Hockey is a sport celebrated for its speed, skill, and physicality. However, it carries a hidden risk: chronic traumatic encephalopathy (CTE). This issue has gained increasing attention in recent years. This neurodegenerative disease is linked to repeated head impacts. It poses a serious threat to hockey players at all levels, from youth leagues to the professional ranks. While CTE has been extensively studied in American football, research on its prevalence and impact in hockey has lagged behind. Recent studies have shed light on the alarming connection between hockey and CTE. This has raised concerns about the long-term health of players. It has also prompted calls for greater awareness and prevention efforts.

What is CTE?

Chronic traumatic encephalopathy (CTE) is a progressive degenerative disease of the brain. It is found in people with a history of repetitive brain trauma. This includes symptomatic concussions and asymptomatic subconcussive hits to the head. CTE is a neurodegenerative condition primarily seen in contact sports. It can only be diagnosed by examining the brain after death. The condition slowly damages parts of the brain. It may cause trouble with memory and other thinking skills. Behavior, personality, speech, or balance may also be affected.  

Subconcussive hits are impacts to the head that do not cause a full-blown concussion. However, they can still contribute to brain damage over time. These hits may not result in immediate symptoms, making them difficult to detect and manage. These impacts can lead to significant changes in the brain over time. They may potentially contribute to the development of CTE.  

Prevalence of CTE in Hockey Players

Recent research suggests a strong correlation between playing hockey and the risk of developing CTE. A groundbreaking study was published in JAMA Network Open. It was the largest of its kind. The study examined the brains of 77 deceased male hockey players with varying levels of experience in the sport. These experiences ranged from youth leagues to professional play. The study’s findings revealed a concerning trend: the longer a player’s hockey career, the higher the likelihood of CTE.  

To illustrate this correlation, here’s a breakdown of the study’s findings:

Player Level	Percentage with CTE
Professional Players	96%
College/Junior Players	46%
Youth/High School	10%

These findings align with studies. They have linked head impacts to CTE in other contact sports, such as American football, soccer, rugby, and wrestling.  

Symptoms of CTE

CTE is a disease that develops over time, with symptoms typically appearing years or even decades after repeated head trauma. Early signs of CTE can be subtle. They may include mild memory loss, persistent headaches, irritability, slurred speech, and difficulty with balance. As the disease progresses, individuals may experience challenges with concentration, organization, multitasking, and short-term memory.  

Experts believe that CTE symptoms can manifest in two distinct forms. The first form, typically emerging between the late 20s and early 30s, primarily affects mental health and behavior. Symptoms include depression, anxiety, impulsivity, and aggression. The second form appears later in life, around age 60. It is marked by cognitive decline and memory problems. There is also an increased risk of dementia.  

Causes of CTE and its Relation to Hockey

Repeated head trauma is the primary cause of CTE. CTE has been widely studied in American football players and military personnel exposed to blasts. It’s crucial to recognize that hockey players also face a significant risk due to the nature of the sport.  

In hockey, repeated head impacts can occur in various ways:

Checking

Body checking is a fundamental aspect of hockey. This is especially true in men’s leagues. It can result in forceful impacts against the boards, glass, or ice. These impacts can cause concussions and contribute to the accumulation of subconcussive hits, increasing the risk of CTE.  

Fighting

Fighting has decreased in hockey. However, it still occurs. Punches to the head during fights can cause significant brain trauma. Studies have shown that enforcers in the NHL are more likely to engage in fights. They die an average of 10 years earlier than non-enforcers.  

Other Causes

• Collisions with other players: Accidental collisions with teammates or opponents can also result in head injuries.  
• Falls: Players can fall to the ice and hit their heads during play. They can also fall due to a loss of balance.  
• Pucks and sticks: While less common, a puck or stick can still strike someone in the head. This can also cause head trauma.  

It’s important to note that CTE is not limited to enforcers or players who experience frequent concussions. All hockey players are at risk due to the cumulative effect of subconcussive hits over time.  

Prevention and Treatment of CTE in Hockey Players

Currently, there is no cure for CTE. However, CTE is linked to recurrent concussions and head injuries. Therefore, prevention strategies focus on minimizing head impacts. They also emphasize managing concussions effectively.  

Prevention Strategies

• Rule changes: The NHL has implemented stricter rules and penalties for hits to the head. These include hits from behind and those targeting the head as the principal point of contact. Rule changes regarding fighting have also been implemented. Players are not allowed to remove their helmets before a fight. Visors are also mandated.  
• Equipment improvements: While helmets cannot entirely prevent concussions, they can reduce the severity of impacts. Ongoing research and development of helmets and other protective gear are essential for improving player safety.  
• Education and awareness: Educating players, coaches, and parents is crucial. They need to understand the risks of head injuries. It is important to know the signs and symptoms of concussions. Proper concussion management is key for early detection and appropriate care.  
• Baseline testing: Preseason baseline testing can assess an athlete’s cognitive function. It provides a valuable comparison point if a concussion is suspected.  
• Delaying body checking: Some experts recommend delaying the introduction of body checking in youth hockey. This approach aims to reduce the risk of head injuries in younger players. The Canadian Academy of Sport and Exercise Medicine recommends removing body checking in all levels of minor hockey. Exceptions are made for elite leagues. For these leagues, only players aged 16 and older should engage in body checking.  

Treatment

Treatment for CTE focuses on managing the symptoms. This management may include medications to address mood and behavioral changes. It can also involve therapies to help with cognitive and motor impairments.  

Personal Stories of Hockey Players Diagnosed with CTE

Several former NHL players have been diagnosed with CTE after their deaths, highlighting the devastating impact of this disease. These cases underscore the need for continued research. Prevention measures are crucial. Support for hockey players who may be at risk for CTE is essential.

Here are a few examples:

• Bobby Hull: The Hall of Fame forward helped the Chicago Blackhawks win the Stanley Cup in 1961. He was diagnosed with stage 2 CTE after his death in 2023.  
• Steve Montador: This NHL veteran openly discussed his struggles with depression. He faced issues following concussion problems. His diagnosis of CTE was confirmed after his death in 2015.  
• Derek Boogaard: He was one of the most feared enforcers in the NHL. Boogaard died of an accidental overdose at age 28. He was found to have advanced CTE.  

These are just a few examples of the many hockey players whose lives have been tragically affected by CTE.

Ongoing Debate and Discussion Surrounding CTE in Hockey

There is growing evidence linking repeated head impacts to CTE. However, the issue is still debated and discussed, particularly within the hockey community. NHL commissioner Gary Bettman has denied a direct link between playing hockey and developing CTE. He maintains that any links are anecdotal. However, medical professionals specializing in brain injury research have criticized these comments, asserting a definitive link between hockey and CTE.  

The NHL’s stance has been met with accusations of a “culture of denial” that puts players at risk. Dr. Chris Nowinski is a leading voice in concussion research. He has expressed concern that the NHL’s denial hinders efforts to help former players. It also impedes efforts to prevent CTE in current players.  

Initiatives and Efforts to Address CTE in Hockey

Despite the ongoing debate, various initiatives and efforts are underway to address CTE in hockey:

• NHLPA CTE Advisory Committee: The NHLPA formed a CTE Advisory Committee in 2024. It helps players understand CTE. It also addresses the impact of concussions.  
• Concussion Legacy Foundation: This foundation actively promotes CTE research and provides support for athletes and families affected by CTE.  
• Rule changes and enforcement: The NHL has implemented rule changes. It has enforced stricter measures to reduce hits to the head. These changes aim to make the game safer.  
• Research: Ongoing research at institutions like Boston University’s CTE Center is crucial for understanding CTE in hockey players.  
• Concussion protocols: The NHL has a concussion protocol. It requires players with suspected concussions to be removed from play. A physician evaluates them for 15 minutes in a quiet office location.  

Conclusion

CTE is a serious concern in hockey, with potentially devastating consequences for players. Research is ongoing. Debate continues. It is clear that repeated head impacts can increase the risk of developing this neurodegenerative disease. The hockey community can make the game safer by raising awareness. They can also work towards safety by implementing preventive measures. Supporting further research and advocating for changes in the sport are crucial efforts as well.

CTE is honestly something that scares me. I have had multiple concussions from playing hockey and lacrosse as a youth. Who knows what other kinds of damage were done with hits that did not result in a concussion. A few years ago, I registered as a Brain Donor. I did this to help study the causes of CTE. I also wanted to explore possible symptoms and treatments while people are still living. I highly recommend that others do the same. The only way that we can find treatments is with the research done with the donation.

To learn more about CTE and how you can contribute to prevention efforts, visit the Concussion Legacy Foundation website at(https://concussionfoundation.org/). You can also support research initiatives by donating to organizations like the Boston University CTE Center. Together, we can make a difference in protecting the health and well-being of hockey players.