Ice hockey is a popular recreational sport among kids and adults of all ages. While playing a sport has significant benefits and is a great way to stay active and have fun, it can also pose a risk for injuries.
While all physical activities have some potential for injury, the fast-paced and physical nature of hockey and the fact that it is played on a solid sheet of ice can lead to added risk.
While there is no absolute way to avoid injuries playing sports, there are many steps that can be taken to minimize the risk in order to ensure that safe, lifelong sports participation is possible for everyone.
What is a concussion?
A concussion is a temporary brain injury caused by an impact or trauma, leading to abnormal neurological function and a wide range of signs and symptoms. Most often, this injury is caused by a direct hit to the head, commonly from a collision between players or contact with the boards or ice. However, it is even possible to have a concussion from a forceful hit to the body that leads to significant force transmitted to the head and neck. Signs and symptoms of concussions typically start immediately or soon after the impact and evolve over hours to days.
Symptoms a concussed athlete may report:
- Headache or head pressure
- Memory problems
- Sensitivity to light and/or sound
- Not “feeling right”
- Nausea and/or vomiting
- Feeling tired or fatigued
- Balance problems or dizziness
- Mood changes
- Feeling sluggish, foggy, or slowed down
Signs that may be observed after concussion:
- Loss of consciousness
- Confusion or slowed responses
- Dazed or stunned look
- Inability to recall events prior to or after the hit
What to do if you suspect a concussion
If there is concern that an athlete has a concussion, it is important to remove them from play immediately. Removal from play does not confirm the diagnosis of concussion, but it is an essential step to avoid the potential risk of further injuries. Concussed athletes who are removed from play immediately, have quicker symptom recovery and return to sports compared to athletes who continue playing after a concussion.
Most people with concussion do not need to be seen in the emergency room. Following a suspected injury, they should be observed for the next few hours for signs of worsening that could indicate a more significant injury. Individuals who are stable or show improvement in the hours after an injury can be managed at home until an expedited appointment with a physician specializing in concussion can be made.
If you notice these symptoms, call 911 or visit an ER/Urgent Care:
- Prolonged loss of consciousness
- Increasing confusion or irritability
- Declining level of consciousness
- Repeated vomiting
- Weakness or numbness
- Extreme or unusual behavior changes
- Slurred speech
- Significant facial or posterior head bruising
- Obvious skull fracture or deformity
Concussion management and recovery
It is important to be seen by a physician with experience in the diagnosis and treatment of all neurological conditions and expertise in concussion management as soon as possible after an injury in order to confirm the correct diagnosis and begin appropriate treatment. Ideally, this should be within 24-48 hours of a suspected injury, so seeking an expedited appointment is preferred.
While some formal testing may be done as part of the initial evaluation for concussion, it is important to keep in mind that the diagnosis of concussion is made clinically, primarily based on a comprehensive history and neurological examination.
It is essential to take good care of yourself after a concussion. Drinking plenty of fluids, eating healthy meals, and getting a good night of sleep after an injury can help to minimize early symptoms.
For treatment of headache within the first 24 hours, medication should be limited to Acetaminophen (Tylenol), but after that point other over-the-counter medications can be used (Ibuprofen/Motrin/Advil, Naproxen/Aleve, etc.).
There is a brief period following injury, typically 24-48 hours, where significant rest may be beneficial due to the number of symptoms a person is experiencing. This period should be guided by how the patient feels and is not necessary for everyone. If an athlete feels comfortable, he or she should be encouraged to continue or gradually resume usual daily activities (excluding sports) as tolerated (including school, homework, chores, use of technology/screens, social activity, and light physical activity) and to use accommodations early on as needed.
The final clearance for return to play can be made after the completion of a supervised stepwise return to physical activity and sports. This process should be individualized based on the specific sport, position, and level of competition, and is done in order to ensure that the athlete is tolerating all activity related to his or her sport with normal brain functioning, indicating a complete recovery from concussion.
Concussion management and recovery should be an active rehabilitation process from beginning to end. The old approach of prolonged rest and avoidance of activity until all symptoms are gone is not helpful and should no longer be recommended.
Typically, a concussion should heal completely within a couple of weeks and should not cause any permanent damage or impairment. With proper management, including an active rehabilitation approach under the guidance of an experienced healthcare provider, athletes can return to their usual activities in a safe and timely manner.
Long-term concerns, prevention strategies, and baseline evaluations
There is no number of concussions that is too many. Every person is different, and every injury will be different too. Deciding to retire from a sport is a complicated decision that should not be rushed or taken lightly. A comprehensive evaluation and in-depth discussion of all prior injuries, other medical problems, current symptoms and concerns, and long-term risks and benefits of each individual sport are necessary to make an informed decision about continued participation.
While our understanding of the long-term risks and benefits of playing contact sports like hockey is continuing to improve, there are still many things we don’t know, and each person needs to be assessed on an individual basis.
Like all sports-related injuries, there is no absolute way to avoid concussion. However, there are several considerations that can help to minimize the overall risk of injury. For starters, proper education of players, parents, and coaches about the signs and symptoms of concussion and updated information about current standards for diagnosis and management can help with more accurate and timely injury recognition and initiating the process of seeking appropriate medical care.
Additionally, proper fitting equipment worn correctly and in good condition is essential for protecting players from injury. While no piece of equipment has been shown to prevent concussion, helmets, facemasks/shields, and mouthguards can prevent serious cranial, facial, and dental trauma, including lacerations and fractures.
Enforcement of recent rule changes that have sought to eliminate dangerous hits from behind and hits to the head and proper coaching on technique and safe play related to checking can help in minimizing injuries as well.
Finally, being proactive and getting a baseline neurological evaluation prior to each season can allow for a more accurate diagnosis and a more efficient return-to-play process in the event of a concussion. Knowing how your brain functions when you are healthy, can give you an advantage in making a fast and complete recovery.
There is no single test that has been established as the best concussion baseline. The most important thing to consider before a season is where an athlete would be seen in the event of a suspected concussion.
Ideally, the baseline should be conducted with that person or at least ensure that the baseline information collected will be useful to that provider while managing a concussion. While there are many commercial tests that have been used as part of concussion baseline testing, no single test can diagnose a concussion or determine when an athlete is ready to return to play.
An ideal baseline should be conducted by a physician with expertise in neurological injuries and conditions, including concussion and center on a comprehensive medical history, neurological exam, and discussion about concussion diagnosis and management, long-term risks and benefits, injury prevention, and safe play recommendations. Preferably, a baseline should be done every 1-2 years while an athlete is still playing competitively.