Toronto — Once upon a time eye injuries were a frightening reality at all levels of hockey. From the professional ranks to Atom, eyes were exposed to the randomness of high sticks and flying pucks and tragedies followed.
Accidental blindness was a part of the sport.
It's almost hard to imagine now, but over his nearly 50-year career Dr. Charles Tator has watched hockey safety evolve to the point where kids can play their entire minor hockey career without risking their eyesight to bad luck or carelessness. And even in the professional ranks, playing without a visor will eventually become a thing of the past, as every player entering the league from 2013-14 is required to wear one.
When it comes to protecting players' eyesight at all levels, the battle has been won in spectacular fashion, although the NHL was the last holdout to common sense.
Will the same be said for brain health in hockey?
The question has become the prism through which hockey is increasingly viewed these days, as everyone from hockey moms to NHL commissioner Gary Bettman wrestle aligning the nature of a hard, fast game and the increasing knowledge of the risks of brain injuries for those who play it, at all levels.
Tator has become synonymous with the push for greater concussion awareness, the sport's conscience in many ways.
The Toronto-based neurosurgeon was referenced multiple times by members of the NHL's head office as executives discussed the league's concussion issues in a trove of previously private email communications that have become public. They are evidence in a class action lawsuit filed in Minnesota alleging the NHL was aware or should have been aware of the long-term effects head trauma could have on its players.
From then-NHL senior vice-president Colin Campbell making reference to those advocating for greater safety as 'Greenpeace pukes', to former NHL senior vice-president of hockey operations Mike Murphy complaining the league has become 'over-doctored', to vice-president of hockey operations Kris King lamenting about the league having to answering to the Charles Tators of the world, the member of the Canadian medical Hall of Fame has become part of the NHL vernacular.
Tator doesn't mind. If anything he's encouraged that his message about the need to make hockey safer had penetrated the highest levels of the sport, even if his views were met with resistance, if not outright derision.
"I have a very thick skin in terms of criticism," he says.
He's got more important things to worry about. He's been on a quest dating back nearly two decades, when NHL players and minor hockey players alike began arriving at his office in greater numbers, their brains injured through acts that he views as tertiary to the game itself.
"It was obvious that aggression and violence were the cause of many [brain injuries]," said Tator. "Do you remember how [former New Jersey Devils defenceman] Scott Stevens played? A good shoulder to the head would lay them out flat, people would clap, that was a good thing to do, 'good for you Scott'.
"But it wasn't good for the player that was knocked out. Not only was there the knockout on the ice, but there were the after effects … it wasn't death on the ice, but almost a slow death."
He hopes that he will eventually see the same consideration for protecting players' brains as has been given to preventing eye injuries and spinal injuries, even if the path to such a seemingly obvious goal seems uncertain and resistance apparently is at the highest levels of the sport.
"I believe we can change the game," he said during an interview at his offices at Toronto Western Hospital. "But it has gone very slowly because those who are in charge of the professional game have another idea. They believe that violence and aggression sells, that that's what the public wants.
"[But] now I think we've realized when we've reached the level of parents withdrawing their kids from hockey, when we've reached the level of kids as young as 13 having to withdraw because of repetitive concussions … all of this evidence is mounting.
"The evidence that we need a cultural shift in hockey, it's all there to be appreciated by those that are running the game."
The league bristles at the characterization.
"Other than I don't agree with Dr. Tator's opinion, and that the actual facts belie it, I have no intention to comment further," said NHL deputy commissioner Bill Daly.
For inspiration about the possibility for change, Tator cites the influence of Dr. Tom Pashby, an ophthalmologist inducted to Canada's Sports Hall of Fame for — among many accomplishments — first introducing helmets to minor hockey and publishing research regarding eye injuries that led to face protection becoming mandatory in Canadian minor hockey in 1980.
Tator joined with Pashby as evidence that spinal injuries could be reduced with greater awareness and rules against checking from behind.
"Protecting the eyes was a big item and he was instrumental in helping me figure out how to prevent broken necks," said Tator. "I'd like to see it down to zero, but we have made progress. We used to see 14 or 15 cases a year and now we're down to one or two a year, so that is an improvement."
But brains are trickier. No one needed to be educated about the risks posed by sticks and pucks hitting players in the eye, and the solution was obvious.
Spinal cord injuries were another challenge and remain so, even if progress was made. Cutting down on them required education about their causes and subsequent changes to player behaviour. Helping the effort was the stark evidence of what happens when players break their necks when hit from behind: A young athlete in a wheelchair sends a powerful message.
Intentionally checking from behind has quickly become one of the sport's new taboos.
Helping hockey understand its concussion problem proved more difficult. The injuries occurred in the course of the way the game has always been played and their effects were harder to demonstrate, sometimes even to the players themselves.
Tator applauds changes the NHL has made in banning checks to the head, blindside hits and checks from behind.
But he's adamant that the league should take a bigger role in promoting safer hockey. A hockey fan himself, Tator believes there is a style of play that would simultaneously thrill fans and soothe his physician's conscience, citing the way the game is played during the Olympics or even the Stanley Cup playoffs as examples.
"The game can be played safely and well and be extremely enjoyable," he says. "And if people want fights and blood, go to a different sport."
With nearly 50 years of medical practice under his belt, Tator is accustomed to taking the long view. He's seen eye injuries in hockey become a thing of the past. He's been instrumental in helping grow awareness around the prevention of spinal injuries.
If the brain is the final frontier, he's confident there can and will be progress made there too. He cites the push to pass Rowan's Law in the Ontario Legislature – a bill requiring the coroner's recommendations made following the death of Rowan Stringer, an Ottawa high school rugby player who died after suffering three concussions in a week – as an example of the growing momentum around concussion awareness.
He's seen dramatic changes in the approach to hockey safety before. He's confident there are more to come.
"You have be an optimist to be a neurosurgeon," he says. "You're always hoping that there will be a change of attitude towards this. And it could happen tomorrow … it's going to be in the best interests of everyone for there be an acknowledgement that the game needs to be changed."
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