Getting ‘Your Bell Rung’ in Hockey is Not Music to Anyone’s Ears

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Glenview anesthesiologist Rich Berkowitz will never forget the day his son Josh suffered a major head injury playing the sport he loved.

“Josh had a concussion when he was 13 years old,” he said. “He got wacked on the boards in hockey. You get scared. You hold your breath.”

Berkowitz, who specializes in pediatric anesthesia and used to work in pediatric intensive care, said even though Josh did not lose consciousness he could tell his son had suffered a concussion due to some typical symptoms: nausea, headache and memory loss. As a result Josh, who is now 16 and a junior in high school, stayed out of play for a full seven days. 

“No way was he going to play again any sooner,” Berkowitz said. “You wonder if it’s worth it or not. You start asking yourself if this is something you really want him doing. But, you know they love [the sport] and it’s part of the risk of the game.”The right helmet can make a huge difference when a hockey player gets hit in the head. But improved equipment also means players are hitting each other harder than ever.  Above, A Chicago Wolves player takes a shot during practice. Kevin Jacobs &Whitney Harding/MEDILL.The right helmet can make a huge difference when a hockey player gets hit in the head. But improved equipment also means players are hitting each other harder than ever. Above, A Chicago Wolves player takes a shot during practice. Kevin Jacobs &Whitney Harding/MEDILL.

Concussions are becoming an increasingly high-profile sports injury, especially since the NFL announced it would be making stricter guidelines for when a player should be allowed to return to games or practices. 

More worrisome and less publicized are the increasing number of concussions among younger—even little league—players.

And while the NFL may be getting most of the attention, but other sports, like hockey, are just as concussion-prone. 

“In general I think the two sports, hockey and football, are on the same level as far as getting concussions,” said Dr. Jeff Kutcher, director of a sports neurology  team at the University of Michigan in Ann Arbor.

Kutcher, a member of the American Academy of Neurology, said that concussions are even more serious in high school sports and younger, where the players, like Josh Berkowitz, are still growing.

“Whenever you’re talking about a brain that hasn’t fully developed yet or finished wiring up, I would consider them to be more fragile,” he said. “The concept is the brain is still developing until age 18 or 19 or so. You want to be careful not to change [it’s] course.”

A graph of the number of sports related injuries in football and hockey for ages 5-18 from 2001-2005. Statistics from the Centers for Disease Control and PreventionA graph of the number of sports related injuries in football and hockey for ages 5-18 from 2001-2005. Statistics from the Centers for Disease Control and PreventionAnd those 18- to 19-year-old hockey players are experiencing a number of traumatic brain injuries that are on par with football players their age. 

According to an analysis by the Centers for Disease Control and Prevention, the number of injuries in football for ages five to 18 was about 321,000. The number of injuries in hockey, including field hockey, ice hockey, roller hockey and street hockey, was about 45,000. But in hockey, 9 percent of those injuries were brain related compared to about 6 percent in football. So the percentage of traumatic brain injury from 2001 to 2005 in young athletes due to hockey is just as important as football. 

Joey Crabb, a right wing for Chicago’s minor league hockey team, the Wolves, said players themselves can help prevent concussions.The percent of hockey and football injuries that are traumatic brain related for ages 5 to 18 from 2001 to 2005. Statistics from the Centers for Disease Control and PreventionThe percent of hockey and football injuries that are traumatic brain related for ages 5 to 18 from 2001 to 2005. Statistics from the Centers for Disease Control and Prevention

“A lot of it is protecting yourself,” he said. “If there’s a loose puck and a guy is charging right at you, you’re still expected to get it. But at the same time you have to be smart. You’re not worth anything if you’re put on the shelf.”

Crabb has had at least five concussions in his hockey career beginning in youth and when he was learning the game. He said he didn’t learn how to hit players properly and that resulted in a lot of dings to the head. 

“When I was young I used to get them a lot,” he said. “Now I hit with my shoulder, but before I used to hit them head on and drive through their chest. I just remember it sounded like a really loud gong, my vision would go out and I’d start thinking funny.”

While Berkowitz said kids aren’t allowed to start checking in hockey until after a certain age, that doesn’t mean they know how to deliver a check that won’t hurt them or the other player. 

“It is mandatory to learn how to check appropriately and learn how to take a check,” he said. “But that depends on the organization. So not all kids get an equal level of teaching.”

Gerry Anderson, president of the Glenbrook South hockey club, where Berkowitz’s son plays now, said the players need to have a better education on head injuries so they know the seriousness of a concussion. But they are not the only ones. 

“You’ve got to get the decision makers involved,” he said. “I think the coaches need to be informed and parents need to have an education. There’s a history of [concussions] not being played up, especially when you get teenage boys that think they are invincible.”

Kutcher said the lack of education for parents and coaches is only part of the problem with high school hockey. The biggest issue is a lack of professional trainers at events. Especially for club sports such as hockey that are not sponsored by the schools in Illinois.

“Teams shouldn’t be [playing] contact sports without a trainer,” he said. “Dealing with the concussion once it happens can be difficult and dangerous, because every concussion is different and every brain is different.”

Chicago Wolves’ trainer Kevin Kacer agreed that having a certified trainer present at all times is a real advantage, because then the trainer really knows the players.

“I spend more time with them than I do with my own family during season,” he said. “I know how they act, I know how they react to things. So a guy gets hit in the head and I’m talking to him, asking him questions that he and I know the answers to. I evaluate how he’s reacting to everything around him. There’s a lot of things that you can look at and if there’s any question, the guy is sitting.”

Those multiple variables are what makes diagnosing concussions so difficult, and it’s one of the reasons we now are paying more attention to head injuries. 

“The problem was that 15 years ago it was normal and okay to have occasional headaches in a contact sport,” said Tory Lindley, head athletic trainer for Northwestern University. “Any time you have a headache that’s the sign of a mild traumatic brain injury, period, end of discussion.”

But sometimes symptoms aren’t as obvious as a headache. 

“You don’t know what is going on in somebody’s head,” Kacer said. “Sure you can take your MRIs and CAT scans and [see] there’s no active bleed, but you’re not going to know what the heck is going on with regard to their feelings, their level of awareness, everything around them. There’s not a lot that can measure that sort of thing.”

Grant Lewis, a defensive player for the Wolves, has had two concussions in his career. He said the feeling is unforgettable. 

“You know, I always thought throughout my life I had taken some big hits and I always thought I had concussions before,” he said. “But until you have a concussion you can’t tell what the experience feels like. I mean, you’re just out of it, you can’t remember what exactly happened. It’s kind of a scary feeling.” 

Kutcher said each injury really needs to be addressed on a case by case basis. You can’t label concussions and have set protocols on how to address them. 

“It’s a tough injury to protocol and we try to stay away from that term,” he said. “It needs to be an individual approach and individually managed, but the key is having access to people who can manage the injury.”

And yes, getting your “bell rung” or “getting dinged” are serious injuries. 

“Technically any hit that causes a force to be applied to the brain that results in symptoms is a concussion,” Kutcher said. 

A lesson that Anderson said he learned after his son got “dinged” as a freshman hockey player. 

“They said it wasn’t a concussion but I suspect it may have,” he said. “We were told at the time he did not suffer one because he never lost consciousness and no memory loss. I tell ya I look back and I can tell my son’s [hit] had an affect for at least a month or more. There was an impact from the fact he had had an injury and it wasn’t even diagnosed as a concussion.”

 

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