There is worldwide concern about concussions because it is now recognized that concussions are not just "dings" or "seeing stars" and you don't just "shake it off and get back in there." Concussions are brain injuries with serious consequences for ignoring them. They are the focus of regular international conferences that sift through the latest concussion research and then advise how to handle people who get them. Many moms and dads are gripped with concern about their kids' involvement in collision sports such as hockey.
Fortunately, the era of shaking off concussions has ended in most places. For example, school boards in Ontario now benefit from Ministry of Education policy PPM158, which protects kids by ensuring that players, their families, teachers and coaches know about concussions, how to prevent them and how to recognize and manage those that still occur. Governments in Canada are now acting to protect citizens from concussions. Indeed, our governments have a major stake in the prevention and expert management of those concussions that still occur, because concussions consume huge amounts of health care resources – especially for the long-term consequences, which can be permanent.
Federal ministries of sport and health instructed Parachute Canada to develop the "harmonized" concussion guidelines recently released for use across Canada. Ontario and Manitoba are poised to enact concussion legislation that will make it mandatory for players and their families to learn to recognize concussions and what to do if one occurs. If the legislation follows what is already present in all 50 U.S. states, it will mandate the removal from games or practices players suspected of a concussion and will advise sending them to a medical doctor for confirmation.
Why is legislation needed? Ask Gordon and Kathleen Stringer, whose 17-year-old daughter, Rowan, died of "second impact syndrome" and malignant brain swelling after a series of unrecognized concussions in high school rugby. Ask Steve Montador's family about the seriousness of repetitive concussions. The former NHLer died at the age of 35, his brain showing the ravages of chronic traumatic encephalopathy (CTE) – concussion-related brain degeneration.
The medical and scientific community does not have all the answers. This is a neglected area of medical research, especially in Canada, where dollars for concussion research are so scarce. Ironically, one of the biggest funders of concussion research in the United States – to the tune of probably hundreds of millions of dollars to date – is the National Football League, partly out of fear of losing more than the billion dollars it has already lost in lawsuits and partly from a sense of responsibility for knowingly damaging so many brains without even trying to save their game.
Perhaps they know that U.S. football is doomed unless some researcher can discover a pill to protect against or ensure recovery from concussion or to remove the abnormal proteins from football-damaged CTE brains. The NFL now recognizes the urgency of the football sickness because U.S. moms and dads are voting with their feet and not signing up their precious young ones.
Let's look at the NFL's hockey counterpart, the NHL, which has not done enough to save hockey. Most of us think it is not too late to save our game. When I played hockey in high school and university, no one got concussions. In those days, violence-preaching commentators were not stoking the fires of aggression, and players were smaller and slower, generating lower impact forces on the brain. Elbow and shoulder pads were defensive safety equipment for the wearer, not offensive weapons for delivering concussive blows to opponents' heads.
Ken Dryden certainly thinks hockey can be saved. Game Change, his new book, is subtitled The Life and Death of Steve Montador and the Future of Hockey. Dryden is asking the NHL to turn the page. In fact, it appears we don't need the entire NHL to act because they speak with one voice about concussions – and the voice belongs to Gary Bettman. The NHL commissioner has the team owners in tow because his reign has been so financially successful for them. Dryden is appealing to Bettman to acknowledge that concussions are killing players and could kill our game as well.
I suppose it is possible that Bettman will listen. As a brain surgeon, I am an optimist, always hoping that some really sick people can still recover – and I have seen some miracles. So I, too, hope that Bettman follows the path Dryden has eloquently recommended.
Dryden's message is his chronicle of Montador's life and death. This is all incredibly poignant for me, because Montador was the wonderful son of my friend, Paul Montador. Several years before Steve died, Paul and I coincidentally were in Vancouver at the same time and Paul invited me to an NHL game. Steve was playing. We were delighted to see him score a goal. After the game, we waited at the dressing room door to greet Steve, whom I had never met.
When he emerged, Paul introduced us and told him about the research on concussions that I was doing at the Canadian Concussion Centre at the Toronto Western Hospital. Steve was really interested, talked to me about his concussions and even had me examine his recent facial fracture. I will never forget his remark: "Well, doc, if you want my brain, you can have it." I thanked him and jokingly explained that we did not accept premature donations, but when the time comes, yes.
When Steve died a few years later of the effects of CTE caused by his 20 or so concussions in hockey, the Montador family made sure that I received his brain and helped with Dryden's wonderful and important book.
Over to you, Bettman, to save our game! It is serious: In its present form, hockey will die.
Dr. Charles Tator is professor of neurosurgery at the University of Toronto, senior scientist and director of the Canadian Concussion Centre, Krembil Neuroscience Program, Toronto Western Hospital, and a board member of Parachute Canada.