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Concussion in the NHL: A Case Study



Concussions have become a major concern in professional sports particularly in the National Football League and the National Hockey League with most of the attention being directed at the NFL. With these thoughts in mind, this chapter will trace the actions taken by the NHL beginning in 1997 to the present. In some ways, the league was proactive in addressing concussion with the implementation of baseline neurological testing but was slow to implement other changes such as a formal concussion protocol. Comparisons are then be made with the NFL and conclude that the NHL did not engage in fraud and deception in terms of concussion research, but, on the other hand, conducted very little research on the subject. Finally, the article analyzes the league's concussions policies in terms of the NHL's culture and the structure of the league, which accounts for the conservative approach to reform.
Journal of Contemporary Athletics ISSN: 1554-9933
Volume 12, Number 2 © 2018 Nova Science Publishers, Inc.
William Beaver
Robert Morris University, PA, USA
Concussions have become a major concern in professional sports particularly in the
National Football League and the National Hockey League with most of the attention
being directed at the NFL. With these thoughts in mind, this chapter will trace the actions
taken by the NHL beginning in 1997 to the present. In some ways, the league was
proactive in addressing concussion with the implementation of baseline neurological
testing but was slow to implement other changes such as a formal concussion protocol.
Comparisons are then be made with the NFL and conclude that the NHL did not engage
in fraud and deception in terms of concussion research, but, on the other hand, conducted
very little research on the subject. Finally, the article analyzes the league’s concussions
policies in terms of the NHL’s culture and the structure of the league, which accounts for
the conservative approach to reform.
Concussions have become a major topic of interest in the sport’s world particularly with
the growing realization that concussions can have serious health implications, which can
impact players long after they have left the game. Much of the attention has focused on the
National Football League (NFL) where a best-selling book, League of Denial, and a major
motion picture, Concussion, have directly confronted the issues surrounding head injuries in
the league. More important, however, was the $900 million settlement between the NFL and
former players, which provides compensation for those who suffered long-term harm from
concussions. Much less attention has been given to concussions in the National Hockey
League (NHL), despite the fact that concussions are commonplace. Although there are more
concussions in the NFL, the number in the NHL are such that the league has attempted to
address the issue for nearly two decades.
The article will attempt to provide a clearer understanding of how the NHL approached
concussions and is divided into three parts. The first part will chronicle how the NHL has
attempted to deal with the issue beginning in 1997 and will trace the development of league
policies. (See Table I). The second part will compare the policies of the NFL with the NHL.
Finally, I will discuss the league’s actions in terms of culture and structure.
E-mail address:
William Beaver
Table I. Concussions in the NHL: Chronology of Events
Concussion Study Group formed and baseline neurological testing is implemented.
Injury Analysis Panel formed.
Eric Lindros sits-out 10 weeks to recover from a concussion.
Injury Analysis Panel makes first report and recommends covering exposed hard-shell
plastic padding, the wearing of helmet visors, and the installation of more forgiving glass.
Independent study reports concussions are up in the NHL because more players are
reporting them.
Injury Analysis Panel disbanded
The league begins to crack down on vicious illegal hits imposing more suspensions and
Gary Bettman proposes penalizing all hits to the head if the initial contact point is the head
but general managers reject the proposal.
Players’ Association proposes penalties for recklessly or intentionally targeting the head.
Concussions Working Group proposes using helmet sensors to study concussions and
investigate the long-term implications of concussions but is rejected
A formal protocol for concussions is adopted along with the approval of Rule 48.
Sidney Crosby suffers concussion and the concussion protocol is altered.
Three former NHL enforcers who had suffered concussions die.
Insurance industry expresses concern about growing number of concussions.
Former player’s lawsuit is filed in U.S. District court.
Independent study finds Rule 48 has had little impact on the number of concussions.
The league institutes hybrid icing, the wearing of helmet visors, and penalizes players who
remove helmets during fights.
NHL reports that 17 percent of concussions from illegal hits, 26 percent from accidental
hits, and 44 percent from legal checks and a double-digit drop in concussions.
NHL reports the number of physical penalties has declined
Concussions spotters system implemented.
League reports that fighting down substantially over a five-year period.
U.S. District Court rejects NHL’s motion to dismiss player’s lawsuit and emails between
NHL officials are released.
Concussions in the NHL
The simplest definition of a concussion is a blow to the head that alters brain functions,
and hockey players have always known about them. For years they were often described as
dings or “getting your bell rung,” but such hits to the head were usually not taken that
seriously. Perhaps Brain Burke, now president of hockey operations for the Calgary Flames,
best described how players handled concussions in the old days. “You went to the bench,
threw-up, and as soon as you got your vision back you played” (Williams, 1996). Coaches
favored players who could “suck it up” and still give it their best to help the team win. Indeed,
players who exhibited such toughness were role models to be emulated. These values
dominated the NHL’s culture from its inception but began to change during the 1990s. The
NHL started to crack down on hits from behind but more telling was the 1995-96 season,
where 52 head injuries were reported (a large number for that era), and two-thirds of these
coming to the New York Islanders forcing the retirement of Brett Lindros who was only
twenty at the time. Besides Lindros, star players from other teams, like Dave Taylor and
Michel Goulet, were also forced into early retirement due to concussions (Elliott, 1996). In
response, the NHL and the NHL Players’ Association formed a Concussion Study Group
made up of team doctors, coaches, and trainers to improve understanding of the phenomena.
As Chip Burke then Pittsburgh Penguins team physician put it, “We thought we should look
at the problem and see what we could find out.” (Biggane, 1997) After reviewing the data and
talking to experts for six months, Burke concluded that physicians could identify and treat the
disorder, but other than that there was little scientific research available (Biggane, 1997).
The most important initiative taken by the NHL also occurred in 1997, when players
were given baseline neurological tests during the pre-season so that if a head injury occurred
a player could be tested again and not allowed to play until they returned to the baseline level.
Although the new policy was a major advancement and unique to the NHL, no formal
protocols were enacted. As Larry Pleau then the general manager of the St. Louis Blues put it,
“There is no league formula to follow” (Nelson, 2000). Hence, teams treated concussions
differently. For instance, the Blues required that a concussed player be free of headaches (the
most common symptom) to begin light workouts on a stationary bike, followed by skating,
and finally, a return to contact. Apparently, the Blues policy was driven by the fact that
Pleau’s son had his hockey career cut short by concussions. On the other hand, Dallas Stars
defenseman Richard Matvichuk was permitted to play in the 2000 playoffs with what was
described as a “partial concussion” even though Matvichuk complained of headaches (Nelson
2000). Over the next several years, the league would require concussed players to be
symptom- free as indicated by the Impact-2 test (developed by the NFL) and then have a team
physician clear them for play (Gillogly 2007), but there was no formal protocol to cover the
entire process, which was left up to each team.
The NHL also assembled a 20-person Injury Analysis Panel in 2000 consisting of
coaches, team physicians, trainers, along with referees, and chaired by Dave Dryden, a former
NHL goalie. The purpose of the panel was to gather objective data to prevent injuries. The
panel took a cautious approach toward concussions. Dryden noted his group was “struggling”
with the issue and stated “the worse thing to do with injuries is to move before you know all
the details” (Todd, 2001). Similar comments would be echoed by league officials over the
next decade. In 2001, the panel issued its first report. Among other things, they recommended
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a reduction of deliberate blows to the head, the wearing of a new helmet every year with
visors, covering exposed hard-shell plastic padding, and the installation of more forgiving
glass to soften impacts from checks (NHL industry analysis panel, 2001). Only this last
recommendation was acted on with any sense of urgency. New glass was installed behind the
goal lines beginning in 2002 (Heike 2002). Some of the other recommendations would take
some years to come to fruition. For instance, hard shell padding was required on elbow pads
in 2003 but not until 2010 for shoulder pads, while helmet visors were not mandated until
2013. The panel also distributed a fact sheet and video to players about head injuries and
established a hot-line for trainers to report concussions (Dryden 2001). The Injury Analysis
Panel was disbanded in 2004 reportedly because the player’s association feared information
concerning a player’s injuries would become known to management and influence contract
negotiations or personnel decisions (Vogel 2016).
Although no new major policies regarding concussions would be forthcoming for some
years, certain incidents did raise important issues. Eric Lindros, considered one of the
league’s best players had suffered a number of concussions in his career and was widely
criticized for sitting-out 10 weeks to recover from one of them. Some implied that Lindros
was a malingerer who violated the norms of the game, feeling he should return to the ice
particularly during the 2000 playoffs, which he eventually did only to be concussed again
(Leonard, 2016). Nonetheless, his behavior of sitting-out until recovered would become the
standard in future years.
Another issue where the rules themselves, which seemed to precipitate head injuries. For
instance, in 2002 Jeremy Roenick, then playing for the Philadelphia Flyers, blindsided Mike
Madano of the Dallas Stars resulting in a concussion the second such incident between the
two players. Yet Roenick, although eventually suspended for the hit, did not receive a penalty
for his actions. When the referee involved was later asked why, he responded that blood
would have had to be drawn for a penalty to be called. For his part, Madano called for an end
to all hits to the head, just as the NFL had outlawed spearing and clothesline tackles (Heika,
2002). Although not banning all targeted hits to the head, the league did begin to increase
suspensions and fines for vicious illegal contact, particularly after the career ending hit by
Todd Bertuzzi on Steve Moore in 2004 (Campbell 2005). In 2007, NHL commissioner Gary
Bettman proposed penalizing any hit to the head if the initial contact point was the head at a
general manager’s meeting. Only one general manager voted in favor of the proposal,
although league officials would continue to promote the idea (Agenda: NHL general
managers meeting).
Perhaps one of the reasons for a lack of new reforms was a study published in the
Canadian Journal of Neurological Sciences in 2003. The study found that concussions had
tripled between the 1986-87 and 2001-2002 seasons with a particularly sharp increase after
the 1997-98 season. Some hypothesized that players had gotten bigger, hence more violent
and damaging hits. However, the study concluded that more awareness and reporting of
concussions was the major cause, not larger players. “It’s becoming much less of a macho
thing” stated Dr. Richard Wennberg one of the authors of the study in referring to the slowly
changing league norms (Wennberg & Tator, 2003). The findings could also be interpreted as
evidence that the league’s policies requiring baseline testing were working and further
changes were unnecessary.
One of the more curious aspects of the concussion issue was the study group formed in
1997 produced so little research, although apparently the data existed to do so. Emails
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between the NHL’s deputy council Julie Grand and Gary Bettman indicate the lack of
research was troubling. Grand felt the primary reason was the group was not paid, along with
a lack of leadership. In 2007, a new entity the “Concussions Working Group” was formed
(Westhead 2016). In 2011, an article was finally published which focused on the 1997-2004
regular seasons. Among other things, the article reported that headaches were the most
common symptom of concussions and games missed due to them had increased (Benson
et al., 2011). In 2009, the group (currently called the Concussion Subcommittee) wanted to
begin a pilot program where selected teams would wear helmet sensors to measure the
magnitude of blows to the head. If a player received a hit beyond a certain threshold, they
would be removed from the ice and medically evaluated. The group also wanted to conduct a
study of retired players who had suffered repeated concussions to determine if there were any
long-term health implications. In an email, Julie Grand wrote that helmet sensors would be
“too expensive”. As for the study of retired players, Grand wrote, “We don’t think anything
can be gained that would benefit our game” (Grand, 2009).
In March 2009, the NHL Players’ Association head Paul Kelly, during the league’s
general managers meeting, announced that referees should have the option of calling penalties
on players who intentionally or recklessly target the head of an opponent. Kelly stated that
perhaps three-quarters of the players favored the rule change. However, accidental or
inadvertent hits should not be penalized since they “don’t cause a great deal of injury”
according to Kelly a puzzling statement given the fact any hit to the head, accidental or
otherwise, can result in an injury (NHL Players’ Association urges GMs to consider
penalizing hits to head, 2009)
The union’s support of new rules to protect players marked something of a turning
point in that another important NHL constituency, along with the league’s brass favored
change. At the same time, external forces were also at work. League documents indicate the
NHL felt it was being targeted and blamed for concussions triggered by the fact that more
players were sitting out for longer periods, which many viewed as a positive development. In
addition, the NFL’s concussion issues had generated a great deal of publicity and focused
unwanted attention on the NHL (Executive Summary, 2010). The end result being the
league’s general managers finally acquiesced, which brought about two important changes. In
January 2010, the NHL announced the implementation of a formal concussion protocol
developed by the Concussion Working Group. The protocol required that if there was an
incident on the ice, a trainer on the bench would make an initial evaluation. If the trainer
deemed there was a problem, the player would be taken to an isolated area where a team
physician would administer the Sport Concussion Assessment Tool or Scat-2. During the test,
players are asked to perform simple motor skills like standing on one leg and then asked a
number of questions such as, who hit you, and then repeat four numbers spoken by the
physician in reverse order, something a non-concussed player should be able to do. Following
the exam, which takes 10 to 15 minutes, the physician would make an initial diagnosis.
If a concussion was diagnosed, the player would sit out until they were symptom-free, and a
team doctor cleared their return (NHL protocol for concussion evaluation and management,
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The other major change involved rule 48 and was based on the league’s Concussion
Video Analysis Project. The new rule stated that lateral or blindside hits where the head is the
primary target are illegal and would result in a major penalty. Apparently, there was some
confusion about what constituted a blindside or lateral hit. As a result, the following year the
rule was modified. The words lateral and blindside were removed so that any hit to the head,
where the head was the primary target would be penalized. Brandon Shanahan, then senior
vice-president of the NHL, also announced that players would also be subject to
“supplemental discipline” (usually a suspension and or a fine) even if a penalty was not called
during the game. (Rosen, 2011). This would be accomplished through the Department of
Player Safety, who would video monitor all games for violations. (Department of player
safety, 2011) In 2013, the rule was changed once again. The new wording stated that an
illegal hit occurred when the head was the main point of contact and such contact was
avoidable. It should be emphasized that not all hits to the head were illegal. For instance, no
penalty would be called if contact was deemed to be accidental or where contact had been
initiated squarely through the body and the head not targeted. In addition, if a player put
themselves in a vulnerable position or changed positions just prior to contact, a penalty would
not be assessed (Brigidi, 2013).
An independent analysis of rule 48 revealed it had little impact on the number of
concussions. The study, after examining three seasons (2010 through 2012), found that 28
percent of the “interactions” that generated a concussion resulted in a penalty, but blindsiding
occurred in only 4 percent of the cases, which rule 48 explicitly addressed. The authors of the
study also felt that allowing referees to make judgement calls regarding players putting
themselves in vulnerable position, should be reevaluated (Donaldson et al., 2013). While not
directly addressing this issue, Gary Bettman pointed out that many concussions occurred
because of accidental or inadvertent contact, where teammates collide or when a player is
checked legally but then hits his head on the ice or boards and not because players were
intentionally targeting the head. The commissioner went on to add “It’s easy to say the league
needs to do X, Y and Z on concussions. It’s not that simple.” Bettman also implied that it was
important to take a cautious approach. As he put it, “Changing a rule which doesn’t address
what’s actually causing the concussions may not be the right thing to do. Changing equipment
may not necessarily be the right thing to do” (Frequently asked questions about concussions,
On January 1, 2011 the “Winter Classic” was held outdoors at Pittsburgh’s Heinz Field
between the Washington Capitals and the Penguins. During the game, Sydney Crosby,
considered the league’s best player, was hit in the head from behind. The hit was ruled
accidental and no penalty was called, and Crosby, although dazed, played the rest of the
game. After the game, Crosby spoke with the media and seemed to be alright. Four days later
Crosby played in the team’s next game and was checked heavily into the boards. He left the
game and was subsequently diagnosed with a concussion. Crosby would take the next 15
months to recover. Pat Lafontaine, a Hall of Fame player, who was driven from the game by
concussions gave his take on the Crosby situation when he told The USA Today, “He wasn’t
healed from the first one and that’s why the damage was greater from the second one. When
Concussions in the NHL
you get hit again after a short period of time after you’ve been concussed, that’s where the
exponential damage comes in” (Alan & Brady, 2011). Shortly after the Crosby incident, the
Concussions Working Group modified the concussion protocol, which was quickly
implemented in March 2011. There would no longer be a bench evaluation if a concussion
was suspected. Instead, the player would be immediately be taken to a “quiet room” for
evaluation by a team doctor. Although the league denied Crosby’s concussions had anything
to do with the change, the timing suggests otherwise. Had Crosby been immediately removed
from the ice and evaluated after the first incident, his recovery might have been more rapid, as
recent research indicates (Peachman, 2016). To some, including Lafontaine, former
Philadelphia Flyer Keith Primeau (an often-concussed player) and then Capital’s coach Bruce
Bourdeau the change was not enough. As Bourdeau put it, “You’re never going to take the
hitting out of hockey. But at some point the hitting to the head has got to stop” (Alan &Brady,
2011). One could also add Bourdeau’s comments were particularly appropriate in regard to
star players whose extended absence could harm the entire league.
Besides the Crosby incident, one other event brought concussions to the forefront in
2011. Three former league enforcers (fighters), Derek Boogaard, Rick Rypien, and Wade
Belek all died either by an accidental overdose of drugs or suicide and all had suffered
concussions (Branch, 2016). The NHL is the only major professional sport where trading
bare-knuckle punches is viewed as a normal part of the game and a behavior for which
players are not ejected. The tragic deaths of the three players would raise new questions. Are
players who regularly fight more prone to concussions? Were the deaths of these players
somehow linked to concussions and are there long-term health implications? Questions the
league would be forced to grapple with in the years to come. A recent analysis did shed
some light on the subject finding that 8 percent of concussions were the result of fighting
and 75 percent of these were caused by the player’s head hitting the ice (Kuhn &Solomon,
The official position of the league was that the effects of fighting and the long-term
health implications of concussions were unclear. However, in March 2016 the U.S. District
Court in Minneapolis ordered the release of emails between league officials, which appeared
to contradict the official position. For instance, deputy commissioner Bill Daly wrote,
“Fighting raises the incidence of head injuries/concussions, which raises the incidence of
depression onset, which raises the risk of personal tragedies.” There were also emails between
Daly, Bettman, and Shanahan, which discussed outlawing fighting. However, Bettman felt
that the NHL Players’ Association would block any moves to ban fighting since it would
eliminate jobs for enforcers (Branch, 2016). NHL officials maintained that part of the
problem with implementing new rules was the players’ association. According to the
collective bargaining agreement between the league and the union, proposed rule changes are
made by the NHL’s Competition Committee and then approved by the league’s Board of
Governors. Five members of the Competition Committee are current players chosen by the
players’ association, the other five are selected by the league. Seven votes are required for a
rule change to be recommended, which obviously gives the union a major voice in any rule
changes (Competition Committee, 2015).
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There were also economic pressures to confront the concussion issue. Air Canada
reportedly informed the NHL that it was considering withdrawing its financial support if
more was not done to combat concussions (Concussions: New rules for treating NHL players,
2011). The league also requires teams to take out insurance policies which covers 80 percent
of a team’s the top five player salaries if they are injured for extended periods. With the
growing number of reported concussions and players sitting out longer, the risk to insurance
companies increased. As one insurance executive put it in 2012, “Right now you’ve got 10
percent of the league affected by concussions. While I don’t know where the breaking point
is, at some point, if it keeps trending this way, companies are not going to be able to insure
the NHL players for concussions.” The executive went on to say, “The entire framework of
the NHL is in jeopardy. There is a risk of bringing down the house” (Westhead, 2012). In
addition, a study released in 2014 found injuries cost the league $200 million a year, with
head and neck injuries costing $60 million a year and accounted for missed games than any
other type of injury (Brean, 2014). The study highlights the on-going dilemma the NHL
faced--injures were expensive but would making the game less physical be ultimately more
expensive due to reduced fan interest and revenues?
That said, the league would continue to make minor changes. For instance, more
padding would be added along the boards, while other improvements were made to the glass
surrounding the ice. In 2013, players were finally required to wear helmet visors, while
players who removed their helmets during fights would be penalized. Hybrid icing was
also introduced, which meant icing would automatically be called rather than have players
race back for the puck, where violent contact often occurred (Rosen, 2013). In addition,
both the players’ association and the league ramped-up efforts to educate coaches, players,
and staff about head injuries (Memorandum: Concussions program update, 2012).
Gary Bettman stressed that players had to take responsibility and follow the concussion
protocol for the system to work. In this regard, various news accounts indicated that
players were able to skirt the system. In 2014, James Wisniewski, a defenseman with
the Columbus Blue Jackets, told reporters that he avoided the protocol after he went head
first into the boards. In another incident, Montreal forward Mike Weise was blindsided
during a 2014 playoff game. He went to the dressing room but returned to the ice. The
following day, the Montreal’s general manager Marc Bergevin said that the protocol had
been followed, and the team did not know Weise had a concussion. These two incidents
are indicative of an on-going problem. First, marginal or journeyman players are more
likely to attempt to avoid the system for fear that if diagnosed with a concussion and forced
to sit-out, someone will replace them. Secondly, the urgency of the situation can play a
role. Specifically, if it’s a crucial regular season game or the playoffs, with a lot at stake,
the system is more likely to be compromised by players or team officials (NHL still grappling
with concussions, 2014). In an attempt to mitigate such occurrences, the NHL introduced
a “spotter system,” borrowed from the NFL in 2015. During each game, an NHL official
with access to live streaming and video replay watches for visible signs of a concussion
and then notifies the appropriate bench. The player in question is then taken off the ice
and formally evaluated. Of course, the judgement of the spotter is paramount and
spotters have been maligned for missing what some thought were obvious visible signs
(Enger, 2015). Perhaps this is why the NHL will now have 4 concussion spotters at a
remote location as well as those on-site, and all will have authority to remove players for
the game (Clinton, 2016).
Concussions in the NHL
What has been the impacts of the league’s various initiatives to reduce concussions? A
review of the literature by Kuhn and Solomon (2015) discovered that between 1986 and 2012
the rate of concussions increased. The lowest number occurred in 1986-87 season (.417
concussions/100 games) and the highest number in the 2011-1212 season (4.8 concussions
/100 games), while 88 percent of the concussions were related to a violent act. However, the
reasons for the increases were not more violent or larger players, but, once again, increased
awareness and reporting. In 2014, the NHL stated only 17 percent of concussions were from
illegal hits, 26 percent from accidental ones, and 44 percent were from legal checks (Stimson,
2015). In a related issue, the number of fights declined from 645 in the 2010-11 season to 317
as of March 2016, while the number of so-called “physical penalties” assessed per game
declined from 1.34 to 1.03 over a five-year period (Goss, 2016). There was also a double-
digit drop in concussions to 53 for the 2013-14 season, compared to the 2011-12 (the last full
season before the players were locked out), where the number was 78 (NHL still grappling
with concussions, 2014). Critics questioned the double-digit decline, suggesting there may
have been less reporting by players or teams in any given season, which may be directly tied
to the fact that the NHL does not require teams to disclose the specific nature of an injury.
Hence, concussions can be reported as an “upper body injury” making accurate assessments
difficult (Stinson, 2015).
Much of the discussion about concussions was heightened by a lawsuit filed in November
2013 by 10 former NHL players in U.S. District Court. In a nutshell, the suit alleges the
league knew or should have known about the dangers concussions posed, and as result, failed
to do enough to reduce the risks involved and educate players about them. The suit seeks
medical care for those requiring it and “the full measure of damages” allowed under the law.
The suit did not specify any dollar amounts, nor was there any mention of the players’
association. Since the initial filing, more than 100 players have joined the class action lawsuit,
which is open to all 4300 players who retired before February 2013 and suffered brain trauma
and or injuries that were caused by concussions or sub-concussive contact (Mcindoe, 2013).
The NHL filed a motion to dismiss the suit, arguing that any claims by former players are
preempted by labor law, in this case, contractual agreements reached between the league and
the players’ association. However, in May 2016 a U.S. District Judge in Minneapolis ruled
against the motion allowing the player’s lawyers to proceed with the discovery phase of the
suit, which precipitated the release of 298 emails between league officials. The league
responded by declaring it would defend the suit “vigorously” (Heitner, 2016).
Any discussion of the NHL’s concussion policy will inevitably lead to comparisons with
the NFL. In this regard, both leagues formed committees to study concussions. In 1994, the
NFL announced the formation of the “Mild Traumatic Brain Injury Committee.” (MTBI) This
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committee, much like the NHL’s concussion study group, was largely made up of individuals
with ties to each league, making them vulnerable to the charge that independent voices were
lacking, but that is where similarities end. The most obvious difference was in the amount of
research published. The NHL group published very little, while the opposite was true of the
MTBI. Beginning in 2003, the committee would publish 13 peer-reviewed research reports
appearing in the journal Neurosurgery. The reports were based on data gathered from team
doctors between 1996 and 2001. In general, the research supported the NFL’s contention that
concussions are not associated with long-term harm. A 2005 report claimed, “Return to play
does not involve a significant risk of a second injury either in the game or during the season”
(Petchesky, 2013) In the meantime, independent research increasingly contradicted the
MTBI. For example, a survey of NFL retirees with a history of concussions found they were 5
times more likely to suffer cognitive impairment, while an earlier study discovered that if
players had multiple concussions the chance of developing depression later in life doubled
(Faibaru-Wada & Fainar 2013). A more recent investigation by the New York Times revealed
100 diagnosed concussions were not reported to the MTBI since teams were not required to
participate in the study. The result being that concussions appeared to be less frequent than
they actually were. In addition, some of the reviewers for Neurosurgery had strong
reservations about the validity of the studies but had little impact on the decision to publish
(Schwarz et al., 2016). By 2010, the MTBI was discredited to the point that its two co-chairs
resigned, and the committee was disbanded and was replaced by the Head, Neck, and Spine
Committee. In speaking about the MTBI one of the co-chairs of the new committee stated,
“We all had issues with some of the methodologies… the inherent conflict of interest …that
was not acceptable by any modern standards or not acceptable to us” (Petchesky, 2013)
Others likened the NFL to the tobacco industry where for years bogus studies were used to
cover-up the harmful effects of smoking (Schwarz et al., 2016).
Certainly, publishing very little is better than publishing research that would later be
discredited and not many have equated the NHL with big tobacco. Nonetheless, there are
questions that arise. First, did the NHL know more about the potentially harmful effects of
concussions than were revealed? At this point, this does not appear to be the case. Although
emails indicate that league officials felt concussions could produce long-term harm, the NHL
did not conduct any studies in this regard, and when the Concussions Working Group
proposed doing so, they were turned down, which suggests the league’s position was “what
we don’t know can’t hurt us.” One can also wonder to what degree was the NHL influenced
by the NFL’s MTBI reports, which downplayed the seriousness of concussions?
An area where the NHL was proactive was the implementation of baseline neurological
testing, beginning in 1997. In contrast, the NFL did not mandate baseline testing until 2008.
Interestingly, when the NHL implemented its program, Elliot Pellman, then team physician
for the New York Jets, and a much-maligned co-chair of the MTBI, stated he tried to initiate a
similar program early on, but only 6 to 10 teams showed any interest (Biggane 1997). As
discussed, the NHL implemented its formal protocol in 2010 and the NFL in 2011, although
beginning in 2009 the NFL placed posters in locker rooms warning players about the dangers
of concussions (Coates, 2013), and the majority of teams were voluntarily following a
protocol. The formal protocols of each league are similar: a player is removed from the ice or
field and taken to the dressing room for evaluation. One important difference is before a
player returns from a concussion in the NFL an independent neurologist, and not a team
Concussions in the NHL
physician must approve a player’s return, removing any pressure on team doctors to clear a
player before they are recovered (NFL’s 2013 protocol for players with concussions,2013).
In 2009, the NFL publicly admitted for the first time a connection existed between head
trauma and lasting injury when league spokesperson Greg Aiello stated, “It’s quite obvious
from the medical research that’s been done that concussions can lead to long-term problems”
(Coates, 2013). For its part, the NHL has never made any such public statements, maintaining
there is no clear link between the two. Moreover, in March 2016 an NFL official admitted a
connection between developing chronic traumatic encephalopathy (CTE), the degenerative
brain disease and concussions. Gary Bettman then attempted to distance the NHL from the
NFL. He told reporters, “It’s fairly clear that playing hockey isn’t the same as playing
football”, then added, “and as we’ve said all along, we’re not going to get into a public debate
about this.” (Kilgore 2016). Bettman’s statement is, to say the least, curious. There are
obvious differences between the two sports, but the NHL is the only other professional league
which comes close to the NFL in terms of physical contact and head injuries, and although
there is no conclusive link between playing hockey and developing CTE, experts on the
subject believe that once more brains of deceased NHL players are examined a link will be
established (Kilgore, 2016). Perhaps the commissioner’s comments should be viewed in the
context of the player’s lawsuit where any public admission would be viewed as detrimental to
the league’s financial interest while the suit proceeds.
Beginning in the 1990s, the NHL began to take concussions more seriously as its culture
began to slowly change. The initial actions, like baseline neurological testing, appeared to be
prompted not by external forces, which would come later, but with the realization that star
players, the league’s most valuable commodity, could have their careers shortened and would
be an important and on-going contingency. Over the years, a policy evolved that aimed to
protect players without changing the fundamental nature of the game, which proved to be a
difficult balancing act. As discussed, by 2007 league officials wanted to penalize all direct
hits to the head but the teams, general managers nixed the idea. Although one can only
speculate as to why, since the minutes of the general managers meeting in the released emails
have been redacted, two possible reasons come to mind. First, further limitations on the more
physical play would hurt certain teams who specialize in being aggressive. Second, hitting
was an essential component of the NHL’s culture and limiting it might change the game, to
the point that it would diminish the sport’s popularity and ultimately revenues. These values
were expressed by Mike Murphy, former player and NHL executive in an email to Gary
Bettman when he wrote in regard to a less physical play, “We run the risk of having a totally
different game than we have now… Less physical, less combative etc. One we probably
wouldn’t like” (Murphy 2008).
The same values were also embraced by the players’ association. Why it took until 2009
for the union to recommend that intentional hits to the head should be penalized is puzzling.
Certainly, protecting players from career ending injuries and lasting harm should be of
paramount concern for a union. Did the players also fear that new rules would change the
nature of the sport and negatively impact their careers? There are any number of players who
stay in the league because of their physical play, perhaps that’s why surveys over the years
William Beaver
have found that players did not want fighting eliminated (Wyshynski, 2012). As mentioned,
NHL officials indicated in their emails that the players’ association would oppose the
elimination of fighting because it would eliminate jobs for enforcers. Apparently, the union
felt a sense of loyalty to players who had been groomed in junior hockey and the minor
leagues to fight and who otherwise did not possess the skills needed to remain in the league.
In a 2013 interview, Gary Bettman stated the NHL had undergone a cultural change. He
noted the implementation and modification of rule 48, equipment changes, the formal
concussion protocol, along with more players willing to report suspected concussions
(Duhatschek, 2013). One could also add the decline of fighting and the diminished role of
enforcers to the point that many teams do not employ one. The decline in fighting is
intriguing since the NHL has never banned it. Perhaps the best explanation is the tragic deaths
of Boogaard, Rypien, and Belek and negative publicity generated had as much to do with it as
anything (Kelly, 2016). The fact that fighting is still a part of the NHL’s game points to
another important variable in understanding the concussion issue the structure of the league.
The NHL has three prominent stakeholder groups, league officials, the teams (typically
represented by the general managers), and the players’ association. For any meaningful
change to occur, there must be some consensus, and in terms of fighting, none of the three
groups have favored banning it, despite the fact that it might improve the league’s image. On
the other hand, the addition of rule 48 illustrates how consensus is needed to effectuate
change. League officials first proposed changes in 2007, followed by the players’ association
in 2009, and finally the general managers in 2010. All nudged along by growing social
pressures to do something about concussions, spurred in part by the NFL’s difficulties.
The interplay of culture and structure in the NHL lends itself to what some have called a
glacial approach to reform. That said, one wonders if other reforms will eventually be
approved. Besides eliminating fighting, the league could penalize any hit to the head,
accidental or otherwise. Indeed, Montreal Canadians owner Geoff Molson, fearing lawsuits,
proposed such a rule change in 2011 (Vogel, 2016). Other organizations, including the
International Ice Hockey Federation, the Ontario Hockey (OHL), and NCAA Hockey, have
all done so. Perhaps at some point, the NHL will follow suit, but as yet there appears to be no
consensus on the issue, even among the players. Skilled players tend to favor the change,
while the more physical players are opposed. Not surprisingly, they argue that penalizing all
head contact would take away the hitting and physicality that epitomizes NHL (Klien, 2011).
Another element that should be pursued is safer equipment, particularly helmets. The NFL’s
experience with developing a safer helmet has been frustrating but research needs to continue.
In this regard, the NHL does have a protective equipment subcommittee, which should
investigate the helmet issue more vigorously. Finally, two minor changes could add some
credibility. First, the league needs to be more transparent and require teams to report
concussions, rather than “upper body injuries,” and second, an independent physician (not
team doctors) should clear a player’s return to the ice like the NFL.
Gary Bettman has stated that concussions are a complex issue, and there is no “magic
bullet” for reducing them, which the research supports—witness rule 48. The NHL was not
unmindful of the problems associated with concussions, and made reforms, and to this point,
Concussions in the NHL
has also avoided the scandal experienced by the NFL. On the other hand, additional changes
could have been put into place like penalizing all blows to the head and eliminating fighting,
which could further protect players but no consensus exists to do so. In addition, the fact that
NHL officials have never made any public statements concerning the dangers of concussions
is troubling to say nothing of the paucity of research produced by its own committees. The
most important element, however, in the league’s conservative approach, appears to be the
fear that if the culture of the NHL was changed too much, its popularity and revenues would
decline. There is no doubt that fans are drawn to the violence of hockey. Yet, fighting is down
significantly in the past few years, and the role of enforcers diminished, neither of which have
appeared to have any impact on the NHL’s popularity or revenues and suggests that other
reforms will not lead to hockey’s demise. In this regard, it will be interesting to see if more
changes are eventually implemented in future years and how the outcome of the player’s
lawsuit impacts the league.
Allen, A. and E. Brady (2011, March 8). NHL concussions touch off debate. USA Today, p.
01c. Retrieved from:
Benson, B. W. Meuwisse, J. Rizos, J. Kang, and C. Burke. (2011). A prospective study of
concussions among National Hockey League players during regular season games: The
NHL-NHLPA Concussion Program. Canadian Medical Association Journal, 183(4), 905-
Biggane, B. (1997, October 12). The lost consciousness NHL has become a leader in research
on concussions. The Palm Beach Post, p.12c. Retrieved from:
Branch, J. (2016, March 28).In emails NHL officials conceded concussion risks in fights. The
New York Times, p. B11. Retrieved from:,03/29/sports/hockey/
Brean, J. (2014, January 19). NHL’s violent ways costing the league $200-million a year,
study says. Retrieved from:’s/-violent-costing-
the-league-200-million-a year-study-says.
Brigidi, M. (2013, September 9). NHL rule changes: League rewrites illegal checks to
head rule. SB Nation. Retrieved from:
Campbell. C. (2005, September 12). Memorandum: Player Disciplinary Procedures.
Retrieved from:
Clinton, J. (2016, September 9). NHL concussion spotter will have power to remove players.
The Hockey News. Retrieved from:
Coates, T, (2013, January, 25). The NFL’s response to brain trauma; A brief history. The
Atlantic. Retrieved from:
e-totraumatic-brain-trauma-a brief-history/27250.
William Beaver
Donaldson, L. Askbridge, M., and M. Cusimano. (2013) Bodychecking rules and concussion
in elite hockey. PLOS/ONE, 8(7). Retrieved from:
Dryden. D. (2001, September 17). Concussion Hot Line. Retrieved from: https://www.docu
Duhatschek, E. (2013, November 15, 2013). Gary Bettman: King of the castle. The Globe and
Mail. Retrieved from:
Elliiott, H. (1996 May 10). Head cases: With more players missing time than ever before,
concussions are part of the game that has NHL walking on eggshells. The Los Angeles
Times, p. 1.Retrieved from:
Enger, Eric. (2015, December 2). NHL concussions protocol under question after Beaulieu
incident. Sportsnet Canada. Retrieved from:
ESPN. NHL Industry Analysis Panel Recommendation. (2001, October 8). Retrieved from:
ESPN. NHL Still Grappling with Concussions. June 8, 2004. Retrieved from:
Fainaru-Wada, M and S Fainaru. (2013). League of Denial. Three Rivers Press: New York,
Heike, M. (2002, December 22). Concussions a real problem in the NHL. The Gazette, P. B6.
Retrieved from:
Heitner, D. (2016, May 16). NHL loses motion to dismiss concussion cases. Forbes.
Retrieved from:
cases/#45 1c598b.
Gillogly, S. D. (2007, December 11). Memo: All NHL Team Physicians and Head Athletic
Trainers. Retrieved from:
Goss, N. (2016, March 11). Gary Bettman: Decline in Fighting is Part of How Game
Evolving. Retrieved from: -
Grand, J. (2009, December 11). Re: Concussion Working Group. Retrieved from: https://
Kelly, C. (2016, March 29). Unsealed e-mails show NHL in midst of existential crisis. The
Globe and Mail. Retrieved from:
Kilgore, A. (2016, May 25). Former players are suing the NHL over concussions, but remain
loyal to hockey. Washington Post. Retrieved from:
Klien, J. (2011, September 19). With stricter rule on hits to the head, some N.H.L stars are
split on a full ban. The New York Times, B13.
Concussions in the NHL
Kuhn, A.W., and G.S. Solomon. (2015). Concussion in the National Hockey League: A
systemic review of the literature. Future Medicine, 1(1). Retrieved from: www.future
Larose, J. Executive Summary: Hits to the head. (2010). Retrieved from: https://www.docu
Leonard, P. (2016, February 29). CTE worries Lindros after concussions shorten NHL career.
The New York Daily News. Retrieved from:
lindros-leading activist-cte-research-artice-1.254787.
Mcindoe, S. (2013, March 27). Everything you wanted to about the NHL’S concussion
lawsuit. Grantland. Retrieved from:
Nelson, K. (2000, June 2). NHL should take more charge in heading off concussions. The St.
Louis Post-Dispatch, p. D1. Retrieved from: https://reddog.rmu/login?url=http://search.
NFL. NFL’s Protocol for Players with Concussions. (2013, October 1). Retrieved from:
NHL. Agenda: NHL General Manager’s Meeting. (2007, June 7). Retrieved from: https://
NHL. Concussions: New Rules for Treating NHL Players. March 14, 2011. Retrieved from:
NHL. Frequently Asked Question about Concussions. February 7, 2011.Retrieved from:
NHL. Memorandum: Concussions Program Update. (2012, August 27). Retrieved from:
NHL. NHL Protocol for Concussion Evaluation and Management, January 8, 2010. Retrieved
from: Competition Committee. (2015). Retrieved from:
Peachman, R. (2016, August 29). Playing with concussions doubles recovery time, The New
York Times. Retrieved from:
Petchesky, B. (2013, August 30). A timeline of concussion science and NFL denial.
Deadspin. Retrieved from:
Rosen, D. (2011, June 21). Board of Governors Approves Changes to Two Rules. Retrieved
__________ (2013, September, 30). Hybrid Icing Tops List of Rule Changes for 2013-14.
Retrieved from:
Schwarz, A., Bogdanich, W., and Williams, J. (2016, March 24). NFL’s flawed concussion
research and ties to tobacco industry. The New York Times, p. A 1. Retrieved from: http://
Stinson, S. (2015, August 6). Grey Areas: The NHL says concussions are down. Denying
their occurrence would do that. National. Post, B1. Retrieved from: https://reddog.rmu
William Beaver
Todd, K. (2001, January 25). Concussions NHL: Panel won’t jump the gun on solutions to
head injury problem. Calgary Herald, p. D1. Retrieved from: https://reddog.rmu.ed/
Vogel, J. (2016, June 23). No easy answers in concussion suit. The Buffalo News. Retrieved
Westhead, R. (2012, January 31). Concussions cause NHL New Headaches. The Toronto
Star, p.s1. Retrieved from:
__________ (2016, March 29). NHL concussions group folded without any conclusions after
leadership worries, PA roadblocks. TSN. Retrieved from:
Wennberg, R.A. and C.H. Tator. (2003). National Hockey reported concussions, 186/87-
2001-02. Canadian Journal of Neurological Sciences, 30(3), 206-209. Retrieved from:
Wheeler, Paul. (2016, March 23). The Unsealed NHL Emails Reveal a League with a
Horrifying Attitude to Player Safety. Retrieved from:
Williams, J. (1996, July 9). Special report: Concussions, sports, crosschecking-NHL exams
rash of head injuries. Newsday, A52. Retrieved from:
Wyshynski, G. (2012, February 20). Once again, NHL Players Voice Overwhelming
Opposition to Fighting Ban. Retrieved from:
dy/once-again-nhlplayers-voive-overwhelming-oppossition-to-fighting-175 57533.html.
___________ (2016, March 30). NHL Email Dump 12 Scandalous Insights. Retrieved from:
... As knowledge of the damaging consequences of fighting and violence in hockey became mainstream, "hooting at two men pounding each other senseless no longer seemed cool" (Kelly, 2017). Inspired by these shifting public opinions of fighting and following the deaths of several retired NHL enforcers, the NHL began paying more attention to concussions and head injuries (Beaver, 2018;Kelly, 2017;Smith, Farrell, Roberts, Moris, & Stuart, 2019), and the role of fighting in promulgating such injuries. The league has taken steps to render the game less violent, with a view of protecting athlete health (Scanlan, 2006). ...
... The importance of physical play, "the code" and "sticking up" for oneself and teammates when physically challenged (Allain, 2015;Bernstein, 2006) remains a constant part of hockey culture at all levels, including the NHL. Even as more attention has been brought to the ubiquity of concussions and to the extent of their detrimental effects on player's mental and physical health (Beaver, 2018;Cabot, 2017;Kelly, 2017;Smith et al., 2019), coaches, players, and fans still support "playing through pain" and "toughing it out" (Malcom, 2006;Yeldon & Pitter, 2017) when faced with injury. Alcohol, partying, and the objectification of women also remain pillars of hockey masculinity and are not (Ahead of Print) addressed in comments pertaining to the place of fighting on the ice (Roy & Camiré, 2017). ...
Between 2000 and 2018, the number of fights in professional hockey decreased by more than half, reflecting rule changes intended to preserve player health. A 2019 playoff fight ignited debate on social media over the place of fighting in hockey. This research involved a content analysis of an incendiary tweet and the 920 replies it solicited. Content analysis confirmed that cultural backlash exists in sport and provided insight into manifestations of backlash. Comments exhibiting backlash varied by subject (i.e., what or who is being discussed in the tweet) and attitude (i.e., positive approval for fighting and negative attitude toward change), with many defending hockey masculinity. Connections are drawn to manifestations of backlash in the political realm, the extant hockey masculinity literature, and implications for sociological theory and the sport of hockey are discussed.
Full-text available
Players in the National Hockey League (NHL) are often sidelined by injuries, including concussion. The acute, intermediate and long-term effects of repetitive head trauma remain a concern of many. In 1997, the NHL and NHL Players Association established the NHL-NHL Players Association Concussion Program to diagnose, assess and treat concussion via a standardized and scientific approach. Documenting and analyzing the trends, incidence and underlying mechanisms of concussion may help in devising future prevention and treatment plans for concussion in hockey in general and the NHL in particular. The purpose of this study, therefore, was to systematically review and summarize the existing published literature on the trends, incidence rates and underlying mechanisms of concussion in the NHL.
NHL concussions touch off debate. USA Today, p. 01c. Retrieved from: usatoday30
  • A Allen
  • E Brady
Allen, A. and E. Brady (2011, March 8). NHL concussions touch off debate. USA Today, p. 01c. Retrieved from: eny-crosby-nhl-conncussion_N.htm
A prospective study of concussions among National Hockey League players during regular season games: The NHL-NHLPA Concussion Program
  • B W Benson
  • J Meuwisse
  • J Rizos
  • C Kang
  • Burke
Benson, B. W. Meuwisse, J. Rizos, J. Kang, and C. Burke. (2011). A prospective study of concussions among National Hockey League players during regular season games: The NHL-NHLPA Concussion Program. Canadian Medical Association Journal, 183(4), 905-911.
The lost consciousness NHL has become a leader in research on concussions. The Palm Beach Post
  • B Biggane
Biggane, B. (1997, October 12). The lost consciousness NHL has become a leader in research on concussions. The Palm Beach Post, p.12c. Retrieved from: login?url=http://search,Proguest.Com/docview/322608590?accountid=28365.
NHL's violent ways costing the league $200-million a year, study says
  • J Brean
Brean, J. (2014, January 19). NHL's violent ways costing the league $200-million a year, study says. Retrieved from:'s/-violent-costingthe-league-200-million-a -year-study-says.
NHL rule changes: League rewrites illegal checks to head rule
  • M Brigidi
Brigidi, M. (2013, September 9). NHL rule changes: League rewrites illegal checks to head rule. SB Nation. Retrieved from: rule-changes-rule-48-illegal-head-hit.
NHL concussion spotter will have power to remove players. The Hockey News
  • J Clinton
Clinton, J. (2016, September 9). NHL concussion spotter will have power to remove players. The Hockey News. Retrieved from:
The NFL's response to brain trauma; A brief history. The Atlantic. Retrieved from: theatlantic
  • T Coates
Coates, T, (2013, January, 25). The NFL's response to brain trauma; A brief history. The Atlantic. Retrieved from: e-to-traumatic-brain-trauma-a brief-history/27250.
Bodychecking rules and concussion in elite hockey
  • L Donaldson
  • M Askbridge
  • M Cusimano
Donaldson, L. Askbridge, M., and M. Cusimano. (2013) Bodychecking rules and concussion in elite hockey. PLOS/ONE, 8(7). Retrieved from: 137/journal.pone.0066122.
Gary Bettman: King of the castle. The Globe and Mail
  • E Duhatschek
Duhatschek, E. (2013, November 15, 2013). Gary Bettman: King of the castle. The Globe and Mail. Retrieved from: 42.html.