Mayo Clinic aims to make hockey safer

As Rochester prepares to host its third ice hockey summit since 2010, it's possible the Med City has become ground zero for research and rule changes aimed at making the sport safer. That daunting task is a byproduct of hosting Mayo Clinic and its renowned sports medicine faculty.

Foremost among them is Dr. Michael Stuart , according to Michael "Doc" Fatis, owner of the Rochester Ice Hawks.

Fatis credits Stuart for leading recent safety reforms in response to rising concern about head trauma, noting his built-in credibility is critical for winning the necessary support to effect change within the tight-knit hockey world.

"Dr Stuart is the leader in this field — players and the hockey community listen when it comes from one of their own," Fatis said. "It's important that it comes from the medical community, but it's not like someone is imposing things on you. He understand these players and the sport."

Stuart is the vice-chairman of Orthopedic Surgery and co-director of the Sports Medicine Center at Mayo Clinic, while also serving as the chief medical officer for USA Hockey. His three sons have all played in the National Hockey League and his daughter, Cristin, played Division I hockey.

Stuart and colleague Aynsley Smith, a sports psychologist who coined "the yips," are scheduled to host "Ice Hockey Summit III: Action on Concussions" on Sept. 28-29. There are four main goals of the summit:

• Present the latest developments in epidemiology, prevention, diagnosis, treatment and future directions of concussions.

• Provide a scientific evidence base for action on concussion.

• Attendees will help identify actions to prevent, manage and ultimately treat concussions in hockey

• Scientific advances and potential pockets of resistance that apply to all contact sports, ages and levels of participation will be identified.

Stuart agrees that his extensive hockey background and existing connections make him a credible voice when calling for changes.

"I do understand the game — I live it," Stuart said. "I go to squirt, peewee, high school, college, Olympics, World Cup and pro games. I've been through it all. We try to go about (making safety recommendations) very logically and objectively, but we also interject some science."

A notable absence?

The list of presenters and expected attendees at the two-day event reads like a who's-who in the hockey world, as medical experts around the globe will be presenting new research in hopes of finding acceptable safety precautions.

Mayo Clinic will have at least 14 faculty members participating, including Stuart and Smith. USA Hockey's Mark Tabrum and Matt Leaf will serve prominent roles, along with Jim Whitehead, vice president of American College Sports Medicine, and various other medical experts from across the U.S. and Canada. Multiple former NHL players are also taking part, including Ben Eaves, Jordan Leopold, and Rochester players Shjon Podein and Mike Stuart.

Dr. Stuart says engineers, equipment manufacturers and "a host of other folks who have a vested interest in making hockey safer" will also be in the crowd gathered at the Siemens Building in downtown Rochester.

However, it appears the NHL may be the exception.

No one from the NHL is listed on Mayo Clinic's promotion flier for the event, which includes 44 names. The NHL is also not listed among the monetary sponsors, which includes The USA Hockey Foundation, International Ice Hockey Federation, American College of Sports Medicine and various other groups and organizations.

The NHL did not respond to questions about its potential involvement or attendance at this summit, or the two prior events. Stuart and Smith both demurred on similar questions, citing the pending lawsuit over the NHL's handling of concussions in Minnesota's U.S. District Court involving more than 100 former players.

Criticism of the NHL has mounted in recent months as the professional league has denied the existence of chronic traumatic encephalopathy and refused to fund concussion research, according to a recent story from USA Today . Representatives from three of the top CTE research facilities in North America — Boston University, University of North Carolina and the University of Western Ontario — are among the presenters at Mayo's upcoming summit.

Stuart offered a general comment about his work and its role in reforming the game.

"Hockey in general, including the NHL, has made strides — certainly in international hockey — to reduce the risk and severity of concussion in sports," Stuart said. "The thing I always try to get across to people is we need to make sports safer, especially at the youth level.

"Our job is to minimize risk, realizing that they'll never be risk free, but the benefits of sports are … very, very important."

The goal of the summit, Smith said, is to make sure the latest concussion research gets in the hands of those who need it most.

"The physicians seem to be saying the players are not getting the care they need, the diagnoses they need," Smith said. "They're getting what the NFL and NHL needs to get their players back on the field, in my opinion. They're really not seeking out the most sophisticated, strong evidence that's available to us. They're practicing at a level inferior to what they could be practicing."

In response to questioning last year by Congress, NHL commissioner Gary Bettman has argued that concussion research is still developing. Bettman's letter to the House committee last fall echoed that same skepticism.

"As you are likely aware, the most recent Consensus Statement on Concussion in Sport concluded that, 'The speculation that repeated concussions or sub-concussive impacts causes CTE remains unproven.'" Bettman wrote. "Likewise, the '2015 Consensus Document' you cite itself highlights that there are many 'gaps' in the CTE research.

"Please be assured that medical consultants for both the NHL and NHLPA follow the research closely and have done so for many years in conjunction with the NHL/NHLPA Concussion Program," Bettman added.

Summit action items

Following each summit, attendees are asked to vote on an action plan that prioritizes specific ways to improve on-ice safety. The first two sets of recommendations were published simultaneously in five medical journals, breaking traditional publication rules.

It's been allowed because medical experts feel the concussion debate has reached a crisis point, and the action items were established by a post-summit vote by attendees across the spectrum.

"It's usually not ethical to publish in more than one (journal), but because it was a public health crisis, we felt it was right to do this all at once and the editors agreed with us," Smith said.

The 2010 action items led to no checking in youth hockey until age 13. Stuart also wrote an award-winning paper that has prompted all levels of hockey to require visors in recent years; the NHL was the last to approve that rule in 2013 , after three years of dialogue and debate.

The 2013 summit called for zero tolerance for fighting and head shots , while also changing body checking policies. Those goals remain a work-in-progress.

"It's not easy and sometimes people resist change," Stuart said. "I love to have debates with old-time hockey folks about this, but we also inject data, science and proof with our opinions."

Kyle Farrell, Smith's research coordinator, notes that the NHL's basic rule on fighting — a 5-minute major penalty — hasn't changed since 1922. That history has been detailed by The Hockey News and The Denver Post in recent years as calls for change have increased.

Fighting is already banned at most levels, but it continues in professional leagues and junior hockey, which includes local teams like the Rochester Ice Hawks and Austin Bruins.

Nick Fatis, the former Ice Hawks head coach who resigned last fall due to post-concussion symptoms, equated his own semi-pro playing days to the "legalization of bare-knuckle boxing." He's 41 years old and three of his former teammates have committed suicide, which he believes is related to depression caused by repeated head trauma.

"It was real throwback hockey, but the damage that was accumulated by a lot of us was pretty insane," Fatis said. "Controlling the play with your gloves on is showing that toughness, but without that added penalty or injury of a fight. As a receiver of a lot of right crosses, that was pretty much a lesson learned."

Those lessons often precipitate hard conversations with the medical staff. That unseen damage comes with an unknown recovery timetable, which creates further angst.

"When a parent or coach asks me when their athlete will be able to return after a concussion, I tell them I don't know," Stuart said. "It might be a week and it might be never. They look at me like I'm crazy."

Ice Hawks intervention

It's not a crazy concept to the Ice Hawks, who are all too familiar with the concussion dilemma.

Fatis was forced to resign last fall and Vinnie Susi, the Ice Hawks' top assistant, just made the same decision this month. Both men face long-term health concerns due to concussions and were simply unable to fulfill their duties in their current state.

Years ago, Fatis' personal struggles prompted him to approach Mayo Clinic about enrolling his whole team in research studies that could prove mutually beneficial. That offer could end up impacting a variety of sports.

Mayo has installed three video cameras to monitor every Ice Hawks home game, while the players have also been fitted with accelerometers that help researchers track linear and rotational acceleration. When that data is compared to reported concussions, it provides experts with a concussion threshold.

For example, the acceleration data can help determine at what speeds concussions are likely, reducing the reliance on subjective testing.

"In order to take concussion research further, you have to be able to recognize the concussed athletes," Stuart said. "If we're better at identifying them at the rink, we're better at treating them. We think that's pivotal for future concussion research."

Smith added: "Research is all converging on objective measures, which are very important. We can't just say we're fine and then go back out to take another hit on the head."

Stuart says Mayo is currently testing a variety of methods on the Ice Hawks, including blood draws, that "we hope will develop someday into prime time."

Those types of breakthroughs — or hypotheses, for now — make Ice Hawks owner Michael "Doc" Fatis, Nick's father, optimistic about the future of the sport. However, it also makes him wish this science had been available decades ago.

"We were unaware of so much back then," Doc said. "Back then, if a kid got his bell rung, he was eager to go back in. It was the manly thing to do. The problem (with concussions) is there's no visible signs. Back then, we were just unaware of all of these things.

"This new sophistication, the stuff we're doing with Mayo on our team … now it's a matter of providing players with all the necessary safeguards. Sometimes it puts us at odds with players who want to play. The big issue is having the player sit until he's ready because the biggest risk is coming back too soon."