'

,/

Concussions
in the National Hockey

gue .

NHL0023041

I
I
i

Why Concussions Have Been In the

,.""&p.r@t1rgnt,1:R zem=e=l.1 '"'.~"~ .
-

1.
2 ..

..

-=

NHL - new Rule 48

Pl:ayers out long term
M:arc Savard, David Perron, Andy McDonald, Matthew Lombardi, Raitis'
Ivanans , Jeff Halpern, Derek Boogaard, Kyle Cumiskey, Tom Poti, Jim Slater,
Sidney Crosby

3.

Recently released studies of junior teams

i) Paul Echlin (London, Ont.) followed two junior teams (average age of 18)
in 2009-10 season. 69% of hits causing a concussion were to the head, and
80% of hits that caused concussions were intentional.
U} University of Alberta Assistant Professor Martin Mrazik foltowed two
Edmonton minor hockey associations (age 12-13) in 2009-10. 10% of players
suffered concussions.
;;"

4.
5.
6.
~ 7.

NFL- rule change, media coverage, aem,entia

~

Mayo Clinic co:nfer.1ence ~n'. oo~niCf:~sf~~~li.1~youth hockey (Fall 2010)

Boston Sport Legacy lnst1tut~IT"E (fHern1lng, Probert, NFL)
Legislation regarding youth concussions introduced in most states.
National concussion legislation.
2

NHL0023042

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1. March 2010 - Adoption of Rule 48

2. Concussion Evaluation and Management
Protocol - Revlslons
3. Continued Education/Training
NHL BOG, GMs, Team Athletic Trainers, Doctors

4. Shoulder Pads - Increased Padding (September

2010)

')

<

5. Concussion Educa~~i'~~ - ThinkFirst

6. Seamless Glass ~njury Analysis
3

NHL0023043

Step 1: Neuropsvchologlcal baseline

testing:
- Neuropsycholoqlcal testing examines neurocoqnitive
functioninq ..... ~.-'-~
- l.earnlnq, Memory, lnforrnation Processing Speed,
Problem Solving Skins, Cognitive Flexlbillty.
- Emphasis on functional rather than structural
assessment,
.-

_\! l-i. \ \i s
1

NHL0023044

and
Management 'Protocol- . . .

Concussion Evaluation
- Step 2:

If visible signs of concussion are observed by the Club,

or symptoms of concussion are reported by the player:
- Player shaH be removed from playing environment
discretionary) to be evaluated for concussion

(not

- Atearn physician shall conduct evaluation in a quiet place

- NHL SCAT2 (trial tool)

- Players who have theseh signs or symptoms shall not be
returned to play until ~l;i;ey nave been examined by a team
phvslcian, and t>!a.l'ed~tb t,u~rn..
to play
-

. ~ \Ir /' L
I

NHL0023045

Concussion Evaluation and

\: ... ~{!;;_'"''":_,.:

';:::

.'t{' .. ".' ..
' "'"'~:

, .

, . ~~

Manage rnentProtoeel

Concussi:on SJgns (Observa.ble)

Any loss of consciousness;
~
Difficulty getting to feet following a hit:
Motor lncoordinatlon/balance problems {stumbles,
"rubber legs", trips/falls, slow/labored: skating);
Blank or vacant look : Disorientation (e.g unsure of wh.ere he is on the ice or
location of bench);
Clutching of head after a flit;.
~
Visible facial injury im~h_tl:>th~~n with any of the
above.
6

NHL0023046

Concussion Evaluation and

. . _,,m - . -*"

Ma Aagem=ent:Proto;to=I
1

Co:ncussion Sym:ptoms (Player re,ported}

Headache;
Dizziness;
Balance or coordination difficulties;
Nausea;
Amnesia for the circumstances surrounding the injurv (Le.,
retrograde/anterograde amnesia):
Cognitive slowness;
Light/sound sensitivity;

Disorientation;
Visual disturbance;
Tinnitus.

"~

-_3 \\1 S'

NHL0023047

 Orientation
Symptom Questionnaire
Motor Coordination~~~- Cognltive Assessment (Verbal

Leaming/Concentrationl
.-

De~ayed Recall

l-- .\;\i

Phvsical Exercise
8

NHL0023048

Concussion Evaluation and

MaiA8gement:Protoc0~
Step 3:
If a concussion: is not diagnosed, can return to play.
If a concussion is diagnosed, in most instances do not
return to plav,
- Although uncommon, it mav b:e appropriate for th:e Team
Physician to clear the player to return to play in the same
game if the player has rapid and complete recover of
symptoms at restand upon exertion, and has returned to
neurocognitive baseline as determined by a formal acute
evaluation tool such as th/e
NRI.~ 5CAT2.
-

. - If diagnosed with: a c'Q,nc~s,i~'l,~ ~~fer for

neuropsvchologicat te'sting n\:e-symptom free at rest and
upon exertion.
9

NHL0023049

Concussion Evaluation

and

-Manageme nt P=rotoeiel-""" - "

Step 4: At minimum, a player must be symptom
free at rest and upon exertion and cognitivelv
at baseline before returning to play,

Ii

~~ \\1S'
10

NHL0023050

and
... -Management Protocol -c'" ,~;, .
Concussion Evaluation

,~c."'''"~'''~y

Emphasis on the importance of accurate,

immediate symptom reporting.
Emphasis on prompt a.nd thorough eva~uation of
any p~ayer evid:encing visible signs of concussion,
or reportin,g symptoms of concussion.
Emphasis on evolving and dvnarnic nature of
concussion symptoms.
Each concussion i51.ma~~~,e~ ~ndividuaHy.
No mandatory pen~_p!aYe~halI be withheld
from play following a concussion.
11

NHL0023051

Concussion! Evaluation and

Management Protocol ~

,,;.r.

Protocol issued by NHL Concussion Working

Group - NHL and NHL:PA neuropsvchologists,
NHL team physicians, N!Hl team athletic
trainers
First major professional sports league to issue

such a co~prehe,ns~~~fr~t-?col.
Adapt/revise prot~la~\t~ science evolves
and based on

O'Ur

experience
12

NHL0023052

 Some players suspected of having a

concussion are not evaluated away from the
ice surface.
- Revisions to the protocol address this.

Some players are returned to plav without

post-injury neuropsvchologlcal testing.
Some players are returned to play even

though they are n'~t)~~i'i~~elynormal as per

the neuropsvchological testing.
13

NHL0023053

""!~,- . .\-I
-;

14

NHL0023054

Monthly Concussions . 2010-2011

Oct

Nov

Dec

Jan

Feb

15

NHL0023055

Concussion Count
:C(;tfp.to Mc:fr1$tofeacn year)

% of all Regular Season MGl

9%

8%

8%

7%

17%

Significant increase in regular season game concussions and MGL

2G .new concussions ,in. 270 garii~s sirn~ \a~uar~ 15
10 players account for 391 MGL ~?010/\l \I 0
-

5 accidental; 2 legal hits to the body; 2 fighting; 1 illegal hit to head

10 players account for 172 MGL in 2009/10

-

1 accidental'; 5 lega'I hits tothe body; 3 illegal hits to the head; 1 illegal hit to the body

NHL0023056

Concussions
r-~e. -~.
:r"\
-n a __ :pp. . . -e
1->'U:i: :rI ).g. ?

. O.- w
.- . . : .. ..>a
. . <~:.g,
. -_e
. - - . U;_ 1: u
~., FLI
lf-,-v

-y--

1l: . ~U--

~-.N,~' .i':;-."+~,

..

'

Incidents Not Involving Opponents+ Inadvertent Collisions with Opponents

Collisions with teammates
Trips and falls not involving an opponent
Hit by puck
Inadvertent colllslons with opponents

Fighting
Legal Hits
Hits to the body
Hits to the head

IHegal Hits
Blindside hits to head
Other hits to the head
Hits to the Body
0

17

NHL0023057

Concussions
,

., , ,):.: M;C)W;:aire

......

Tfiey.;.~ 11ap . ne
It-" nin~-g
' . .' ?;7!c. <.. ...
<;.: : -::

'

Video of A~~ Concussions

2010/2011
(thrQugh Mafch 1)

~3\1v,S'

18

NHL0023058

Concussions {thru March 1)

How .a . r~. .Jh~\l. :H app.~.n. i; .n.
:MGt

Concussions

80

Accidental

11

22

47

234

Legal

33

38

114

242

70
V'),

c:
0

60

Grand Total

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c:

(blank)

V')
V')

61

86

30
272

753

so

40

L..

(1)

..c

30

::::J

11.2009-2010

20
111112010-2011
10

Accidental

Fight

Legal

Illegal

NHL0023059

How are.Man Garnes Lost?

700
i!ll

2009-2010

El

2010"2011

600

500
+-'
V)

....J

400

V)

Q)

ro

l!)

300

c
ro
~

200

100

-+------

Accidental

Fight

Legal

Illegal

NHL0023060

Players
(as of March l)
INADVERTENT/ACCIDENTAL

LEGAL HIT

Player 1- inadvertent collision~ 62 games

Playe.r 2 - hit by teammate.-27 games
Player 3 - hit by teammate -23 games
Player 4 - inadvertent collision - 21 games
Player 5 - hitby .puck-10games

Player 10 - hitto
Player 11- hit to
Player 12 - hit to
Player 13 - hit to
Player .14 - hit to
Player 15 - hit to
Player 16 - hit to
Player 17 - hit to

body-46 games
body-15 games
body-13 games
body - .9 .games
body - 7 games
head - 5 games
head - 5 games
head - O games

FIGHT

Player 6-65.games
Player 7 - 35 games
Player 8 - 5 games
Player 9 - 1 game

ILLEGAL HIT

Player 18 - blindside hit - 53 games

Pia er , 9 - hit to body- 19 games
Player 20 - hit to head - 7 games

'\.
_ ~ 2\~i
av.rr.'{j". "\
,
Pl~'ertE-

hit to h. ead - 6 games

hit to head - 0 games

21

NHL0023061

Accidental Play and

lnadverte ntCcllision

.s

Video

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22

NHL0023062

Accidental Play and

. . .,. , tnadvertent

. co1 ~:isions:~
MGL

Concussions
Hit by teammate

59

Hit by puck

38

47

234

272

753.
31%.

All Concussions
Percent of all concussions

-'

86

61
18%

17%.

26% of concussions are from ~d~t\j

,P a1J(~dvertent

collisions

Significant increase in concusslorrs caused by-accidental play and inadvertent

collisions from 2009/10 to 2010/11- from 11to22
MGl increase year to year from 47 to 234 (S .. fold increase)

23

NHL0023063

Accidental Play and

<<;>;i~f''

....

1.:,R c1dvf:'e rter1t. to11i1:sjiCJ.n,s

0

MGL

Concussions
Hit by teammate

5,g

Hit bvpuck

38

47

234

272
17%

753

All Concussions
Percent .of all concussions

61
18%,.;

86

31%

.
d wit
. h II acctid ent~
. -, I")-..
Ji- I ~;w
.:-'), 'teammate,
. f a II , hl rt b y puc k\1
MG.L associate
copuuplt
1:r1\oy
increased .8-fold (from 17 to 136}
\ \ L

'.

M:Gt associated with "inadvertent collisions with an opponent" increased 3-fol'd

(f ram 30 to 98)
24

NHL0023064

Concussions

All Concussions
Fjghting Percentage

61
2%

MGL

86

272

753

8%

0%

16%

reported from fighting are likely understated.

Increase in number of fights and :MGL caused by concussions,

Concussions

"'

from year to year.

F1ghtm~
accounts for 8~\ . t~t\
~,-I~riq1ss1ons and 16% of the
f ~

MGLth1s year

Ivanans has been out since the first game of the year {65
MGL), Boogaard has 35 MG:L
25

NHL0023065

Video

ii

. \!~ \l\lS

NHL0023066

Concussions

All Concussions
Percent of all concussions

61

86

54%

44%

MG L
89

196

114

.242

272
42%

753
32%

Legal hits account for 4~% of concussions this year.

Hits to the body increased stightly year to 'le~ ~itp a)~ig~ificantincrease in :MGL from 89 to

196.

-~G \'\!

27

NHL0023067

28

NHL0023068

Lega'I Hits . . . SeccndarvContact

Concussions

Total Legal hits

Percent with Secondary Contact

33
61%

MGL

38
58%

29

NHL0023069

E.Dvi r.onment
~ .... .

- ...

""

- --

Concussions

.l\c:~ylic: . .

Seamless
(blank)
Grand Total

RELATIVE RISK

...... . . ...........

11
12
_ ...........
_.

-----

MGL .

12
5
-.-. ... --------.-. ...... --->

23

4.4

62
125

43

17

187

84

0.7

8.1

1.7

41

Although there are only 6 venues e:ntirely fittea[ witfii seamless glass, and 5 with seamless
sides,there are almost as many concussions ~gpi1nst seamless glass (17) as there are against
acrylic (23)
.
.
,
-; \
There are more MGL against seamless- 1!66') than atJ_yllc (105)
The risk ofconcussion is 4.4 times higher against seamless glass ln the ends and the risk of
time loss is 8 times higher
The risk ofconcussion against seamless sides is about the same (but risk of time loss is
almost 1. 7 times higher).

l\ / ~ . . .

30

NHL0023070

Video

31

NHL0023071

Concussions

Blindside hit to the head

58

53

Hit to body

26

43

~rand Total

16

15

111

127

61
26%

86
17%

272
41%

753
17%

All Concussions
Percent of all concussions

MGt

There has been little change in the number of illegal' acts causing concussions .
There has been a decrease in the bltndsi,ele tl.its!i'to the head following the
introduction of rule 48.
,, 1.- -..
r '? -..,.

J-

Illegal hits are not the cause of~ th,e\,,..:..___'

inirea~~~
\

l.i; , are seeing .

~

32

NHL0023072

lllegal Actions Ca using Concussions

, .:2.01'.Q~11(tnroug:h~: Mar

33

NHL0023073

'

'Rule .: 48
..

'

....

.....

:, ,.........

,'

Rule 48.:.... "tllegal C.heck to the Head"

(adopted March

2010, modified June 2010)

- A major penalty and a game misconduct shall be

assessed for a 'lateral or blind side hit to an opponent
where the head is targeted and/or the principle point
of contact'
- ~f deemed appropriate, a referee can assess a match
penalty

- Two game misconducts_[~~

~t~in

\1 \i ~

an automatic

suspension
~ --;..
- Can be reviewed for supplemental discipline
34

NHL0023074

Rule 48 Incidents
)NN, .. ,."

'(Mar~~h2010 ~ Marcf1. 1:2011~:<

03-Feb--11

Daniel Paille

- major and
4
'""anre"'irnisp. ~ " 1..

r-

i , ..

. ..

No

N/A (minors)

4 of the 6 Rule 48 incidents o~cu~~d Th tt/e\fir,month of this season, as players

were adjusting to the new rule
1 of the 6 Rule 48 incidents resulted in a concussion and games missed
{Perron - 53 games)
5 of the 6 Rute 48 incidents did not result in a concussion

35

NHL0023075

Supplemental Disclpllne

-lmposed for~Hitstothe .Hea . d

2009-10 (through Mar 1)

--.j_

In 2009/2010 (through Mar 'i), pursuant t Supplemental Discipline, 7

players were suspended for hits to the head.

36

NHL0023076

Supplemental Disclpllne
Imposed forHits to the Head
"no
< : . . 1.;..1 . 11roug . , . ar -1:) .: " .
. 1;0 1

.. (. t. u;.;.. . ~.

M
.

There has been an increase in the number of suspensions (13 tn 2010/11 vs. 7 in 2009/10)
In 2010/2011 (through Mar 1), in 13 suspensions, 6 players have missed games due to injury.

37

NHL0023077

D.ISCUSSION
POINTS

38

NHL0023078

11

Do we have a problem with concussions in our leaque, and

with head hits specifically?

If so, how should we address it?

11

The challenge: How to maintain the physicality in the game

while reducing the incidence of concussions?

39

NHL0023079

Discusslon Points

. A.c .c,i:d.e.nta1 :ana l n.adve'.rteint: Ct)l'l:i

1

. sions

111

26% of concussions this vear are from accidental play/inadvertent

collisions

Accidental play/inadvertent collisions have doubled year to year, and

resulted in a five-fold increase in ;man games lost

8% of concussions this season (7 of 86) have involved an "inadvertent

collision" where the player is totally unaware (no penalty) - four of these
incidents have involved a shoulder hit to the head

11

Last season there were only 2 inadvertent collisions

>-

Are these "inadvertent"?

~ Should we consider penalizing inadvertent collisions?

MGL associated with "accidental.'' conduct (hit by teammate, fall, hit by

pucklincreased 8cfold_(from'i7 tb~'~\Y~~oyear

.
>- Should we be making cna~'eS to the environment and equipment to
address these?

'.' 40

NHL0023080

Discusslon Points
~.iri:ghti:n:g

Fighting accounts for 8% of the concussions and 16% of the MGL this year

The number of concussions and man games lost due to fighting has
increased significantly- MGL increased from 0to120 year to year.

Concussions reported from fighting are likely understated.

Should changes be made to the rules regarding fighting?

41

NHL0023081

Discussion Points
LegalHead ~tlts
'11

Over the past two seasons, there were 24 "legal hits" to the head resulting
.
.
m concussion:

14 shoulder to head

~ 5 arm to head
~ 2 hel met to helmet --~ 3 glove to head

In the last six weeks legal hits to the head increased from 5 to 12, and
account for 23% of new concussions.
~ Should some or all of these legal hits to the head result in a penalty?
~ If so, given the difficulty{,hlft a.n:;,ice qffi{ialshave had in identifying
"principle point of con~9c'K;/(Jr,R.1(1\ h~ what role would supplemental
discipline have to play?

42

NHL0023082

Discussion Points
Hea;a.Hits. -Environment.
Glass:

The risk of concussion is 4.4 times higher against seamless glass in the
ends and the time loss is 8 times higher ..

The risk of concussion against seamless sides is about the same (but time
loss is almost 2 times higher).

The six buildings with seamless glass on the ends wil=I be changed for

2011-12.
>Should seamless glass on sides be changed as well?

43

NHL0023083

:DiSCU:SSio.n Points
.:<.):.fl.ea:d. H1ts . ~. :E nV:i'ron:ITT:ent~-'.
1

D2::; o;.,/.

Boards:

13% of concussions over the past two years (19/147) involve contact with
the boards. 5/19 resulted in a penalty.
~ Should more of these hits result in a penalty?

Of the 102 concussions caused by legal hits and illegal hits this year, 57
(56%) have been along the boards.
~ Should the player doing the hitting along the boards bear more
responsibility?
~ What responsibility should the lJ./ay_er being hit bear for being aware of
his surroundings?

44

NHL0023084

Charging, Boarding
"'

-- --- ---

'

'"'::;,;~~).:::-.:;l,'."\:'}('

Discussion

Video

\! ~\,\1S~
45

NHL0023085