The growing number of notable NHL stars sidelined by concussions this season have given rise to concern of an “epidemic” of head trauma-related injuries. Here’s a look at the situation, the measures taken by the league to address it, and what more can be done.

In recent years, head trauma injuries – specifically, concussions –  have become a significant issue for the National Hockey League.

Because an unusually high number of notable players have been sidelined by various degrees of the injury (including “concussion-like symptoms” and “post-concussion syndrome”) this season, it has become the hot button topic facing the league.

Over the past couple of weeks, stars like Pittsburgh’s Sidney Crosby and Kris Letang, Philadelphia’s Chris Pronger and Claude Giroux, Ottawa’s Milan Michalek and Carolina’s Jeff Skinner were sidelined by concussion-related injuries.

Pronger’s season is over, while Crosby, re-injured only two weeks after his return from an lengthy absence, is once again on injured reserve, raising questions over his future in the NHL.

It was bad enough when the league were losing average players, though few seemed to express as much concern whenever they were knocked out of the lineup, but the sidelining of big name stars like Crosby, Pronger, Giroux, Letang, Michalek and Skinner in the span of two weeks is enough to make everyone – from fan to blogger to pundit to players to coaches to team and league executives – sit up and take notice.

It’s also given rise to considerable criticism toward the NHL over its handling of this issue, creating something of a cottage industry for those seeking one factor upon which to pin a solution to the problem.

Unquestionably, the league dragged its feet for a number of years regarding the assessment, treatment and prevention of concussion injuries. Superstars of the 1990s, like Eric Lindros, Pat Lafontaine and Paul Kariya, had their careers shortened as a result of the league’s lack of knowledge, and seeming unwillingness to learn, about concussions.

One can only guess at how many NHL players of the more distant past had their career hampered or cut short by concussions.

But in recent years, the league has taken steps to seriously address the issue, implementing Rule 48 to crack down on blindside or targeted hits to the head, investigating other measures to reduce concussion injuries, and exploring ways  to better assess and treat them.

As for finding one specific reason for the occurrence of these injuries, that may be unreasonable. Players on skates traveling at high speeds, encased in hard, plastic protective gear, clutching long, narrow sticks,  playing in an enclosed space on a hard, slippery, unforgiving surface, surrounded by boards and shatter-proof glass run a significant risk of injury.

Several factors have led to the growing perception of an epidemic of concussion-related injuries in the NHL.

Deliberate targeting of the head. For several years this was considered the leading cause of head injuries amongst NHL players. A player lying unconscious, usually face down upon the ice, following a vicious blindside or targeted hit to their head was a sickening sight,  invoking considerable criticism of the game.

But statistics released earlier this year following a study of 80 concussions reported during 2009-10 revealed 44 percent of those injuries were the result of legal checks to the body, not targeting the head. Moreover, the implementation of Rule 48 clamping down upon targeted hits to the head last season resulted in a decline in such hits and concussions resulting from same, while the rise in concussions last season was more the result of accidental collisions among teammates.

Interestingly, 14 percent of those concussions resulted from secondary injuries, either from whiplash from a legal bodycheck, or the head stiking the ice or boards from such a hit.

The league has further toughened up Rule 48, but stopped short of banning all hits to the head.

Concussions from fighting. File this under “blatantly obvious”. Only the willfully ignorant or the incredibly stupid would dismiss the possibility a hockey player can receive a concussion from punches to the head. It’s more than coincidence studies of the brains of former enforcers Derek Boogaard, Bob Probert and Reg Fleming discovered those late players had various stages of CTE (chronic traumatic encephalopathy), though the league is reluctant to accept those results.

The NHL could eliminate fighting overnight if it wished, but won’t because they believe, with justification, most of their fans enjoy it, and most of the players don’t want fighting banned from the game. There’s two ways fighting could be eliminated from the game;  if a player dies, on the ice, in front of thousands of fans, as the direct result of one, or if more studies prove the risk for serious head trauma exists as a result.

Even then, it could take years to bring about a ban.In the meantime, expect the league and the defenders of hockey fights to persist in defending it as part of the game, who’ll also point out – correctly – most concussions in the NHL aren’t due to fights, but from bodychecks.

Increase in reporting injuries. It wasn’t that long ago, a little over a decade, when the standard response to a concussion amongst NHL players was to simply “shake it off”, that they’d had their bells rung, and just needed to “clear the cobwebs” and get back to action. Those who didn’t were considered weak or lazy, and were often ordered back into game play before they’d either been properly diagnosed or received proper treatment.

Of course, in today’s NHL, there’s considerably more acknowledgement that concussions are more than just momentary fuzziness, that they are indeed serious head trauma, which seeming affect different people different ways. Players, and teams, are taking the issue more seriously in the past, and thus it’s being reported more than in past years.

Still, a recent report suggested players at all levels of hockey are reluctant to report these injuries, either because they insufficiently understand the symptoms, or don’t want to come out of the lineup.

Hopefully, with better understanding of the symptoms, this will be a trend that changes.

Equipment. Since the late-1990s, hockey personality Don Cherry has been advocating for changes to current upper body equipment, especially shoulder and elbow pads, pointing out the hard plastic encasing those pads may be a reason for the increase in upper body injuries among NHL players.

It’s an issue the league has taken seriously in recent years. The Toronto Star reported the league had banned the hard plastic shells on elbow pads in 2003 and on shoulder pads last season.

Helmets continue to be improved. One never sees the flimsy Jofa style helmets once favored by Wayne Gretzky in his heyday in today’s NHL.

The league is also conducting a pilot program regarding the potential implementation of smaller equipment.

It remains to be seen if this smaller equipment will be implemented in future, let alone if it’ll reduce inflicted injuries.

Bigger players. NHL players have been getting bigger, taller and stronger over the past thirty years,  a trend unlikely to change.

Thanks in no small part to the post-lockout rule changes putting emphasis on speed and skills, there’s been an increase in smaller players in recent years making the NHL, but  the trend remains toward players who best incorporate size, skills and speed.

Rink dimensions. The players are getting bigger, but the average dimensions of an NHL rink (200 feet by 85 feet) haven’t changed for decades.

The result is there’s no longer as much room on the ice for players to maneuver as in previous decades, meaning the possibility for collisions – intended or accidental – have increased.

Complaints were raised over the glass surrounding the rink, especially seamless glass, contributing to the head injuries. Since last summer,  the NHL has replaced seamless glass in all their arenas with more flexible stanchions to better absorb the force of player impact into the glass.

Increase in pace of the game. The NHL eliminated the red line following the season-killing lockout of 2004-05 in an effort to increase the tempo and excitement of its product following a decade of what is now derisively known as “The Dead Puck Era”, where speed was sacrificed as uncalled obstruction masquerading as defensive hockey sucked the life out of the game.

Unquestionably the NHL product is much faster now compared to the pre-lockout era, but now there’s concern speed is creating too many situations where players are getting involved in more collisions with defensive players or teammates.

The increase in speed has undoubtedly contributed to the concussion situation, but not to the extent where the league will consider it too dangerous and bring back the red line. Having seen the significant improvement in their product since the lockout, as well as the positive reviews from fans and pundits, the NHL won’t go revert to something which could potentially suck the life out of the game again.

So what needs to be done to better address the concussion issue?

Forget about reimplementation of the red line. The league won’t establish height and weight restrictions upon its bigger players. Don’t even think about increasing the rink dimensions, as that would mean costly changes to the 30 NHL arenas, resulting in reduction of seating, which spells loss of revenue, meaning no chance of implementation.

Perhaps the best way to significantly reduce concussions would be to eliminate all body-checking, but no one wants to see that. Rightly so, since body-checking is part of what makes the game exciting. The hockey world may be torn over the issue of fighting in the game, but there would be unanimity against eliminating body-checks.

Since that’s not an possibility,the best ways to address the issue is to continue finding ways to improve equipment that would help reduce the infliction of injury without sacrificing individual player safety, the elimination of all hits to the head,  penalizing those who engage in such tactics, continued examination of rinks to ensure player safety won’t be compromised, and continuing education over the causes, prevention and treatment of concussions.

Ultimately, there’s no way to completely eradicate concussions from hockey at any level. The risk is always there, even in a non-contact league.

But every effort can be made to eradicate “head-hunting”, improve player equipment and safety, and continue to better understand, report and treat all head trauma.

If there’s any good that can come from the rash of concussion injuries sidelining some of the NHL’s best players, it’s that it is forcing the league into becoming more proactive in addressing the issue and to take the necessary, realistic means to improve the safety of its players.