Banner by Shirin Kaye

Off the Floor, On the Board: The Concussions That Changed the NHL

by Ore Fawole

“Devils with five odd-man rushes, none for Anaheim.”

The Arrowhead Pond of Anaheim was buzzing. Nobody had expected Paul Kariya or his Anaheim Ducks to be in the Stanley Cup finals, let alone lead an elimination game against the trophy-favorite New Jersey Devils. As the seventh-seeded team in the Western Conference, their path was tumultuous. Upset after upset—all eyes were on the underdogs.

“Into the zone, Sykora kicked it out, got it back, near side Kariya.”

In a physical era of hockey, Paul Kariya—standing at just 5’10”— faced relentless pressure from league “enforcers” who could flatten players. Yet, his speed and finesse led him to Anaheim’s captaincy, averaging nearly a point per game during the 2002–03 season.

“Kariya! The fans want one!”

Facing elimination on home ice, the Ducks got on the board early with three unanswered goals in the first period, fighting to force a Game 7 in their first Stanley Cup Final appearance. During a very brutal second period, Kariya was ready to add a goal to his two assists. Down the ice, past Gionta, slapshot.

“SCORE! OFF THE FLOOR, ON THE BOARD! PAUL KARIYA!”

This is the game of a lifetime. Every goal is special, but this is a goal horn you’d want embossed on your eardrums.

So, why can’t he remember any of it?

Athletes, sports fans, and those who don’t identify as either are all aware of what concussions are. For high-intensity sports such as soccer, hockey, and football, concussions are a leading injury, no matter the level of play. Balls, pucks, legs, fists—entire bodies—constantly fly all over the place, and more importantly, at players' heads.

Football is America’s heartbeat and a healthy brain’s nightmare. In 2023, there were 219 reported concussions in the NFL alone. Due to an average of 17.9 million viewers per regular season game and the 40+ tackles occurring during each of them, it’s not surprising that there has been a plethora of research published on concussions in the NFL. The league has allocated $34 million to support neuroscience research that will aid in the recognition, diagnosis, and proper treatment and recovery processes for their athletes. In contrast, their on-ice counterparts have not made this same jump. Ice hockey is inherently a dangerous sport. With NHL players flying around the ice at speeds of up to 30 miles per hour and each glass-shaking body check toward the boards, the sport produces a lot of concussions. However, the league has only donated $500,000 to one university’s concussion research. This disparity raises an important question: why does one league embrace the research while another hesitates?

“Getting your bell rung,” “knocked silly,” “knockout,” “brain shake,” or simply a “bump on the head,” whatever the terminology—concussions make up 90% of traumatic brain injuries (TBI). Although the mildest form of TBI, the effects of concussions are unsettling for sufferers. Common symptoms include loss of consciousness, headaches, amnesia, confusion, dizziness, nausea, ringing ears, and blurry vision.

While the aforementioned colloquialisms are not clinical definitions, they illustrate what the injury looks like internally. Medically, a concussion is defined as an alteration in brain function, including altered mental status or consciousness. Stemming from the Latin word “concussus,” meaning to shake violently, that is what happens upstairs. The physical cause is a rapid exchange of kinetic energy between the skull and brain because of an instant acceleration or deceleration. Whether it be from direct trauma, whiplash, or an explosion, the brain bangs back and forth around the skull like the clapper inside of a bell. The skull is purposefully inflexible—it has to keep the brain safe from the exterior—but there is little protection from interior injury. Following the biomechanical injury, neurotransmitters, ion channels, and glycolytic processes are disrupted.

A disturbance to the N-methyl-D-aspartate-activated channels results in rapid neuron depolarization because of an efflux of potassium and an influx of calcium, thus altering the membrane potential of a neuron, a crucial factor for stabilization and cellular function. This creates compounding issues. To restore the membrane potential when potassium exits the channel, the sodium-potassium pump, the primary regulator of membrane potential, must overcompensate, which depletes cellular energy reserves. The energy crisis is fueled by impaired cerebral blood flow and the mitochondrial deficits caused by calcium influx. This series of changes in neuron physiology, along with other secondary neurobiological issues, manifest in the symptoms typical of post-concussion syndrome. While all of these chemical processes are issues on their own, they leave the brain incredibly vulnerable, which is why second impacts after improper recovery are so dangerous.

Playing through injury is a tenet of hockey culture, especially at its highest level. Team injury reports at the end of the playoffs detail players skating on fractures and strains that should have ended their season. This culture is detrimental, especially with concussions. Research by the University of Melbourne has demonstrated that multiple concussions can possibly cause cumulative effects. Football players with three or more previous concussions were three times more likely to have a repeat injury and slower recovery time. Additionally, evidence suggests that patients with a history of multiple concussions had significantly lower scores on memory tests than their counterparts with no concussive history. Worse still, those patients also were almost eight times more likely to have a major dip in performance on memory exams. These results appear in patients with proper recovery. The risk is even higher without rehabilitation. Although exceedingly rare, the chance of second impact syndrome is not something to ignore. The syndrome, which is a second concussion on top of an initial unhealed injury, is characterized by disastrous neurological injury. The interrupted cerebral blood flow increases intracranial pressure, causing the brain to herniate against the skull. The resulting brain stem injury can rapidly devolve and cause death within five minutes. The effects of these injuries are frightening when they’re anonymous participants in research studies, but they’re even more horrific when watching them play out on the ice.

“Down on the ice, is that Paul Kariya? Oh my goodness. Paul Kariya has been leveled by Scott Stevens.”

After Kariya dished the puck down the ice early in the second period, prolific captain and enforcer Scott Stevens laid an open ice hit that sent him to the floor unconscious. Just five minutes after being sent down the tunnel and presumably out of the game, Kariya would shock everyone by returning to the game and scoring the legendary “off the floor, on the board” goal. The shot is infamous in hockey history, but Kariya has stated he doesn’t remember the 72 hours immediately after the hit. Despite what was clearly a concussion, he returned under the pretense of only having the wind knocked out of him. His team lost the Cup, and post-concussion syndrome sidelined him for the majority of the next season. After six documented concussions, he would end his career prematurely in 2010 for fear of his long-term brain health.

Kariya is far from the only player with a career tormented by concussions. During the 2011 Winter Classic, Sidney Crosby was subjected to another open-ice hit, this time from David Steckel. Although the impact sent Crosby to the ice, he was not out of the game. In fact, it would take another hit three days later for Crosby to be diagnosed and benched with a concussion. It would take almost a year for him to return to play, but he returned as good as new.

The case of Philadelphia Flyers’ center Eric Lindros was dissimilar. Lindros was touted as the next generational talent in hockey. However, during the 1999–2000 season, he suffered four concussions, missing minimal game time after each injury. Scott Stevens laid another career-altering open ice hit during the 2000 Eastern Conference Finals. Lindros left that game and subsequently departed the team after missing the next season due to post-concussion syndrome. Before this hit, his career average was over a point per game, putting him with the likes of Wayne Gretzky and Mario Lemieux and making him one of the most promising players in the league. Following the Stevens hit, his production would drop significantly to 0.75 points per game, before ending his career five seasons later. Not only did the Flyers' consistent negligence and culture of playing through injury ruin the career of a future superstar, they would lose the conference finals and still have not hoisted the Cup. Their Lindros replacements never lived up to his potential, and the hockey world often wonders what the Flyers could have been if they had let Lindros recover properly.

If concussions can truncate bright careers, what excuse does the NHL have for not funding research to protect its athletes? Their answer lies in the league’s evolving approach to player safety. Scott Stevens' physical style of hockey is no longer part of the game. At the time, those hits didn’t even yield a penalty. Now, with the advent of Rule 48 in 2010, which banned hits where the head is the main point of contact, his hits would have yielded a major game ejection and suspension in the modern NHL. Unlike the NFL, the NHL has changed its style of play to address concussions. League-wide concussion spotters were implemented in 2016. Players with concussions are taken out of the game immediately and follow a strict return-to-play protocol, resulting in a sport where concussions no longer end careers.

At first glance, the changes made to treatment are answer enough for not funding concussion research, but the damaging nature of hockey culture is irreversible. While enforcers like Stevens no longer officially exist, young bloods like 2024 rookie Matt Rempe still throw hits like he did, despite the punishment. The damage to careers from initial negligence cannot be undone, and for some, the damage is far greater than diminished playing time. NHL alumni with premature deaths like Derek Boogard, Steve Montador, Bob Probert, and Greg Johnson have all been diagnosed with chronic traumatic encephalopathy (CTE), a brain disease caused by repeated head injuries. It can only be diagnosed posthumously, leaving a world of research that still needs improvement, and more importantly, funding. However, despite these diagnoses, NHL Deputy Commissioner Bill Daly denies the link between CTE and hockey, stating, “No, I think the science is still lacking.” The history the league has created leaves it with a moral and financial responsibility to support research and provide better care for the players who built its legacy.