Design NATIONAL HOCKEY LEAGUE PLAYERS EXPERIENCES WITH CAREER-ENDING CONCUSSIONS 4th International Consensus Conference on Concussion in Sport, Zurich, CH Jeffrey G. Caron 1, Gordon A. Bloom 1, Karen M. Johnston 2, & Catherine M. Sabiston 2 McGill University 1 University of Toronto 2 Youre on your own little island… Youre not really around the guys because the team doesnt want you around the guys. They dont want injured guys around. They dont want that epidemic around and youre cast aside. (P2) 4. Emotional Turmoil The emotional turmoil described by our participants varied in intensity, and included symptoms of anxiety, depression and suicidal ideation: Anxiety, absolutely. That year was the worst Ive ever felt. I really believe that stress was a contributing factor too. Use the comparison of having your foot on the gas pedal and everything was going too fast. Everything was going too fast for me. (P3) There were two or three months where I was down and out. I didnt feel good. Id forget everything. Deep depression. Emotional because you think your career is over. Really, I think my wife came home one day and I think I was under the table crying. (P2) The first time I went through a really deep depression. I was a very scary time… If you hit your head hard enough, things can get really confusing. Things can come unraveled and you have no control… People dont understand going from, in their eyes, a hockey celebrity to the point where you cant walk out of your house. You cant shave. You have no desire to do anything. Youre depressed. (P5) I was at the point where Id be driving along and would think about going full speed and hitting the wall. Just end it. The pain was unbelievable. I had headaches everyday for a minimum of three and a half years. Not just a little headache where you want to take an Aspirin. I almost wanted to scream. So many times I just wanted to end it. (P1) I dont know if youre familiar with the (name of player) story… He was just at his breaking point and he couldnt deal with it anymore. And I get it. I understand it. You dont want it. Believe me. You dont want this for you or your kids. You dont want to wake up everyday with a headache. (P4) 5. Professional Sport Transition They all experienced a challenging retirement from professional hockey, which was complicated by a loss of identity: Losing your sense of identity is the hardest thing in the world. You go on the road, you go to the rink, its that atmosphere you had. Now youre at home and you dont feel great all the time. Its the weirdest thing to retire so young because its all youve ever known. Youre not a hockey player anymore; youre just a regular guy. (P2) Objective Five former NHL players whose careers spanned the 1980s, 1990s, and 2000s were interviewed for this study. All participants suffered medically-diagnosed concussions during their careers and retired due to persistent concussion symptoms. At the time of the interviews our participants were retired 4–14 seasons. Discussion and Conclusions Introduction Results Athletes of all ages and skill levels are at risk for suffering a concussion, which impacts daily functioning, personal relationships, and quality of life. In North America, 3.8 million concussions occur annually in sport and recreation. Athletes competing in ice hockey are at particular risk for suffering concussion due to the aggressive nature of the game. Additionally, the culture of ice hockey encourages athletes to play through pain (Young et al., 1994), which may in turn influence these athletes to underreport symptoms of a concussion (Delaney et al., 2002). Research has extensively documented physical symptoms (e.g., headaches, fatigue, vision impairment) of concussions (Benson et al., 2011; Echlin et al., 2010; McCrory et al., 2009). There is evidence that athletes may suffer psychological sequelae as a result of a concussion (Chen et al., 2008; Johnston et al., 2004). Specifically, Chen and colleagues found that functional Magnetic Resonance Imaging scans of concussed individuals indicated similar neural responses in brain areas commonly linked with major depression. Athletes who experienced a career-ending injury suffered depression, substance abuse and suicidal ideation (Werthner & Orlick, 1986). The purpose of this study was to investigate former National Hockey League (NHL) players experiences with career- ending concussions. The specific research questions guiding this work included: How are NHL players affected physically and psychologically by career-ending concussions? How do NHL players who suffered a career-ending concussion experience career termination and transition? Our study used an Interpretative Phenomenological Analysis (IPA; Smith et al., 2009). IPA is a qualitative research methodology used to understand and explore how people make sense of important life experiences. Significantly, IPA has been extensively used in health research (Smith, 2011). Participants 1. Prevalence of Concussions They were unsure of the number of concussions they suffered during their careers: I cant remember my first one. I have four documented concussions and there are numerous ones that I played through. Theres no way I could ever put a number on it because it was never really recognized as a concussion. It is well north of ten. (P4) 2. Physical Symptoms They all discussed the types of physical symptoms they endured after suffering a concussion. In addition to headaches, they all described the vision impairments they experienced during their careers: I played in (name of city) that night. I took a face-off and everything went blurry and I got scared. And somehow I held it together I guess. I dont even remember the game. (P5) I went to the penalty box and couldnt see out of my left eye. My vision was all blurry. Everything was blurry in my whole eye. Couldnt see our of it, but I played the rest of the game. But obviously I was worried because I couldnt see. (P2) In addition, they all still experience a variety of concussion symptoms (4–14 years after retirement) in their day-to-day lives: Im not as sharp as I was communication-wise. Im not able to focus for long periods of time or process things as well, or as quickly. I used to love to read. But, you know, longer than a half- hour I still cant do it. And if I do, then Im dead tired. Im less tired after going to the gym than I am after reading for a half-hour. (P1) 3. Isolation and Withdrawal They felt isolated after their concussion because they were unable to socialize with their teammates. Some also felt alienated by their coaches during their recuperation: After suffering a concussion, some of our participants hid their symptoms from teammates, coaches, and medical professionals and continued to play (Delaney et al., 2002). It is possible they were perpetuating a macho mentality of playing through pain, that often occurs in male sports (Young et al., 1994). These results indicate a need to increase concussion education among athletes, coaches, and family members. The symptoms of isolation (Bloom et al., 2004) may have resulted from the concussion rehabilitation protocol that separated them from their teammates (e.g., McCrory et al., 2009), and/or because their coaches alienated them from the team functions until they received medical clearance to return to play. Although participants did not articulate it, feelings of isolation may have elicited more severe psychological symptoms such as depression, anxiety and/or suicidal ideation (Chen et al., 2008; Werthner & Orlick, 1986). Because they occurred concurrently, it is not clear whether these symptoms were initiated by their concussions or their career termination. Regardless, these mood states indicate a need for psychological counseling in addition to medical guidance during their rehabilitation and transition to post-athletic careers (Kontos et al., 2004; McKnight et al., 2009). All participants continue to experience concussion symptoms up to 14 years after retirement, including headaches, memory detriments, and vision impairments. In accordance with McCrory et al. (2009), concussion research needs to consider potential long-term problems associated with the injury and account for athletes no longer competing in sport. * References readily available upon request: They all have felt limited in their post-hockey careers due to ongoing concussion symptoms: As active as I am, my concussions have hindered my ability to work at the highest level. Im afraid that Ill get into a situation where I wouldnt be able to fulfill a commitment or an obligation. So, I wouldnt be able to travel if I became a scout, general manager, or coach because my head wouldnt allow me. I can get through my day and do stuff but if I need to take a rest, I take a rest. If you have a job where youre being relied upon, you dont have that kind of flexibility. (P4)