12/14/2011 03:18 EST | Updated 02/13/2012 05:12 EST

Carolina's Skinner and Pitkanen; Ottawa's Michalek out with concussions

The NHL's concussion list keeps getting longer.

Jeff Skinner and Joni Pitkanen of the Carolina Hurricanes, along with Milan Michalek of the Ottawa Senators are the latest players to go down with the injury.

Skinner leads the Hurricanes in scoring, while Pitkanen is the team's top-scoring defenceman.

The Hurricanes confirmed Wednesday that both players suffered concussions and are out indefinitely.

Michalek, who leads the league with 19 goals, suffered his concussion in last night's 3-2 overtime win at Buffalo. Michalek collided with teammate Erik Karlsson late in the second period.

"We all hope it's going to be short term," said Senators captain Daniel Alfredsson. "He's a very important player for us. He does so many little things right. He works hard at both ends, he scores off the rush, he scores in traffic, but every team goes through this, we might be a little bit thinner than some teams in the league, but we'll try and make up for it and do our best."

Take a whirl around the league — especially among the Eastern Conference contenders — and you'll see key cogs missing time because of concussions. Penguins superstar Sidney Crosby, Philadelphia's top scorer Claude Giroux and defenceman Chris Pronger, Buffalo goalie Ryan Miller, Los Angeles centre Mike Richards, Boston centre Marc Savard and Rangers defenceman Marc Staal have all missed chunks of time, if not the entire season, as they deal with the lingering effects of brutal blows to the head.

"It seems like someone is going down every single night now," retired NHL standout Jeremy Roenick said. "It's frustrating to watch. You don't like having your top guys out."

Even worse for the league, the injuries come after a devastating summer that saw the deaths of enforcers Derek Boogaard, Wade Belak and Rick Rypien.

The NHL has acted, taking steps with new policies and harsher punitive enforcement that was aimed at curtailing some of the violent hits that left the fine-tuned player complaining of dizzy spells. Quiet rooms and ImPACT tests have joined hat tricks and power plays among the league's vernacular.

But despite all the hand-wringing over the head being used for target practice by some NHL players, the blows that knocked out Crosby, Giroux and Michalek were mostly accidental.

The Senators showed a lack of finish without Michalek Wednesday night, falling 5-2 to Boston despite outshooting the Bruins 49-29.

"It's tough. He's our leading goal scorer, he’s a big player on our team and plays in all situations," Senators forward Nick Foligno said. "It's tough to replace a guy like him and he's been playing so well of late. He's the type of guy whose going to work hard and do everything he can to try and be back quick."

Crosby's return from a 10-month layoff was short-lived after he complained of a headache following a game last week. Against Boston, Crosby collided with teammate Chris Kunitz and absorbed an elbow from Bruins forward David Krejci, both potential triggers that caused his symptoms to resurface.

"It tends to seem like it's an epidemic when we're just better at recognizing them," said Mark Lovell, the founding director of the UPMC Sports Medicine concussion program and CEO of ImPACT, a system designed to diagnose concussions.

Gone (mostly) are the days when players are told to "shake it off" and get back on the ice after they're knocked senseless. Today's players aren't soft, they're smart and safe.

The number of players who have missed at least one game a season due to a concussion or concussion-like symptoms has been sliced by more than half since the 1999-2000 season.

In that regular season and post-season, 94 players missed time because of the injury, according to STATS LLC. By the 2009-10 season, the number dipped to 33 players. It spiked to 52 a year ago and stood at 32 this season, through Tuesday's games.

Like in any contact sport, concussions will never become obsolete. Violence is inherent and no sports league celebrates fighting like the NHL.

What the league, teams and players can do is minimize the chances with accurate diagnosis and better handling of the situation.

Yes, a player like Crosby needs time to heal. But once he comes back, can he ever be treated like a "normal" player?

"I think the difficulty in dealing with the injury is that there's not a lot of general comparisons in dealing with individual players," Penguins coach Dan Bylsma said. "Last year we had other players as well, at the end of the year, that were dealing with a concussion and they all seemed to follow different symptoms, different patterns, different recoveries and different lengths of time.

"It's tough to say, 'This is how we're going to treat this instance different.'"

Unwanted as his condition is, Crosby's plight put the spotlight on concussion treatment.

"Things that have gone on the last few years have certainly raised the awareness, and the protocol that we use to treat players has changed drastically over the last number of years," Holmgren said. "So that's a good thing. We're looking after the players.

"They're our most important asset."

One asset is the NHLPA/NHL Concussion Program that was instituted during the 1997-98 season.

The ImPACT test has transformed the way concussions are managed by giving a tangible measure of what's going on in the brain — and proof for eager athletes that their heads may not be ready to take the next hit. It's a computer-based series of fast-paced quizzes involving words, pictures and colours. Scores reflect how quickly and correctly the questions are answered, and are compared to a baseline test that athletes take at the beginning of a season.

The test was developed in the early 1990s by Lovell and Dr. Joseph Maroon, the longtime neurosurgeon for the NFL's Pittsburgh Steelers.

Not even the imPACT test is foolproof. Crosby, who had 12 points in eight games, passed the test and still suffered from symptoms.

"For some people, one concussion is too much. Three concussions you're done," Lovell said. "The one thing we do know for sure is that we do not want people going to back to play while they're still having symptoms because that definitely ups the risk."

But can a player become fully healed? Crosby was out 10 months and still suffered a serious setback.

Lovell said "most people get better" with proper rest and treatment.

Critics who howl for a total ban on head shots as a solution won't get their way any time soon. Fighting is here to stay, at least until concrete evidence is presented that shows punches are a major cause of hockey concussions.

The NHL continues to cite data that states concussions are caused more often by accidental contact with players, the boards, the glass and ice, than by hits to the head.

"The majority of concussion issues that you see are not linked to fighting," said Lovell, who has consulted with the NHL. "I'm not endorsing it. I'm saying hits on the ice tend to be more involved with people having concussive issues."

The concussion is the toughest, most complicated injury, to diagnose. Safer equipment, visors, larger Olympic-sized rinks and a greater respect for the opponent could all lessen the chances of concussion.

Not all players want to err on the side of caution.

Washington Capitals centre Brooks Laich railed against the NHL's increased safe-than-sorry stance on concussions in October.

"I'm sick of hearing all this talk about concussions and the quiet room," Laich said. "This is what we love to do, guys love to play, they love to compete, they want to be on the ice. How do you take that away from somebody?

"We accept that there's going to be dangers when we play this game and you know that every night you get dressed. Sometimes it feels like we're being babysat a little too much. We're grown men, we should have a little say in what we want to do."

Laich's views are a throwback from another era when players like former Flyers centre Eric Lindros were ripped for expressing concern or sitting out over head injuries.

"Back in the '90s, you'd get guys who'd say they have headaches every game or memory loss all the time," Lovell said. "It's in their best interests to report them. I wouldn't say we're 100 per cent there yet, but there's a lot of work going into that."

The high-speed collisions never slowed down Roenick, who played for five teams over an 18-year career.

"It wasn't a big deal when we played. We didn't know much about them," he said. "Guys didn't seem to go out as often with concussions. Guys seemed to be, I don't want to say tougher, but we played through a lot more scenarios and situations than they do now. It's a different mentality, a different league, a different sport now, almost, in general."

Roenick said he was diagnosed with 13 concussions over his career and always answered the bell for the next shift. He recalled a game he was knocked out against the Minnesota North Stars during the 1990-91 season and awoke on the trainer's table with no idea how he got there. He played the next night — and scored a hat trick.

Three years after he retired, Roenick said he has some short-term memory loss and sometimes grasps at finding the right words in his role as TV analyst.

While Boogaard suffered from chronic traumatic encephalopathy, a degenerative brain ailment related to Alzheimer's disease that is caused by repeated blows to the head, the 41-year-old Roenick insisted he can't worry about how those repeated brain-rattling shots will change his physical state down the road.

"I'm not going to sit here and worry and waste any minute of my life wondering how the next 10 years is going to be," he said. "Even if something happens when I'm old, I know three-quarters of my life was off-the-charts fun."

Lovell noted doctors are "nowhere near the final answers" on C.T.E. and who gets it or is susceptible to the disease.

Today's players are more aware of the frightening consequences of trying to tough it out and play through a concussion. Miller missed nine games after being bowled over by Boston's Milan Lucic in November. He stayed in the game before starting to feel woozy in the second period. He was diagnosed with a concussion and whiplash.

"I's not that we don't want to give it all we've got out there sometimes," Miller said. "But you have to really think ahead. As we learn more about it, it becomes almost more confusing because it's like, 'How many ways can it happen?'"


— Dan Gelston of The Associated Press contributed to this report.