By John McGill – B.PEd University of Regina, Strength & Conditioning Coach, Comprehensive Concussion Management Certified, NCCPT, Hockey Canada High Performance 1 Certified, Assistant Coach University of Lethbridge Women’s Hockey Team

I can bet, that almost every day across the country someone at a rink looks at a player and says, ‘that kid has never been the same since they’ve been hurt’.

The issue of athletes getting hurt or having a concussion is never going to go away, but there is an opportunity to improve our response to it and I want to share with you ways we can improve it.

Let’s start with an injury.

The best thing that can happen is the doctor has medically cleared the athlete. That means they have been to a doctor and been properly assessed. Then how things typically play out, is the athlete informs their coach they’ve been cleared and they can return to play. This is where I think by adding in another step, we can improve the chances of an athlete’s safe return to sport.

Let me explain.

Kids want to play, players want to play, athletes want to play. I have kids myself so I understand, kids aren’t being purposefully difficult they just want to play.

With on-ice injury recovery, my first priority is to help a player return to pre-injury status or as close to it as possible without recurrence or subsequent injury. Concussion research has determined that players returning from a concussion are more likely to suffer a subsequent lower-body injury due to issues with balance, coordination and or reaction time. This was found across several sports including hockey. Therefore, it becomes even more important to ensure we are doing everything we can concerning preparing them to return to play.

When I work with hockey athletes, I create a program that is unique to each player, each injury and each incident. Our first meeting provides an opportunity to acquire a complete understanding of the injury, the context of how it occurred and where the player is mentally concerning current status and expectations going forward. From this initial meeting, I create an on-ice program specific to the described injury.

Each on-ice program is tailored to meet the skill specificity demands of the sport not only at the injury site, but in the case of a physical injury, along the entire motion segment and beyond. By addressing all on ice elements, we are taking the appropriate steps to mitigate any re-injury or any subsequent injuries that could hamper continued long term player development.

My first piece of advice for parents is to get involved and to get to a doctor when an injury occurs. I am sure many of you would not be surprised to hear that there are many instances where it is expected upon the player to “tough it out”. Any unassessed injury can be detrimental to the player’s ability to progress or to remain injury-free.

Talk to the doctor, talk to your child, talk to the coach before they return to their sport. Whatever you do, don’t push them back in. We see it all the time, kids being pushed back into sport when they’re not ready. It’s cause for another conversation, but making sure your child is healthy in the long run is the most important part. The health of your child should be the number one priority, not the fact they’re missing too many practices or games.

My second piece of advice is for coaches and before I begin, I do want to state that I understand the state of hockey coaching across the country. It’s generally a volunteer position, oftentimes with 20 or more kids on the ice and 1 coach and 1 assistant and ice time is very, very limited.

Will injuries and or concussions ever stop? I really don’t think so, but I know there is an opportunity to mitigate some of this through the education of parents and coaches.

When the athlete returns to the ice from an injury, ask the coach to take a look at the athlete before practice gets into full swing. Look at how the player is skating. Are there any glaring issues?

Having spent time as a Strength and Conditioning coach at the Major Junior level, I am confident when I say that it is difficult to identically replicate “on ice” skills in an “off ice” capacity. Just the addition of skates alone makes this an issue.

If the opportunity is available, try to ease the player back into on-ice skills to re-introduce the movements. Time, space and knowledge are all factors that come into play at this point but do what you can to assist this player to recover sport specifically. Maybe an assistant coach can take him or her off to the side to individually work with the child and to make sure there’s no problem.

My long term goal is to hopefully work with governing bodies like Hockey Canada, and or Hockey Alberta and see if they will build awareness around post-injury into the coach’s education they already do. If coaches can be better prepared for what to look out for when an athlete returns from an injury, as well as how you can re-introduce them back safely, it would go a long way with long term player development. Lifelong participation is the goal. Players, regardless of level, need the opportunity to fully recover from an injury and to do so sport specifically.

Lastly, I want to address the issue of concussions, but I will preface it by saying I am not a medical professional. My strategy with concussions is recovery-based only. I do not assess or manage a concussion. Assessment and management belong in the hands of highly trained and educated medical professionals. Should any symptoms become apparent, I immediately stop and the athlete is referred back to the medical professionals for further assessment.

Hockey Canada has an excellent resource called “Return To Play”, which is a concussion protocol for athletes. There are 6 steps outlined in ‘Return To Play’, all designed to return the player back to sport gradually after a concussion. Once kids clear steps 1 and 2 (consisting of light activities and light exercises), and they are cleared by a medical doctor and moved onto step 3 which is sport-specific activities and training. But what does that mean?

This is where my own research and practice in dealing with athletes with injuries and concussions comes into play. I would like to see step 3 include going back to their sport WITH GUIDANCE. Right now it’s going back to their sport but nothing specific about going back with guidance or any progressive on-ice program to follow.

This is where my strategy is employed by again developing an on ice set of skills for unique to the individual and their circumstance. Each concussion is unique. Each affects the individual differently. Therefore, upon stepping back on the ice for the first time following medical clearance to do so, the athlete should be guided to allow for a “re-wiring’ to take place. Let’s mitigate what we can when we can.

For all kids in their sport, they have a coach and if you’re lucky you have an athletic therapist. I would love for a doctor to be on site when a kid returns from a concussion but I know that’s not realistic. But why not have an athlete return to the sport with guidance by a concussion or injury knowledgeable skating professional? This way they are provided an opportunity to recover sport specifically ensuring they are ready for steps 4, 5, 6 and a full return to play.

It’s so easy for an athlete to get back on the ice (if that’s their sport), skate around the rink, tell their coach they’re feeling fine, they have no headaches and or symptoms and then move onto the next step, putting them closer to returning to play. Yet balance, coordination and reaction time may not be where they need to be to ensure they remain healthy moving forward.

I believe that with specific guidance on the ice, having someone prepare skills for their balance, their timing or tracking a puck to receive a pass, they would be a better position long term after returning from a concussion. It may only take a few sessions to be fully ready to move on. Or, it could take months.

The concern is that subsequent concussions are more easily attained now, so the player regardless of age or ability, needs to be ready to return to play. Athletes not only want to know they are getting better, they need to know. What better way to accomplish this than on ice, in equipment while progressively guiding the re-introduction of skills needed to play the game.

I would like nothing more than to work with all governing bodies starting with Hockey Canada concerning helping youth athletes. Last year there were over 600,000 registered hockey players across Canada and 90,000 coaches. I hope that one-day National and Provincial governing bodies across Canada will see the need to not change but rather enhance the current ‘Return To Play’ protocol for concussion injury.

Concerning the Long Term Athlete Development Model, further education and awareness can only help us prevent injuries and concussions in the long run. If prevention is the primary concern and if athletes are more susceptible to secondary or subsequent concussion, there is a need to make sure they are ready to move up the protocol.