It’s a known fact: hockey is getting faster and the game is evolving quicker than ever before. Players aren’t necessarily bigger, but that doesn’t tell the whole story.
Speed is the real culprit.

An increase in game play velocity creates more opportunities for body impact and therefore an increase in injury risk, notably when it comes to brain and head injuries.

Leagues and national hockey associations across the world have introduced a variety of resources and methods to help improve concussion prevention and treatment in recent years. But do they work? And why or why not?

One of the hottest topics as of late has been baseline testing. That specific term brings up a slew of emotions amongst hockey officials, health officials, parents, clinicians, providers and medical professionals.

But, what does baseline testing really consist of? Why is it so controversial? Can it be useful or helpful, and under what conditions?

Let’s dive in.

The challenge of defining it

Theoretically speaking, baseline testing as understood by most professionals is an examination of an athlete’s health conducted before the start of a sporting season. As per the CDC, These tests are used to provide a benchmark of what key performance indicators an athlete currently hits in different sectors such as balance, learning, memory, concentration and various other qualitative and quantitative brain functions.

This benchmark allows health professionals to see how the athlete’s performance has been affected after they suffer a head injury in order to better understand if they have suffered a concussion since there is an initial reference point.

Some health professionals suggest that certain baseline and concussion assessment tools should only be used on athletes over the age of 10 due to their neurocognitive development.

Others believe that since the technology and process exists and is actively used by top professionals in the sport, our society should provide children with the same level of care that professionals receive.

How are the results of baseline tests used?

It’s important to understand that the results of baseline tests and concussion evaluations, are not meant to serve as a diagnosis. Instead, they are used to serve as a resource to help health care professionals to make a return to play decision.

Results recorded from baseline tests are used to compare with concussion evaluation test results in order to gain a deeper understanding of how much the subject was affected by their injury.

This assists medical experts and doctors in accurately identifying the effects of the injury and making the safest possible decision for the athlete in terms of their return to play time.

According to the CDC, baseline test results should be used to provide athlete’s and their parents with information on:

‍1- How and when to return to play.
2- How to recover from their injury correctly and safely.
3- Possible danger signs to look out for in case they require further care.
4- And how to reduce their risk of suffering a similar injury in the future.

Who supports it?

Unsurprisingly to some, but completely baffling to others: most governing bodies within the hockey world mandate the use of baseline testing.

All major leagues in Europe adhere to the IIHF’s rulebook, which uses the recommended guidelines published from the most recent International conference on Concussion in sport.Under those guidelines, all major leagues mandate the use of pre-season baseline testing of all players.

However, baseline tests are more restricted among younger players in compliance with the “neurocognitive development” of different age groups.

The NHL also mandates the use of baseline testing. According to their official concussion protocol, all NHL players must undergo a baseline test before the start of any “unrestricted play.”

Neither the NHL nor the IIHF mandate the use of neuropsychologists to administer baseline tests.

Instead, they allow for any trained medical professionals to administer the tests (including team physicians and athletic trainers) to make the proceedings easier.

Who wouldn’t want to use what the professionals use?

Who is against it?

Hockey Canada is one of the only governing bodies in Ice Hockey that doesn’t support the use of baseline testing. It adheres to recommended guidelines by Parachute Canada’s national charity dedicated to injury prevention.

Parachute released the ‘Canadian Guideline on Concussion in Sport’ in July 2017 which was based on publications from the fifth International Consensus Conference on Concussion in Sport.They then released an updated statement in November 2018 to clarify their stance on baseline testing.

In the updated statement, the organisation mentions that: “Baseline testing using any tool or combination of tools is not required to provide post-injury care of those who sustain a suspected or diagnosed concussion and mandatory pre-season testing is not recommended.”

They added: “In general, current evidence does not support a significant added benefit of baseline testing athletes.”

Following the release of this statement, Hockey Canada does not use baseline testing at any level. 

Instead, Hockey Canada (under Parachute’s recommendations) requires “written medical clearance by a medical doctor or nurse practitioner with expertise in concussion management” for any athlete with a diagnosed concussion to make a return to play.

In 2019, the Ice Hockey Summit released a variety of statements which were all published by the National Library of Medicine.

The purpose of the summit was to provide updated scientific evidence on concussions in hockey and create a list of “prioritized action items” which should be integrated into official policies across hockey.

According to the statement, 155 attendees, ranging from athletic trainers to neuropsychologists, voted to approve six prioritized action items within their ‘action on concussion’ segment.

One of those six items was to “mandate baseline testing to improve concussion diagnosis for all age groups.” Ironically, the piece was co-signed by Mark Aubry, the head physician for Hockey Canada. 

Despite this, Hockey Canada still to this day does not mandate the use of baseline testing at any level, and it vehemently disapproves any organization, physician or provider that provides such a basic service offering.