DENVER — Avalanche coach Jared Bednar is comfortable with how the team has handled the health of Cale Makar after the defenseman, on two separate occasions this month, was cleared to return to games in which he sustained head injuries that later turned out to be related concussions.
The defending Norris and Conn Smythe winner is listed as day-to-day while in concussion protocol after the second hit to the head area, which occurred during the third period of Colorado’s 4-1 win Saturday at St. Louis. He’s in a separate protocol from the one he went through after the initial injury Feb. 7 in Pittsburgh.
Makar will not be available for the Avs’ upcoming back-to-back Friday (6 p.m. MT) at Winnipeg and Saturday (8 p.m.) vs. Calgary. The protocol lasts seven days with baseline testing every day and a gradual return process. “We listen to the player once all the tests are passed,” Bednar said.
During a third-period Avalanche power play at St. Louis, Makar was involved in a collision with Blues forward Alexei Toropchenko, whose glove slammed into Makar’s face visor. Makar grabbed his face and skated down the tunnel to the dressing room. He returned to the ice later in the period with Colorado leading 4-1.
Bednar said the team did not consider keeping Makar out for the remainder of the game, “because at the time, it was his nose, is why he left the ice.” Bednar and Makar both expected that he would play the next day vs. Edmonton, but when Makar arrived at the rink Sunday, he had a headache and felt pressure in his head. He did not warm up.
“That’s it,” Bednar said. “It’s all we have to hear, and he’s out.”
Makar was exhibiting delayed symptoms of a concussion — similar to what happened after he was cleared to return to the ice 11 days earlier in Pittsburgh.
There was one difference between the in-game procedures in Pittsburgh and St. Louis, though: League concussion spotters contacted team medical staff to pull Makar for testing in Pittsburgh. Spotters did not pull Makar after the play in St. Louis.
According to the NHL’s concussion evaluation and management protocol for the 2022-23 season, a spotter notifies the team if a player “exhibits an observed visible sign following a direct or indirect blow to the head.” The four visible signs that trigger mandatory evaluation are as follows: lying motionless on the ice, motor incoordination or balance problems, blank or vacant look, or slow to get up.
Although Makar grabbed his face, and even though he had just returned from a concussion, he did not exhibit any of those visible signs.
“(Spotters) don’t look into the guy’s past,” Bednar said “They’re just watching the play that’s happening on the ice. The spotters don’t know the history of every player in the league.”
In both cases, the Avalanche followed NHL protocol for such injuries, which Bednar said is “crystal clear” with “no wiggle room in it.” It’s just that an in-game head evaluation was not triggered after the second incident.
So whether Makar should have returned to the ice in St. Louis on the heels of a concussion is a gray area, dependent on context. In his case, the context is a recent example of showing delayed symptoms. After Jeff Carter’s blindside hit left Makar lying on the ice against Pittsburgh, Makar passed in-game testing but ended up missing the next four games.
“Let’s face it, (the concussions) are related,” Bednar said. “… I don’t think that he goes into protocol on the hit in St. Louis with the glove to the face, on any other occasion … except for the fact that he’s just coming out of one.”
So, given Bednar’s point that league spotters can’t be expected to know the injury history of every player, does the responsibility lie on Bednar and team medical staff to consider those factors when deciding to send a player back on the ice?
“Sure. Yeah,” Bednar said. “Our medical trainers are aware of it when they go talk to him. But if you’re going out for a nose injury, and you’re bleeding out of your nose and you get fixed. Then you’ve got to listen to the player. Is he good? Is he not good? What’s the deal? And there wasn’t a concern for (Makar) coming back in. He was just getting work done on his nose.”
Those comments reflected Bednar’s explanation two weeks earlier when asked about the evaluation process for the initial injury. He said at the time: “No. 1 … you talk to Cale. Most players now, they’re not going to make something up to get back into a game. They know how serious it can be.”
Bednar maintained Tuesday that — “no question” — the player is a reliable source about his own health, even in a situation where the player’s brain might be impacted. Avs defenseman Bo Byram, who has his own history of severe concussions, agreed.
“When you feel like you’re good to go and you’re comfortable playing, I don’t see why there’s reason why you shouldn’t be playing,” he said. “I don’t know how many concussions I’ve had now. … Never once have I been pushed into a position of playing. It’s not like that at all here.”
Considering that Makar’s new concussion is related to the first, there is also the question of whether he should have been playing in St. Louis in the first place. That calls into question the league’s guidelines more so than how the Avalanche handled Makar’s situation, though. Bednar said Makar had passed the required tests that allowed him to return in St. Louis.
Still, Bednar said he doesn’t think the league’s procedure needs to change.
“The protocol’s in place because they deem it the best protocol to make sure players are safe, and able or unable to return to play,” he said. “And when they are able or unable to return to play.”
