The Concussion Blog

As expected the Sidney Crosby news made the numbers move, especially in Canada, along with that I have only heard more questions than actual answers.  The inbox was full of speculation and “told you so, it’s not a concussion”, or “told you so Crosby was being a (insert your expletive)”, however there was NOT ONE email that could shed light on an actual diagnosis.

I asked all the emailers if I could re-print their submissions and none took me up on the offer, except one, and his opinion is one of clarity and perspective.  This email also provided the closest thing to what could be the actual issue.  Below you can read it in full (in the email correspondence we never hammered out if he wanted his name published, so it will remain anonymous);

As a Canadian we’re inundated with daily Sid updates, and I was shocked to hear that they were presenting his case a “not a concussion”. I’m totally in agreement with you, that Sidney did/does have a concussion, and there’s no way to spin the story away from that fact. While I am shocked by the presentation of this story, I’m not totally shocked that Sid might have some sort of cervical component to his injury.

As a physical therapist most of the concussion patients I see are typically at least 3-5 mo. post onset of concussion (so probably the opposite of who you’re working with). All of these patients clearly are concussed, but many of them do have some sort of dysfunction in cervical musculature or articulare structures. The one thing I hated about the Crosby report is that it feels like they are being purposely vague (can’t imagine that happening in the NHL!). What exactly do they mean by a “soft tissue injury”? I’d agree with you, that most of the soft tissue problems I see would be some tight suboccipitals, UFT, SCM which might cause a tension type headache, but that would be about it. I certainly wouldn’t expect to have memory, concentration or mood disturbances with some tight musculature.

The upper cervical joints can refer pain to the head and result in headache (cervicogenic headache) via the trigeminal nucleus which descends in the spinal cord to C3/4. These headaches can result in some nausea and dizziness but that’s a lot less common than in say, a migraine. Cervicogenic headaches tend to be unilateral and tend to also present with neck pain and a loss of neck range of motion.  I wouldn’t consider this a “soft tissue injury” and I also wouldn’t expect some of the other symptoms we’ve come to associate with a concussion.

Sorry for being so long-winded. In the end I think it’s shame that they’re now trying to pass this off as something it’s not. Even if I find a patient with some upper cervical dysfunction, I always explain to them that they have a concussion and we treat them as such. I feel like this story is even more suspicious given that this has been the most widely publicized concussion in the history of sports, and all of a sudden they came up with another diagnosis.

The comment section of the original post has provided some good discussion as well;

“Sens Fan” – If we look at the Crosby case, it isn’t clear that the second event (i.e., what stopped his return) that he had cognitive issues, balance disruption, or sleep disturbances. He certainly had these sorts of symptoms back in January 2011, but the symptoms after he stopped his return were much more mysterious. After suffering the first concussion, he may have interpreted a headache (didn’t feel quite right) with a concussion.

Sens makes a good point about the “mysterious” circumstances, but again with the above email, the next comment and my continual diatribes on the subject, isn’t the NHL way to “cloak-and-dagger” about all of this?  I can understand they are trying to protect a product, but what about protecting the players and the future generations of players?

“Joe Bloggs” – It would be useful for the Health Canada to release the cases on the NHL players treated in Canada for inspection. The NHL should request players treated in the US do the same.

It would also be useful understand the mechanics that cause the injury? How does neck strength play into the injury? Is it unique to hockey or would one see it in other sports?

It seems odd that these injuries are missed for over a year in separate cases by multiple unrelated medical teams. Given the economic value of Crosby and numerous players reporting head and neck injuries (granted some reported as comorbid) this year in the NHL and the league’s unwillingness to recognize the seriousness of concussion in isolation, the league needs do illustrate the nature of the injury and means of diagnosis.