Freezing Out Brain Injury

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Ken Dryden
To hockey fans, the name Ken Dryden is synonymous with Stanley Cups, elite goaltending and one of the greatest books ever written about a life in pro hockey, The Game (1983). Dryden thinks the game of hockey, perhaps unlike any other. He doesn’t just analyze it or report on it, he passionately advocates for its evolution, to make it something better.

Part of that passion extends to staying brain healthy, both on and off the ice. Dryden’s latest book, Game Change: The Life and Death of Steve Montador, and the Future of Hockey (Signal, 2017) is a cri de cœur about how professional hockey needs to adapt to eliminate hits to the head and stop the scourge of concussions and assorted brain injuries that take such a heavy toll on its athletes.

Speaking to BrainMatters recently, Dryden discussed why it was important for him to write his new book and to be part of Baycrest Health Science’s board of directors. He noted that in 2005, as the Member of Parliament for York Centre, he was the Minister of Social Development. Part of that portfolio related to seniors issues. He became interested in Baycrest because it was “on the forefront of aging care” and believed that the organization could make a tremendous impact on the trajectory of aging care in Canada and beyond; a belief he still holds today.

“Baycrest is the best and most interesting place in terms of aging population in all of its aspects; not just in residential care, but also in research and innovations. The organization increasingly looks at the possibilities for an aging life. It’s not just that a focus on aging adults is done by default or out of obligation; Baycrest looks at this population with enthusiasm and excitement,” he says. “Baycrest is at this wonderful moment where, at 100 years, the natural instinct is to look back and see where we’ve been and all we’ve accomplished. But now we get to follow that up and see where we can get to next.”

Speaking of where things go next, Dryden has definite opinions about what the next step of the evolution of professional hockey should be. In two words: zero tolerance.

In his playing days, Dryden says, when players would get hurt they would just “shake that off” then refocus on getting back in the game and playing in order to help their team win. “And to a great extent, that’s what is still going on” in today’s professional sports world.

Except, we now know that the effects of hits to the head can be lasting. And while injuries to other parts of the body - a shoulder or a knee for example - can be lasting, over the course of one’s life the knee can recover from difficulty in moving to becoming a workable limp. “It’s no big deal to have a knee that limps. It is a big deal to have a brain that limps,” Dryden emphasizes.

For today’s professional hockey player, the frequency and the force of the hits in today’s game create many more head injuries. Those injuries, in turn, have many more immediate and long-term effects on an athlete.

When asked what he thinks needs to happen to deal with head injuries and concussions in professional hockey, Dryden advises fans, both the rabid and the casual, to sit down for a game and “watch the sport” as objectively as possible.

His new book, he says, is “explicitly not about awareness. It is purposely making the distinction between what awareness can and can’t do. All of us, whether scientists, media, or citizens, hope that if we generate enough awareness the [impact of that awareness] will happen automatically. But it doesn’t.

“So the question is: How do certain decisions [about the rules of the game] get made? Or how do you get somebody who has always made certain decisions, to make different ones? That’s what the book is about. And if the question is about head injuries, then the first focus is about hits to the head. There’s a lot we don’t know about it, but there is a lot we do know. One thing we know is that a hit to the head is not a good thing. And that many hits to the head, and hard hits, are worse.”

From Dryden’s perspective, hockey rule-makers have always understood that the head was vulnerable in the sport. “That’s why about 100 years ago, we created a high-sticking penalty. You don’t hit people in the head with the stick. And we created shoulder or elbow-to-the-head penalties, to protect the head.”

Over the years, he explains, the game has quickened. Not that the players skate faster, but that they skate faster for shorter shifts. Dryden elaborates: “At one time, hockey was a no-substitution game. If you were playing all the time, you also needed to rest during that time too. Then it became a game where you could substitute, but the shifts were still long. Right up into the 1950s and later, shifts were two minutes long. Now, they’re 35 seconds long. When a player goes on the ice now, it’s full-speed, full-sprint all the time until they go back to the bench, only to be replaced by someone else who is going full-sprint. The game is now a 60-minute sprint.

“When that happens, there is less space, less time, more collisions… more forceful collisions; and what used to be the most dangerous instrument on the ice, the stick, is no longer. Now, the most dangerous instrument on the ice is the body-in-motion. The effect of a collision [in today’s game], can be significant,” Dryden says. “And the head is less-well protected than the rest of the body [in hockey]… the helmet doesn’t do as good a job protecting the head as other pads do for things like the knee, the elbow or the shoulder.”

And if the nature of the game has changed so significantly, shouldn’t penalties and rules for protecting the head catch up to it, he asks. “What’s the difference, really, of a hit to the head from an elbow, a stick, a shoulder or from a fist? They’re all hits to the head. We’ve just decided to understand them differently. But what they really all are, are hits to the head. Whether a hit is legal or illegal, intentional or accidental… the brain doesn’t distinguish. It’s still a blow to the brain. So you must deal with it in a consistent way.

“Again, all you need to do is watch a game now. Don’t watch the game that’s stuck in your head,” Dryden insists, noting that many longtime fans may be watching today’s game and looking for the way things were, not as they are currently developing during matches.

“There aren’t that many hits to the head anymore. Watch the game. Truly watch it. What you’ll see are players who are far more skilled, doing far more remarkable things, where the focus is no longer on smashing people,” Dryden says. “If you want to do a test for yourself, watch the highlights post-game. I did this test. What you’ll see in the highlight packages are: one big hit, an injury, a few big saves, a few missed shots, and more than 20 goals scored. What do you think kids who are watching those highlights remember when they go to practice… or go play road hockey with their friends the next day? They are fantasizing about all the magical goals and moves they saw. That’s the game that is coming… in fact, it’s already here. Kids aren’t thinking about going out and hitting somebody. It’s not what they see when they watch games or highlights; and it’s not what they’re dreaming about doing when they play in their next games.”

BrainMatters: How close is the game today to making every hit to the head a penalty?

Dryden: “I can’t answer that. But I can tell you it is absolutely and easily doable. All you need to do is ask officials to do it. They make these adaptations all the time. This season, the big new rule was clamping down on slashing. They did it. And what happened? At first there were all kinds of arguments by coaches and players. But two weeks later, no arguments. Life goes on and players and coaches adapt. We can do the same thing with hits to the head. Hits to the head can be penalized. And if they were, players and coaches would adapt. Players take on what they’re asked to take on. As a player, you don’t determine who your opponent is. You’re presented with situations and asked to adapt to that. So in terms of a culture of something… if it is asked of you as a player, you do it.”

BrainMatters: Do you think that the culture of hitting in the game is changing as a result of players knowing how damaging hits to the head are?

Dryden: “That’s not the right discussion to have when it comes to concussions and hits to the head. It sounds so esoteric, ‘changing the culture of the game.’ What do we mean by that? That you need to have more respect for the other guy? People say there’s less respect between players in this generation than there was in prior generations. But I don’t think so. I think it was the absence of opportunity in the game before, where now there is the presence of opportunity because of the unrelenting speed of the games today and the need for every player to be going all-out, every shift.

“When you skate that fast and that hard at such close proximity, violent collisions will happen. Is it a different culture in the game today that has players slashing less? No. It is a decision that the stick is there to only deal with the puck. It isn’t there to obstruct, hook or slash an opponent. It is there for the puck, that’s what it was always there for. When we became lax with the rules on the stick, we toughened them again. Is this a change of culture? Are players now more respectful of others so they don’t slash? No. They don’t do it anymore because they’ll get a penalty if they do it. So they find other ways. If they can’t stop someone by slashing them, they’ll do it in a different way.

“Many of the decisions that are being made about the nature of penalties and punishments in hockey are based on a game that no longer exists. One of the things I say in my book is that those in the NHL offices have a background in hockey – they played the game, but they never played today’s game.

“Like in a lot of things, one tends to know what they always knew. But it’s that knowing that gets in the way of you seeing the new thing. It’s the game you see now that you should be reacting to and making decisions on.”
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