin on a major study of concussions, said the NHL needs to change its protocol because trainers are not qualified to diagnose concussions.



"From, my point of view and the work I've done, you have to have at least a 15-minute medical evaluation, not one by a therapist," Dr. Echlin said. "A therapist can identify a probable medical problem but can't diagnose it.



"For them to make those calls, I don't think is a good thing."



Dr. Tator pointed out that athletes will often give misleading answers due to their desire to get back on the ice. There is also a language barrier in professional sports due to the number of players from outside North America. Grabovski is from Minsk, Belarus, whose uncertain grasp of English is well-known.



"It is not an easy diagnosis to make," Dr. Tator said. "The co-operation of the person who is suspected of having a concussion is very important. If there is a combination of a language problem and he is so keen to get back and get more goals, then [the player]can actually fudge it."



One of Grabovski's teammates, defenceman Mike Komisarek, admitted Wednesday that was possible.



"If you ask Grabo, I don't know if he doesn't understand in English if you ask if he's okay or not, but if you tell him he's got a concussion, he's going to want to go out there," Komisarek said. "You're going to have to pull a guy like that off the ice. And that's said with a lot of athletes. You have a lot of pride and you want to get out there and you want to be battling."

For his part, Grabovski said after playing in Toronto's win over the Buffalo Sabres on Wednesday night that he hadn't experienced any symptoms in the 24 hours since absorbing Chara's big hits.

"I feel good," he said. "I felt really good. Same like before. I feel much better than before. My body okay."





















<p> "When I see injuries that occur when players sustain heavy hits to the head or body and have signs that are externally exhibited, signs of the inability to co-ordinate, slowness to get up, those guys have to be evaluated medically, not just tapped on the shoulder, asked if they are okay and they say they're good to go," said Dr. Paul Echlin, a sports medicine physician from London, Ont., who studies concussions. "That is antiquated." </p> <p> In Boston, the Maple Leafs did not have a team physician with them. Leafs general manager Brian Burke said Grabovski was examined and questioned at the bench by trainer Andy Playter, who determined he did not suffer a concussion. </p> <p> "[Playter]went right to Grabbo [Grabovski]and said, 'How are you?' He had total recall, he said the puck hit the crossbar, like total recall on the situation. No blackout, no loss of memory, no dizziness, no nausea," Burke told Toronto radio station Sportsnet the Fan 590. "And so the trainer said to him, 'Are you good to go?' and he said, yeah, he got it in the jaw. He said he just got it in the jaw and was disoriented. No symptoms." </p> <p> The Maple Leafs refused to make either Player or Grabovski available for comment prior to their game in Buffalo on Wednesday night. </p> <p> Former NHL player Keith Primeau, who was forced to retired from the NHL in 2005 at the age of 33 after his fourth concussion, said it is common for players to lie about their symptoms in order to get back on the ice. Primeau, who now works to educate young players about concussions through his non-profit group Play It Cool, said he was often in the same situation. </p> <p> "I lived it," he said. "It doesn't make it right. I applaud his courage, I think we all applaud his courage, but at the same time there has to be greater awareness to the situation. </p> <p> "In that moment, 100 per cent of the pressure is placed on the individual by themselves. It is their desire and their intent to get back out and play." </p> <p> Primeau said he was surprised Grabovski was allowed to play after the first hit and the fact he did not miss a shift after the second hit made him "even more unsettled." This was echoed by Dr. Richard Wennberg, a neurologist and concussion expert at the University of Toronto, who studied video of both hits. He is also a consultant to the NHL Players' Association. </p> <p> Dr. Wennberg said he could not criticize the immediate actions of the Leaf trainers because their view from the bench was not as good as a television close-up complete with replays. But he thought Grabovski should not have been allowed to continue playing. </p> <p> "It was heroic in a sense, but it flies in the face of modern medical recommendations to be cautious," Dr. Wennberg said. "By medical definition, if someone can't get up off the ice after a hit because their balance is off, that is a concussion." </p> <p> An NHL spokesman said the league is "comfortable" with its present protocol, although he added "it is constantly being reviewed." </p> <p> A joint NHL-NHL Players Association working group on concussions is expected to recommend that any player who is suspected of sustaining a concussion undergo an exam in the dressing room by a doctor. That policy could be in place by the beginning of next season. At present, a player can be cleared to return to play by his team's athletic trainer. The current protocol says, "A player suspected of having sustained a concussion should be initially evaluated by the team's athletic trainer and/or team physician at the bench. If a concussion is suspected the player should be removed from the playing environment …" </p> <p> At the All-Star Game recently, NHL commissioner Gary Bettman admitted the concussion rate is rising from last season but wouldn't specify numbers. Currently, there are at least 16 players sidelined by concussion including Marc Savard of Boston, who is out for the year after suffering his second head trauma in as many seasons. </p> <p> On occasion the symptoms of concussion do not become obvious immediately. After being hit by Victor Hedman of Tampa Bay on Jan. 5, Crosby flew with the team to Montreal for a Jan. 6 game, only to return to Pittsburgh on a charter flight that morning. He hasn't played since. </p> <p> Grabovski was symptom-free on Wednesday, Burke said. </p> <p> Both Dr. Echlin and Dr. Charles Tator, a neurosurgeon at Toronto Western Hospital who worked with Dr. Echlin on a major study of concussions, said the NHL needs to change its protocol because trainers are not qualified to diagnose concussions. </p> <p> "From, my point of view and the work I've done, you have to have at least a 15-minute medical evaluation, not one by a therapist," Dr. Echlin said. "A therapist can identify a probable medical problem but can't diagnose it. </p> <p> "For them to make those calls, I don't think is a good thing." </p> <p> Dr. Tator pointed out that athletes will often give misleading answers due to their desire to get back on the ice. There is also a language barrier in professional sports due to the number of players from outside North America. Grabovski is from Minsk, Belarus, whose uncertain grasp of English is well-known. </p> <p> "It is not an easy diagnosis to make," Dr. Tator said. "The co-operation of the person who is suspected of having a concussion is very important. If there is a combination of a language problem and he is so keen to get back and get more goals, then [the player]can actually fudge it." </p> <p> One of Grabovski's teammates, defenceman Mike Komisarek, admitted Wednesday that was possible. </p> <p> "If you ask Grabo, I don't know if he doesn't understand in English if you ask if he's okay or not, but if you tell him he's got a concussion, he's going to want to go out there," Komisarek said. "You're going to have to pull a guy like that off the ice. And that's said with a lot of athletes. You have a lot of pride and you want to get out there and you want to be battling." </p>
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