WASHINGTON — Sidney Crosby went 320 days between games after his most significant concussion suffered in January 2011.
The Pittsburgh Penguins captain was out all of five days — and just one game — with his most recent as he skated more than 19 minutes in a 4-2 loss to the Washington Capitals in Game 5 of their Eastern Conference Semifinal series at Verizon Center on Saturday night.
“You just want to be back out there,” said Crosby, who had the secondary assist on Phil Kessel’s second period power-play goal. “I think you just go with the flow. You try to eliminate expectations as far as when you think you’re coming back. Playoffs, you want to be in the lineup.”
Like other sports, the NHL’s concussion protocol states “there is no mandatory period of time that a player must be withheld from play following a concussion.” Crosby took part in a full-contact practice on Friday and was was cleared to play Saturday. Teammate Conor Sheary was also back in the lineup after he was concussed in Game 3.
“The guideline is to treat every concussion on its own merits,” Chris Nowinski, executive director of the Concussion Legacy Foundation, told USA TODAY Sports. “Each one is different. It’s not impossible to pass the protocol within five days. That doesn’t mean it’s a great idea. It doesn’t mean this isn’t a calculated risk.”
Research has shown that clinical recovery — when somebody no longer shows concussion-like symptoms — doesn’t always mean the brain has fully healed. Other studies have shown there is an increased cerebral vulnerability (ICV) in the days after an initial concussion that could lead to serious health consequences if a person incurs another brain injury soon thereafter.
The NCAA and Department of Defense created the Concussion Assessment, Research and Education Consortium (CARE), and the consortium studied 1,200 concussions among service academy cadets and student athletes over a three-year period. In a study published in the Sports Medicine journal in March, the authors pointed out the “window of cerebral vulnerability may extend beyond the point of clinical recovery, leaving the brain physiologically compromised and student athletes at heightened risk of repetitive injury.”
The study also stated the current concussion diagnostic tools — like the ones used to clear athletes — may be unable to reliably detect the often subtle signs that somebody hasn’t fully recovered.
The NHL’s protocol mandates three things that have to happen before a concussed player is allowed to return:
- There is complete recovery of concussion-related symptoms at rest.
- There is no emergence of concussion-related symptoms at exertion levels required for competitive play.
- The player has been judged by the team physician to have returned to his neurocognitive baseline test levels following an evaluation by the club’s consulting neuropsychologist.
Researchers are exploring blood biomarker and brain imaging tests to better diagnose concussions and gauge when the brain has fully recovered. Until those become approved for clinical use, athletes are taken through memory retrieval, balance and an inventory of physical symptoms to assess recovery.
“It’s come a long way,” Crosby said when asked how concussions are handled compared when he came into the league as a rookie more than a decade ago. “Year after year, everyone is trying to be more aware and they’re tricky things. I think just been the process for everybody. It’s changed a lot.”
Half the questions Crosby answered after his team failed to eliminate the Capitals dealt with his latest concussion. Nowinski said the Penguins and the NHL — which is in the midst of a class-action concussion lawsuit filed by former players — would have faced far more had Crosby been concussed again.
“If he took a bump to the head and gets knocked unconscious, the decision to allow him to play would be scrutinized for ages,” Nowinski said.