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This Jan. 5, 2011, file photo shows Pittsburgh Penguins' Sidney Crosby playing against the Tampa Bay Lightning in the first period of an NHL game, in Pittsburgh. Penguins captain Sidney Crosby has taken another step forward in his recovery from a concussion. Doctors cleared him for contact prior to Thursday's morning skate at Consol Energy Center. THE CANADIAN PRESS/AP, Gene J. Puskar (Gene J. Puskar/CP)
This Jan. 5, 2011, file photo shows Pittsburgh Penguins' Sidney Crosby playing against the Tampa Bay Lightning in the first period of an NHL game, in Pittsburgh. Penguins captain Sidney Crosby has taken another step forward in his recovery from a concussion. Doctors cleared him for contact prior to Thursday's morning skate at Consol Energy Center. THE CANADIAN PRESS/AP, Gene J. Puskar (Gene J. Puskar/CP)

Matthew Sekeres

Sidney Crosby can hit, but at what risk? Add to ...

Sidney Crosby took a step toward returning to National Hockey League action Thursday, but the Pittsburgh Penguins superstar still faces a significant hurdle in his bid to recover from a brain injury.

Crosby has been out more than nine months after taking two blows to the head in the same week last January. He has experienced postconcussion symptoms as recently as late August. On Thursday, the Penguins captain happily announced that he has been cleared for contact in practices, and said he was excited to be moving in the right direction.

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But with a patient such as Crosby, who has been out of action and suffered symptoms for such a prolonged period, doctors should just now be discussing the risk-reward consequences of a return to play, according to a concussion specialist. Crosby has reached the final step prior to completing his comeback – the fifth of six stages in the “graduated return to play protocol” agreed to in November, 2008, by the International Symposium on Concussion in Sport – but being cleared for contact could mean that a return to action is still weeks away.

Paul Echlin, a sports medicine physician from Burlington, Ont., advises patients in similar circumstances that they are at risk of sustaining another concussion with a similar or lengthier symptom duration. He informs individuals that have suffered multiple concussions, or that take a long time to recover, that there may be some permanent brain injury. The risk of sustaining another concussion is greater in these patients.

“The risk after this period of time is significant,” Dr. Echlin said of Crosby. “That’s the risk he takes when he returns to play, and we make sure patients understand those risks.”

Dr. Echlin said that after so much time off, he tells patients that they require “multiple episodes of full contact” and drill participation before a return can be considered.

He also guards against thinking that concussed athletes can return in a matter of days should they pass the baseline tests used to determine the severity of a concussion. He said such tests were developed as a “catchall” and “do not cover someone with the depth of injury we’re talking about.”

Mark Aubry, an Ottawa-Gatineau physician and one of the authors of the return to play protocol, said there are no set rules for clearing patients such as Crosby to return, but added there is a conservative trend among medical professionals.

“The trend has been that we allow longer periods of rest,” Dr. Aubry said. “It might take longer than you would expect, based on how long they’ve been out, and how many concussions have occurred.”

In Pittsburgh, Crosby said it was not difficult to stay patient, and that there remains no timeline for his return to game action. He shed the white helmet – signifying no contact – that he has worn for nearly a month and was a full participant in a morning skate Thursday.

Crosby didn't throw or accept any checks as the Penguins mostly skated and went through shooting drills in advance of their game against the Washington Capitals. Still, Crosby said he won't be reluctant to instigate contact when he does practise.

While the Penguins initially said Crosby had a mild concussion, it proved to be anything but. It affected his vestibular system, which controls a body’s stability and movement. For months, even the simple acts of walking with people around him or trying to concentrate while watching TV proved troublesome.

With a report from The Canadian Press

Follow on Twitter: @mattsekeres

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