Injury Report: Bryan Little

[Jets 31]

Jets are better off with his cap space.

 

[scelaton]

I still have basically a normal life except before the bleed i never got migraines , they are debilitating pain and thank god there is medication that now can stop them for me. The pain is so bad when they happen , i can't describe it. The other thing that happens is, not alot mind you, is you get feelings , they are hard to describe but basically you can't compute things right. I would love to get to talk to Little and hear how he's feeling right from him because i might be able to know first hand how he's doing. Anyway long story short i hope he can live a fairly normal life and wish him the best.

TBI can be debilitating so many ways, but you have an amazing attitude, which is essential for a sustained recovery!

There are BI support groups--people who have lived experience and know first hand--I hope you are engaged with them!

 

[Jets 31]

TBI can be debilitating so many ways, but you have an amazing attitude, which is essential for a sustained recovery!

There are BI support groups--people who have lived experience and know first hand--I hope you are engaged with them!

I haven't but i'm doing ok besides i use HF Jets to help me. Thanks though.

 

[GumbyCan2]

That means Stanley will get a million penalties if he plays physical.

Maybe he can do the "fire-stopper" = Stop-Drop&Roll right thru opponents? They'll come up with a new penalty call, though, I guess.
" Fallen tree interference, 2 minutes minor penalty,Winnipeg, #64..."

 

[AlaskaJet]

I don’t think it’s at all likely that Little’s injury was mainly to the inner ear.

There was an uncomfirmed report from soon after the injury that he had bleeding in the brain. Given the mechanism of injury, I speculated at the time (I’m a neurologist) that he could have had a contusion, which is basically a bruise in the brain.

A more severe brain injury like a contusion would explain why he wasn’t allowed to fly, and wasn’t cleared to return to play despite being able to skate. The limiting step wouldn’t be persisting symptoms (unlike recovery from concussion, or with a vestibular injury), but safety given the possibility of re-injury. If he had persisting post-concussion symptoms we would probably get reports of him trying therapies to improve those symptoms (like Crosby going to a chiropractor). And if he was off-balance because of vestibular issues, we’d probably get reports of him doing physiotherapy to improve that. But nothing like that has been reported, as far as I know.

The way Little’s case has been managed only make sense to me if he’s been told not to return to play because it would be unsafe for him to risk getting injured again.

I’ll defer to your considered opinion and recognize he had a cerebral bleed, whether sub-dural or not I don’t know, (and I was only a drugless practitioner) so that with his history of previous concussion, the odds are perhaps against him, I doubt we would be privy to any news of Physiotherapy appointments. I was simply holding out hope that any vestibular pathology would be remedial. Fingers crossed..

 

[Krauser]

Are there decent long term outcome studies on small bleeds in athletes who do, or do not, return to high level sports, or are the recommendations based on an abundance of caution?
It seems to me that this would a difficult group to study, for a variety of reasons.

There are studies of return to play after concussion, but by definition concussions don’t involve the intracranial bleeding and permanent structural brain damage that I fear Little suffered.

I’m not usually involved in these kinds of cases (which are typically managed by neurosurgeons, not medical neurologists like me), but I can’t imagine any surgeon or sports medicine specialist would clear a player to return to contact sports after that kind of injury. You wouldn’t even begin to consider it unless, as in Little’s case, the contact sport is that person’s livelihood. And even then it just seems obviously much too risky.

So there’s no evidence, because it doesn’t happen enough to be studied (or at least doesn’t happen with official medical sanction — there must be some people who’ve played contact sports after an intracranial hemorrhage, but I can’t imagine a doctor signed off on it).

So I think the advice Little probably received was: even if you’re feeling fine physically and mentally, we think it would be too dangerous to put you in harm’s way again, so we can’t clear you to return to play in the NHL.

 

[scelaton]

There are studies of return to play after concussion, but by definition concussions don’t involve the intracranial bleeding and permanent structural brain damage that I fear Little suffered.
I’m not usually involved in these kinds of cases (which are typically managed by neurosurgeons, not medical neurologists like me), but I can’t imagine any surgeon or sports medicine specialist would clear a player to return to contact sports after that kind of injury. You wouldn’t even begin to consider it unless, as in Little’s case, the contact sport is that person’s livelihood. And even then it just seems obviously much too risky.
So there’s no evidence, because it doesn’t happen enough to be studied (or at least doesn’t happen with official medical sanction — there must be some people who’ve played contact sports after an intracranial hemorrhage, but I can’t imagine a doctor signed off on it).
So I think the advice Little probably received was: even if you’re feeling fine physically and mentally, we think it would be too dangerous to put you in harm’s way again, so we can’t clear you to return to play in the NHL.

Yes, I agree he most likely received that advice, but, as I suspected, from an abundance of caution, in a litigious environment, rather than evidence based.

It's completely understandable, but also curious in a way. We know that concussions can cause diffuse brain injury (bad!), that they are frighteningly common, especially in football, and lead to serious sequelae (and ultimately CTE) all too often. And yet, we have found ways to justify getting players back on the field/ice. Why? Because otherwise it would be the end of some pro sports as we know them.

In contrast, the rare player with an isolated, localized small bleed due to a freak play may theoretically have a lesser risk of re-injury or long term damage after a sufficient period of healing. But there is no risk to the sport to keep him out indefinitely. For Little, who was at the end of his career, it's an easy decision. But imagine if it happened to him at age 20...