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Concussion concern, Rinne's riches & blue Jackets

The NHLPA's neurology consultant said players who have sustained a concussion often don't recognize the symptoms. (Getty Images)

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The NHLPA's neurology consultant said players who have sustained a concussion often don't recognize the symptoms. (Getty Images)

By Nicholas J. Cotsonika

The NHLPA's neurology consultant said players who have sustained a concussion often don't recognize the symptoms.

As NHL Players' Association executive director Don Fehr makes his fall tour, traveling from city to city to meet with players away from the rink, the discussion covers more than the looming labor agreement. One of the other major issues is – you guessed it – concussions.

Expert Jeffrey Kutcher has traveled with Fehr to educate players on the basics: what the injury is, how it presents, what can affect it, how to come back from it. You might think that from a union perspective the biggest problem would be getting guys to speak up and seek help, but that isn't it.

"I think the misconception out there is that that is the biggest problem, that they don't speak up," said Kutcher, the chair of the Sports Neurology Section of the American Academy of Neurology and an NHLPA consultant. "I think it is a problem. Don't get me wrong. That is a real problem."

But the bigger problem is players recognizing the symptoms in the first place.

"They don't understand it either at the time when they're acutely injured during the game, because they don't understand because they're concussed, or afterwards that next day, that night or whatever," Kutcher said. "They're feeling a little lousy, and they don't assume it's a concussion. They assume it's something else."

[ Related: Brain disease claims divide NHL doctors and researchers ]

The NHL strengthened its return-to-play protocol in March, requiring players suspected of having a concussion to be evaluated by a doctor in a quiet area. Players are tested for things like attention, concentration, learning, memory and balance.

My immediate reaction was to go a step further to address the in-game issue: Have neurologists cover games in each city, and make them completely independent – paid by the league, not the teams, or perhaps both the league and union. That would be expensive in a league that plays 1,230 games a season, plus the playoffs, but it would assure the players are examined by brain specialists, the exams are consistent and there is no conflict of interest.

The union has discussed the idea internally as a potential collective bargaining issue.

Problem is – as it so often is when it comes to the brain and our still-evolving knowledge of it – it's not that simple. Few neurologists are actually experts in evaluating athletes in the heat of competition. The league and union would have to develop a network and train people to do it.

"I can't just take the average neurologist and say, 'Hey, you go cover this game,' " Kutcher said. "They wouldn't know what to do."

[ Related: Expert perspectives on chronic traumatic encephalopathy (CTE) ]

Kutcher is an associate professor at the University of Michigan and the director of Michigan NeuroSport, which specializes in the prevention, treatment and management of neurological sports injuries. He has covered college football games for about six years.

"When I first started doing it, I was clueless – on the sidelines, trying to figure out how to do a neuroexam in that environment, when I'm used to a quiet clinic room where I can take my tools out and spend an hour," Kutcher said. "I've got five minutes, a marching band, coaches, football equipment. The player wants to get back. And so it's a totally different thing.

"But I think it's a good concept. And obviously the team physicians are going to grumble about it, but from the players' perspective, from the health of the players, whenever there's somebody around who is an expert at something, the care of everybody becomes a little more conservative. Is that ultimately a good thing? In the acute setting, yeah, I think it is."

Ruben Echemendia, however, said he doesn't think "it's that great of an idea." He is the NHL's neuropsychological consultant and the chair of the NHL/NHLPA concussion working group. He said the league is comfortable with the protocol it has refined with the union over many years of experience.

"I mean, it doesn't hurt to have a neurologist on the sidelines or obviously in the rink, but I don't think that that is a necessity," Echemendia said. "There are many primary care, sports-medicine trained physicians who are very good at diagnosing this injury. But beyond that, we have developed very specific diagnostic approaches. We have standardized those approaches, and we have trained our medical personnel in doing that."

Where neurologists can play a greater role is after the game. Symptoms of a concussion don't always show up initially, and even when a concussion is diagnosed properly, returning to play can be tricky. In 2009, the NFL required a player to be cleared by "both his team physician(s) and the independent neurological consultant" before he could be "considered for return-to-football activities."

Telling hyper-competitive, elite athletes simply to rest until they're 100 percent isn't enough.

"I can't tell you how often that doesn't work," Kutcher said. "It's about resting until [you are] back to yourself. Yeah, you can have some aches and pains. The real key there is then moving on to a very well-documented, well-managed return to physical activity. That's the part that's missing right now.

"People have this idea [about] concussions, 'You have a headache, and then if you don't have a headache, come see me, and then I'll put you on the bike.' 'OK, go on the bike.' And then they go up, and they do it. They come back. 'Yeah, I'm fine.' 'OK, go skate.'

"And there's no interaction, there's no discussion, there's no watching them work out, examining them before and afterwards, keeping track of their heart rate and their exertional scales. And their symptom scores and things. That's the kind of level that needs to be done to introduce activity in way that, 'Yeah, this concussion is over.' "

FIRST PERIOD

The cover of the latest issue of The Hockey News shows Ryan Suter, Shea Weber and Pekka Rinne standing shoulder to shoulder with the headline "SLASHVILLE" splashed across the front. The subhead asks: "Suter. Weber. Rinne. Who would you kiss goodbye?"

The answer, of course, is none of them. But the last of those three I'd kiss goodbye would be Rinne, the guy the Nashville Predators signed Thursday to a seven-year, $49-million deal.

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Normally, I'd be wary of making such a long-term, big-money commitment to a goaltender – even one that just finished second in the voting for the Vezina Trophy as the league's top goalie and fourth for the Hart Trophy as the league's MVP. (See DiPietro, Rick; Luongo, Roberto.)

But this is an unusual situation. The Predators are a team with a budget below the salary cap and two cornerstone defensemen they need to sign – Suter, a pending unrestricted free agent, and Weber, who can be unrestricted after next season.

Unless something changes with the team's fortunes or the collective bargaining agreement, the Predators are never going to be able to spend to the cap to collect shiny offensive toys. A lot of teams say they must win with defense and goaltending; the Predators have no choice but to do it, while hoping they draft a scorer who can put up big numbers before he bolts for big bucks.

So start with the goalie. If you're the Predators, you hope that you still have enough money left over to sign Suter and Weber – or at least one of the two, more realistically – and that locking up Rinne makes Nashville more attractive to them. If you lose Suter and Weber, at least you still have Rinne and can play a defensive style. Nothing covers up for shortcomings like an elite goalie.

What if Suter and Weber leave and Rinne suddenly stinks? Yeah, that could happen. But this is the NHL, and you were going to have to pay up for somebody under any scenario.

SECOND PERIOD

When I watch the replay of New York Rangers winger Wojtek Wolski's collision with Ottawa Senators captain Daniel Alfredsson on Saturday, I immediately think of the David Steckel-Sidney Crosby play from the Winter Classic.

To me, both represented the type of incidental contact that is inherent to the game, not worthy of supplemental discipline and especially dicey for Brendan Shanahan, the NHL's senior vice-president of player safety and hockey operations.

[ Related: Is a four-game suspension long enough for Patrick Kaleta? ]

Two differences: First, Wolski's elbow hit Alfredsson's head; Steckel's shoulder hit Crosby's. Two – and this is a big one, if you believe Steckel was sneaky – Wolski looked behind him immediately after the hit to see what happened, as you would expect an innocent man to do.

Wolski isn't a dirty player and has no history of previous incidents, as Shanahan pointed out on NHL Network. Same with Steckel. Shanahan said there are collisions in which one player sees it just prior, tenses up and even leans in to brace for impact. That's what he thought Wolski did. That's what I thought Steckel did.

It's a fine line, but it's a hockey reality. As I have written in the past, the NHL needs to eliminate targeted hits to the head but allow for the fact that accidents happen. Shanahan has and will take criticism for inconsistency, even though he has and will explain his thinking publicly. But that is inherent to the game, too.

THIRD PERIOD

I do think it's unfair to judge the Columbus Blue Jackets when their major off-season acquisitions haven't been on the ice much and haven't been together at all. Center Jeff Carter played only the first five games before he suffered a foot injury and had three assists. Defenseman James Wisniewski has played only the last four games because of a suspension, and he has four points in those games.

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But do I think Columbus will take a big leap forward when Carter comes back? No.

And you have to look at why general manager Scott Howson had to be so aggressive to land Carter and Wisniewski – trading winger Jakub Voracek and first- and third-round picks to the Philadelphia Flyers for Carter, who didn't want to leave Philly and had 11 years and $58 million left on his contract; trading a seventh-round pick to the Montreal Canadiens for the rights to Wisniewski and signing him to a six-year, $33-million deal before free agency.

This goes back to the beginning, before Howson even got the GM job in 2007. The Jackets have never drafted well. One top pick has really lived up to his billing: Rick Nash, the first overall pick in 2002. Look at their top picks after that: Nikolai Zherdev (fourth overall), Alexandre Picard (eighth), Gilbert Brule (sixth), Derick Brassard (sixth), Voracek (seventh), Nikita Filatov (sixth) …

We'll stop there. You get the point.

POWER RANKINGS

TOP 6

Washington1. Washington Capitals: So Alex Ovechkin didn't like being benched down a goal with 62 seconds left in regulation Tuesday night. So he said something foul about coach Bruce Boudreau. So what? If Boudreau was trying to light a fire under him, he did. And the move worked. The Caps ended up beating the Anaheim Ducks in overtime, 5-4.

Pittsburgh2. Pittsburgh Penguins: Still have Nov. 11 against Dallas circled – in pencil – as the long-awaited comeback of Sidney Crosby. The Pens will return from a Western trip and have five days off to practice.

Chicago3. Chicago Blackhawks: Patrick Kane is settling in at center. Put the puck on his stick more often, and he makes more things happen.

Toronto4. Toronto Maple Leafs: If this is just another hot streak for the streaky Phil Kessel, well, it's become a long streak. He leads the league in goals (10) and points (20), and he has been held off the scoresheet only twice in 12 games.

Dallas5. Dallas Stars: As good as Kari Lehtonen has been in goal, the Stars need to cut down on their shots against – and they're starting to. They allowed an average of 34.1 shots against during their first seven games. They have allowed an average of 29.3 over their past three.

Edmonton6. Edmonton Oilers: Might be the best story in the NHL, and I'm not talking about Ryan Nugent-Hopkins and the rest of the kids. I'm talking about old-guy goalie Nikolai Khabibulin, who is 38, spent time in jail in the off-season for drunken driving and has started strong. He's 5-0-2 and leads the league in goals-against average (1.12) and save percentage (.960).

BOTTOM 6

Calgary25. Calgary Flames: Not worried about Jarome Iginla – not yet, anyway. Yes, he has only two goals and four points in 10 games. Yes, he's 34. But he missed the preseason because of a back injury, and he's known for slow starts. He struggled early last season and still scored 30 goals for the 10th straight season.

New York Islanders26. New York Islanders: That note I wrote in mid-October about the Isles being a sleeper pick for the playoffs? Yeah, that's one prediction of mine that isn't looking so good.

New Jersey27. New Jersey Devils: Apparently that solid 3-0 victory at Los Angeles last week was an aberration. The Devils are 1-4-1 in their last six, and they sure didn't help a rusty Martin Brodeur return from a shoulder injury Wednesday night in a 5-3 loss to the Leafs.

Winnipeg28. Winnipeg Jets: Go figure. The Jets win that wild 9-8 game at Philly last Thursday night and follow it up with a 1-0 loss at Tampa Bay on Saturday night.

Boston29. Boston Bruins: This is where the Bruins start to emerge from their funk. After Saturday night's game at Toronto, they have a five-game homestand – Isles, Oilers, Sabres, Devils, Jackets.

Columbus30. Columbus Blue Jackets: Maybe this is where the Jackets start to get it together, too. There is no question they need to practice. They had two days off before Thursday night's game against the Leafs, and they'll have four more days off after Saturday night's game in Philly. Of course, the question in Columbus is whether the right coach is leading those practices.

PLUS/MINUS

Plus: Toronto's Joffrey Lupul has a great shot, and he's using it. His hat trick Wednesday night gave him eight goals, putting him two behind linemate Kessel for the league lead. Finally, it looks like the Leafs have a legit top line. Lupul has the potential to crack 30 for the first time in his career.

Minus: As bad as things have been for the Bruins, can we calm down the talk of firing the coach and shaking up the roster? These guys did just win the Stanley Cup. Maybe the hangover shouldn't be this bad, but even in this what-have-you-done-for-me-lately world, it almost makes you wonder what the point is of winning it all. The B's now know how Sisyphus feels.

Plus: From a league perspective, the Bruins' struggles are another good sign of parity. As one veteran hockey man pointed out to me, the B's were considered a good-but-not-great team last season. They weren't the favorite until the night they won the Cup. They show you can win a championship by playing as a team in front of a great goalie, but they also show that if you slip, if you lose your edge, you can fall fast. Anything can happen.

[ Related: Minnesota's Clutterbuck accidentally punches lineman in the face … twice ]

Minus: The downside of parity? Well, look at the San Jose Sharks. They looked like my preseason pick to win the Cup as they began a six-game road trip with five straight victories – rolling through New Jersey, Boston, Nashville, Detroit and Long Island before finally falling to the Rangers in New York, 5-2. Still, they were in ninth place in the West on the Thursday.

Plus: After Sharks captain Joe Thornton ripped the Rangers for being soft, he played it well. "Every couple of years, you have to say some sort of boneheaded thing," he told reporters. Me, too, Joe. Except I do it every couple of minutes.

Minus: Patrick Kaleta is a classic case of not using your head when you use your head. A head-butt with his rap sheet? See ya.

Plus: Dominik Hasek has been playing volleyball on the beach, skiing on glaciers, biking across Albania and driving race cars against professionals. He says he still thinks about returning to hockey next year – even though he turns 47 in January. Let's raise a Dos Equis to the most interesting man in the (hockey) world.

Minus: Ty Conklin has shared this before, but the Red Wings netminder did it on the scoreboard Friday night in Detroit – telling an interviewer, and therefore the crowd, that one of his superstitions is to relieve himself after each period. Does he really want to be known as a leaky goalie?

@COTSONIKA TWEET

“Said I wouldn't do this again, but … Got a feeling B's win tonight. Can't see Sens winning seventh straight over floundering champs.”

Yep. Three for three. I thought I'd be pushing my luck after calling the Winnipeg Jets' first victory and Jaromir Jagr's first goal, but it seemed like a pretty safe bet the Bruins would beat the Ottawa Senators on Tuesday night. Law of averages. Bruins won 5-3.

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