The NHL Concussion Protocol and Erik Johnson

Last night, Colorado Avalanche defenseman Erik Johnson suffered a blow to the head on a check from Martin Hanzal of the Arizona Coyotes. The hit left Johnson motionless on the ice for several seconds, although it appeared he never lost consciousness. Johnson left the game, and it has since been reported he was evaluated for a concussion. Under the NHL Concussion and Management Protocol, he will continue to be monitored in the upcoming days.

I thought it would be interesting to look a little deeper at how the league handles these injuries, and how it will affect EJ. I will also give my own commentary, and also review the hit that caused the injury. Given my own personal history of having a severe head injury, I tend to air on the side of caution, and be pretty sensitive towards any player receiving a blow to the head.

NHL Concussion and Management Protocol

The complete document updated for the 2009-10 season can be found here. Also note, that the league added a mandatory “quite room” protocol required for any player who appears to have an on-ice head injury, before that player can return to the game. Information on that procedure can be found here.

Per the league document, a concussion is defined as follows:

A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.

The document goes on to elaborate on the causes of a concussion, as well as the symptoms you can expect to see in the aftermath. I would like to highlight one point. “Clinical symptoms largely reflect a functional disturbance rather than a structural injury.” You also cannot detect a concussion through standard structural neuroimaging.

According to the Mayo Clinic website, symptoms for a concussion may take hours or even days to fully reveal themselves.

The NHL policy states, that a “player must be symptom free at rest and at exertion, and determined to be cognitively at baseline,” before they are allowed to play again.

This makes concussions extremely difficult to deal with, even for a trained and professional medical staff. Symptoms are sometimes slow to onset, and constantly evolving. There is no way to detect a concussion, other than with mental aptitude tests, and self-evaluation from the player who is injured. Plus, there is still so much unknown and up for debate in the medical community when it comes to head injuries and how the brain works.

When I was recovering from my head injury, one of the things doctors said, was even in times where I was symptom free, my brain was still healing and recovering. I also was told I was at much greater risk of having another severe head injury during this phase. Granted, my injury was a bit more traumatic than your run of the mill concussion. However, this makes it extremely frustrating, and also extremely tempting to lie to yourself about your condition so you can do what you want to do.

In Erik Johnson’s case, it is obvious that he endured a blow to the head, and it had some sort of effect on him. I have no idea what his symptoms are, or how he performed in cognitive tests given by the team physician after the play. What I do know, is the Avalanche organization, and Erik Johnson, should air on the side of caution. Especially in a back-to-back situation, where he hasn’t had much time to truly be evaluated.

If a concussion can take more than a day to show symptoms, and a player is at risk of suffering a more severe brain injury during a time of healing after a minor injury, why risk playing tonight? He hasn’t even had a full 24 hours to recover yet. There is no way you can confidently confirm he has no sign of a concussion. I call any doctor who says you can, an absolute quack. To me, there is no reason Erik Johnson should be in the lineup. Playing tonight has risk, no matter how you slice it. At least give him until Saturday, to really evaluate how he is feeling, and make sure that no effects from the hit surface.

The Hanzal Hit, and Player Safety

Because concussions are such a difficult injury to deal with, and they so easily ruin a player’s career or negatively affect life after hockey, it is important for the league to do whatever they can to prevent them.

The hit by Hanzal has a couple of elements, that make it difficult to call it a blatant headshot. Many hockey fans, and even Avalanche fans have come out and called it a clean hit. They defend Hanzal, saying that he is obligated to challenge the puck-shooter, and finish that check.

To me, this is a preventable play. Sure Hanzal has a responsibility to defend against the shot. However, in my opinion he looks more intent on checking Johnson than he is on actually preventing the shot on goal. By the time Hanzal arrives at the point of contact, the shot was already well on its way toward the net. Hanzal also had plenty of time to realize that Johnson was in a vulnerable position. There is no need to initiate a violent collision with a player who is in a dangerous position.

Hanzal surely saw that Erik Johnson’s head was likely to be a primary point of contact if he finished that check. It even appears that he drives through Johnson’s head with his elbow, to really finish off the hit. Hanzal could have taken a path to obstruct the shooting lane if he really was intent on defending the play. He also easily could have pulled up once he saw that he would be putting Johnson’s head at risk with a collision.

Players should be held responsible for blows to the head, even if the head isn’t where you would expect it to be. Even in a fast paced game like hockey, there is usually ample time to realize when you are about to light up someone’s dome piece. As long as players can get away with it, because of the “vulnerable position” argument, preventable head injuries will continue to be a thing.

Erik Johnson also takes some responsibility. He took a lunge at a puck to get a shot away, and put himself in that dangerous spot. Just like Hanzal was doing what he thought he needed to do to defend the play, Johnson did what he thought he needed to do to make a play for his team. In essence, both guys were being aggressive. In Johnson’s case, he shouldn’t trust other players to have his safety at heart. I’m not trying to be critical of EJ, but the onus is on himself to protect himself while on the ice.

The league has already announced Hanzal will not receive a hearing. Under the league rules, I can understand why this is the case. Johnson did put himself into a vulnerable position. However, I believe the mindset that allows this to be a legal check, is one that will continue to get players hurt. If player safety is the concern, these types of plays should be reviewed, just like any other head shot.

For Erik Johnson’s sake, I hope he is doing well. If he does have any lingering effects from the hit, here’s to a speedy recovery. And to Johnson and the Avalanche, whatever you do, don’t put yourself at risk and play tonight. We need Johnson, healthy brain and all, for the long haul.

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