The NHL’s Culture of Safety is at odds with the Culture of Hockey
Kids as young as six are joining traveling hockey teams. Tiny skates on their feet, tiny sticks in their hands, they’re taught how to be big: how to be bold and brash and brutal, when to drop gloves and when to just skate. That the game is most important, and more important, than whatever hurt they may have.
Decades of ‘grin and bear it’ are on display now in the NHL. Steve Mason, and his rush to return to play from his concussion; Matt Beleskey who played for the Ducks with a torn abdominal muscle; and Derek Stepan who had jaw surgery on a Saturday and played in the Western Conference Finals on the next Tuesday.
Hockey players are denying their bodies the time to heal. It’s a practice that’s become as commonplace the singing of the national anthem. Shake it off, swallow this, tape that—and get back out there.
#Because it’s the cup.
It’s definitely hockey season because I just searched for the GIF of an injury on Twitter.
— The Royal Half (@theroyalhalf) September 24, 2014
Dr. John D. Kelly, associate professor at the University of Pennsylvania and former assistant team physician for the Philadelphia Flyers, tells me there will always be the warrior types.
“Sometimes really tough guys who love to play will not tell you the truth,” he says. “It’s not a character flaw, they just love to play and won’t tell you.”
Like Columbus Blue Jackets forward James Wisniewski, who admitted to lying to trainers and claiming his back hurt, when really it was his head, in order to avoid the mandatory concussion test and risk being pulled.
When it comes to players like Wisniewski, Dr. Kelly says it’s important for the team physician to know the players. To be able to weed out the guys disclosing everything, from those who are holding back.
Easier said than done. Especially when it’s becoming clear that there’s more motivating these guys to lie than just the culture of hockey.
Dr. Cory Bank, a sports psychologist from Philadelphia, points to a larger talent pool as one of the reasons players rush back from injury.
“20, 25 years ago, your roster spot was more secure,” he tells me. “You look back at the rosters of teams like the Flyers, and in the 70s and 80s, your rate of return from year to year was probably 80-85%.”
He directs me to look at the Flyers in just the last 5 years. “I think 10, maybe 15% of those players are still on the team,” he says. “The talent pool is larger. You’re more replaceable.”
And then there’s that ever-tricky money issue. Big contract announcements may make it seem like most NHL players make bank, but Dr. Bank insists we’re looking at it the wrong way.
“The shelf life of the average NHL player is about five years,” he says, meaning those non-marquee players, your third- and fourth-liners. “They have to make what we make in a 50-year career, in about 10.”
If a player like that, who barely sees ice time, gets injured, the incentive is to play through an injury in order to make money and potentially fulfill stipulations in their contract in order to collect bonuses.
“I’ve seen this with clients I’ve worked with,” Dr. Bank says. He paints a picture for me of a player, maybe in his 2nd year in the league, making $175,000 year. Maybe they get a bonus if they play 68 out of 82 games, or if they score 20 goals or more. That could be an extra $25,000 dollars. If they get an extra 60 points during the season—that’s another $100,000. Say that player is injured—maybe it’s a hamstring, could be a pull, could just be tight—they can take the time and rest the injury, or play through it If they have 18 goals so far for the season, and there’s 5 games left…they have a better chance of hitting the 20-goal mark if they play all 5 games, then if they sit out 3 and heal, and play only 2.”
There’s the risk of losing their spot, the risk of losing money—and then, of course, there’s the culture of the sport itself, that says it’s better to play through it than sit on the bench.
“They feel invincible,” Dr. Bank says. “They believe they’re invincible. And society and culture plays into that.”
“Even the best players will wear out.”
In hockey, maybe more than in any other sport, players are expected to bleed for their team
Fans will let a player get carried off on a stretcher, but demand he be back and ready to play again as soon as possible. They want to feel the pride that comes next, at knowing that player is in pain, but playing anyway.
The idea that hard hits or fights can leaving lasting impact doesn’t seem to be one fans want to have stick. Maybe it’s because then we’d have to have a real conversation about the level of safety in the game, or the role of fighting. Or maybe it’s just that we, culturally, want to encourage the idea that pain isn’t a real thing. Hard things don’t leave a mark. They can be washed away with determination and words like “heart” and “grit.”
Pain isn’t real. Not if your favorite hockey player can get back in the game so easily. If it isn’t true for them, than it isn’t for you.
If a player really wants to play—there’s little that can stop him.
The line of defense that exists to save a player, sometimes from himself, and from further injury, is a thin one. It often amounts to just the team trainers and physicians.
One would think that would be enough. After all, according to the NHLPA and NHL CBA, “the primary professional duty of all individual healthcare professionals […] shall be to the player-patient.”
Yet complexity is introduced quickly. The next paragraph in the CBA states that the determination regarding a Player’s “fitness or unfitness to play” will be completed by these physicians who are operating, “on behalf of the Club.”
The physician’s primary focus is meant to be the player-patient. But they serve at the pleasure of the Club. And if the Club wants a player to play…
“You can do what’s best for the patient or what’s best for management,” says Dr. Kelly. “You can’t serve two masters.”
Many likely try—and that’s where trouble can begin.
“Most sports guys have high ethics,” says Dr. Kelly “But I’ve had players not listen to me. I’ve made recommendations and they haven’t done it. The trainer or management finds a doctor to say what [the player] wants to hear…”
In the past, he tells me, being offered the position of team physician was an honor. Someone from the club asked you to do it.
“Nowadays,” he says, “it’s whatever health system’s around with the most money gets to be the team doctor, which turns out to be very perverse.”
The problem with people who are in the job for all the wrong reasons is that they’re not willing to do anything to jeopardize their position with the team. So if management doesn’t like a diagnosis—maybe one that sidelines a player for a few vital games—this kind of doctor is more likely to cite an upper body injury, instead of a concussion, or not look too closely at a certain injury, in order to keep the player in the game and management happy.
Dr. Kelly has served as a physician with the Philadelphia Phantoms and the Philadelphia Flyers. He’s currently serving as a physician with the Philadelphia 76ers.
The Flyers have a history, a poor one, when it comes to dealing with player injuries. They are, after all, the club that stripped Eric Lindros of his captaincy when he dared sit out more games than they wanted him to in order to heal from a concussion injury.
They’re also the club that insisted that they wouldn’t have allowed goalie Steve Mason return to play if he was anything less that 100% healthy; yet when Mason relieved Ray Emery in game 3 against New York, Mason was still experiencing concussion symptoms.
Concussion prevention is the one area the NHL would like to think they’re at their most successful, when it comes to this ‘culture of safety’ stuff.
“If it’s a head or neck injury, we don’t compromise,” Dr. Kelly says, confirming the severity with which medical professionals view concussions. “There’s too much risk.”
The message about the risk, of not just concussions but also secondary, lingering symptoms and increase-severity with re-occurrence, seems not to have trickled down to the players.
Blackhawks Captain Jonathan Toews either ignored or fail to report his concussion symptoms, and drove his car into a pole. He denied that his car accident had anything to do with his symptoms, but it’s hard to imagine any world where brain injury plus operating heavy machinery doesn’t equal massive accident.
Dr. Sam Zizzi, professor of sport and exercise psychology at West Virginia University, explains the disconnection when it comes to head injuries.
“They don’t involve bandages so you kinda look like you’re okay,” he says. The result is many times other players, fans, management, look at a player and say, “Well, you look fine.”
Now former head of the department Brendan Shanahan has taken pride in the work that NHL Player Safety has done, cracking down on head-hits and suspending repeat offenders. But for all that every team is required now to have one physician familiar with post-concussion protocols, few league-mandated restrictions exist when it comes to post-injury reporting and treatment or returning to play. Discretion is left in the hands of the club and club physician.
“You need some kind of standard protocol on returning these people to play after these types of injuries,” says Professor Zizzi. “Some teams have ‘em.”
Some teams don’t.
Winnipeg Jets' Jacob Trouba on decision to leave worlds: “This neck has to last me my whole life.” http://t.co/oKtWqvFs8t
— Sportsnet (@Sportsnet) May 21, 2014
A physical sport like hockey can never be absolutely safe. And the “NHL Culture of Safety” feels like the worst oxymoron. But there are steps the league can take to make hockey, at the very least, safer.
We can do that by introducing safety concepts as early as possible, so the next generation brings them up through mite hockey to juniors to the NHL. And we can do that by implementing return to play standards and practices.
I had hoped, since I discovered in the CBA that the NHLPA had a Health and Safety Subcommittee that promised to address medical standards and “pre-participation evaluation,” to some answers from them via their website. I clicked on a link that promised more details.
It brought me to a 404 page.