Concussions aren’t going away. Over the last few years, concussions and head trauma have become as much a part of the sports discussion as what you can find in the box scores. As more is learned about the human brain and what happens when it gets injured, it’s a topic that can’t be discussed enough.

(Photo via stemgenex.com)

It is particularly important when it comes to younger players, players who have not yet earned the big contract, or more importantly, whose brains are still developing.

It is well known that hockey is a high-risk sport when it comes to head trauma. This weekend, there was yet another startling reminder of how serious concussions can be for young players.

Jarrod Maidens, an Ottawa Senators prospect playing for the Owen Sound Attack in the Ontario Hockey League, missed all of last season with post-concussion symptoms. Maidens suffered the injury in the early portion of the 2011-12 season when he caught an accidental knee to the head. He remained in the game after apparently showing no signs of concussion, but the symptoms arose after the game.

The forward was due to make his return this year, but over the weekend he was sent home, still suffering from post-concussion symptoms with no timetable for a return. Hockey doesn’t even matter at that point, you worry about his quality of life. He’s 19.

The NHL, with its heightened exposure and every single game televised draws the most conversation and most attention. The concussion issue is a major one for the league, but it goes far beyond that. It is a major issue in the leagues that feed the NHL, which in some ways makes that also the NHL’s problem.

When it comes to junior and college hockey, the topic of concussions probably doesn’t get enough attention. This despite the fact that its players are more susceptible to concussions than full-grown adults, may take longer to heal and are at greater risk of recurring concussion problems later in life, putting them at an increased risk for long-term brain damage.

Boston University’s Dr. Robert Cantu, one of the foremost experts on chronic traumatic encephalopathy (CTE), explained to the Boston Globe in 2011 explained why younger people are at a higher risk:

According to Dr. Robert Cantu, the co-director of Boston University’s Center for the Study of Traumatic Encephalopathy, younger brains are not as myelinated, meaning they have less insulation than brains of adults. Also, boys’ necks are weaker than those of adults. Their heads are disproportionately large for their bodies.

“That sets up a younger person to have injuries to the brain that are greater than those sustained at a later age from the same force,’’ Cantu said. “It takes more force later on to produce the same injury.

Hockey is a game that already comes with a high risk of concussion. Some are preventable, but many aren’t. Because of the unpredictability of how and when a concussion can happen, it’s more difficult to prevent them. In fact, it’s impossible to prevent all concussions.

That said, due to the age of the players and thinking of their long-term health, there may need to be a bigger emphasis on identifying and treating concussions. It’s easier said than done. Symptoms might not show up right away and some players are getting good at getting around their cognitive tests, if a team even implements any.

Because of the aforementioned relative lack of attention paid to hockey at the junior and collegiate levels, there’s less public and media oversight of what is happening at the lower levels of hockey. There is less known about concussion protocol and even less known about how closely its being followed on a league-by-league, team-by-team basis.

If an NHL team puts a guy back on the ice just a shift or two after he appeared dazed, it’s big news, even if those on the outside can’t know for certain if that player was concussed. If it happens in junior or college hockey, it’s less likely to get much attention.

Junior leagues and college athletics programs are definitely taking the concussion crisis seriously, but it’s hard to know for sure if how they’re dealing with it is effective enough.

Just last season the USHL announced a player safety initiative focusing on supplemental discipline and a bigger commitment to education. The OHL has among the most strict supplemental discipline policies in hockey and has made changes to its equipment requirements to promote safety. The league has also made strides to curtail fighting by implementing suspensions once a player reaches a certain number of fighting majors.

The rules at least would seem to be helpful and as far as the USHL is concerned, the added emphasis on education is a huge step in the right direction. However, rules can only go so far to protect players.

A study conducted by PLOS 1 in Canada showed that the OHL, specifically, which adopted stricter rules when it comes to head contact, saw no decrease in the number of concussions suffered in the league from 2009-10 to 2011-12. Basically, the rules didn’t work. Even as players were getting suspended eight or 10 games for a high hit, the numbers stayed fairly flat.

Concussion rates in the league were similar to those in the NHL, according to the study, despite the fact that the OHL’s officials called more penalties connected to aggressive actions and fighting — both high-risk instances for concussion.

For the record, the study also found that the NHL’s implementation of Rule 48 for checks to the head did nothing to curtail the instances of concussions between 2009-10 and 2011-12 and that most concussions in the league appeared to come from legal plays.

You would expect the stricter rules would lead to increased awareness of preventing concussions and for players to avoid high hits at all cost, but the study concluded it probably hasn’t accomplished that at all.

Without numbers for the USHL and no public reporting of injuries, it is difficult to know if their new safety initiative had any impact one way or another.

When it comes to the NCAA as a whole, the organization has specific concussion guidelines within its Sports Medicine Handbook, but their enforcement is up for debate. They’re not really rules, though the NCAA does require its schools to have a Concussion Management Plan within its bylaws. It reads:

“Institutions shall have a concussion management plan on file such that a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussions. Student-athletes diagnosed with a concussion shall not return to activity for the remainder of that day. Medical clearance shall be determined by the team physician or his or her designee according to the concussion management plan.

“In addition, student-athletes must sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. During the review and signing process, student-athletes should be presented with educational material on concussions.”

The NCAA has taken steps, but the enforcement of such policies is much more difficult to execute. That lack of enforcement may be leading to a potential lack of diligence on this issue, which is part of the problem.

Furthering concern, a truly important piece of journalism by The Chronicle of Higher Education published Monday, showed that athletic trainers are getting push-back from college football coaches on the treatment of concussions and in some cases are losing their jobs for reasons that may be tied to those disagreements. The Chronicle conducted a survey of hundreds of athletic trainers in putting this piece together and some of its findings are disheartening, to say the least.

There is just a ton of quality information in that piece and if this is a topic you care about, you owe it to yourself to read it. It’s going to really piss you off, and if this is something you don’t care about, you should.

Now this piece may have been tied to college football, but it certainly could be applied to all sports and all leagues. According to The Chronicle, more than 30 of the respondents said the head coach or member of the football staff had influence over the hiring and firing of the athletic trainer.

Seeing as most head coaches in junior hockey are also general managers and make the majority of hockey decisions, I believe they would also have that same influence in most cases. I do know that some junior teams have partnerships with local health systems to supply athletic trainers as well, which is probably a better situation as the care is being handled by an independent third party. University athletic departments, however, use their own people.

While we’d like to believe coaches have the best interests of their players first and foremost in their hearts and minds, it’s hard to see it being placed above winning. The fact that those individuals may hold the athletic trainer’s job security in their hands is a little on the scary side. If they don’t like an overly-cautious athletic trainer, they can and probably will get rid of them.

From the Chronicle:

The survey findings disturbed Kevin M. Guskiewicz, a leading concussion researcher from the University of North Carolina at Chapel Hill. “Any institution that places a coach in a supervisory role over the athletic trainer or allows a coach to put pressure on medical decisions is just asking for trouble,” he says.

Concerns like those have led nearly a dozen medical groups to take a closer look at the relationship between medical-staff members and coaches. Many football coaches played with concussions themselves, and have trouble relating to new guidelines that urge medical staffs to run baseline and post-injury tests and to rest players for longer periods after head injuries. The recommendations changed last year as researchers have suggested possible links between repeated head trauma in football and chronic traumatic encephalopathy, a degenerative disease that can lead to permanent brain damage.

Coaches may need more education on those changes, says Stanley A. Herring, a professor of neurosurgery at the University of Washington.

“Part of participating in team sports is to be tough,” says Dr. Herring, a team physician for the NFL’s Seattle Seahawks and a consultant to the Huskies’ football team. “But no one has a tough brain.”

No one has a tough brain. Yet there are people in the sports world that say we’ve become too cautious about concussions or that they’re being over-diagnosed or worse, as one respondent told The Chronicle, “a bunch of hype spurred on by the media.”

We know this culture exists in hockey. Just last year, a study published in The Journal of Neurosurgery and reported on by the New York Times, found that many coaches at all levels of hockey were defying doctors’ orders when it came to concussions.

From the Times:

“Unless something is broken, I want them out playing,” one coach said, according to the study.

In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.

Awful. No one has a tough brain.

Somehow, Sidney Crosby’s long-term absence from the game due to concussion issues hasn’t scared people enough. The best player in the game got knocked out for the better part of a year and the culture still exists.

In today’s sporting world, players need an advocate when it comes to their health. Sometimes the players won’t even want one themselves, but in many cases they have no idea what is best for them. Their careers are on the line, but more importantly, their long-term health is on the line.

That advocate probably needs to be the team’s athletic trainer or team physician, but the coach has to be on board as well. That’s the key in all of this.

The coach is the chief executive of the team and his decisions are often final. By applying pressure on a player or trainer to rush back in a potentially dangerous situation is irresponsible, especially at the junior, college or any amateur level.

The “shake-it-off” culture is fine for bumps and bruises, but it’s not when it comes to brain. No one has a tough brain. That may mean erring on the side of hyper-cautiousness at times when a medical professional sees a high-risk situation or collision. Taking those extra couple of minutes to be absolutely certain is probably not going to make a large difference in the outcome of a game, but it could have a gigantic impact on that player’s future.

Every coach needs to come to terms with the fact that anytime they put a potentially concussed player on the ice, they are putting far more than a game on the line, they have that player’s life on the line potentially.

No one is going to sit here and say this is an easy fix. Concussions are tricky. They are difficult to diagnose, can be all over the map in terms of severity and long-term effects and no two seem to be the same, but as more is learned about them, more needs to be done to protect our young players.

As studies show that stricter rules have little-to-no impact on the level of concussions, we have to find a way to dig deeper.

More research on head trauma is coming out with increased regularity and hopefully those that are running college and junior hockey leagues are paying extremely close attention. This is one of the biggest and most important issues in modern sport. If rules and equipment can’t make a difference, it’s the individuals that have to find a way to.

That could mean more, stricter rules, but more than anything teams and leagues should be examining how they are going about identifying high-risk incidents, while also examining the diagnosis and treatment of concussions and head trauma in a sports setting.

The adults in charge of the leagues making money off of these players need to do right by their young people. How to do that in the most effective manner may take years to discover, but the search has to start now, if it hasn’t already. It could be the difference between a few days on the sidelines and the end of a career. Or worse, a life forever altered.