By the end, Steve Montador’s brain was not functioning normally. The former Bruin’s symptoms included depression, memory loss, and erratic behavior. The 35-year-old Montador died on Feb. 15. An official cause of death has not been released.
In the years before his death, Montador’s thinking was clear enough for him to agree to donate his brain.
On May 12, the Krembil Neuroscience Centre’s Canadian Sports Concussion Project (CSCP) announced that Montador’s brain showed buildup of tau protein consistent with chronic traumatic encephalopathy (CTE). Experts believe concussions trigger CTE, which can lead to brain degeneration and initiate symptoms such as those that afflicted Montador. He was diagnosed with concussions throughout his career.
Dr. Lili-Naz Hazrati, a neuropathologist at Toronto’s University Health Network, conducted the autopsy. Hazrati classified the tau buildup as widespread, meaning it was distributed in different areas of the brain, including the frontal, temporal, and parietal lobes. The locations of the tau, according to Hazrati, corresponded with Montador’s symptoms. It’s likely that Montador’s problems would have worsened.
“Once you get those different concussions, it initiates something in the brain that’s automatic and on its own,” Hazrati said. “Once you get multiple concussions, even though they stop, the damage to the brain has been initiated. It becomes a process that can evolve on its own.”
Montador played for six NHL organizations. He appeared in 571 career games, including 13 with the Bruins. The defenseman fought and checked. Montador’s concussions proved that his brain accelerated, decelerated, and rotated after collisions. His brain stretched. Upon trauma, tau transformed and clustered, triggering inflammation and damage.
But Montador might also have been unlucky. The CSCP concurrently analyzed the brain of John Forzani, a 67-year-old former CFL player. Forzani’s brain did not show signs of CTE, even though he was diagnosed with concussions during his playing career. Forzani could have had genetic safeguards that Montador was without.
Montador did not have good luck. But his decision to donate his brain may save other people at risk for CTE. As grim as it may sound, researchers need more brains of hockey players to expand the knowledge of what’s taking place on the ice that could worsen lives upon departure from the game.
“We don’t know the full extent of the changes that occur after hockey,” said Dr. Ann McKee, chief of neuropathology at the VA Boston Healthcare System and codirector of the Center for the Study of Traumatic Encephalopathy at Boston University. “We don’t know if it’s identical to what goes on in football. I’d imagine there are differences. There might be different regional variations of what parts of the brain are most vulnerable. It’s possible. I do think hockey has the potential to really limit the amount of head trauma. There are going to be the unfortunate collisions. But rule changes will make a huge difference in hockey.”
Massachusetts General Hospital and Brigham and Women’s Hospital are among the facilities conducting positron emission tomography (PET) scanning on Alzheimer’s patients to identify tau buildup. According to McKee, it will be harder to apply PET scanning to diagnose CTE because the lesions in the disease’s initial stages are very small. So for now, the only accurate method for CTE diagnosis is by studying brains. This is the heart of McKee’s work.
McKee is based at the Bedford VA Medical Center. Donated brains — donors include athletes and veterans — are stored in the morgue, which is located in Building No. 2 of the Bedford campus. Ideally, brains arrive within 24 hours of death.
They are stored in a refrigerator until McKee and her team are ready for their work. The process — cutting the brain into segments, preparing slides, making the initial diagnosis, confirming the existence of CTE — can take as long as six months. Samples are then frozen and made available for further research.
There have been 262 brains, including 183 from football players, donated to McKee’s group. Eleven are from hockey players.
Postmortem diagnosis happens too late to save someone with CTE. But it confirms to family and friends that there is a reason behind depression, personality changes, and memory loss.
“The families then understand that this isn’t willful behavior,” McKee said. “It’s not voluntary that these guys are aggressive, irritable, out of control, or abusive. You’re dealing with this brain injury and brain damage that causes them to act in often very unpleasant ways.”
It’s possible that current and former hockey players are suffering from CTE. If so, they’re subject to further deterioration. There is no cure for CTE. It could progress into other conditions such as Alzheimer’s. In the future, genetic markers could determine who is most likely to develop CTE. This could convince at-risk hockey players to stop playing.
Advances in CTE study could also produce drugs to treat the disease. Experts believe they know how CTE is initiated. This could allow researchers to target specific areas of the brain that could be treated with medicine.
“With Alzheimer’s, we don’t know when it starts,” Hazrati said. “Here we have a situation where we know that if we get a concussion, it may initiate something in the brain. We could intervene earlier when we get symptoms.”
Hockey is dangerous. Even amid the decline of fighting, concussive contact takes place regularly. It’s the nature of the sport, just like it is in football, boxing, and other contact sports.
CTE awareness is growing. But more research and more brains (donation information can be found here) are required to develop criteria for players to follow when head trauma takes place. In years to come, a player such as Montador could take a pill, retire, or not even play hockey at all. This could be part of his legacy.
“At this point, we’re still pretty unclear about what all the risks are,” McKee said. “We can be kind of general. But we need to develop some concise information about how much exposure, what type of exposure, and what is the cumulative risk to be able to inform them so they can make a good decision.”
Stars are proactive in preventative measures
Since last summer, five Stars have undergone hip surgery: John Klingberg, Valeri Nichushkin, Trevor Daley, Ales Hemsky, and Jamie Benn. Part of this is bad luck. The Stars just happened to have five good players require hip repairs in a compressed period of time. But another reason is because the organization is taking an active approach toward diagnosing and treating hip injuries that other teams may still be trying to solve.
According to the Dallas Morning News, the Stars are aggressive in identifying players with femoroacetabular impingement (FAI), a condition affecting the hip’s ball-and-socket mechanism. Dr. Bryan Kelly, associate attending orthopedic surgeon at New York’s Hospital for Special Surgery, classified FAI to the Globe as a chronic injury to the cartilage and labrum within the hip joint because of the load required of certain athletic activities.
At last year’s camp, Stars doctors asked all participants to have their hips X-rayed to determine their risk for impingement. Head athletic trainer Dave Zeis told the News that approximately 70 percent of the players who agreed to X-rays had potential for problems. Kelly, who is also codirector of the Center for Hip Preservation, performed double hip surgery on Benn in April. According to Kelly, hockey, soccer, and football are the three sports in which FAI is most common. Genetics is one factor. So is repetitive stress. The motions required of skating grabs at the cartilage. Goalies are also at risk of hip injuries because of the strain involved in thousands of repetitions of slamming pads flush to the ice.
“It’s usually resulting from a combination of early development changes and repetitive load,” said Kelly. “It occurs during overtraining as an adolescent and the positional requirement of the hip joint in sports.”
Hockey players suffering from FAI sometimes complain of groin discomfort. Teams then prescribe rest, stretching, and treatment to promote healing in the groin. This is where the condition is frequently misdiagnosed as groin strains. Players can play for years with persistent groin ailments when the problem lies within their hips. Discomfort comes and goes and performance crests and wanes when an accurate diagnosis could prevent issues from prolonging. It’s possible, for example, that David Krejci’s chronic groin issues in 2014-15 were related to his hips.
If teams improve at diagnosing FAI, surgical intervention could reduce the peaks-and-valleys cycle of groin and hip injuries.
“It would prolong people’s careers,” Kelly said. “Probably in the past, they’d not be able to continue playing. Performance would deteriorate. Careers would be stopped. There would be a reduced rate of cartilage risks.”
Hitchcock always gets his message across
The Blues are a stable franchise. They’ve made the playoffs in all four years of Ken Hitchcock’s guidance. They have star power in Vladimir Tarasenko and Alex Pietrangelo. GM Doug Armstrong has built his team around two cores — a veteran crew and an up-and-coming group. Jake Allen is growing into an ace goalie.
So even after their first-round exit against Minnesota, the Blues made the logical move by re-signing their coach to a one-year extension.
Hitchcock is one of hockey’s smartest coaches. He knows the Blues better than anybody. He has a history of getting players to buy what he’s selling, even if he does so in a way that makes them uncomfortable.
Hitchcock is also good at identifying patterns. After the Blues’ season ended, Hitchcock studied video from approximately 25 regular-season games and all six postseason matches to determine why his team was more inconsistent than he’d been used to seeing. What he saw was a problem he believes can be fixed.
“We got isolated too much,” Hitchcock said in a press conference after agreeing to the extension. “We had three forwards too far ahead of two defensemen. We had two defensemen too far behind our forwards. We got caught with too many gaps in our game. We played with skill, but we were far too conservative. The league’s gone right by that. The four fastest teams in the league are playing right now. They played that way in October and November and they’re still playing. We’ve got to get to that pace. We can do that if Doug doesn’t change anybody. We can do that. We can change the way we play.”
Last year, the Blues were good at setting up in the offensive zone. They cycled well. They maintained possession of the puck. Pietrangelo and Kevin Shattenkirk launched pucks from the points. By Hitchcock’s estimation, the Blues had few rivals when it came to spending time in opponents’ ends.
But the game, especially in the playoffs, does not reward teams for zone time. Goalies stop everything. Coaches instruct their players to protect the house. Nobody is afraid to block shots. Scoring goals is often dependent on luck. The Blues want to reduce luck from their approach.
The aim is to play five-man, fast-paced hockey. Hitchcock wants his group to play tighter, force turnovers, then attack with speed and numbers. This might lead to defensive breakdowns. Hitchcock doesn’t see an alternative.
“All of our shots and scoring chances are confronted,” Hitchcock said. “We don’t create any odd-man situations with speed. It’s like half-court offense in basketball. That’s good in the regular season. But everybody blocks shots and steps in front of shots in the playoffs. We’ve got to find other ways to be more dangerous.”
The Blues aren’t as fast as the Lightning or Blackhawks. But they can manufacture speed by compressing their formations and hounding the puck. David Backes, Alexander Steen, and T.J. Oshie can be threatening players when they attack together and launch through center ice. Hitchcock’s the best coach to get the Blues to play this way.
Coup for Canucks
Deal could wear thin
The Rangers had no choice but to re-sign Henrik Lundqvist on Dec. 4, 2013, seven months before he became an unrestricted free agent. Lundqvist, then as he is now, is one of the league’s elite goalies. The Rangers would have twirled down the Eastern Conference standings had they given the crease to backup Cam Talbot or acquired a cheaper goalie. Lundqvist’s window is not subject to immediate closure. But a seven-year extension through 2020 carries a lot of risk for any aging goalie, even if his future is in the Hockey Hall of Fame. Lundqvist will be 38 and carrying an $8.5 million annual cap hit in the final year of his deal. Lundqvist plays deeper and turns to his reflexes more than younger goalies. As the pace of the game quickens and Lundqvist ages, it will become harder for the goalie to continue his sterling performance.
Taking it from a different angle
Good teams utilize the ice below the goal line to make plays down low, open up the points, and stretch out defensive formations. They should also take more cracks at shooting from behind the line. Goalies aren’t expecting shots to arrive. They’re anticipating passes out front or jams in front of the net. Goalies are positioned awkwardly because they’re twisting their necks to track the puck. Once it arrives, the puck is hard to control for a goalie when it bounces off his back or shoulder. The shot might not necessarily go in, but it could create a dangerous rebound. Being unpredictable is critical.
Chatter around the league favors the Bruins retaining Claude Julien. However, management will keep Julien under watch. If things go sideways early next season, Julien will be out. Bruce Cassidy and Mike Milbury will be considered as replacements . . . Full applause for Jon Cooper’s preference for dressing 11 forwards and seven defensemen. If the Tampa coach believes he’s maximizing his roster that way, then it’s the right move. Most coaches wouldn’t consider doing anything but 12 forwards and six defensemen because that’s the way it’s always been done. Double-shifting players and managing ice time based on team strengths and situations should be standard operating procedure . . . It’s easy to see the similarities between Ondrej Palat and Marian Hossa. Like Hossa, Palat is a left-shot right wing who’s committed to three-zone play. Hossa’s stronger on the puck, but Palat is a shade quicker. Both wings have excellent hockey sense . . . Chris Kreider is a rare blend of speed and power. Those gifts, however, are limited by his tendency to take foolish penalties. Kreider finds himself in a position familiar to hard-nosed players: finding balance between aggressive and silly.Fluto Shinzawa can be reached at email@example.com. Follow him on Twitter @GlobeFluto. Material from interviews, wire services, other beat writers, and league and team sources was used in this report.