A concussion is an injury to the brain, caused by trauma that affects the head and interferes with brain function. However, using the word concussion doesn’t sound as serious as brain injury.
We’re only born with one of these treasured body parts so we should protect, nurture, and, most of all, use it to ensure we enjoy a healthy mind long into our golden years.
A player doesn’t have to be knocked out to suffer a concussion. An MRI or CT scan rarely detects brain injury, making diagnosis more problematic.
Fortunately for the majority of hockey players, a history of multiple concussions is rare.
Every concussion and every player is different, so two concussions can leave a player with as much damage as one who has suffered several.
It’s important to treat every concussion carefully, especially the first one, and Powell River Kings are very aware of that fact.
“My first one was an elbow to my jaw,” said Kings’ assistant captain Steven Schmidt. “It rattled me a lot. I had a headache and felt nauseous so I knew right away that I had a concussion. We took the necessary steps and I stayed out for a week or more.”
His second concussion came just two weeks later. “It didn’t seem like the symptoms were as bad as the first one. Being precautionary I stayed out longer after that one to make sure I was 100 per cent.”
Schmidt added, “You don’t want to fool around with concussions. You don’t want to come back too early because it could probably end your career.”
How did a 20-year-old become so wise? Through education and trust. Kings’ physician Dr. Steyn Naude sees communication as an important improvement in the treatment of concussions.
He tells players to talk to the trainer, tell them something is not right and get assessed. “If the trainer feels that I need to see the player, then I usually get called down [to the dressing room].”
Management goes to the degree of the concussion, Naude explained, “grade one being the less serious and grade two or three being not returning to the game and being reassessed.”
Diagnosis of a concussion, he said, eventually leads to, “a seven-step return-to-play program once you are asymptomatic.”
It sounds pretty cut and dried but Naude has found that pressure and protocol sometimes interfere with treatment and recovery.
“It’s difficult at times,” he said, “because you are not staff and just there to give your opinion. What they do with that opinion is out of your hands.”
The relationship between the coach and the team doctor is critical, he explained, adding with deep concern, “It’s important that there is mutual respect and understanding. If it isn’t there, it makes it tough.”
Pressure at all levels of hockey can come from a number of sources and Naude recalled an incident that still haunts him.
During a game in Powell River in which his son Jaunre was playing, he was called to assess an injured Atom division player from Vancouver Island.
“The player was concussed,” he said. “We initially thought possibly neck and back injury, so the ambulance was called, got him off the ice and he was sent to the hospital.”
The X-rays were inconclusive so the player was sent to Vancouver for a CT scan because there wasn’t access to that procedure in Powell River over weekends.
Naude’s diagnosis was a third-degree concussion and his advice to the coach was to keep the player out for four weeks.
Comfortable with his judgement and the report he filed with minor hockey, he was taken aback when he received a message from the association that the parents insisted their son play the following weekend.
“He had been cleared by [BC] Children’s Hospital,” said Naude. “His spine was fine with no neck injury. I never got feedback from concussion symptoms but the hospital’s focus was with the neck injury.”
The coach was concerned because the minor hockey report the doctor had submitted stated the player should be off for four weeks and the parents insisted he return for a tournament.
“I gave him my two cents explaining my decision,” said Naude. “He was president and safety person of their association and agreed. The parents took the player to their doctor who cleared him, saying he can play.”
If it was his own son playing, Naude said the boy would have been out a month. He wonders if the family doctor received all the history or if the parents were selective to get the outcome that they wanted.
“I don’t know, I wasn’t there so I can’t comment,” he stressed. “That’s why I think education isn’t just for players and coaches but for family and parents.”
Questions about protocol, assessment, or life and death decisions about a player’s treatment and return to play remain cloudy when severity of the injury demands clarity.
This is the second of a five-part series on concussions in hockey.
