By stuhackel
December 14, 2011

Sidney Crosby has become a case study in hockey's myriad dangers, how vulnerable players can be, and how difficult it will be for the NHL to further prevent concussion incidents. (Photo by Gene J. Puskar/AP)

By Stu Hackel

Sidney Crosby sat calmly at his dressing room stall on Monday, a Penguins cap pulled low on his brow and casting a shadow over his eyes. In a chipper tone, he described his condition as "not bad."

Frequently smiling, Crosby patiently answered questions from those huddled around him about his latest injury, which is being called "concussion-like symptoms." He believes he is not as seriously injured as when he was originally concussed last January by a combination of blows in two consecutive games, and he restated what had been known for a few days: that he had passed an ImPACT  test of his brain activity, which ruled out that he had suffered another concussion.

But he ominously added, "The ImPACT isn't everything. You've got to listen to your body, too." He said there was no time frame on his return.

So the NHL's fleeting feel-good story of the first half of the season has now ground to a halt and you have to wonder if it will transform into a recurring nightmare. There have to be legitimate concerns that Crosby is now one of those players who becomes highly susceptible to concussions after suffering one, that a series of them could be ahead, and his once-sunny future is now at least partly cloudy.

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Despite modifying its rules on head contact this season, the NHL's concussion problem does not appear to have subsided. Crosby, the league's most famous victim, is but one of a sizeable number of high-profile stars who are currently sidelined with acknowledged or suspected concussions.

The NHL's leading scorer, Philadelphia's Claude Giroux, is also out with what his team originally called "whiplash" sustained when a teammate's knee struck his head on Saturday. He began feeling worse every day and the Flyers announced Tuesday that he had a concussion. General manager Paul Holmgren said Giroux would rest on Wednesday and try skating again on Thursday.

The Flyers' captain, Chris Pronger, who missed two weeks after a wayward stick jabbed his eye in October, returned to play six games, then left the lineup again while suffering what was first called a virus. He then underwent knee surgery and as he recovered, the team announced last week that his "virus" was actually "concussion-like symptoms" that didn't appear for weeks. Like Crosby, Pronger also initially passed his ImPACT test.

Los Angeles' key offseason acquisition, Mike Richards, the former Philadelphia captain, was apparently concussed on Dec. 1 against Florida, although the Kings are calling it an "upper body injury." Playing for the Flyers two years ago, Richards was the perpetrator of the blindside hit to the head of the Panthers' David Booth that helped usher in the NHL's first rules against hits to the head.

"It’s not a stretch to suggest Richards’ suspected concussion cost head coach Terry Murray his job (on Monday), because the Kings haven’t been able to score consistently without Richards; in fact, haven’t won a game since his injury," writes Wayne Scanlan in The Ottawa Citizen. (Well, they didn't score consistently with Richards in the lineup either, but they did score more and at least won sometimes.)

Crosby's teammate Kris Letang, one of the game's top young defenseman, had his nose broken late in November by a check to the head from Montreal's emerging star forward Max Pacioretty -- himself a concussion victim last season. Letang had his nose straightened, returned to the game and scored the winning goal in overtime. Two days later, symptoms began to emerge, although he, too, was first thought to have a virus. He's now' out indefinitely with a concussion.

And on Tuesday in Buffalo, Ottawa's Milan Michálek took over the league's goal scoring lead from Toronto's Phil Kessel and shortly afterward left the game after colliding with a teammate and suffering what the Senators called "an upper body injury." He'll be reevaluated on Wednesday.

UPDATE: Michálek was confirmed to have suffered a concussion. His brother Zbyněk, who plays for Pittsburgh, is also out with a concussion, injured in the same game as Letang.

After some good news on the concussion front early in the season, the headlines are turning bad again.

This is a problem that the NHL will certainly not ignore as a leader among sports leagues in studying concussions after having joined with the NHL Players Association in 1997 to develop evaluation protocols. And for the last four years, the NHL has had an independent group of three doctors (one from the league, one from the players union and one independent) charting a wide range of data, including what body parts and equipment make contact in concussion incidents, how they happen, where on the ice they take place and at what times in the game they occur.

The league also strengthened its rules on hits to the head this season, outlawing a broader range of willful contact than had first been banned two seasons ago. Establishing a new Department of Player Safety, the league has taken a fitful stab at being more aggressive in fining and suspending players than in the past. The NHL is also looking into further shrinking and softening shoulder and elbow pads that might cause concussions on contact.

But despite early reports of a decrease this season, the rate of concussions now seems about on par with last season.

When the league's general managers met in mid-November, Brendan Shanahan, the former NHL star who has been charged with overseeing the Department of Player Safety and disciplining transgressors, estimated that concussions were down by about half (video). He credited the players for adjusting to the league's stronger measures and voiced a more optimistic view than the one held by Dustin Fink, the athletic trainer from Illinois who tracks concussions in professional and collegiate sports for his Concussion Blog. Fink put the decline at 23 percent in his early season NHL report, but still lauded the NHL, calling the early results "very encouraging."

Still, both Shanahan and Fink cautioned that the season was still young. Now, just one month later, concussions have spiked and Fink estimated last week that with 13 additional traumatic head injuries in the preceding four weeks, the difference between last season and this is a mere two percent.

The NHL will reportedly not make its concussion figures public until the next GMs meeting in March, but tracking injury information provided by the teams indicates there are at least 22 players currently sidelined by concussion. Some have not yet played in 2011-12, such as Boston's Marc Savard, who has suffered several. He played sparingly last season and his career appears to be in jeopardy.

Then there's Colorado's talented young Peter Mueller, who missed all but 15 games two years ago with concussion symptoms, and all of 2010-11. He came back for the first three games of this season only to leave the lineup again with a recurrence of symptoms.

Despite the NHL's efforts at improving the protocols for diagnosing and treating concussions, the business of reporting them can be curious at best, spurious at worst. The league's policy on disclosure of all injuries is questionable, but repeatedly concussion victims are mischaracterized as suffering an "upper body injury," a "head injury," a "virus," the "flu" or "flu-like symptoms" or an "undisclosed injury." Sometimes, concussion symptoms are not readily apparent and testing has not been done. But teams also regularly hide specific injuries entirely or under vague terms. Fearing concussed players may be targeted when they return to action, the information on their condition may be hidden.

Additionally, players themselves who want to stay in the lineup can deceive their team's medical and training staff by not disclosing an injury. Earlier this month, Philadelphia's promising rookie center Brayden Schenn delayed for two days in telling the Flyers staff that he was suffering symptoms. Some players may wait even longer. Like Crosby and Pronger, Schenn passed his initial ImPACT test. The Flyers say they believe Schenn's concussion is "mild."

The current list of concussed NHLers does not include Carolina's Jeff Skinner, last season's Rookie of the Year. Skinner's true situation was rendered uncertain when the Hurricanes changed his malady. Some who observed him get rocked last week by Edmonton's Andy Sutton (video) said Skinner appeared dazed afterward. He was first said to be suffering from "flu-like symptoms" when he was scratched for the next game, and that pronouncement was switched to "undisclosed injury" when he was scratched again Tuesday night in Toronto. The Hurricanes stated that he had not suffered a concussion.

UPDATE: Skinner's status was changed again on Wednesday when the Hurricanes announced he indeed was suffering from a concussion. Carolina's best defenseman, Joni Pitkanen, who left the lineup a game before Skinner, was also confirmed as suffering a concussion.

New York Rangers All-Star defenseman Marc Staal collided with his brother Eric of Carolina in a game in Raleigh last February. Clearly there was head trauma, but he missed three games with what was called a knee injury. Actually, it was an undetected or unreported concussion. He returned but left the lineup again 17 days later. His problem was classified as "undisclosed," always a suspicious designation. It was almost certainly related to his original injury. He returned two games later and played the balance of the season and a round of the playoffs, but could not ramp up his offseason workouts without difficulty. When he reported to training camp in September, Staal was unable to take part in drills and his concussion was, finally, properly diagnosed or publicly acknowledged. He has yet to play this season and only this week was cleared for his first practices with the team while wearing an orange "no-contact" jersey. He cannot participate in contact drills.

The nefarious nature of concussions can mask their existence until the delayed onset of symptoms. But on his Concussion Blog last Saturday, Fink expressed outrage at NHL teams' penchant for masking concussions and describing them with terms that he thinks minimize their severity. "All these terms do is muddy the water about concussions," he wrote, adding, "There is NOTHING mild about a concussion, period....During my public speaking I often relate being 'mildly' concussed to being 'mildly' pregnant. You are either concussed or not, just like you are pregnant or not."

Like Staal, Crosby's initial injury last season -- late in the second period of the Winter Classic game against Washington on New Year's Day due to an accidental hit by the Captials' David Steckel -- did not receive the immediate treatment it warranted. Anyone watching the nationally televised game or later seeing the film shot in the Penguins' dressing room for HBO's 24/7 series could easily conclude that Crosby was far from 100 percent. But he finished the game, which is what hockey players have always been expected to do.

The only real cure for a concussion is rest. But Crosby did not rest. Apparently asymptomatic, or wanting to play through the symptoms he had, Crosby dressed for the next game in Tampa Bay. A rather routine bodycheck by Lightning defenseman Victor Hedman finished him for the season.

Crosby's lengthy absence cast a shadow over the entire NHL and was one main reason why the league strengthened its rules on head contact. His long-awaited comeback, a two-goal, two-assist dominant performance on Nov. 21 in a 5-0 win over the New York Islanders, was hailed throughout the sporting world and beyond. Now, eight games later, he's off the ice again. His recent injury on Dec. 5 was, not surprisingly, first reported to be something other than a concussion. It was originally classified as a knee injury after he went knee-on-knee with teammate Chris Kunitz.

Following the game, Crosby said he'd gotten a "stinger," a sports term for an injury resulting from the neck and shoulder being pulled in opposite directions. That's not what took place in his collision with Kunitz. But it was apparently what happened shortly thereafter on a seemingly innocuous collision with Boston's David Krejci during which, the video below shows in the last replay, Krejci may have elbowed Crosby in the head.

"I know I got hit in the head there, but I felt like I was pretty good after that," Crosby said this Monday while acknowledging a week later what caused his absence from the lineup (video). "I didn't feel like it was anything too major. But if I had to look at one was probably that one" with Krejci.

Another characteristic of concussions, now widely known, is that victims can become more easily prone to them, with less force needed to produce a similar outcome. The blow by Krejci did not seem especially potent, even though Crosby and Krejci jawed at each other for sometime afterward. Once again, Crosby did not feel any immediate symptoms and finished the game.

In this video, Dr. Tom Hackett of the Steadman Clinic explains the symptoms that have sidelined Crosby.

Now Crosby will rest again. "I'm not happy ... to be dealing with this," he told reporters on Monday. "But I've got a pretty good idea of things now, and know that this is not where I was before. "That's encouraging."

Asked if he worried that something like this might happen at some point when he returned to play last month, Crosby replied. "No. I mean, I wasn't thinking about it. That's the honest truth. I came back feeling comfortable and ready to accept whatever came with playing hockey. So I wasn't expecting it, no."

But now, as positive and optimistic as pro athletes usually are, as strong-willed as they can be in blocking out distractions to maximize their performance, this particular exceptional athlete may be forced to adjust his thinking.

There will be calls for the NHL to do things in the wake of its ongoing concussion problem. Stiffer suspensions, which Shanahan reserves only for repeat offenders, might help. Rules changes will be demanded, such as zero tolerance for all head contact. The Hockey News' Rory Boylen wants the NHL to crack down on "snap back" head embellishment that players fake to draw unfair penalties, which only embarrasses referees and dissuades them from calling real heashots.

But how can hockey legislate against accidental concussions from flying pucks and sticks or inadvertant collisions with teammates or even foes? It can't. There plainly are inherent dangers in the sport -- all the more reason to eliminate all currently permitted actions that deliberately target an opponent's head.

Improved measures aside, however, it's worth a moment to think about Sidney Crosby. He will come back, that's for sure. But will concussions plague him the way they did Pat LaFontaine, Paul Kariya, Eric Lindros and the others in this photo gallery? And will the prospect of being more prone to head trauma start to worry him now? If so, will it effect his play?

And even if he can keep these troubling questions from his mind, how can any of us watch him and avoid thinking that his brilliant career may be running on borrowed time?

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