In recent years there have been far too many players suffering from head injuries in minor hockey. We all know that this is a rough and physical sport where players are going to get their ‘bells rung’ occasionally, but it is imperative that we try to enforce the fact that players must start to respect each other and if they are not going to show this respect, then they will be punished by the referees and the league.

THE CONCUSSION – A VERY SERIOUS INJURY

Head injuries usually consist of a concussion to some degree. While we will not pretend to be medical experts, we would like to give you some facts about concussions that may help you better understand why it is important to reduce the incidence of head injuries in hockey.  

A concussion is best described as a change in mental status which is the result of some movement of the brain as a result of a blow or jolt to the head.  This movement causes changes in the brain cells and generally results in the individual experiencing feelings of disorientation, difficulty with vision and possibly impaired coordination. It is important to note that a person does not have to lose consciousness in order to suffer a concussion. 

When determining the severity of a concussion, it is customary to categorize the injury by the length of time the symptoms last. 

The first category, which is referred to as a simple, first degree or Grade One concussion, depending on which guideline you use, results from a blow to the head or a whiplash. In this case, there is no loss of consciousness and symptoms usually last no longer than 15 minutes, but in any event, there is usually complete recovery within 24 hours. The person may be a bit dazed or confused immediately after the incident, but improvement is quite rapid and there is usually no lasting effect.

The second category of concussion, referred to as a complex, second degree or Grade Two or Three concussion, usually follows a brief loss of consciousness. Symptoms in this case usually last longer than fifteen minutes, or will return with physical exercise and exertion. Often, in the case of a complex concussion, the person has no recollection of the incident causing the injury. The first time a person experiences a complex concussion, the symptoms will generally disappear within a week. A person who experiences a complex concussion should see a doctor as soon as possible. 

A hockey coach should never allow a player who has experienced a complex concussion to return to practice or games without the approval of his doctor. 

The coach should not even allow a player to return to the ice for at least 24 hours if it is suspected that he has suffered even a simple concussion. 

Therefore, after any blow to the head, it is imperative that the trainer do an immediate examination to determine if there is any symptom present which would suggest a concussion. If there is the slightest sign of a concussion, the trainer must refuse to allow the player back on to the ice.

Even though a person who has suffered a mild concussion may appear fine within a few minutes after the blow, studies have shown that it still takes about 24 hours to fully regain his normal mental functioning abilities. It takes at least a full week to recover from a complex concussion.

If a player returns to the ice too soon, he is risking what is referred to as "Second Impact Syndrome". If he suffers a second concussion during this critical recovery period, his symptoms may last for months. It is even possible that death will occur.

Studies have also shown that in some cases, even with simple concussions, symptoms may last well beyond seven days due to the fact that the biochemical changes that occurred in the brain cells during the initial blow do not get corrected. This is referred to as "Post Concussion Syndrome" and, while rare, it is possible in contact sports such as hockey.

The symptoms of post concussion syndrome generally result in physical complaints such as headache, dizziness/balance, fatigue, problems with vision, sensitivity to noise or light, or problems with sleep. PCS can also result in behavioural changes such as moodiness (depression), irritability (anger), or an inability to sit still. Finally, PCS is know to trigger mental problems which lead to difficulty thinking or solving simple problems.

While a person with Post Concussion Syndrome may exhibit any number of the above symptoms, it is more likely that they will appear when the player attempts to return to action on the ice or take part in some strenuous activity.

To emphasize the importance of giving a person proper treatment if a suspected concussion has occured, consider some of the following facts:

After a player receives a check to the head area, coaches and trainers should be on the lookout for signs and symptoms of concussion. These may include: severe headache, dizziness, vomiting, increased size of one pupil or sudden weakness in an arm or leg.  People who have received even a mild concussion may seem agitated or irritable and are often very restless.  These people may also experience some memory loss or seem forgetful. 

TREATMENT:

The best way to treat a person who you think has suffered a concussion is to observe his states of consciousness.  If he seems to be ‘out of it’ every once and a while, then have him see a doctor for closer observation. Surgery is usually not necessary for concussions unless there is massive damage or swelling to the brain. Injuries of this extent are usually associated with car accidents and are not very common in hockey-inflicted concussions.

Recovery from a concussion is a slow process during which time a person may suffer from post-concussion syndromes such as, dizziness, irritability, uncontrollable emotions, and depression, just to name a few.  The best treatment for a concussion is to rest the patient and to have him avoid any activities that may cause further injury or jarring to the brain, such as playing in another hockey game.  

The rule of thumb is that a player should be symptom free for at least seven days before returning from a complex concussion.

INFORM THE PARENT AT ONCE:

Coaches and trainers must always inform the parents when a player has been hit in the head and seems to be exhibiting signs of a possible concussion. In many situations, the parent may not have even seen the infraction.

The first indication of a possible concussion may simply be a comment made by a player while on the bench. Above all, if a player complains about a headache or says he is a bit dizzy, do not send him back out on the ice. This is the same as sending a boxer back into the ring when he is slightly dazed. If the hockey player is a bit unfocussed, he is vulnerable to a further hit that may push him over the limit, and instead of a mild concussion, he may end up with a severe one.