Sidney Crosby's setback in his recovery from a major concussion is no surprise, according to concussion experts, and while it is too soon to worry that hockey's biggest star could be facing retirement, great care needs to be taken with the decision on his return to the ice.
Dr. Paul Echlin of London, Ont., a sports-medicine specialist, said clearing Crosby to play an NHL game again should be done only if his doctors are sure the prognosis for his long-term health is good.
"I say to parents, 'You want to support your son's excellence in sports but you have to focus on his long-term health,'" Echlin said.
Crosby, 24, and his team, the Pittsburgh Penguins, announced Monday that he will not return to the ice after experiencing a recurrence of concussion symptoms when he was hit a couple of times during a game Dec. 5 against the Boston Bruins. A collision with Bruins forward David Krejci is thought to be the one that caused the setback. "I know I got hit on the head there," Crosby said.
Crosby missed the Penguins' next two games but was expected to play Tuesday against the Detroit Red Wings. However, Crosby said Monday he "just didn't feel right" the day after the Bruins game. Crosby collided with teammate Chris Kunitz in that Bruins game, but he said Monday that was a "knee-on-knee" hit and probably not responsible for his relapse.
No timetable was put on Crosby's return, although he told reporters he is optimistic he is not facing a recovery nearly as long as the one that kept him off the ice from Jan. 5 until Nov. 21. He said he does not feel nearly as bad as he did last January and if he had to compare his symptoms now with his first recovery, he said he feels better "than I did in August, much better than when I was dealing with this the first time, so that's a great thing."
Crosby is on the same recovery program he was for his first concussion. He is not practising with his teammates but said he is "doing a little light [exertion]stuff and we'll see how that goes."
Dr. James Kissick, a sports-medicine specialist in Ottawa who is a member of an international advisory panel on concussions, says it's a concern that Crosby is having problems a short time after a long recovery. But it is difficult to say much beyond that, he added.
"It sounds like the Penguins are being extra cautious, which is a great idea," Kissick said. "There's no question it's concerning."
While Echlin said he cannot discuss Crosby's concussion because he never treated him, he did say a recurrence of concussion symptoms has led him to have difficult conversations with his own patients.
"Then you start to think, is this the wrong sport for you?" Echlin said. "This is a hard decision to make for him."
However, it is not a decision Crosby has to make right away, and Echlin said the fact all of his symptoms were gone when he returned to play on Nov. 21 is "a triumph in itself."
Crosby said Monday he passed an ImPACT test, a neurocognitive evaluation system that tests brain and neurological reactions. However, both Kissick and Echlin said ImPACT tests are not sensitive enough to be used solely as a gauge for concussed patients. Echlin said they are a valuable tool in assessing and treating concussions, but too much emphasis should not be placed on the tests because they are just one part of the decision to let an athlete play again.
"[The decision]comes down to using all a clinician has: his own experience, the patient's history and all the other information," Echlin said. "It's not that easy, so it shouldn't be placed on [the results of]one test."
Echlin and Dr. Kelly Brett of the University of Calgary's sports-medicine clinic, who has been the head physician of the Calgary Flames for the last 11 years, are both skeptical of the treatment Crosby received from Ted Carrick, a Canadian chiropractor based in Atlanta who is a leader in a new field Carrick calls chiropractic neurology.
Crosby turned to Carrick when his recovery proved to be slow. He gave Carrick credit for getting him over a plateau in his recovery and helping him get back on the ice.
Carrick's treatments included using a full body gyroscope, or rotating chair that spins around and upside down. This seems odd to some sports-medicine specialists. The one thing physicians know about a concussed brain, is not to roll it around or turn it upside down.
"It's setting concussion management back again," Brett said.
Although it's not clear where Crosby was in his recovery when this device was employed, the use of it could feed into the superstition of hockey players to try whatever gizmo, gadget or gimmick worked for somebody else, Brett said.
"The whole thing doesn't make any sense. It's unorthodox and there's no science behind it," Brett said of the recovery protocol Crosby received.
Echlin said he would be open to Carrick's ideas, but is not aware of any long-term studies.
"There's no evidence behind it," Echlin said. "It's hard for me to understand or even comment about it."
With a report from Dawn Walton