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USA Hockey’s Dr. Stuart on Concussions

By Minnesota Hockey, 10/02/17, 1:15PM CDT

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One of the hottest topics in youth sports, and rightfully so, is the safety of all participants. Before players and parents can focus on fun and development, they must be confident in their safety.

Minnesota Hockey and USA Hockey place an emphasis on player safety every season, and over the past several years, one of the key topics has been concussions. The research occurring in the scientific and medical communities continues to provide more and more information on the prevention, diagnosis and treatment of these injuries, and it’s critical that all participants stay in tune with the latest developments in this area.

That’s one of the reasons Mayo Clinic hosted its third Ice Hockey Summit: Action on Concussions on September 28-29. To learn more about the event and the latest developments pertaining to sports related concussions, we sat down with one of the event organizers, Dr. Michael Stuart.

Dr. Stuart is an orthopaedic surgeon at Mayo Clinic, the Co-Director of Mayo Clinic Sports Medicine and has served as Chief Medical Officer of USA Hockey since 2001. A native of Rochester, MN, Dr. Stuart also has the unique perspective of having four children, all of whom have excelled in the game of hockey. His sons, Mike, Mark and Colin, all played in the NHL, and Dr. Stuart's daughter, Cristin, played at the NCAA Division I level.

Editor’s Note: This interview took place shortly before the summit and was released after the event. Two representatives of Minnesota Hockey attended the summit, as well as several participants from USA Hockey.

Minnesota Hockey: Could you provide our youth hockey players, parents, coaches and officials with an overview of the Ice Hockey Summit III: Action on Concussions?

Dr. Michael Stuart: Dr. Aynsley Smith and I started this with the goal of reducing the risk and severity of concussion in the sport of ice hockey. We felt the best way to do that was to put together a very diverse group of stakeholders who are involved in the sport of ice hockey. It’s not just a scientific meeting where we have didactic lectures from scientists and physicians, although that’s certainly part of it. We bring together health care professionals, officials, coaches, former players, equipment manufacturers, administrators. Everybody has something to contribute.

The way it’s set up is between the different lectures and panel discussions and the dialogue we put together some action items. Using an audience response system, we literally vote as a group. Everyone who attends has an opportunity to vote on what they feel are the most important action items.

What I like to say is the work starts after the summit because then we take these prioritized action items and we try to bring them to fruition.

MH: The research on concussions seems to be ever-evolving. What are some of the latest developments and how will they impact hockey participants?

Dr. Stuart: I get pretty excited about USA Hockey’s efforts in the past and hopefully efforts going forward. I think hockey has been proactive in a lot of different ways.

I was part of the body checking task force. We were very involved in the rule change that delays legal body checking in games until age 13 at the Bantam level. I think there will be some interesting discussion on whether we should be doing more with making opportunities for hockey players throughout the country to participate in the sport in non-checking leagues or possibly even additional rule changes related to body checking.

In addition, I think there’s a lot interest as I mentioned in objective diagnosis so things like the King Devick Test which is a rapid number naming test. If you have a baseline level, you can test somebody, and you don’t have to be a health care provider. A coach or a parent can administer this test on an iPad and determine if the player can go back into the same practice or game.

Another interesting thing which I’ll be speaking on is biomarkers. Might there be a way from a finger stick blood sample, or possibly even saliva, to diagnose concussion or give some insight into the severity and how it should be treated?

There’s also some very progressive advanced neuro-imaging, which is maybe not applicable to every player who sustains a first-time concussion, but many of us struggle with how to evaluate and treat athletes who have had multiple concussions and persistent symptoms. How many is too many? When should they discontinue contact sports? Some of the more advanced neuroimage give us insights into the actual brain metabolism that you just can’t identify other ways.

Another thing that we’re working on, we have several research projects going on now, and this is in the area of prevention, has to do with neck strengthening. Not just improving neck strength, but improving reaction time and what we call proprioception or joint position sense. We know concussions can occur from a blow to the head. It’s possible that improved neck strength or reaction time could dissipate some of those forces, but also a blow to the body, which is transferred through the neck to the head, the so-called whiplash mechanism of injury. In that regard, we’re hoping that additional information about neck strengthening and reaction time and proprioception could be yet another piece of the puzzle to prevent or at least reduce the number of concussions we see in hockey.

You mentioned the King Devick Test as an objective diagnosis tool at practices and games. That seems like something that would interest a number of coaches, parents and associations. Could you tell us a little more about it?

Dr. Stuart: Essentially, this is a test where the athlete reads numbers as fast as they can from left to right. It used to be on cards. Now, it’s actually performed on an iPad so there is cost associated with registering, but once you’re registered, you do a baseline examination. Every year, prior to the start of the season, each player reads these numbers. They do it in three different sequences, and it records their time automatically on the iPad.

If they are suspected to have a possible concussion, then they can administer this test rink side, in the locker room, or in the physician’s office. You compare their score, or the seconds it took them to complete the test, compared to their baseline. If it took them longer, then they are removed from play because of the concern for concussion.

If there was one area related to concussions that you think youth hockey needs to focus on more and work to improve, what would it be?

Dr. Stuart: I think it’s happening already, but the area I would say relates to behavior modification, sportsmanship and mutual respect. It really starts in the home with parents, and then, it continues at the rink with coaches.

Essentially, the American Development Model, which USA Hockey has now is really an incredible program. The philosophy of course is that we teach the skills of the game in the context of player development but also having fun.

You can legislate, change rules, in an attempt to make the sport safe, but it begins with the individual athlete. To not take the liberty of purposely inflicting harm on an opponent when the opportunity arises. I think that’s part of the culture of the game that we need to continue to work on.

For example, we’ve tried to reduce or eliminate the so called open ice, unanticipated, blow-up hit. The objective of a body check is to separate the player from the puck, gain possession and score a goal for your team. It’s not to render your opponent unconscious or cause an injury because you have an opportunity to do so.

If we focus on fundamentals and skill development and sportsmanship, we can all enjoy this wonderful sport of ice hockey in a much safer environment. 

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