PHILADELPHIA -- Struggling in the opening weeks of the NHL season, the Philadelphia Flyers were dealt a major
blow on Monday learning that captain Keith Primeau will be sidelined indefinitely with a concussion.
In nine games this season, Primeau has one goal and seven points for the second-place Flyers (6-3-1).
"With the history and last 24 months with Keith, we're just not prepared to take any chances,' said Hitchcock
prior to Sunday's game against the Ottawa Senators.
"He's in a situation where with the history we're just not prepared to take any risks."
Some of that concern is based on the fact it is unknown how many concussions Primeau has suffered in his career.
"Going back to the year 2004, if he had three then, this is his fourth or fifth," said Flyers trainer Jim
During the 2003-04 season, Primeau missed 21 games beginning in mid-February following a concussion sustained
against the New York Rangers.
Even in the medical community, there is no universal nomenclature to define the condition. The most widely-accepted
classification defines concussion as "a clinical syndrome characterized by the immediate and transient post-traumatic impairment
of neural function such as alteration of consciousness, disturbance of vision or equilibrium, etc., due to brain stem dysfunction."
On Sunday, Primeau stated that he had, "headaches and pressure, and (I) just don't feel right. I feel lethargic."
Fatigue is a significant finding among concussed athletes following injury.
In a 2004 article published in Clinics in Sports Medicine, Lovell et al. reported headache is the most commonly
reported symptom of injury and may be seen in up to 70% of athletes who sustain a concussion.
Complicating the diagnosis of concussion is that headache may not develop for hours following the initial
injury and is usually worsened with physical exertion.
Following Primeau's examination by team physician Gary Dorsheimer and neurologist Gerri McGinnis, McCrossin
added that when (Primeau) "lies down, he feels like he is spinning and he also said his eyes feel busy."
"He may be focusing, but his eyes are going back and forth and they get fatigued," said McCrossin.
According to the article, athletes commonly experience "visual changes, blurred vision, changes in peripheral
vision, or other visual disturbances."
At this point, the Flyers medical staff decline to speculate on how many concussions Primeau can sustain before
there is a serious threat to permanent injury.
There is a lack of evidence-based data available to determine how many concussions preclude return to athletic
competition or forced retirement from sport. Even so, age-related responses to concussion are being exposed and much of the
existing data on returning to competition is based on high school and collegiate-level athletes.
Primeau underwent neuropsychological baseline testing and will be tested again in one week if he is symptom
Once Primeau is asymptomatic, he may begin light aerobic exercise (such as walking and cycling). Should he
remain asymptomatic, Primeau's activity level can be increased to running and ice skating.
He will be free to return to play once he progresses to full contact practice without symptoms.
"Keith's health is our first priority," said McCrossin.