What are repeated concussions doing to Sidney Crosby and the rest of the NHL?

by Day 6 guest host, Rachel Giese

He went down. He stayed down. Just five minutes and 24 seconds into the first period of Game 3 of the NHL Eastern Conference semifinals, Pittsburgh Penguins' Sidney Crosby got a stick to the head from Washington Capitals defenceman Matt Niskanen. Crosby eventually got up but had to be helped off the ice. He didn't return to the game.

The injury is Crosby's fourth diagnosed concussion. In all, over the course of his career, he's been sidelined for more than 100 games due to head injuries. The incident was a sobering reminder of hockey's risks, once again raising questions about the potential longterm consequences of concussions.

A growing body of research ... and unanswered questions

Boston University is engaged in ongoing research into the brains of former pro football players, and has found an association between repeated head injuries and chronic traumatic encephalopathy (CTE), a degenerative brain disease that affects mood, behaviour and cognition.

Meanwhile, researchers researchers at Baycrest Health Sciences' Rotman Research Institute began a study in 2010, focusing on retired professional hockey players' cognitive and behavioural functioning in relation to their age, concussion history, and genetic risk.

A report on their initial findings was published in March. The results offer both good and bad news for players. When it came to objective tests of NHL alumni's cognitive functions, there were only subtle signs of impairment.

However, when it came to subjective reporting of symptoms, players reported higher than average emotional troubles and concerns about behaviour. Fifty-nine percent of former players said they had issues with depression, anxiety, alcohol and substance abuse, compared to only 19% of those in the control group. About 50% of the general population will have a psychiatric disorder in their lifetime.

Speaking to Day 6 guest host Rachel Giese, lead researcher Dr. Brian Levine says that it is unclear whether the reported concerns of players are a result of injury, or related to other factors, such as a struggle to adjust to retirement or chronic pain from injuries not related the brain.

"Ultimately, it's complicated," Levine says. When it comes to concussion and CTE, there's a "tendency to want to over simplify. But there has to be a holistic interpretation" of all the factors that might affect an athlete's health, from physical injuries to social conditions.

Dr. Levine says that regardless of the cause, the symptoms former players describe have excellent treatment options. He encourages current and former athletes struggling with substance abuse, mood disorders and emotional regulation to seek counselling and psychiatric services.

Dementia a growing risk for NHLers

Many of the former players participating in the study say they are fearful about their future and are worried about developing conditions like dementia.

Rod Seiling, who played for the New York Rangers and the Toronto Maple Leafs, is one of the participants in the study. He doesn't experience any symptoms of CTE, but he does know of other players who have developed dementia and other neuropsychological problems.

You got a pat on the back and went back out there.- Rod Seiling

He says he hopes the study will bring public attention to the risks of brain injury and help younger, current players protect themselves.

"I think there is a greater awareness now in the NHL," he says. He goes on to say that athletes now know they shouldn't play after a hit to the head. When he was playing in the 1960s and '70s, if a player was hurt, "you got a pat on the back and went back out there."

Baycrest's study is ongoing and more former players are being recruited to participate. The NHL is currently defending itself in a class action lawsuit in the United States. More than one hundred former players are suing the league because, they say, it didn't do enough to protect them, or make them aware of the danger of concussions. NHL commissioner Gary Bettman has repeatedly denied a link between concussions and CTE.