Friday February 18th, 2011

Former Flyer John LeClair was the very -- but not so pretty -- picture of a hockey player's legendary ability to take a licking and keep on playing in the relentless pursuit of victory. (Lou Capozzola/Sports Illustrated)

By Stu Hackel

Hockey without toughness? Fahgeddaboudit. It's a central component of the sport, as integral as sticks and pucks, and it's ingrained in the game's culture. Players are almost required to display courage when facing adversity. Playing hurt is considered a sign of one's character, willingness to compete, and desire to give everything in the pursuit of victory. It's still a man's game and if you're too hurt to play -- like the Canadiens' James Wisniewski, who took a shot in the face in Edmonton last night -- you ought to look something like he did. (More photos of the toll taken on players can be seen in this gallery entitled The Faces of Battle.)

Toughness is a huge part of what makes hockey players special, and the culture around the game permits us even to make light of injuries. The photo of Wisniewski linked above has a comment underneath that reads, "Nice hockey scratch Wiz." Injuries inevitably invite jokes, and minimizing danger with humor reflects the fearlessness that hockey players display, perhaps better than any other athletes. Playing with broken bones is not unheard of. A few stitches, a busted nose, a stick in the teeth? Nothing to it. Patch 'em up, get 'em back out there quickly.

But when it comes to concussions, that essential aspect of the game's make-up is now being reconsidered.

Gone are the days when, for example, Oilers coach Ted Green, having been informed during an early '90s game that rookie center Shaun Van Allen had suffered a concussion and didn't know who he was, would respond, "Good. Tell him he's Wayne Gretzky." And there's another side to toughness besides its humorous and testosterone-fueled aspects. Players also deny injuries to keep their jobs. They want to play. They don't want to be labeled as soft, injury-prone or damaged goods.

Let's go back to last Tuesday night and the big hits that 6-foot-9, 255- pound Bruins captain Zdeno Chara put on 5-foot-11 Maple Leaf Mikhail Grabovski...

...the goal Grabovski scored after the first hit...

...and his game-winner not long after the second hit.

You had to love it. This was an impressive display of fortitude that no doubt drew respect not just from his teammates but anyone with an appreciation of what it takes to play this game.

Still, when you see Grabovski staggered like that, especially after the second hit, some new alarms begin to go off. “I feel bruise in my eyes,” he told reporters after he game, “but like I tell it before it give me more motivation to play harder.”

Bravo for the motivation, Mikhail, but that "bruise in my eyes" feeling is considered a possible indication that you have a concussion.

Fortunately, Grabovski seemed well enough to play on Wednesday against the Sabres and didn't show any further symptoms. What we are learning about head injuries, however, tells us that the way he stumbled around often signals that a player is in trouble. And that's how Dr. Charles Tator, the Toronto neurosurgeon and leading advocate of stronger safety measures in hockey with respect to concussions, saw it.

“In this particular instance, when I looked at the video, he did have a lot of features of concussion,” Tator told Sean Fitz-Gerald of The National Post. “And if I were sitting there, I would probably have not let him go back. I would say that.”

Tator added, “We say, in the injury-prevention field, ‘When in doubt, sit them out.’ My view is to try to make people as cautious as possible, because you’re dealing with the brain — you’re not dealing with the ankle, or a rib or a groin.”

And that's the crucial point. Concussions are not like other injuries. They don't necessarily heal and, as we now know, they can have a cumulative effect. Repeated concussions can lead to depression, agitation, uncontrollable violent behavior, attention deficit disorder and early onset Alzheimer's disease. This injury requires a different approach.

Both Leafs coach Ron Wilson and GM Brian Burke were adamant that Grabovski had not been concussed. “He had no concussion symptoms when he reached the bench, or he would not have been permitted to return to play,” Burke wrote to The National Post. “No symptoms post-game, none today. If any emerge, we will act accordingly.”

Kevin McGran of The Toronto Star reported that, on the bench, the Leafs followed the NHL's procedure for potential concussions with their trainer, Andy Playter, administering to Grabovski the Standardized Concussion Assessment Tool 2 (SCAT 2) protocol: The player is asked a series of questions designed to demonstrate his ability to think. If the player answers wrong, or has problems answering, he’s pulled from the game. The player is also asked if he has a headache, feels sick, or sees lights. If he answers yes to any of the signs of a concussion, he’s likewise pulled from the game.

For Playter, Grabovski didn't appear to be concussed, so he allowed him to stay in the game. "But athletes are competitive and can lie," McGran writes. "It then falls to the examiner to make the call based on his quick review of the player."

Grabovski may very well be fine and Playter could well have made the right call based on SCAT 2. But we also know that some concussions don't begin to reveal their symptoms for a few days. That was the case with the Blues' David Perron, who was flattened in early November by the Sharks Joe Thornton...

...but shook off the hit and stayed in the game to score a big goal later in the same period.

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Perron hasn't played since, as he he's been sidelined by a concussion. Similarly, the Penguins' Sidney Crosby was famously (or infamously, depending on your perspective) clocked by the Capitals' David Steckel in the Winter Classic on Jan. 1 and not only stayed in that game, but played the next one three days later despite admitting that he didn't feel 100 percent. Crosby had his head jostled again and he hasn't played since.

Fitz-Gerald wrote that Tator wasn't questioning the Leafs' diagnosis as much as he was the methodology that was used to determine Grabovski's condition. Another expert in the field, former Harvard football player Chris Nowinski, also believes the NHL should be more cautious. Nowinski founded the Sports Legacy Institute based in Boston. The group collects and analyzes the donated brains of deceased former athletes, which has led to a series of important connections in medical research. The brains of a number of football players and one NHLer, Reggie Fleming, who, as The New York Times reported in December 2009, were found to have damage likely caused by trauma.

“If I see a player get hit with his head to the boards, and then appear dazed and have trouble skating, I immediately assume concussion,” Nowinski told The National Post. “Even if he doesn’t have symptoms on the bench, that doesn’t mean he didn’t have symptoms on the ice.”

Ideally, Nowinski said, Grabovski should have been subjected to a 10-to-15 minute evaluation. “I’ll even go so far as to say I may accept he may not have had a concussion,” he said. “But you can’t figure that out in two minutes on the bench. You just can’t.”

During the NHL on TSN intermission panel discussion on Wednesday night (video), Darren Dreger reported that the NHL is, in fact, working on developing an improved protocol -- procedures for a more thorough test that would be administered to a player in the dressing room after he has taken a hit that staggered him the way Grabovski was by Chara. It's possible that this system will be in place next season. Bob McKenzie added that bringing the player into the room -- away from the bench and potential pressures from both the coach who wants him back in action and crowd noise that might ignite his competitive desire -- is a key element in the plan.

Had Grabovski been sent to the room for a 10-to-15 minute test on Tuesday night, he likely wouldn't have been back on the ice in time to score the game-winning goal. But that could be the new reality that NHL players face in the near future.

Watching Darren Pang in that clip of the TSN panel, you can actually hear and see him caught between the game's long-standing conventions about toughness and the emerging understanding of the need to proceed with caution on head injuries. He knows better than many, being a Blues broadcaster and having witnessed Perron's plight close up.

But Pang also recalls his own playing days and admits that had he seen a teammate like Grabovski "mail it in for the rest of the night" after being wobbled by a hard check, he'd have been disappointed. He calls it a "Neanderthal way of thinking," but also said that players today still might judge their teammates by the old standard. When the Leafs saw Grabovski get up, dust himself off and stay in the fray regardless of the consequences, Pang said, they appreciated it.

But the concern about brain trauma is forcing attitudes to change. It's a lot harder now to joke about "having your bell rung" and getting the trainer to tape a couple of aspirin to your head so you can get return to the ice.

Holy jumpin', Panger. When it comes to head injuries, it looks like we're going to have to shake off that "Neanderthal way of thinking."

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