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Capitals center Nicklas Backstrom has ‘day-to-day’ struggle with concussion

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Nicklas Backstrom stood outside the Washington Capitals’ dressing room Thursday night at Verizon Center, leaning against a doorway in a charcoal gray suit. He caught up with his Swedish countrymen from that evening’s opponent, and occasionally cracked just the slightest smile.

For that moment, it seemed easy to forget that Backstrom remains sidelined indefinitely by a concussion, unable to play or even skate for more than five minutes over the past month. His plight is not atypical of players who have suffered head injuries this season, and his return will come only after he meets protocols established by the league.

Sunday, when the Capitals take on the Eastern Conference-leading New York Rangers at Madison Square Garden, will mark 40 days since the center absorbed an elbow to the head from then-Calgary forward Rene Bourque. The blow caused a concussion that has forced Backstrom to miss 16 games and counting. He hasn’t skated for more than five minutes since Jan. 6 and there remains no indication of when the center will return.

“I’m not 100 percent to skate right now,” Backstrom said Saturday in his first English interview in more than a month. “We’ll see when it’s going to be time for me to hit the ice. Right now, I’m taking it day-by-day to see how I feel.”

The NHL this season has seen 66 players ranging from superstars such as Sidney Crosby to fourth-line grinders such as Washington’s Jay Beagle miss time because of concussions or concussion-like symptoms, according to an informal tally by the Canadian Broadcasting Corporation.

Like Backstrom, most players have a strong desire to get back on the ice. But physicians across the league and involved in the NHL and players’ association’s concussion working group preach patience. As awareness about the severity of these injuries grows, players and management have learned that each head injury is different — symptoms and recovery time vary from person to person and there is no way to predict what they will be.

“Players by their very nature will want to deny their symptoms in order to get back in the game, but I think we’re starting to see a change in that attitude,” said Mark Aubry, chief medical officer of the International Ice Hockey Federation. Aubry also works as a team physician with the Ottawa Senators.

Backstrom’s comments to reporters in Washington and to Swedish newspaper Gefle Dagblad offer a snapshot of his slow recovery process that weighs heavily on the Capitals as they fight to make the playoffs for a fifth consecutive season.

Backstrom, 24, said he is evaluated by Capitals trainer Greg Smith every day. He said he has been riding a stationary bike, but declined to go into further detail about his recovery.

NHL concussion protocols, which were established in 1997 and modified in March 2011, mandate that in order to return to play, a player must be symptom free at rest, then symptom free with exertion up to levels required for game play, then reach his baseline level on a neuropsychological test. Players undergo neuropsychological testing before each season to establish a baseline.

“It’s tough, for sure,” Backstrom told Gefle Dagblad, as translated by Malin Andersson, about his time away from hockey. “I don’t do much, basically I have spent much of my time on the couch napping and resting. Sometimes I’ve been at the practice rink, but I try to stay away from it as much as possible. It’s so frustrating for me to be there right now.”

Trying to limit the damage

Backstrom’s frustrations are not uncommon, yet the league has been diligent in making sure players meet the established protocols before they get back on the ice. Healing properly from a first concussion is a significant step in prolonging a player’s health and career, according to neuropsychologist Ruben Echemendia, the chairman of the NHL and players’ association concussion working group.

“What we do know with a fair degree of certainty is if you get hit again and have another concussion before recovering from the effects of the first, it will be a more significant symptom burden,” said Echemendia, who helped found the NHL’s neuropsychological testing program in 1997. “It can lead to a more severe concussion, more time off for recovery and in certain cases, permanent damage.”

The Capitals understand the recovery process varies from player to player. To a man, they say they know how important it is to wait for the symptoms to subside.

“You can’t count on anything,” right wing Troy Brouwer said. “Concussions are very finicky things as I think everyone in the league has learned. We all want him to feel better as soon as possible, but you can’t expect a certain time for [Backstrom] to come back. You can’t sit around hoping for him to come back either. You just have to try to move forward and get by as best you can without him.”

Not so ‘ready to go’

Through the first three months of the season, Backstrom was easily the Capitals’ best and most consistent player. He recorded 42 points (13 goals, 29 assists) and stood as the team’s leading scorer until Thursday.

Backstrom’s course changed dramatically when Bourque, who was later suspended five games for the blow, elbowed Backstrom on Jan. 3 at Verizon Center. Backstrom immediately leaned over the boards then sat on the bench hunched over. He returned to the ice for the ensuing power play and took two more shifts before the Capitals removed him from the contest with just more than three minutes to play.

Over the next three days, Backstrom, who has a history of migraine headaches, took part in two practices with his teammates, including one in San Jose. Backstrom, who only missed five games in his four NHL seasons before the concussion, brushed off questions about his health in the days following the hit.

“I felt pretty good actually. I think I’m ready to go, that’s my thoughts,” Backstrom said on Jan. 6, the last time he was on the ice with his teammates. He was sent back to Washington two days later.

Backstrom would later try to skate on Jan. 23, but after a few minutes on the ice and some half-speed strides, he went back to the dressing room and hasn’t been on the ice since.

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