Biological Sciences


Van Sciver, Barbara

Advisor Department

Biological Sciences




Concussions; Head Injuries; Hockey; NHL; Chronic Traumatic Encephalopathy; Depression; Suicide

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.


The Center for Disease Control and Prevention (CDC) estimates there are between 1.6-3.8 million sports and recreation related concussions per year. In fact there are over 4 million concussions (including non-sports related) in total each year. A concussion is defined as a serious brain injury caused by the rapid movement (linear front-to-back, side-to-side) or rotational (angular) movement of the brain inside the skull, which results in damage and disruption to the brain cell function, causing brain trauma (sports concussion library). Sports-related concussions (SRCs) are concussions that are specifically sustained during a sporting event. The sport with the highest incidence of concussions is actually biking; among team sports the highest are football and hockey. The literature shows concussions result in a wide range of cognitive, somatic, and neurological symptoms. As of now, there is no specific treatment for concussions, other than rest until the patient is completely asymptomatic. Then a graded return-to-play (normal activities) protocol is followed.

Concussions are looked at as a “silent epidemic” not only in the National Hockey League (NHL), but also in the entire hockey community. For children, hockey has the highest concussion rate in team sports, even more than football. Estimates show that concussions account for 15% of injuries in hockey players ages 9-16. Rule 48 of the NHL, which was established to eliminate body checks (or hits) that target the head, was implemented during the 2010-2011 season. However the incidence of concussions in the NHL has steadily risen from 2009 until the present. There have been seven NHL fighters/enforcers (players whose role on the ice is to fight or body check, not to score goals) who have passed away since 2009 and have donated their brains to science to be studied for Chronic Traumatic Encephalopathy (CTE) and other concussive disorders. The growing number of educational programs for hockey players, coaches, and parents, aimed to reduce aggressive behavior and injury rates, has also increased the awareness of the potential danger of head injuries.

Studies indicate that concussions have been shown to play a role in starting or catalyzing the neurological cascade leading to negative long-term neurological and neurodegenerative issues. Studies done by the NFL show that there is a large increase in the number of suicides in retired NFL players (and other contact athletes such as hockey) compared to the rest of the population. Furthermore, depression is the most prominent psychological disturbance after suffering a Traumatic Brain Injury (TBI). Research shows that athletes with a single concussion or multiple concussions in early adulthood are more likely to develop depression than the general population.

This literature review will cover concussions, with a focus on head injuries in hockey. Also, the review will look at concussion symptoms, diagnosis, testing, treatment, and will focus on long-term effects such as depression and Chronic Traumatic Encephalopathy (CTE). The main focus of this paper is concussions in the NHL, the incidence rates, the mechanism for concussions, why the incidence rates continue to climb, and the long-term effects that plague these athletes.