Concussions and Serious Head Injuries in Sport
Tuesday, November 1st, 2011
By Harvey R. Mayson, exclusively for www.McChad.com.
Introduction
Following the increased media coverage of the career thre
atening injury to Sidney Crosby, The National Hockey League has been forced to address growing concerns regarding the serious nature of concussion injuries. Crosby is by no means an isolated case, but his star profile has increased public awareness of the dangers of serious hea
d injury, not just in hockey, but in all contact sports.
While the NHL wrestles with the issues of protecting players without impacting on the nature of the game, many other sports are still waking up to the reality that concussion injuries need to be taken far more seriously. Soccer may have long-since moved on from the old-style leather football but players are still sustaining concussions at an alarming rate through the use of elbows.
Data from the NFL shows an increase in concussion injuries being reported and there is a growing belief that the culture that would brush off a concussion as little more than “a bad headache” is finally changing. Players and officials are at last prepared to take precautionary measures where a concussion is suspected and laws are being introduced across a wide range of sports to ensure that these injuries are dealt with immediately and efficiently.
The following article is not intended to be exhaustive and highlights just some of the individuals who have lost their careers, their long-term health and, in some tragic cases, their lives as a direct result of a serious sporting head injury.
National Hockey League
Individual cases
Sidney Crosby, aged 24, captain of the Pittsburgh Penguins, was hit in the head by David Steckel’s shoulder in an accidental collision in the Winter Classic against the Washington Capitals. He was dazed but continued for the rest of the game. Four days later he was checked into the boards, finished the game and has been out since with post-concussion syndrome.
Crosby, a Stanley Cup and Olympic gold medal winner, is the most high profile NHL player to suffer such a career threatening injury. Yet to make his return to the ice, Crosby has called for a ban on all headshots. But he is far from being an isolated case. The list of players whose careers are currently on hold due to the effects of concussions includes skilled players Marc Savard, Paul Kariya, David Perron and Peter Mueller. Also, enforcers Raitis Ivanans and Colton Orr are sidelined by concussions suffered in fights.
Derek Boogaard – Minnesota Wild and New York Rangers enforcer. On 9th December, 2010, Boogaard suffered a season ending concussion in a fight with Matt Carkner of the Ottawa Senators. On 13th May, 2011, Boogaard was found dead in his apartment due to the lethal mixing of alcohol and oxycodone. He was just 28 years old.
Pat Lafontaine – The Hall of Famer suffered 6 concussions in his 15-year career. His first came in the 1990 playoffs when he was knocked unconscious by a James Patrick hit. A hit from the Penguins’ Francois Leroux knocked him out and forced him to miss most of the 1996-97 season. His last concussion occurred in 1998 when he collided rather innocently with Mike Keane. The effects of five previous concussions had taken their toll and Lafontaine was forced into retirement.
Eric Lindros – Team Canada. His career didn’t end with a head injury, but the eight concussions he suffered certainly shortened it. He suffered four concussions during the 1999-2000 season alone, the last coming on a devastating hit by Scott Stevens. He missed the entire 2000-01 season as result and was never the same force again. Eric’s younger brother Brett Lindros retired at the age of 20 because of repeated concussions.
Scott Stevens – Hall of Famer retired in 2004 due to post-concussion syndrome. During the 2003 playoffs, Pavel Kubina of the Lightning fired a puck into the Devils zone, striking Stevens on the side of the head.
Mike Richter – Team USA goalkeeper New York Rangers. Traditionally, goalies have been spared when it comes to severe concussions. Richter, however, is an unfortunate exception. He retired in September 2003 after sustaining two concussions within eight months.
Keith Primeau – The former captain of the Philadelphia Flyers suffered four concussions in his career and fully admits he rushed back from the first three out of a sense of obligation to his team-mates. The final concussion came as a result of a shot to the head by Montreal’s Alexander Perezhogin early in the 2005-06 season.
Geoff Courtnall – He played 17 NHL seasons and avoided concussion problems until late in his career. In the 1998-99 season he suffered a severe concussion, but returned for the playoffs. Early the next season a shot to the head from the Leafs’ Bryan Berard eventually forced him into retirement. Berard received a two-game suspension for the head shot.
Adam Deadmarsh – Quibec Nordiques. Two serious concussions were enough to force Deadmarsh into retirement. He played his last game at the age of 27. His first concussion occurred as a result of a fight with Ed Jovanovski; the second came after he was accidentally kneed in the head by a team-mate.
Jeff Beukeboom – NHL defenceman had six concussions during his 13-year career. The most notable came after he was sucker punched from behind by Matt Johnson in one of the worst examples of on-ice violence in the modern era. Johnson was suspended for 12 games. Beukeboom returned after a few games off but another concussion, which he suffered on a minor collision in February 1999, ended his career. Beukeboom was left with recurrent headaches, memory loss, nausea, and mental fogginess that lasted for months. He was diagnosed with post-concussion syndrome, and ordered to never play hockey again.
Petr Svoboda – The well-travelled veteran of 17 NHL seasons is one of the few European-trained NHLers to retire due to post-concussion syndrome. In 2000 he was knocked unconscious by a Shane Doan hit and never played again.
Steve Rucchin – Centre who played for 3 NHL teams, most notably the Mighty Ducks of Anaheim. A concussion suffered on a hit by Ben Guite of the Colorado Avalanche in 2007 ended his career.
Summary
Records for the 2010-11 NHL season show that some 85 players have missed time due to post-concussion syndrome.
The new rules for the 2011-12 season mean that players will now face a minor penalty for any hit that involves primary contact to the head and shots that target an opponent’s head and make it the principal point of contact. The original wording to Rule 48 applied only to hits that came from the lateral or blindside. Those words have been eliminated. This ban applies to hits anywhere on the ice and from any direction.
Statistics show that 14 percent of N.H.L. concussions are caused by “legal head shots”; i.e., north-south hits to the head that did not specifically target the head. Those hits remain legal under NHL rules and yet are outlawed by the N.C.A.A., I.I.H.F. and O.H.L., which supply 75 percent of all N.H.L. players. Whether a minor penalty or major penalty or no penalty is assessed for these infractions, players could still be subject to suspensions.
The new concussion-evaluation protocol, approved jointly by the N.H.L. and the N.H.L Players Association announced in March this year mandates that players showing concussion symptoms be taken off the bench and evaluated by a team physician.
Soccer
Individual cases
Jeff Astle, died 2002 aged 59, West Brom an England international footballer who scored 168 goals, court ruled his premature death was caused by industrial injury. The risks were greater in the 1960s, when footballs were made of leather and became 20 per cent heavier when wet. Some of the great names from that era – Joe Mercer, Bob Paisley, Alf Ramsey, Danny Blanchflower, Stan Cullis and Stan Mortensen – suffered dementia later in life.
Billy McPhail, Celtic player, In 1998 McPhail lost his legal battle to claim benefits for dementia that he said was caused by heading old-style leather balls. Evidence from the department of mechanical engineering at Glasgow University showed the peak force a player’s head would need to absorb from an old-style football travelling at speed, was half a ton.
Stan Cullis, the Wolves and England centre-half, was knocked unconscious during a game against Everton in the 1938-39 season. He suffered severe concussion that required intensive medical care. His doctors warned him that another serious concussion could kill him. A couple of years later a tremendous shot hit him in the face. Once again he suffered from severe concussion and was on the danger list for five days. A doctor warned him that because of his previous head injuries, even heading a heavy leather football could prove fatal and despite now being England’s captain, Cullis decided to retire from playing football. In his later years, Cullis, like many footballers from this period, suffered from dementia.
Daniel Agger, currently of Liverpool, was at the centre of controversy in August 2010 when he was allowed to return to the pitch during a game against Arsenal despite clearly suffering from concussion. Subsequently, this then-manager Roy Hodgson commented, “Daniel is not doing that well. It is three days after the incident and he is still suffering from the concussion. He has no memory of the game. It was quite a serious concussion he received and we can only hope it will settle down in time for Monday’s match against Manchester City.” Liverpool and their medical staff were rightly criticised for not looking after the players best interests but it is sadly typical of the attitude still existing in British football. Agger was later declared fit to return and resume his career.
Petr Cech, Chelsea and Czech Republic goalkeeper. On 14th October 2006, Cech was caught by the knee of Reading midfielder Stephen Hunt just twenty seconds into the game. Cech was left dazed and eventually substituted. His replacement, Carlo Cudicini, was himself knocked unconscious later in the same match.
Cech underwent surgery for a depressed skull fracture which doctors later revealed could have cost Cech his life. He continued to suffer acute headaches and was warned by his doctor that returning too early could be fatal. He eventually made his comeback against Liverpool on 20th January 2007, wearing a rugby style headguard, which he has worn in every game since. The headguard includes extra plastic polymer foam protection to cover the areas of his skull weakened by the collision.
A number of commentators, including current and former goalkeepers, saw the incident as highlighting the need for greater protection for keepers.
Taylor Twellman, former Major League Soccer star who played for the New England Revolution in MLS and was the league MVP in 2005, was forced to retire in 2010 due to a slew of head injuries he suffered during his career. The latest and most severe came in 2008 against the Los Angeles Galaxy. Taylor now works with ThinkTaylor.org – Research surrounding concussions and concussion prevention and education.
Summary
According to a survey by the National Electronic Injury Surveillance System (NEISS), heading the ball actually caused only 6.6 percent of injuries. Concussions were far more likely to result from player-to-player contact which were recorded at 70%, while ball contact concussions were only at 7%. In fact, player-to-player contact was the leading cause of soccer injury at 40% of all soccer-related injuries.
Several soccer players have also developed cases over long careers, apparently because of high-speed soccer ball impacts to the head. This has prompted a small movement in the sport to promote head safety gear for soccer players, especially in children’s leagues.
The old-style leather footballs were much heavier than today’s hi-tech version, and therefore more likely to inflict damage. There is a growing body of evidence documenting subtle brain injury among people who have played football for many years. Cases have been reported of accelerated tissue death, and of changes to the electrical activity in the brain with some players experiencing problems with loss of memory, concentration and alertness. Tests carried out in the US found that amateur footballer players performed significantly worse in test of memory and planning than other sports people.
The International Football Association Board (IFAB) has urged referees to be more aware of, and to deal properly with, the use of the elbow during challenges. This has been in response to elbows being used to gain an unfair advantage and, often, to injure opponents.
National Football League
Individual cases
Steve Young of the San Francisco 49ers. During a game against the Arizona Cardinals at the start of the 1999 season, Young was violently sacked by Cardinals’ cornerback Aeneas Williams due to a missed blocking assignment by 49ers’ running back Lawrence Phillips. Young was knocked out of the game and did not for the rest of the season, suffering from symptoms of post-concussion syndrome. Young was forced to retire at the end of the year; the team informed him that he would be released if he did not retire.
Troy Aikman, Dallas Cowboys quarterback. Aikman suffered ten concussions over the years. The last of these, at the hands of Washington Redskins linebacker LaVar Arrington, ended his run as an NFL quarterback. The 2000 season was Aikman’s final season as a professional football player. He announced his retirement at the age of 34.
Owen Thomas, Amateur football player, University of Pennsylvania lineman committed suicide at the age of 21. An autopsy revealed mild stages of a type of brain damage typically seen in retired or ageing athletes and had chronic traumatic encephalopathy, making him the first active college football player known to have had the debilitating condition.
CTE is also called dementia pugilistica, because career boxers who’ve suffered repeated blows to the head and concussions have been known to develop the syndrome. Its effects are mainly neurobehavioral, including poor decision-making, impaired memory, erratic behaviour, use of drugs and alcohol, depression and suicide.
Wally Hilgenberg, Minnesota Vikings, donated his brains after his death in 2008 at the age of 66 due to amyotrophic lateral sclerosis or Lou Gehrig’s disease.
Ted Johnson, New England Patriots, suffered more than 100 concussions. A linebacker who helped lead the New England Patriots to three Super Bowl victories, suffered two concussions in four days in August 2002. When he returned to play, he received several more concussions before his playing career ended in 2005. His neurologist told The New York Times in 2007 that the 34-year-old was already “showing the minor cognitive impairment that is characteristic of early Alzheimer’s disease.”
Dave Duerson, a member of the legendary Chicago Bears that won the Superbowl in 1985 and also the Giants team that took the championship five years later. He enjoyed an 11-year-career with NFL and many years subsequently helping younger and less fortunate players find their way. As he grew older he complained of lapses in memory, mood swings, piercing headaches on the left side of his head, difficulty spelling simple words and blurred vision. On 17 February 2011, aged 50, Duerson took his own life inside his Florida apartment and left his brain to science.
Tom McHale, NFL Tampa Bay Buccaneer player, who died in 2008 at the age of 45. McHale, who retired from the game in 1995, focused his final three years of life on trying to overcome increasing anxiety and depression and an addiction to pain killers. He died of an accidental overdose of prescription medications and cocaine. Tests revealed that McHale suffered brain abnormalities that are typical of concussions received by footballers during their playing days (CTE).
Summary
In the United States, over 300,000 sports-related concussions occur annually, and the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19% per year of play. More than 62,000 concussions are sustained each year in high-school contact sports, and among college football players, 34% have had one concussion and 20%, multiple concussions. Concussions often cause significant and sustained neuropsychological impairments in information-processing speed, problem solving, planning, and memory, and these impairments are worse with multiple concussions.
Suffering a second concussion while still having symptoms from a previous concussion can be lethal. In 1973, R. C. Schneider was the first to describe the deaths of two athletes who died after suffering a relatively minor head injury during recovery from a previous concussion. In 1984, R. L. Saunders reported the same scenario in a 19-year-old college football player and coined the term “second-impact syndrome” (SIS). Since then, at least 26 deaths have been attributed to SIS, 20 of them occurring in the past 10 years.
A study commissioned by the NFL in 2009 reported that former NFL players have been diagnosed with Alzheimer’s disease or other memory problems 19 times more than the normal rate for men between 30 and 49.
Many more concussions are now being reported in the NFL this season, which the league considers evidence that players and teams are taking head injuries more seriously. According to NFL data, 154 concussions that happened in practices or games were reported from the start of the pre-season through the eighth week of the 2010 regular season. That is an increase of 21 percent over the 127 concussions during the same span in 2009, and a 34 percent jump from the 115 reported through the eighth week of the 2008 season.
Dr. Hunt Batjer, co-chairman of the NFL’s head, neck and spine medical committee, called the numbers “a great sign” because they showed that “the culture is changed.”
“We’re trying to make sure that players have the message: Playing through pain is good; playing through pain is what sports are about. But that’s leg pain. That’s arm pain. Not brain injury. Because a brain injury and spine injury can threaten their future.”
Boxing
Individual cases
Muhammad Ali (born Jan. 17, 1942, Louisville, Ken., U.S.) U.S. boxer. Cassius Clay took up boxing at the age of 12 and rose through the amateur ranks to win the Olympic light heavyweight crown in 1960. His first professional heavyweight title win was against Sonny Liston in 1964. After defending the title nine times between 1965 and 1967. As Muhammad Ali he regained his title in 1974 by defeating the former champion Joe Frazier and the then-current champion George Foreman. He lost to Leon Spinks in 1978 but later that year regained the title a third time, becoming the first heavyweight champion ever to do so. He retired in 1979, having lost only three of his 59 fights.
Throughout his career Ali was known for his aggressive charm, invincible attitude, and colourful boasts. Ali’s later years have been marked by physical decline. Damage to his brain, caused by blows to the head, has resulted in slurred speech, slowed movement, and other symptoms of Parkinson disease. However, Ali’s own physician Ferdie Pacheco MD states in his book ‘Fight Doctor’ that Ali’s condition is often misquoted and that Ali actually has Parkinson’s Syndrome.
* Other ex-boxers who appear to have suffered from dementia pugilistica include;
Jimmy Ellis, Floyd Patterson (who resigned from the New York State Athletic Commission because of his deteriorating memory), Bobby Chacon, Jerry Quarry, Mike Quarry, Wilfred Benitez, Emile Griffith, Willie Pep, Freddie Roach, Sugar Ray Robinson, Billy Conn, Joe Frazier, Fritzie Zivic and Meldrick Taylor.
Michael Watson, MBE (born 15 March 1965 in Hackney, London) is a retired British boxer whose career ended prematurely as a result of near-fatal injury sustained in a WBO super-middleweight title fight defeat by Chris Eubank in September 1991. On 19 April 2003, Michael Watson’s recovery has been slow but he made headlines when he completing the London Marathon, walking two hours each morning and afternoon for six days to raise money for the Brain and Spine Foundation.
Summary
Protective headgear is mandatory in all U.S. and major international amateur boxing competitions, including the Olympic Games. It effectively protects against cuts, scrapes, and swelling, but does not protect very well against concussions. It will not protect the brain from the jarring that occurs when the head is struck.
Headgear is still not permitted in professional bouts, and boxers are generally allowed to take much more punishment before a fight is halted. There is still an argument that headgear does little or nothing to prevent brain injury by presenting a larger target and restricting the fighter’s vision.
Racing
Individual cases
Liam Cooper – Having ridden 182 winners over jumps (many for Jonjo O’Neill) most notably being associated with the top-class hurdler Intersky Falcon – Liam had his race riding career cut short in 2004 by serious injuries and recurrent concussion. He turned to JETS for guidance on how to become a farrier, his second choice of career – the training for which is extremely rigorous and takes a minimum of four years to qualify.
Bruce Dowling – 46, Cheltenham, Glos. Race Riding Career: NH jockey (1984 – 1992) over 100 winners from 550 rides. Reason for Retirement: Career ending head injury. Career Development: Now a Sports Therapist. JETS support provided/Training undertaken: Fitness Training Diploma and Therapy/Sports Massage.
Mark Nicholls – 29, Banbury, Oxon. Race Riding Career: NH jockey (1998 – 2008), 34 winners from 845 rides. Reason for Retirement: Career ending head injury. Career Development: Now a helicopter pilot working towards his commercial licence. JETS support provided/Training undertaken: Career Coaching and pilot training courses.
Declan Murphy – approached the end of the 1993-94 season with 60 winners, his best-ever total, to his credit. Following a heavy fall at the last flight of hurdles aboard Arcot at Haydock in the Swinton Handicap Hurdle, Murphy was left close to death. Even after leaving hospital, it was several weeks before he could walk unaided and a return to the saddle seemed unrealistic. However, he achieved this and rode a winner before retiring permanently shortly afterwards. Murphy went on to pursue a career in broadcasting with the Racing Channel.
Kim Stover – Rode over 1000 winners, mostly quarter horses in south west America. Severe head injury when her horse stumbled leaving the starting stalls at Louisiana’s Evangeline Downs.
Summary
A jockey who has suffered concussion will be automatically stood down for six or seven days. This is because the ensuing week is a very important period in the recovery from concussion. It is recommended that he/she do very little during this vital period so that they rest their brain completely. They are then reassessed using a neuropsychological test.
Wrestling
Individual cases
Chris Benoit (May 21, 1967 – June 24, 2007) a Canadian professional wrestler whose career and life ended in a tragic murder-suicide. During his professional wrestling career, Benoit worked for such major promotions as Extreme Championship Wrestling (ECW), World Championship Wrestling (WCW) and the World Wrestling Federation/World Wrestling Entertainment (WWF/WWE).
Benoit was one of only three men to have held the Big Gold Belt in both WCW and WWE and a record-equalling five-time WCW/WWE United States Champion.
Described by WWE as “a favourite among WWE fans for his unbelievable athleticism and wrestling ability”, Benoit was widely regarded as one of the most popular, respected, and gifted technical wrestlers in history.
Benoit murdered his wife and son on June 22, 2007 and subsequently hanged himself on June 24, 2007. Since Benoit’s suicide, numerous explanations for his actions have been proposed, including concussions, steroid abuse and a failing marriage.
Former wrestler Christopher Nowinski contacted Michael Benoit, father of Chris Benoit, suggesting that years of trauma to his son’s brain may have led to his actions. Tests were by Julian Bailes, the head of neurosurgery at West Virginia University and results showed that “Benoit’s brain was so severely damaged it resembled the brain of an 85-year-old Alzheimer’s patient.” He was reported to have had an advanced form of dementia, similar to the brains of four retired NFL players who had suffered multiple concussions, sank into depression, and harmed themselves or others.
Andrew Martin (March 17, 1975 – March 12, 2009) Canadian professional wrestler. Wrestled for the World Wrestling Federation from 1998–2004, and 2006–2007. While under contract with WWF/WWE, Martin enjoyed success as a singles competitor, becoming an Intercontinental Champion, European Champion and Hardcore Champion. Martin was also successful in the Tag team division, becoming a WWF and WCW Tag Team Champion with Booker T.
Martin was found dead in his Tampa, Florida home on March 13, 2009. His death was ruled an accidental overdose of oxycodone. It was later determined by forensic pathologist Dr. Bennet Omalu that Martin had severe chronic traumatic encephalopathy, an Alzheimer’s like form of brain damage caused by repeated concussions and subconcussive head injuries.
Chris Nowinski - After playing football at Harvard, he became a professional wrestler with World Wrestling Entertainment. His over-the-top personality and penchant for referencing his Ivy pedigree made him a superstar in the ring. In 2002, he was named the “Newcomer of the Year” by RAW Magazine and became the youngest male Hardcore Champion in WWE history. But Nowinski’s wrestling career was cut short in 2003 after he suffered at least six concussions. Nowinski is the founder of the Sports Legacy Institute, a non-profit organization which raises awareness of concussions in contact sports.
Summary
A rule requiring immediate removal of any contestant who shows signs, symptoms or behaviours consistent with a concussion and prohibiting his or her return to competition until cleared by an appropriate health-care professional was approved by the National Federation of State High School Associations (NFHS) Wrestling Rules Committee last year. The previous rule directed officials to remove an athlete from competition if “apparently unconscious.” The previous rule also allowed for return to competition based on written authorization by a medical doctor.
Dr. Michael Koester, chair of the Sports Medicine Advisory Committee, said “Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain and even death. The safety of the athlete is of paramount concern during any athletic contest. Referees, coaches and administrators are being asked to make all efforts at ensuring that concussed athletes do not continue to participate. Thus, coaches, wrestlers and administrators should also be looking for signs of concussion in all wrestlers and should immediately remove any suspected concussed wrestler from competition.”
Professional wrestling has been accused of being out of step with changes in other sports and some of the most basic moves in wrestling can readily cause concussions.
Speedskating
Kristina Groves, aged 34, Ottawa, Canada, a four-time Olympic medallist and world championship winner as a long-track speed skater. A serious concussion injury sidelined her for one year and eventually forced her retirement.
The injury happened in just the second World Cup of the season in Berlin when Groves hit a bad patch of ice during a team pursuit race and went down on her behind, slamming back-first into the safety mats. “I just didn’t have time to recover and I was down before I knew it,” said Groves.
She said she didn’t hit her head very hard but suffered a bad case of whiplash, which she believes contributed to the concussion. She’s even had trouble determining which symptoms were from the concussion and which were caused by whiplash.
Like so many athletes, Kristina Groves didn’t realize right away that she had suffered a concussion.
Initially she thought that she’d be fine after a couple days rest. When she still wasn’t feeling right four days later, she knew it was more serious.
“I felt exhausted, like I didn’t want to move,” she recalled. “I never really had splitting headaches, it was more a feeling of just this fogginess and wooziness.” She was also sensitive to light and loud noises.
As soon as she relayed her symptoms to the team doctor, he knew right away what the problem was.
Summary
The risk of head injury is inherent in all contact sports but there are some basic steps that can be put in place to reduce that risk. There have been advances in the quality of protective headgear and greater awareness of the need to wear it. By wearing footwear designed for the activity you’re engaging in, you mitigate the chances of having an accidental fall that may cause a head injury.
Other preventative steps include always wearing a batting helmet when playing baseball; never engage in football without a helmet; and don’t step foot on the ice without a hockey helmet on.
Learn some basic first aid to treat concussions. Keep the victim awake and talking, and prevent them from moving to the greatest possible degree until an ambulance arrives. Call for help at once if a player suffers a head injury, especially one that causes them to lose consciousness, even if only for a brief period.
Sources; Wikipedia.com, thecheapseats.ca, soccer-training-guide.com, cbc.ca, ehow.com, neurosurgery.pitt.edu, momsteam.com, jets-uk.org, nfl.com, npr.org
About the Author
Harvey Mayson is a freelance sports writer based in the United Kingdom. Harvey was commissioned to research and write this article exclusively for this website and can be contacted by email to HRMayson@aol.com.
