The Sports Doc: New concussion protocols to keep athletes safe

TheSportsDoc graphic

Welcome to MiHockey’s new column, featuring Dr. Jeff S. Pierce, a Michigan Board Certified Doctor specializing in Sports and Rehabilitation. Dr. Pierce will discuss all things hockey and keeping players healthy and injury free on and off the ice.

Participation in sports is an important part of physical, mental, and social development for our youth. While they are meant to promote health, sports carry an inherent risk of injury.

Evidence is growing that the short and long-term health risks associated with brain trauma in sports are more serious than previously known. While concussions have been the primary focus of the medical community, the media, and the sports world, it appears they are only part of the problem. A growing number of studies show the risk of short-term and long-term brain damage, and neurodegenerative disease may be more closely related to an athlete’s cumulative brain trauma over their lifetime. This brain trauma includes both concussions and subconcussive impacts, which are rapid movements of the head that don’t cause any concussion symptoms.

Studies are now finding that some athletes who have received subconcussive impacts, but have never shown any concussion symptoms, still have abnormal findings on certain tests of brain structure and function. It is not yet clear if these results were caused by too many impacts in a day, a season, a year, and even a lifetime, but one thing is clear: hits to the head are dangerous and more needs to be done to protect athletes.

Photo by Michael Caples/MiHockey
Photo by Michael Caples/MiHockey



Dr. Jeff S. Pierce serves as Medical Director of the Michigan Sports & Spine Center. For more information on the MSSC, visit their official website by clicking the image above.
Dr. Jeff S. Pierce serves as Medical Director of the Michigan Sports & Spine Center. For more information on the MSSC, visit their official website by clicking the image above.

Concussions are an issue at all levels in many sports. Statistics from the Centers for Disease Control and Prevention show that among high school athletes, boys’ ice hockey poses the second highest rate of concussions, after only football. The prevalence of concussions in youth hockey is surprisingly similar to concussion estimates in the National Hockey League (23 per 1000 player-game hours).

One factor found in a videotape analysis of bantam players is that on-ice skating characteristics helped explain why certain players sustain concussions. These players tended to skate with their heads down watching the puck, positioning themselves in the “danger zone,” which is between 8-16 feet from the boards, and they didn’t optimally position their body to receive a check. Thus, when checked, these players were more often flung into the boards; and collisions too often occurred when their heads were down. Many coaches are working in practice to reduce this style of play; equipment manufacturers are finding ways to increase protection and rinks are installing safety features in the ice; but this type of injury happens to even the best and most experienced players.

The concussion problem goes all the way up the NHL. The NHL is facing multiple lawsuits from former players alleging that it improperly handled concussions and other brain injuries and didn’t do enough to protect them from the long-term dangers of concussions. The suits are similar to the class action complaint against the NFL, which did reach a substantial settlement. This just proves that training and education needs to be implemented at every level of hockey.


Educate yourself on the signs and symptoms of concussions and be sure your coaches and trainers have the same, and they have protocols in place if an injury of this type occurs.

What are the signs/symptoms of a concussion?

Signs observed by coaching staff:

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms observed by athlete:

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  • Just “not feeling right” or “feeling down”

If you suspect that a player has a concussion, you should take the following steps:

  1. Remove the athlete from play.
  2. Ensure athlete is evaluated by an appropriate health care professional. Do not try to judge the seriousness of the injury yourself.
  3. Inform athlete’s parents or guardians about the known or possible concussion and give them the fact sheet on concussions.
  4. All athletes to return to play only with permission from an appropriate health care professional.

“It’s better to miss one game than the whole season.”


All athletes who sustain a concussion, no matter how minor, should undergo an evaluation by a qualified healthcare provider like Michigan Sports & Center before returning to play. In some instances, clearance from your primary care doctor may not be enough. There are many factors that determine when an athlete is safe to return to play. We have very specific protocols that measure an athlete’s responses at different levels of rest and activity; and in some cases other therapy may be needed. Not until they are completely free of all symptoms and remain symptom free during and after physical testing, is it safe to return to play. If you are unsure, please call us to schedule a consultation. Our goal is to get athletes back in the game as soon as possible only when it won’t risk further injury. I also encourage you to talk to your coaches and trainers to make sure they are up-to-date on the latest protocols to keep athletes safe.

We will be addressing all types of common sports injuries, treatments, rehab programs, preventative measures, strength/off-ice training, hydration and proper nutrition right here in each issue. We want to make sure you know when and where to get the proper treatment, rehabilitation and all the information you need to stay healthy, safe and injury-free.

If there is a topic you would like to see covered, or you have a question for The Sports Doc, please submit them to

Meet The Sports Doc

Dr. Jeff S. Pierce serves as Medical Director of the Michigan Sports & Spine Center specializing in comprehensive treatment programs for spine, musculoskeletal and joint injuries including sports and occupational problems. Dr. Pierce treats all types of athletes of all ages and levels and has worked with several professional athletes, including the Detroit Red Wings; has served as team physician for several organizations; and team physician for several elite hockey teams including Belle Tire, Little Caesars, and Oakland Junior Grizzlies. He has also become the doctor of choice for entertainers, with many now referring to him as “Doc Rock”. You don’t need to be a professional to see Dr. Pierce; every patient that comes through the door receives the same VIP treatment and excellence in care.

Contact Dr. Pierce at 248-680-9000, or at to schedule an appointment or consultation about your injury or rehabilitation.