Good reading – great food for thought. From a former NHL goaltender.
During my morning exercise bike ride, I checked out The Concussion Blog on my PDA (thankfully, there’s a mobile version of the blog, so I don’t have to scroll through all kinds of formatting stuff), and I came across a few interesting threads that might have some bearing on each other.
The first was a comment at the post about how Nowinski is leaning towards the “more rest” position of Omalu, and concussion — while widely attributed to the brain being shaken inside the skull — can also be attributed to jaw impacts
where the brain hits off the side of the inner skull like a piece of jello, here the medial temporal lobe is traumatized when the end of the jawbone pierces the temporal bone. The end of the jawbone rests on the skull base, cushioned by a dime sized piece of cartilage, once this cushioning element is displaced, it becomes dangerous. Its been documented in boxers with a “glass jaw”, when this cartilage disk slips out of place, it creates a bone on bone condition allowing hard bone to hammer the area of the medial temporal lobe where CTE manifest. This is diagnosable and documented in research with boxers and now NFL and NHL players.
Hmm. I had heard some discussion about how mouthguards supposedly guard against concussion. I’ve heard a number of people dismiss mouthguards, saying that they can’t protect against the brain banging againt the inside of the skull, and I myself have been skeptical. But seeing it explained — and taking a look at the location of the jaw in relation to the medial temporal lobe — I’m more convinced. Especially after reading that CTE manifests in that exact area.
This is getting my attention.
What’s also getting my attention is another post over at The Concussion Blog where fighting in the NFL is discussed. And after watching some hockey over the past week and seeing all the fights that are not stopped by the refs (and are egged on and celebrated by cheering fans), I wonder how much these fights — with more than a few hits to the jaw — contribute to the cumulative risk of concussion.
Let’s be clear about something — concussions/head injuries/TBIs all add up. Their effect is cumulative. And I can’t see how encouraging and allowing all the fistfights to escalate and play themselves out until someone goes down on the ice can help matters. Concussion awareness, I think, needs to reach beyond the “head hitting against the bony insides of the skull” and expand into the effects of the jaw hitting against the medial temporal lobe. And I’d also like to see/hear more consideration of not only the dangers of sports, when it comes to concussion, but the dangers of fights and getting clocked in the jaw, time after time.
I watched the March 5th ‘The Hotstove’ where Mike Milbury suggests hockey take a look at the level of violence, and how opposed the rest of the panelists were against it. Fighting seems to be endemic to hockey, but I heard once that hockey didn’t become a violent sport until it migrated south to areas where people couldn’t understand the game, and the league turned to fistfights to attract crowds. Apparently, the strategy worked. Now, can the NFL survive its own success? I wonder.
I think it would be quite interesting to do some data analysis on logged concussions and the frequency and types of fights that hockey players get into. I’d also like to see data on the coincidence of recorded fights and concussion in contact/collision sports athletes. It might shed some light on this, and also help us see other contributing factors, such as behavior choices in everyday life, which can jeopardize the safety and future of student athletes — not because of what injuries they cause, but because of the injuries that they may contribute to.
Courtesy of The University at Buffalo Concussion Clinic, this shows a novel approach to dealing with post-concussive symptoms. I wonder if, given how close Buffalo is to Canada, NHL players who have been sidelined by concussion might be able to make the trip to the clinic pretty easily. Just a thought.
I’ve been watching the video on BrainLine – NHL Hockey Hall of Famer Pat LaFontaine Shares His Story
It’s a great retelling of a story about how he sustained multiple concussions and could never get answers from anyone… until he was so impacted, it was obvious to everyone that something wasn’t right. It’s also a very telling look into an often hidden world of athletes who know something is wrong, but are told time and time again by doctors and trainers and other expert folks, that they just have a psychological issue and if they just suck it up, they can get back in there and get back to regular play.
Around 19:10 in the video, LaFontaine talks about how he had to keep calling his doctor (the new one who actually had a clue what was going on) to reassure him that the source of his emotions and depression and headaches and not feeling right was physiological. He thought that the doctor was just being nice, because he felt like he was losing his mind.
How true it is.
When you’re going through the disruption of a TBI, you can genuinely feel like you’re going crazy. Things are strange, you don’t feel like yourself, your emotions may be off the charts or completely changed, and nothing seems to be clicking. And trying to get help can be next to impossible, if the doctors you see are not familiar with brain injury/concussion.
This is so important — I wish more doctors and trainers and coaches of student athletes would pay attention to this and keep up to date with the most current research and best practices, so they can not only help people understand what’s happened to them, but they can also take steps to prevent repeat injuries before healing is complete. Concussions among student athletes is much higher than most guess (and former studies showed), and second subsequent injuries before the brain has healed can be devastating. Second impact can complicate concussion symptoms, and if doctors and coaches and trainers are all pressuring the players to get back in the game and/or telling them that they’re really fine, they can get hurt again — and have even worse problems to deal with after the fact.
I was one of those student athletes who went back in the game after the concussions I sustained, but I’m different from many, in that my coaches and trainers had an eye out for me and kept me out of play (against my will). I was very luck. Lots of student athletes don’t have that same level of vigilance and care.
The one problem was that I’m also one of those folks who never got proper medical care until about three years ago. This was long after the period in which I could file for any sort of assistance or get accurate medical records documenting my injuries — so the chance of me getting any help from any organized sources is slim to none.
I’m on my own. And even though I have doctors who know about my TBI history, I’m still on my own when it comes to advocating for my own care and well-being. They mean well, I’m sure, but when they tell me that I don’t need to worry about how much sleep I’m getting, because I may not need at least 8 hours a night, it’s not particularly helpful. And when they look you over, plying you with questions about your mood in search of clues about psychologically based depression, completely ignoring the physiological aspects of mood and emotion, well, that’s even more depressing.
I can tell you from personal experience that dealing with post-concussion syndrome is a real bitch, when you have no idea what it is, you think you’re losing your mind, everyone around you is telling you to just “shake it off” — or they have no idea you have anything to shake off, and all they can do is give you a hard time about struggling the way you do. And then you go to the doctor, and they tell you to take a meditation class or relax more or go on vacation to get your mood back in order… this is not helpful, in the case of TBI.
According to the medical/mental health system, without proper medical documentation of my injuries, in the eyes of others, I’m probably mentally ill. All that emotional volatility, the perseveration, the rumination, the difficulties getting started and stopping what I’m doing, the extreme swings in energy levels… Even some of my friends who are psychotherapists have written me off as mentally ill and refusing treatment. These are the same people who have flatly discounted the effect of TBI in my life and claim that all I need is to deal with my difficult childhood to get on with my life.
They’re wrong on so many different levels. Especially about me refusing treatment — I’m not. I’m actually getting treatment at the level I need — on the neurological level, not on their preferred level. I know that I’m not mentally ill, and so does my neuropsych. And so does every other person who is intimately familiar with TBI and understands the nature of the issues I face on a daily basis. To say it’s maddening to watch the mental health field have a heyday with folks who have been neurologically impacted, would be an understatement. And hearing stories of doctors playing psychotherapist is equally irritating. But at the same time, I can’t let the shortcomings of our “modern” mental health industry impact my own peace of mind and my own mental health.
There’s no sense in that.
So, I seek out answers for myself. And I share what I find, in hopes that others like me may realize that someone out there actually gets it. They’re are not alone, and there is hope.
Where there is good information and good communication, there is a chance for change.
This past Sunday, the Boston Bruins’ Marc Savard was blindsided by Matt Cooke. Watch it here:
All the YouTube comments about “If you can’t take a hit, you’re a pussy” and “Canucks are friggin’ animals” notwithstanding, getting hit like this in hockey, as well as other sports, is often part and parcel of the game.
Consider also Mike Richards’ hit on David Booth:
I watched both of these videos last night (which is one of the reasons I didn’t get to sleep at the time I was planning), and I had to wonder — if Cooke and Booth actually knew what they were doing when they drove their shoulders into the unprotected heads of their opponents, would they have done it?
If they’d known that repeat concussions can lead to dementia and Alzheimers… memory loss… broken marriages… domestic violence… lasting loss of balance… and more — sometimes ending in unemployment, homelessness, and suicide… would they have done it? If they’d known that “destroying” someone like that isn’t like breaking their finger — it’s more like cutting it off and mangling the other fingers around it — would they have thought twice? And if their coaches and managers and team owners had the right information and any sense, would they have let them get away with it? Furthermore, would the refs have overlooked it?
I’m not sure people’s brains are working well enough to let them make smart choices, here. I’m not sure, given the culture of hockey, and the tough-guy mystique, there’s any chance for anything other than dumb choices, when it comes to these kinds of sports.
I’m not being down on contact/collision sports players. I was one, myself, once. And I loved it. If I could still do it, I probably would. But there’s a logistical issue here, that has to do with how we’re physically constructed, not how mentally and physically tough we are.
One of the problems I see with contact/collision sports is that traumatic brain injury (which is what a concussion is) can lead to reduced appreciation of risk, poor judgment, lousy planning, increased aggression, and a whole host of other cognitive/behavioral issues which can impair anyone. It’s not only pedestrians walking around in the everyday world after car accidents, assaults, falls, and brain viruses, who suffer the ill-effects. Professional athletes do, too.
And when you play a rough-and-tumble sport that involves repeated impacts, including grade 2 concussions, as just part of the game, the cumulative effects can be dramatic and quite serious.
Imagine the long-term effects on kids who are taught/allowed to brawl on the ice or on the field, season after season, year after year, from the time they’re old enough to handle a stick or a ball. We don’t know nearly enough about what concussion does to young brains, but it strikes me (so to speak) that engaging in repeated intense shaking of the brain, which severs fragile axons which are essential for clear thinking and responsible functioning, would ultimately produce the kinds of aggressive and downright stupid behaviors we see in the Cookes and Richardses of the sporting world. It’s not their character I’m questioning (though some might). It’s their neurology.
Add to that the fact that players are getting bigger and faster each decade, and the pressures of money and success, that we’re living in a culture of shoot-first-ask-questions-later and bigger-and-badder-is-better, and you’ve got a recipe for a whole lot more Booths and Savards being laid out on the ice — or on the grassy field/floorboards.
Ultimately, what these kinds of incidents tell me, is that the NHL is not doing its job in enforcing rules that keep play from degenerating to a series of full-on assaults over possession of a little round black puck. It’s also doing a piss-poor job of educating its players about the long-term effects of the concussions they dole out to each other. Either that, or it’s breeding numb (if not hateful and bloodthirsty) assailants who don’t give a crap about the long-term consequences of their chosen actions.
According to some definitions, that would qualify as sociopathic behavior.
One of the reasons I’m so pissed off about this is that Richards and Cooke are professionals. They should know better. They can do better. But they didn’t. And somehow, that’s okay. It’s just part of the game. Never mind skills. Never mind sportsmanship. That’s for pussies. It’s much quicker and easier to knock your opponent out with a blindside hit than have to actually play against them. Screw the game. All that matters is the win.
I have to wonder if folks who resort to violence instead of athletic skill are too impaired from their own repeat head traumas to fully grasp the seriousness of what they’re doing.
If that’s the case, then the NHL is really the ultimate culprit in producing what amounts to little more than (briefly) premeditated assault in the name of a “game”.
And the league can thank themselves — in refusing to penalize these kinds of hits — for promoting this kind of behavior in young players, who are too young to know better — and aren’t being taught any different.
Best wishes to Marc Savard and David Booth for full recoveries. Good luck, guys.