A flurry of motion catches the eye behind the goal. The scraping of skates against ice is punctuated with the sharp click of a stick against rubber and a heavy thud of bodies hitting the boards. Red on white. The glass flexes, warping around the helmet pressed against the panes. Seven-thousand voices crescendo into a collective, “Oooo!” The puck skitters away, and the crowd’s attention follows.

 

Boston College’s junior forward David Cotton slips to the ice, his legs tangled up with Boston University’s Cam Crotty. Cotton shakes off the hit and chases the puck back up the ice.

 

This jarring hit was just one of many that Cotton, Crotty, and the other members of the Boston College and Boston University men’s ice hockey teams would endure that night.

 

Chronic traumatic encephalopathy (CTE) is perhaps the greatest villain in the modern era of the violent, contact-defined National Football League, but in the rink, where hard, repetitive contact is as much a part of the game as anything else, the conversation seems a little bit quieter.

 

I set out to answer three questions:

1. How concerning is the CTE problem in ice hockey?

2. How is the hockey community responding to the threat of CTE in the sport?

3. How are top collegiate programs that funnel players into professional careers, like Boston College, dealing with an increased national focus on CTE?

 

How concerning is the CTE problem in hockey?

 

According to a study by Boston University’s CTE Center, CTE is a progressive degenerative brain disease that can be caused by repetitive brain trauma, brain trauma that can be either concussive or subconcussive, like the hit sustained by Cotton.

 

Head trauma, whether concussive or subconcussive, can happen anywhere on the ice, whether it be a collision between players or a player collision with the rink structures, as detailed in a 2001 study by David Goodman, Michael Gaetz and Daniel Meichenbaum that examined concussions in Canadian Amateur hockey.

 

Bert Lenz, the director of Sports Medicine for Olympic sports at Boston College, explained to me that repetitive head trauma is an accepted part of the game.

 

“In ice hockey, it’s—it’s part of the sport,” he said. He compared the game’s interactions to those of football, saying that impacts in hockey are less predictable than those in football because of the nature of the game.

 

“So, in football, you reset the pieces, and you do the play again. I don’t know what the rate is; there’s not a lot of action in football, but there’s a lot of resetting of plays,” he said, “So, that piece for football becomes repetitive trauma based on everything starts again in the exact same position. Hockey, you’ve got to get yourself caught, either with your head down coming across the ice or up against the boards and then you get hit. ... I think the resetting doesn’t make it as repetitive in hockey as it does in football.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Zafonte went on to say that he worries for “all people who have significant long-term repetitive contact” but that “we don’t know who is at highest risk.”

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At any rate, limiting the number or severity of hits, and thus the number of potential concussive or subconcussive hits, may contribute to slowing or reducing the disease in ice hockey players.

 

While the evidence seems to point toward CTE being a problem worthy of address in hockey, there is some pushback from the highest levels of the sport.

 

How is the hockey community responding to the threat of CTE in the sport?

 

In 2016, Gary Bettman, the commissioner of the NHL, denied that CTE was caused by concussions when responding to a series of inquiries by Sen. Richard Blumenthal of Connecticut. Bettman said, “The relationship between concussions and the asserted clinical symptoms of CTE remains unknown.”

Bettman doubled down, saying, “Ultimately, the most concerning aspect of the current public dialogue about concussions in professional sports (as well as youth sports) is the implicit premise that hundreds of thousands — if not millions — of individuals who have participated in contact sports at the high school, collegiate and/or professional levels are not only at a high level of risk for, but actually more than likely to develop, a degenerative, irreversible brain disease (i.e., C.T.E.), and that they should be informed as such.”

In 2018, Bettman continued his insistent denial that there was any link between CTE and ice hockey in an interview with WFAN Sports Radio. When pressed to respond to the study conducted by Boston University’s CTE Center, Bettman said, “Boston [University], they will tell you that as it relates to hockey, they don't have enough evidence to reach any conclusions, and they have told me that directly."

That claim was quickly refuted by Dr. Ann McKee, a neurologist with BU’s CTE Center, and Chris Nowinski, the chief executive of the Concussion Legacy Foundation in a response obtained by several sports media outlets, such as TSN: “... it is misleading for Mr. Bettman to say we haven’t reached any conclusions. The evidence clearly supports that CTE is associated with ice hockey play. Since that 2012 meeting with Mr. Bettman, the VA-BU-CLF [Veterans Affairs-Boston University-Concussion Legacy Foundation] research team has identified CTE in more ice hockey players, including four amateur hockey players, not all of whom had significant fighting exposure.”
 

It appears that Bettman's denial has not necessarily had a widespread effect on the hockey playing community. Denhartog says that the hockey community acknowledges that Bettman's comments are likely in the best interests of the team and the team owners, not in the best interests of the players. He also believes that the hockey community understands the existence of the problem in spite of Bettman's efforts to deny it.

I recently conducted a survey that gathered more than 200 responses from hockey players and fans on Twitter, Facebook and Reddit. In this survey, respondents with collegiate and/or semi-professional ice hockey experience were asked to communicate their perspective on the connection between the sport and CTE. The results indicated that the majority of the respondents that identified as collegiate or semi-professional hockey players saw CTE as a serious problem facing the game.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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How is a top collegiate ice hockey program like Boston College dealing with an increased national focus on CTE?

 

A little over a month before the game against Boston University, I sat down with Lenz to talk about the CTE problem in hockey and how Boston College was addressing it.

 

Boston College falls under the jurisdiction of the Gameday Safety Ordinance, a measure proposed by Councilor Josh Zakim and signed into effect by Boston Mayor Marty Walsh in 2014.

This ordinance requires schools participating in Division I NCAA events to employ a neurotrauma consultant on call at all football, hockey and men’s lacrosse games held in the Boston area. This ordinance predates the NFL’s 2017 move to employ neurotrauma consultants at every game.

When asked about how protocols have changed at Boston College, Lenz said that not a lot changed as a result of the ordinance.
 

“I feel we were ahead of the curve,” he said, “and a lot of that goes to us already having football and being ahead of the curve on including our physicians. We had a team already available. We didn’t have a 'neurospecialist.' But we’ve had sports medicine-trained family medicine physicians that have the extra certification, the extra qualifications that come under that ordinance that allow you to have the proper coverage at football games, and our team physicians have always had that.”

 

One of the notable differences between the Gameday Safety Ordinance and the NFL’s recent rule change is that neurotrauma consultants are not required to be on-site during Boston collegiate sporting events and thus would not be able to identify a potentially serious head injury and stop play temporarily.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“So the individual has to report the symptoms. The NCAA pushes them, and they have to sign certain papers saying that they will report the symptoms. They still don’t report the symptoms. But they’ve all been educated way more than anyone who played 10 or 15 years ago.”

 

If the players will not protect themselves, and, as Denhartog noted, there seems to be a lack of understanding among coaches and referees, who is protecting these players?

 

I asked Zafonte if there was anything that sports organizations could be doing right now to address the problem of CTE and protect younger players.

 

His primary suggestion was to introduce rules-based changes to the sports. He pointed out that USA Hockey amended their rules in 2011 to outlaw hitting in youth leagues with players under thirteen years old.

 

“I think some of these things are being done,” he said. “I think USA hockey and changed the age of hitting for kids, early on at some time, understanding how we do that, and how we play the puck and what the optimal teaching scenarios are in limiting some elements of that early contact. And drawing up rules-based changes that accommodate for that is true.”

 

Similarly, Denhartog praised the hockey community for its efforts to ensure that equipment standards in youth hockey are working to protect players’ heads.

 

“Now what I feel was a step in the right direction was adding a helmet rule mandating all players require HECC approved helmets that are not expired (stickers on the back of helmets.) While a lot of gear can be passed down the plastic on helmets age and with newer tech to helmets this helps players by wearing gear designed to take hits better,” he said.

 

I asked Denhartog if he, as a referee and one of the closest observers of the sport had recommendations about changes that could be implemented immediately. He recommended that penalties for specific checks be made more severe in youth hockey to try and decrease some of the illegal checking that can be seen at the lower levels.

 

Denhartog also suggested that education in a different area could help reduce head injuries as hockey players move through their careers: technique.

 

“I firmly believe we need to find a way to teach some sort of hitting at an earlier age in a safe manner,” Denhartog said. “Finding a way maybe to teach hitting without the risks early on so players have a better way to separate a player from the puck without excessive punishment. Teaching things like rub down techniques by skating and guiding a player into the boards without a full on check could be extremely helpful in teaching proper hitting without punishment.”

 

As for the future of head injuries in ice hockey, “it’s hard to say,” according to Lenz, “because they still have so much more to study. … There’ s so much research for them to do.”