How risky is Canada's favourite game?

Troy is an 18-year-old junior hockey player taking part in his first Memorial Cup. National Hockey League scouts are scattered throughout the capacity crowd. Troy knows that if he has a strong game and impresses them, he could dramatically increase his chances of being chosen at next summer's NHL entry draft.

With less than a minute left in regulation time and the game tied at three, Troy finds himself slightly ahead of an opposing player as he races to try to prevent his team from getting called for icing the puck. Just before he touches it, the opposing player places his stick between Troy's skates, causing him to trip and slide face-first into the boards.

Troy lies motionless for several minutes. He keeps saying that he cannot feel his arms or legs. As the minutes continue to pass with no sign of movement, a hush falls over the once-boisterous crowd and players from both teams, with grave concern, surround the young man. His spine has been damaged. In one split second Troy has gone from a budding NHL superstar to a quadriplegic.

Each year in Canada, hundreds of athletes fall victim to debilitating spinal cord injuries. While medical advances and new technologies promise hope for spinal cord patients, the best defence against a life confined to a wheelchair is common sense and fair play.

According to Charles Tatter, a neurosurgeon who teaches at the University of Toronto, approximately 20 per cent of all spinal cord injuries suffered in Canada are sports-related, and 85 per cent of those victims are males between the age of 18 and 24. The results of an injury to the spinal cord are often devastating, leaving people paraplegic or quadriplegic.

Paraplegia is a paralysis of the lower extremities and part or all of the trunk muscles. There is often a loss of sensation in paralysed limbs as well as muscle spasms, pain, and loss of bowel and bladder control.

Quadriplegia occurs when there is damage to the spinal cord in the upper back or neck region. Such injuries often cause impairment to the hands and arms in addition to the effects associated with paraplegia.

When a person suffers a spinal cord injury, he or she may sustain a complete or incomplete injury. A complete injury occurs when the victim cannot move his or her body beyond the point of damage; people with an incomplete injury maintain limited function in the affected body parts.

There have been medical advances that can minimize the amount of permanent damage caused by a spinal injury. The drug methylprednisione provides neuro-protection, increases blood flow, and prevents calcium build-up in the victim's body. It must, however, be administered within eight hours of the injury if it is to be effective. And the drug does have substantial side effects.

"The rate of serious infection is significantly higher. In fact, it doubles," explains Michael Fehlings, associate professor of neurosurgery at the University of Toronto. "But we accept that as a worthwhile trade-off because [methylprednisione] results in improved function of nerve cells."

There have also been advances in rehabilitation for spinal cord injury victims, partly as a result of the early treatments like methylprednisione.

"Rehabilitation for people is becoming increasingly complex," says Molly Varrier, chairperson of rehabilitation sciences at the University of Toronto. "The reason for that is that some of the acute management is having a positive effect. We are finding that people are having increased movement, but at the same time also having increased muscle tone and spasticity."

Halo stabilization is one of the more recent improvements in the rehabilitation process. It involves the placement of a ring on the patient's head, which is then attached with screws to cross bars connected to a vest. The halo allows victims of spinal cord injuries to become mobile at a much faster rate.

There have also been substantial improvements made to the protective value of sports equipment, but Fehlings cautions that there is no one piece of equipment that will fully protect against a neck injury.

"[Kids] are trying to emulate NHL players," he says. "They have their helmet and face-mask, they look like Arnold Schwarzenegger, yet they have these tiny neck muscles and there is hitting from behind."

This reality has lead to the creation of an innovative programme in the Novice Windsor Minor Hockey Association (NWMHA), which aims to prevent spinal injuries by discouraging hitting from behind.

All players, parents and coaches involved with the league are now required to sign a Fair Play Pledge, which prohibits players from hitting other players from behind. In addition, all players must wear a three-inch STOP sign on the back of their jerseys.

Despite the fact that the age of players in the NWMHA ranges from four to nine, rules concerning hitting from behind are strictly enforced, says Kevin Stubbington, vice-president of the league and co-creator of the Safety Toward Other Players (STOP) programme.

"We suspend our players for three games if they are caught pushing or shoving from behind," says Stubbington. "If they do it again I cut them a check and send them home, they're done for the rest of the year. I don't want them in hockey if they can't play the game properly."

Since the STOP programme was introduced three years ago, 4000 minor league hockey players in Windsor have stitched the STOP crest on their uniforms. Penalties for hitting from behind are rare, and not one player has suffered a spinal cord injury.

Stubbington says he wants to see the programme move beyond minor hockey in Windsor and he can't understand why the STOP signs are not more widely used. "A lot of leagues have [adopted] the programme, but those that haven't are probably sitting back waiting for some numbers, waiting for a graph, waiting for some results. All the time they are doing that there are kids out there getting hurt every day."

There is currently no cure for spinal injuries--prevention remains the best cure. But advances in nerve regeneration research are providing hope. Tatter says he is optimistic about the possibility of regeneration of the human spinal cord in the not-so-distant future.

"There are several strategies that now work with animals. For example, we can transplant a piece of the spinal cord from one animal into another animal and have it actually grow, or we can take a nerve graph and place it in the gap of a spinal cord injury and the nerve graph will hook up with the stumps of the injured spinal cord," Tatter explains.

He adds that it is not unrealistic to think it will be available to injury victims by the turn of the century.

But for now, the best hope is to play it safe.

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