Breaking down 'hockey culture' barrier

In Jim Johnson's heyday, NHL players considered broken fingers or bloodied noses mere nuisances. They weren't going to let those obvious injuries keep them out of a game, so why would a hard blow to the head be any different?

His peers rarely talked about concussions, Johnson said, during his 13 seasons as an NHL defenseman. The former North Stars player figures that's because they knew almost nothing about an injury they couldn't see. Players had no idea that coming back too soon could delay their recovery, or that getting a second concussion before the first one healed could cause serious brain damage.

Johnson learned all those things when three concussions in a short period of time ended his NHL career. Months of severe headaches, blurry vision, mood swings and slowed reflexes gave him a hard-won education about head injuries. As the hockey community considers how it can reduce concussions and improve recognition and treatment, Johnson is among those who view knowledge as the key to change.

Several initiatives are already in place. Organizations such as USA Hockey are heightening discussion of head injuries, as well as offering more educational materials for coaches, players and parents. Minnesota Hockey, which oversees youth and amateur hockey in the state, awards "fair play" points to youth teams that keep penalty minutes to a minimum. Some high school and college teams are using neurological tests to aid diagnosis and guide recovery.

Other ideas are more controversial, including USA Hockey proposals to delay the age at which body checking is allowed and to make all hits to the head illegal. While there can be debate over how to make the game safer, Johnson said, no one should remain ignorant of the threat concussions pose.

"I didn't know the symptoms I was feeling needed to be given time to repair before I returned," said Johnson, a New Hope native who played at Minnesota Duluth and spent three seasons with the North Stars. "I just kept playing, because that was the mentality of the game.

"I believe there should be a comprehensive, compulsory education program every season for players and coaches. All players want to play -- but if they understood the effects that can damage your life and your career, I think they'd take a second look. The more education we get, it has the potential of changing the culture of the way the game is played."

"The more we can educate people about the scientific information and the rationale behind the proposals that are out there, the more accepting the hockey culture will be," he said. "And this is a very important time for change. The clock is ticking."

Safe checking is key The players on Wayzata's Bantam A team know the drill. If one of them takes a solid hit to the head, coach Marc Sorensen will step down from the bench, look him directly in the eye and ask him a series of questions. Sorensen will ask the same questions 10 minutes later, then 20 minutes later, knowing that concussion symptoms don't always show up immediately.

Sorensen is well-versed in the symptoms of concussion and how to handle a player who might have one. As coach-in-chief of Minnesota Hockey's District 3, he wants other coaches to know those things, too. When he runs certification clinics for coaches, Sorensen brings in speakers to talk about concussions and other injuries.

Minnesota Hockey, USA Hockey and the Minnesota State High School League urge members to learn more about concussions, and all promote the educational materials available on their websites. But they do not mandate concussion training, meaning coaches, parents and players must take the initiative. The MSHSL plans to require that coaches take a 20-minute online course about concussions -- something it currently recommends -- beginning this fall.

"With parents and coaches, there's a very wide range of knowledge," Sorensen said. "Some don't have any idea what to look for, which is why it's so important that Minnesota Hockey and USA Hockey are trying to get people trained."

The idea has set off a firestorm in youth hockey. Parents are threatening to pull their children from Minnesota Hockey-sanctioned teams if it passes, and Internet message boards are overflowing with concern about the "wussification" of the sport.

Stuart, who helped write the proposal, emphasized it does not prohibit body contact. In fact, it would introduce body contact at younger levels, along with two years of required instruction on how to properly give and receive a body check. Children would then be better prepared to check safely when they begin doing it in games, and they will have another year focused on skill development before hitting enters the picture.

The proposal was inspired in part by a Canadian study that compared injury rates in peewee hockey in two provinces: Alberta, which allows checking, and Quebec, which does not permit it until the bantam level. Players in Alberta had four times as many concussions as their Quebec peers and three times as many serious injuries. The study, released last year, also estimates 1,000 fewer injuries and 400 fewer concussions among Alberta's players if checking was delayed until bantams.

Rule change is a 'no-brainer' Hal Tearse, coach-in-chief of Minnesota Hockey, agrees with Stuart that the proposal is likely to pass, despite the fact that certain regions of the state are dead set against it.

"This should really be a no-brainer," Tearse said. "But it's a very emotional issue. These kids are not ready for heavy body contact; they're not physically prepared to withstand it. They need to be able to concentrate on their skills without being concerned about getting destroyed by one or two other kids."

Tearse knows that controversial concepts can gain acceptance. In 2004, Minnesota Hockey met with plenty of derision when it introduced "fair play" points in youth hockey. In every game, a team can earn a fair play point if it does not exceed a set number of penalty minutes and if its spectators and coaches behave.

Officials hoped that would reduce the violence that leads to injuries by rewarding respect and sportsmanship. Some coaches, Sorensen said, still mock them as "happy points" or more vulgar names. But fair play points can move a team up in the standings, and data shows that penalties for serious infractions -- such as hits to the head and checking from behind -- fell sharply after the program began.

Education an ongoing plight The concussion problem is also being addressed with technological and legislative solutions. Experts caution that helmets cannot prevent concussions, but manufacturers are developing ones that are more protective. Nine states have passed laws regarding concussions in youth sports, with requirements such as a doctor's permission to return to play and better education for coaches; legislation is being considered in many more, including Minnesota.

For those initiatives to succeed, Johnson stressed, the dangers of head injuries must become more widely known and understood. As someone who learned the hard way, he wants nothing more than to spare others that same fate.

"I'd have battles with parents occasionally when I coached young kids," he said. "They'd tell me, 'My son's ready to play,' and I knew he wasn't. I've been through it. I lived that life. And I know no game is more important than your brain."

• The website www.sports concussions.org compiles the latest news and research on sports concussions, along with personal stories of concussion victims, educational materials, videos and updates on concussion legislation in several states. The site includes a form parents can take to the doctor to guide a thorough concussion evaluation, as well as links to free online training for coaches and samples of concussion-management guidelines for youth sports organizations.

• USA Hockey's website (www.usahockey.com) includes comprehensive information about its proposal to delay body checking in youth hockey until the Bantam level (age 13-14). It also features tips for teaching kids how to check properly, which can reduce the risk of concussion and other injuries.

FAST FACTS • The Centers for Disease Control estimates that as many as 3.8 million sports- and recreation-related concussions occur in the United States every year.

• The number of concussions in youth hockey is comparable to the number in the NHL, a statistic that helped prompt the Mayo Clinic's recent efforts to confront the issue. There are an estimated 23.15 concussions per 1,000 player game hours in youth hockey; the NHL rate is 29.59 per 1,000 player game-hours.

• A 2008 study of high school athletes showed that 40 percent returned to play while still experiencing the symptoms of concussion, which doctors say should never happen.