Concussions: Which way from here?

A little over a week ago, the debate about player safety in the NHL reached a sports analytics conference organized by the Massachusetts Institute of Technology. Two leading voices happened to be seated at the same table.

One was Brian Burke, the general manager of the Toronto Maple Leafs, an outspoken proponent of hard-nosed hockey. The other was Chris Nowinski, the co-founder of the Sports Legacy Institute, whose mission is to “advance the study, treatment and prevention of the effects of brain trauma.”

Burke had something to say to Nowinski.

"He was on a panel where one of the panelists said the pro teams don't care about their players, and what I said to Chris was, 'Don't you dare ever let anyone say that again,' " Burke said. "I said, 'We've got to continue doing the work you're doing, but we've got to play this game, too.' "

Nowinski said they spoke for about 15 minutes. He said it was a good conversation, but a private one.

In general, though, Nowinski said it was important to note how many players have been affected by concussions, including Pittsburgh Penguins captain Sidney Crosby(notes), the face of the NHL, who has been missing for 28 games and counting. He said the league needs to make changes, starting perhaps with its perspective.

"The discussions I've had with people," Nowinski said, "I just think they have to work backwards from our knowledge of the brain rather than trying to make the brain fit their vision of hockey."

Now the debate about player safety in the NHL comes to the general managers' meetings Monday through Wednesday in Boca Raton, Fla.

The NHL became a leader on the concussion issue when it instituted baseline testing and return-to-play protocol in 1997. The league instituted Rule 48 a year ago, banning blindside hits to the head after two violent-but-legal checks concussed unsuspecting players. The question is whether the GMs will initiate further action now that people inside and outside of the league are talking about concussions and ugly incidents.

The latest controversy surrounds the now infamous hit by Boston Bruins defenseman Zdeno Chara(notes), which left Montreal Canadiens winger Max Pacioretty(notes) with a concussion and fractured vertebra but drew no fine or suspension. Complaints have come from Canadian Prime Minister Stephen Harper, to league sponsors Air Canada and VIA Rail, to the owner of the Canadiens.

"Our organization believes that the players' safety in hockey has become a major concern, and that this situation has reached a point of urgency," Habs owner Geoff Molson wrote in an open letter to fans. "At risk are some of the greatest professional athletes in the world, our fan base and the health of our sport at all levels."

It is too simplistic to say there are two sides – knuckle-dragging Neanderthals who want the game played hard no matter the cost and bleeding-heart liberals who want it so soft no one ever gets hurt. There are smart people all along the spectrum who care about the sport and its players with nuanced opinions and uncertainties. It is difficult to come to a consensus on the specific problems, let alone the solutions.

But it does come down to two simple questions: What is hockey? And what should hockey be?

"We're at a crossroads," said Los Angeles Kings defenseman Willie Mitchell(notes), who has suffered three concussions, speaks often about his experience and intends to donate his brain to science.

"What good's the game if we don't have Sidney Crosby in it, our star players? I think you're seeing a group saying, ‘OK, listen, it is an issue. We're losing players. It's happening all the time.' And then you have the old school who say, ‘Hey, it's good, physical hockey, and there's nothing wrong with it.' "

When it comes to concussions, at least, where do we begin?

"You've got to start with the starting point," Burke said. "This is not an elementary school classroom that you can make safe. This is an arena, and go back and look at the origin of the word. It's an arena."

The word comes from the Latin harena – sand, or sandy place, or place where sand was strewn for combat. It was the area in a Roman amphitheater where gladiators fought. The sand soaked up the blood.

A modern definition: an enclosed area for public entertainment.

"I am worried that there is a wave of hysteria coming over our league right now over this issue," Burke said. "I think we have to have a very sober look at the starting point of this game, which is, it is a full-contact game with no out of bounds. There's going to be injuries, including concussions."

Nowinski agrees, to a point. He is also the co-director of Boston University's Center of the Study of Chronic Traumatic Encephalopathy, a neurodegenerative disease that leads to behavioral and cognitive problems. The news broke last week that BU researchers had diagnosed CTE in Bob Probert, the NHL enforcer who died of a heart attack at age 45 and donated his brain. But Nowinski is not advocating for a ban on fighting in the NHL because the risks are obvious and these are professionals, not kids.

"I'm a firm believer that professional athletes getting paid money who understand the risks of their profession can take larger risks than kids," Nowinski said. "So I don't think you have to put pillows on professional hockey players. However, the discussion at the pro level I think should more be focused on how you keep your top talent on the ice."

So how do we do that?

OK. We can't eliminate concussions. But can we keep the best parts of this fast, physical sport while reducing the risk to an acceptable degree? Can we agree on what degree of risk is acceptable? That is the conundrum facing the general managers.

"It's a balancing act," said Penguins GM Ray Shero, who has a 15-year-old son who suffered a concussion in hockey. "I would love to see head hits out of the game. I just … An easy thing to say is ‘zero tolerance.' I don't know if that's the answer."

There are reasons the general managers limited Rule 48 to outlawing "a lateral or blindside hit" in which "the head is targeted and/or the principle point of contact." They wanted to protect the player who couldn't protect himself. They wanted to punish the predator. But they wanted players to remain responsible for keeping their heads up. They wanted to keep the straight-up, straight-on hitting.

NHL officials – including commissioner Gary Bettman – have said that blindside hits have declined this season, but concussions have increased because of other kinds of contact. NHL senior vice-president Colin Campbell, the league's dean of discipline, has pointed to how the game has changed – bigger, stronger, faster modern athletes; the crackdown on obstruction and elimination of the red line since the lockout of 2004-05.

Consider the case of Crosby. His head collided with the right shoulder of the Washington Capitals' David Steckel on Jan. 1, 2011. Then his head went into the end boards after a hit from behind from the Tampa Bay Lightning's Victor Hedman(notes) on Jan. 5. Neither incident resulted in supplemental discipline.

The Steckel play was particularly controversial. "I talked to Sidney about it," Campbell said. "Obviously he was on the receiving end. He didn't like it. He had a sense it might have been on purpose. I said, ‘Sidney, I can't say or prove it's on purpose.' "

Campbell actually was 40 or 50 feet away from the collision at ice level instead of in the league's war room in Toronto watching on television, because it happened at the Winter Classic, the league's annual outdoor game. He could see up close the difference from when he played from 1974-85. He noted the size of the shoulder pads and the size of Steckel.

"He's 6-foot-5," Campbell said. "When I played, 6-foot-4 was a giant."

Campbell pointed out how many hits the NHL has each season – more than 50,000 – and the countless collisions that have nothing to do with hitting. He referenced a concussion suffered by the St. Louis Blues' Andy McDonald(notes), who tripped, fell and hit a guy's leg.

"We made our game faster," Campbell said. "When you do that, you never know what kind of yings come with the yangs. When we made it faster, these are the yangs. … I think it's the speed of the game."

Burke outlined three ways to attack the concussion issue:

1. Keep the status quo.

Keep the rules as they are, with the players accepting some responsibility for putting themselves in vulnerable positions on the ice.

How do you make players more aware?

Burke laughed.

"It's not a penalty," he said. " ‘Keep your head up, kid.' "

There is a lot of sentiment for that inside the league. Even Mitchell, who has been haunted by his own head trauma, said he would accept being blasted by a shoulder to the head, as long as it was from the front.

"I've had a few concussions," Mitchell said. "And even if I took a hit where it put me out of the game of hockey, so to speak, where I had my head down and it was a shoulder check, I don't have a problem with that because I think that's within the rules of the game and you're taught to look ahead of you."

2. Ban all hits to the head.

Follow the lead of leagues overseas and at the college and junior levels.

Several doctors and concussion experts have called that the ideal. (Nowinski said he was leaning in that direction but listening to the arguments against it.) Carolina Hurricanes general manager Jim Rutherford and Detroit Red Wings coach Mike Babcock are among those in the league who have supported the idea.

"There's lots of ways to crunch a guy without hitting him in the head," Babcock said. "If you hit him in the head, you didn't look after it. You had your hands up or you put him in a bad spot, and I think you should be penalized for it, and that can be two minutes, and that can be five minutes and that can be suspended."

But some are dead-set against it.

"I think that would be a disaster," Burke said. "I don't think it's worked in the leagues where they have it. I think it's reduced hitting and produced penalties that are absurd."

And others are unsure.

How would you define a hit to the head? What if the victim lowers his head at the last second? What if the hitter strikes the chest or shoulder and catches the head on the follow through?

How would you determine what is worth two minutes, five minutes or a suspension? How would a referee decide in a split-second on the ice? How would the league office set a consistent standard?

"There's a lot of gray area there," Shero said. "I do know that if we go that way, I don't want to be the guy dishing out the punishment because it's going to be difficult. But I'm not saying that's not the way to go. But I do think … I'm a real proponent of continuing the discussion on this to see if we can do that."

3. Keep the rules as they are, but stiffen supplemental discipline.

"Tell Coli, ‘Let's go a little harder when guys do cross the line,' " Burke said. "And I want to hear the group on that."

There seems to be more support for that within the league. There seems to be a feeling among many that the rules are appropriate, but the fines and suspensions handed out this season haven't been enough of a deterrent for all kinds of conduct – from borderline hits to line brawls. There seems to be a strong sentiment against repeat offenders.

There has been a lot of talk about changing the culture and a lack of respect among players. Players hit not to separate their opponents from the puck but to take their opponents' heads off, part of the fierce competition for jobs and wins. Hits are kept as a statistic and used by agents in arbitration hearings.

Mitchell said the way to change the culture is for the league to be more strict with discipline, because now that it has cracked down on stick incidents and instituted a penalty for instigating fights, players cannot police themselves the way they once did.

"They need to come down fairly aggressive, and I think if they're fairly aggressive and fairly heavy on it, I think there will be a lot of complaining at first – as there always is when there's change – and guys will adapt because they won't want to penalize their team being out 10 games or being fined a bunch of money," Mitchell said. "When that happens, I think you'll see players adapt. We've adapted to all the different rule changes over the history of this game. We sure as hell can adapt to trying to respect each other more."

The general managers have much to discuss. The debate goes beyond blindside hits, extending to the equipment on players, to the padding on stanchions, to the speed of the game, to hits from behind, to hits from the front, to line brawls and more. It goes beyond concussions now to broken necks and the potential of other catastrophic injuries.

But the GMs always have much to discuss. They always talk about ideas, even if they don't adopt them. Shero recalled that one year recently they talked about whether they really needed fighting, and the one who raised the issue was Campbell.

"Everybody thinks Coli's some barbarian or something like that," Shero said. "It's not the case at all. He wants to make the game better. He deals with the rules, how they're spelled out."

In the end, it's the GMs who spell them out, making recommendations to the competition committee and board of governors for final approval. In the end, it's the GMs – not the fans or the media or the medical experts or anyone else – who must lead the way when it comes to what hockey is and what it should be.

"I place great value in this March meeting," Burke said. "I think people would be really impressed if they sat in the room and listened to how the GMs … how much they love the game and how much they care about the game."