Originally written on The Rangers Tribune  |  Last updated 11/11/14

VANCOUVER, CANADA - JANUARY 16: Sidney Crosby #87 of the Pittsburgh Penguins stretches during the team warm-up prior to NHL action against the Vancouver Canucks on January 16, 2010 at General Motors Place in Vancouver, British Columbia, Canada. (Photo by Rich Lam/Getty Images)

This Week in Hockey is a weekly column in which assistant blogger Michael Spinner shares and discusses the major storylines in the National Hockey League from the past week. 

The NHL at a Concussion Crossroads

There is absolutely nothing funny about head injuries, anywhere, at any time. The days are over when we can call an athlete ‘soft’ when he or she does not play because they ‘had their bell rung,’ and we certainly cannot criticize a sport organization for being too cautious when it comes to a potential head injury for an athlete.

During the last few years, the concern surrounding head injuries and concussions at every level of sport have begun to reach a crisis magnitude.  Let’s face it, until a few months ago, the general public did not know too much about Chronic Traumatic Encephalopathy (CTE), which means that those who are experts on the matter probably do not know as much as they will know in, say, five years from now. Concussions are a major hot-ticket item in sports today, which likely means this area of study and examination will evolve very quickly. Concussions have been common in sports for a long time, but the long-term impact of head injuries has never been studied the way it is being scrutinized right now.

How many concussions are too many? Is it five? Is it one? We honestly do not have an answer. But, what we do know, is that athletes are suffering long-term effects and in some cases dying due to medical ramifications of head injuries. And athletes who are surviving severe head injuries are appearing to never be the same. Did anybody see Mike Richter or Marc Savard on NBC during the last month? Neither one of them looked ‘right’ (for lack of a better term). This is a serious matter with absolutely no room within any aspect of head injury prevention and treatment to take the issue lightly.

That is, unless your name just so happens to be Gary Bettman.

This column is not going to be a knock on Mr. Bettman for his role as the Commissioner of the National Hockey League. In fact, the day will come very soon when it will be written that despite all of the knocks he has received, Mr. Bettman has actually performed admirably in his role. However, in policy – and more recently in words – Mr. Bettman is not taking the right steps as NHL Commissioner when it comes to head injuries, prevention, and treatment.

Last weekend, as part of the NHL’s All-Star Weekend, Mr. Bettman held his annual ‘State of the League’ Press Conference where he scoffed at the notion of eliminating fighting from professional hockey. Specifically, he said that he has not heard a complaint from any General Manager about the role of fighting with regards to repeated head injuries, and that while fighting does cause concussions, so do pucks to the head. He stated, “Nobody talks about playing with a foam rubber puck,” as a way to lighten any momentum towards a closer study of fighting in hockey and how it pertains to head injuries.

Bettman’s logic would be valid if: A) At least one NHL General Manager were a neurologist or have at least some medical expertise with regards to what is good and bad for the game in the area of head injury prevention;  and B) Pucks to the head were even remotely as common as fighting in NHL games. The ‘foam rubber puck’ quip was completely inappropriate considering the magnitude of the issue. While this column will absolutely not advocate the elimination of fighting in the NHL, since Mr. Bettman acknowledged that fighting does in fact cause concussions, he has the responsibility as NHL Commissioner to put some degree of effort into an examination as to whether or not a greater deterrent to fighting should be implemented to protect NHL players.

In other words, Bob Probert and Derek Boogaard both died tragically long before their time. Both were posthumously diagnosed with CTE. Rick Rypien and Wade Belak were not posthumously examined for CTE, but both NHL strongmen perished tragically at a young age with mental health issues that very well could have been related to CTE as a cause. Indirectly, fighting during NHL games could be killing hockey players, yet Bettman took an opportunity to not only toss aside the notion of a direct relationship between fighting and long-term medical issues, but to make light of this correlation as well. In the world we live in today, where head injuries are a far more serious issue than ever thought before, that is not good enough.

As things stand, it is a documented fact that head injuries can lead to serious long-term medical issues and death. As a result, the NFL and NHL have taken major steps to preventing and treating concussions in order to protect their athletes both short-term and long-term. Five years ago, NHL players such as Sidney Crosby and Marc Staal likely would have played through the symptoms of post-concussion syndrome that kept them out of significant stretches of play this season.  Now, there is a specific medical place any athlete recovering from a head injury must reach before they can play again. In addition, five years ago, many of the causes of head injuries were not treated the way they are today. Head shots are more closely watched today, fines and suspensions are handed out more liberally, and the NHL has sent a clear message that dangerous play will not be tolerated. Bettman himself said he believes the game is being played in a safer fashion due to the new rules and rules enforcement.

But is the NHL doing enough? The answer is no. The NHL seems to be insistent upon following policy that is in every way reactive, and not nearly proactive enough to offer hockey players more protection from head injuries. Of course, the possibility of a suspension has to have seriously curtailed premeditated head-shots as an act of vengeance during hockey games, and that one particular cause of head injuries is hopefully on the decline. After all, there is no place for head-shots in any sport anymore. Sending a message that if you go after somebody’s head, there will be consequences is absolutely the right thing to do … but it also is policy based on the logic that head-shots are premeditated acts.

A stern warning about the consequences of a head-shot is within the same line of thought that dictates that a player should keep his stick down or he will be called for high-sticking. As a result of this warning, players keep their sticks on the ice, most of the time. But, in the heat of the battle, at times, a player lifts up his stick. And if an opposing player happens to change directions quickly or do something different than what was expected, contact is made, and a high-sticking penalty is called.

With head-shots, I am convinced that an overwhelming majority of pre-meditation is gone, but in the heat of the moment, it is all too common that one player misjudges an attempted check, and the check turns into something that can be deemed a head-shot, or illegal check to a vulnerable player. Of course, there is no way to eliminate these kinds of bang-bang hits from play, but there are definitely steps the league can take to curtail the dangerous play we still have today, and make the game safer:

  • Develop a zero-tolerance policy for contact with the head. Last year, the NHL introduced Rule 48 to penalize hits to vulnerable players in order to protect players from the very injuries discussed above. Brendan Shanahan became the NHL’s lead disciplinarian, and the term ‘Shanaban’ entered hockey vernacular. The suspensions have come, pretty regularly, with Alex Ovechkin’s recent three-game suspension for reckless play being a prevalent example. Shanahan has even stated he will look at a player’s track-record when considering sanctions for dangerous play. All of this is important, but not enough. Three games for Alex Ovechkin? How many times has Ovechkin been penalized for play that is downright dirty? Dozens. How many times has he been suspended? A few. Will a three-game suspension really change his behavior? Probably not. Ovechkin is not necessarily a dirty player, but he plays the game on the edge, and the NHL needs to create a culture where playing the game this way is banned. Ovechkin has been disciplined several times now, so why not suspend him for 10 games? Why not make a first offense 6-8 games, and then make it progressively worse? And, more importantly, a punishment should never have to fit the crime, a dynamic that presently exists within Shanahan’s policy. Because a player was injured or the severity of injury should never, ever be a factor in a punishment for a hit. It should be simple: Was the hit illegal in a fashion that could have caused a head injury or other serious injury? If the answer is yes, regardless of outcome, there should be stronger sanctions than what we have seen.
  • A closer look at the equipment. A major pathway to preventing head injuries is the evolution of helmet technology, like what we have seen more in football and lacrosse than we have seen in hockey. Helmets today are much lighter than ever before, but also much more protective. Football, lacrosse, and hockey are incredibly physical and sometimes violent sports, but football and lacrosse have succeeded in limiting head injuries in part because of new helmet technology. When is the last time a prominent NFL player missed as much time as Sidney Crosby and Marc Staal due to concussions? Of course, there is no way to avoid concussions completely, but it is incumbent on all sports to limit head injuries as much as possible. A closer look at hockey helmet technology and a real summit as to whether the current helmets used in the NHL are as effective as they should be in preventing head injuries is a major first step to preventing head injuries. In addition, since a large number of concussions are caused by an individual banging their teeth together, the NHL needs to look at the mouth-guards being used by NHL players and whether or not there are better mouth-guards available.

The NHL has taken steps with regards to helmet technology, and individuals such as  Mark Messier have developed a helmet that is reportedly safer than the current common models on the market … although few NHL players use the Messier helmet. However, despite all of the studies and meetings, concussions continue to rise. In this regard, safety has to come first. Lacrosse and football helmets are larger and weigh more than hockey helmets, but they are also more protective. For the NHL, it is important to have a helmet that does its job first, and worry about convenience and comfort second. Right now, the NHL does not do that.

 It’s simple, really: Protection to the head has evolved over time. There was time that no hockey player wore helmets. Then hockey players wore flimsy helmets. Now, hockey players wear stronger helmets that are likely not strong enough. A newer, more protective helmet is simply continued evolution within the sport, and the notion that hockey players need to be tougher by wearing less protective helmets needs to disappear.

  • Different fighting penalties: The NHL could actually make fighting safer if it wanted to. Is five minutes for fighting enough of a penalty? Maybe, maybe not. Most would suggest that fighting in hockey will happen regardless of the penalty. However, if the NHL were to mandate if either player’s helmet is removed during a fight, the penalty is more severe (say, 10 minutes), perhaps there will be less fighting and less helmet removal. This will give fighting an element of extra protection by curtailing blows to the head during fights. Essentially, players will be allowed to fight as much as they want (within the rules), but they'll either have to punch a hard plastic shell with their bare hands – something that will limit fights and punches to the head – or serve more time in the penalty box if one or both helmets pop off. Also, the NHL seriously needs to eliminate its ‘pitched battles.’ You know, the fights that occur just as the puck is being dropped during a face-off, or when players spend 10 seconds analyzing whether or not they want to fight before dropping the gloves. There is no place for those fights in hockey – make the penalty for staged fights a 10 minute minimum. It’s one thing for a fight to happen spontaneously when a player runs into another’s goalkeeper, but the madness we saw detailed in 24/7 where players debate the pros and cons of a fight before actually engaging has no more place in this sport. Since the on-ice officials clearly know what is being said and how fights are being planned, the pitched battles can be slowed, if not eliminated.
  • Make the ice surface wider and longer: One of the many causes of head injuries in today's NHL is that while the athletes have become significantly bigger, faster, and stronger, their room to operate has remained the same, leading to increased physical play. Today, an NHL player can take 1-2 strides before leveling a very hard hit on an unsuspecting player, and the hits along the boards - even when legal - are harder than ever before. By making the ice wider and longer - and giving the players more room to operate - the NHL will decrease clutter that leads to contact, particularly along the boards and behind the goals, and also open up the game some more so offensive opportunities increase. Again, will this eliminate head injures? Of course not. But, it will lead to a situation where there are less opportunities for injury-causing hits. With the increased speed to the game and offensive opportunities added to the game via longer and wider ice, this change poses a win-win for the fans … unless you happen to cheer for a team that relies on a trap.

Ultimately, concussions are not going away as a reality in sports and a major medical issue. Hopefully, the day will come when there is a greater understanding of how to prevent and treat these head injuries so hockey and other contact sports can continue to be the games they are, but without the health risks to its athletes. The NHL has a responsibility to act both proactively and reactively to head injury situations, something that is not quite happening right now. In this instance, Mr. Bettman failed to recognize that any steps that can be taken to limit or eliminate concussions is a worthy venture, and if fighting – while important to the game – is a cause of concussions, there needs to be a way to mitigate fighting and punches to the head.

The Scary Sidney Scenario

Speaking of concussions, it is the unfortunate reality that Sidney Crosby is quickly becoming the poster child for why the NHL, and all of professional sports, have to do more to prevent and treat head injuries. Crosby’s story is, of course, just a little bit different because he is probably the first professional athlete of his caliber to suffer the long-term impact of post-concussion syndrome. There have been some great hockey players to actually retire early due to concussion symptoms – Mike Richter, Pat LaFontaine, Eric Lindros, just to name a few. But, Sidney Crosby is on another level. If Crosby is able to return to the game and achieve the success he has already for another 15 years, he could retire as one of the greatest professional athletes that ever lived. However, right now, that is a big if.

There are many out there who adore Sidney Crosby because he is a world-class talent. There are even more who detest Crosby for his in-game antics, dives, cries, and penchant for scoring goals in bunches, and at the most crucial times. No matter where you sit on the Sidney Crosby likeability scale, there are two emotions that one would think after the week he has experienced that would be absolutely natural: A) As hockey fans, we are all very concerned about Crosby because nobody should ever have to encounter what he has faced for the past 13 months; and B) We’re all scared to death to visit any doctor of any kind based on what we have read and heard during the most recent chapter of Crosby’s recovery.

If we are to believe everything we have heard from the Penguins regarding Crosby – and let’s be honest, we have heard very little – we would have to believe the following:

  1. Sidney Crosby has been battling with post-concussion syndrome from what was likely two consecutive concussions in January of 2011. This is very believable, there is film to prove it, and for the most part the Penguins have not deviated from this theory as to why Crosby cannot get healthy.
  2. Somehow, some way, at some point, Crosby suffered as many as two fractured vertebrae along his neck – an injury that sounds an awful lot like a broken neck to me. And somehow, some way, at some point, this broken neck was never discovered for more than a calendar year despite repeated trips to a litany of medical professionals. However, the broken neck (for lack of a better term) is no longer a problem because it is now apparently fully healed. So, in other words, Crosby had an undiagnosed broken neck, was allowed to return to action for eight games this season – during which he may or may not have still had a broken neck – or it is entirely possible that he broke his neck during his return to the ice this year … none of which matters because his neck is ‘fully healed’ now. Which, of course, lends the question as to how they knew he had an injury to his vertebrae in the first place if everything is fully healed now? Does this mean that “fully healed” means it shows signs of having been broken – and if that is the case, how do we know that things are fully healed?
  3. Almost miraculously, a day after the announcement of his broken neck, Crosby’s vertebrae were fine all along, he didn’t break anything to begin with – Crosby’s injury is actually an injury to the soft tissue within his neck … which could lead to concussion-like symptoms that have been plaguing Crosby all along. Although it is possibly the case that Crosby suffered two concussions in succession during the winter of 2011, it is also within the realm of possibility that there was not a second concussion, but instead one concussion followed by a neck injury, that most assuredly was not a broken neck but a tissue injury that could lead to concussion symptoms … for a year.

Without benefit of being a doctor, let me just take a moment to fully understand this. It is possible that this man was misdiagnosed with a second concussion … just to be misdiagnosed with what was essentially a broken neck … to finally be diagnosed with a soft tissue injury? So he went from a brain injury that could kill him if not properly treated, to a neck injury that could paralyze him if not properly treated, to a tissue injury that may in fact require deep tissue massage and physical therapy?

Am I the only one worried by all of this? Are these ‘diagnoses’ based on that which is actually being seen by doctors, or are they pulling diagnoses out of a hat? Are these same doctors moonlighting as weathermen on the news who despite all kinds of doplar radar and satellite imagery still cannot tell me if it is going to rain on Tuesday?

We live in the world of 2012 where medical science has advanced to the point where we can be born as we are, but die 95 years later with somebody else’s heart, another person’s lungs, and be of a completely different gender … but nobody can seem to quite pinpoint exactly what is wrong with Sidney Crosby. Not only that, but one qualified professional saw a broken neck, while another qualified professional said the broken neck never happened, but in fact there is a completely different kind of neck injury.

It’s not like Crosby has consulted with some new-age doctor, using extreme treatments for his symptoms. Sid has not missed a year of hockey because he ignored conventional treatments and instead rubbed his head and neck with greek yogurt and maple syrup before bikram yoga to improve his post-concussion symptoms. It would seem readily apparent that Crosby – being a mega-millionaire, and the face of the NHL – was seen by doctors of the highest level who earn tons of money to analyze hard data and make correct medical diagnoses. These men and women are not just doctors, they are EXPERT doctors, and I am sure there have been a LOT of them to examine Crosby … and yet still, something really big was missed here. One expert saw something broken, while another did not – a year after no expert saw anything. Kind of makes you wonder who you are dealing with the next time you are examined for a common cold.

Crosby and Pittsburgh General Manager Ray Shero both made it clear that Crosby will not resume his NHL career until he is completely symptom-free, and has a clean bill of health from his doctors. It’s probably something more along the lines of, since there are three different theories at play here, they’re going to eliminate all three injury possibilities before allowing Crosby to touch a hockey stick.

At the end of the day, all of this makes you wonder the following:

A – Did the brass of the Pittsburgh Penguins know more during the last 13 months than they made it seem? You almost hope so, because if they were as utterly clueless as it seems, it could very well be the case that there have been more theories about Crosby’s injury than the Kennedy Assassination because medical science simply has not gone past the surface of its understanding of head and neck injuries. As much as it would be a terrible thing if Crosby presented a medical enigma that is only now being understood, thereby setting back medical research on concussions, but at least it would lend some credibility to a medical situation that presently has more questions than answers.

B – Who is this doctor who diagnosed what was essentially a broken neck? I only want to know so I do not see this doctor myself … unless it turned out that he or she were right, in which case, I would like to know who the doctor is who said there was no broken neck but instead a soft tissue injury – for the same reasons.

C – If it turns out that Crosby’s injuries that have kept him out of action for a calendar year had nothing to do with concussions, who is the doctor that blew that one?

D – Did Sidney Crosby play NHL hockey this season with either a broken neck or significant neck injury? This is a question that every hockey player in the NHL should want answered. One would think that if Crosby had either broken vertebrae or a soft tissue neck injury, he would at some point have had discomfort in his neck. Are we to believe that nobody bothered taking a closer look? If so, how safe are any NHL players right now who come back from injury if team physicians are not giving them the proper standard of care?

At the end of the day, what you have here is a terrible situation, any way you shake it. You have Sidney Crosby, one of the greatest professional athletes in all of sports who has an injury that could either impact the rest of his career, or it could be an injury that will heal fully and he can return to action at 100% capacity relatively soon. Imagine being in his shoes, and not knowing the real magnitude of his injury? Imagine then having to make the decision as to whether or not to return to the ice after so many differing diagnoses in medical exam rooms across the country already. This is a full contact sport where men skate on ice about as fast as a slow moving car and hit each other. If the loudest voice is also the wrong voice, and Crosby returns to the ice when he should be in a press box, he would be putting more on the line than any athlete should be expected to do.

Like him or hate him, the NHL is better with Sydney Crosby on the ice … scoring goals, setting up others, and serving as the face of the NHL. Dives and whines aside, if we were to lose Sidney Crosby as a hockey player a decade or so before his career should be ending, or even see a Sidney Crosby less capable than the one we had before, the sport of hockey will lose a treasure the likes of which we may not see for a long time to come.

Shooting on the Shootout

During his ‘State of the League’ address, NHL Commissioner Gary Bettman, among other things, stated that the shootout is pretty much here to stay. During his remarks, he boldly proclaimed that ‘70-80%’ of fans polled during regular NHL research responded favorably towards the shootout as the final conclusion to a hockey game. Bettman pointed to the intensity among fans within an arena once a shootout begins, and how an actual conclusion – as opposed to ties – is better for the game.

Bettman’s statement makes you kind of wonder who these fans were that were so overwhelmingly supportive of the shootout. Were the surveys of the random, on-line variety where one person could conceivably vote 1,000 times? Were the fans only season-ticket holders or did they find a way to poll fans who only watch hockey at home? Did the question specifically ask for an opinion on the shootout, or was it a question along the lines of, “Which do you prefer, a tie after overtime, or a shootout?” to which 80% of fans would likely view the shootout favorably?

The reason for these questions is pretty easy: While there are almost certainly many fans who love the shootout as a conclusion to a game, and many fans who are not in favor of it, it is hard to believe that such a major deviation from the game is so wildly popular. The shootout was not a minor change to hockey like painting the creases blue years ago, this was one of the rare times when a major sport completely changed the game. To say that 80% of the hockey public – based on their poll – favored a continuation of the shootout is, well, just a little bit hard to believe.

The shootout as a conclusion to an NHL game has its pros and cons. On one hand, anything is better than the old system where the two teams each earned one point for a tie at the end of a five-minute overtime. The first New York Rangers game I ever attended was against the New Jersey Devils, and it was a high-scoring slugfest that saw the Rangers tie the score in the final minute after they had pulled their goalkeeper. The five-minute overtime was just incredible with both teams enjoying huge scoring chances, and at least one crossbar was hit. And then, suddenly, it was over … with no winner. Nobody seemed satisfied. That system was awful, it was like one of those shows that ended during the cliffhanger moment in order to have people tune in next week, but there was no ‘next week.’ Having a conclusion – any conclusion – Is better than a tie.

And Mr. Bettman is right … the intensity within an NHL arena absolutely escalates when the shootout begins. It is a very exciting event to close a game with, kind of like the final minute of regulation of a one-goal game, just a bit more focused.

However, what Mr. Bettman and shootout proponents fail to recognize is that to simply pat themselves on the back for the system that is in place fails to recognize that a better system is somewhat apparent. Of all of the changes the NHL made after losing a season to a lock-out nearly a decade ago, the decision to play overtime 4-on-4 was the best one. Overtime hockey is now faster, more open, and more likely for a conclusion than it was previous to this change. If you ask me, the best part of a hockey game that ultimately goes to a shootout is the overtime period since it is in so many ways like watching a hockey video game. You cannot settle the puck down during 4-on-4 play, and even strategy like fore-checking is curtailed with one less body on the ice. The 4-on-4 game is guaranteed play off of the rush, no trapping allowed, and even if the puck does not enter the net, there are guaranteed scoring opportunities.

So if the game has to come to a conclusion – a good thing – and 4-on-4 play is so amazingly exciting and fun to watch, why condense it to only five minutes? In the big picture, it is always better to end a game with an actual hockey goal as opposed to a skills competition, particularly during an era with so much parity in the league that almost everybody is going to be in the playoff hunt until the final week of the season. Do we really want such important points determined by a skills competition, or do we want to do whatever is possible to both provide an NHL product that is entertaining from start-to-finish and determined by hockey at the same time.

A 10-minute 4-on-4 overtime period will do just that … and if the game does not end, then you go to a shootout. 10 minutes is short enough that teams will push their hardest to win the game in overtime, but not too long that it will become a marathon of a game that seems to never end.

So why not keep the shootout in place, but make it less likely to happen?

The point here is that when we get to the middle of the spring, and the stakes are higher, it should be actual hockey – and not a skills competition – to determine who gains a crucial extra point in the standings as much as humanly possible. In 2010, the New York Rangers lost what was essentially an elimination game to the Philadelphia Flyers to end the season … in a shootout. That was a terrible way to end a season for a team. While there is no way to say the game would have ended in overtime if the 4-on-4 play had been extended five more minutes, at least the likelihood of a skills competition would be lessened if overtime were extended just a bit.

The reality is simple: If Gary Bettman were really convinced of the merits of the shootout, and if 80% of hockey fans were steadfastly in support of seeing a game ended by a skills competition, the shootout would also decide the winner of NHL playoff games. The fact that the shootout is merely a regular-season dynamic in the NHL means the system in place is favorable, but not perfect. Perhaps adding one small element like a bit more time of 4-on-4 play would make the overtime system even better.

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