HEAD CASES

On a good day, Paul Kariya feels clear-headed and energetic enough to take a walk.

The left wing for the Mighty Ducks may play a few holes of golf, but not many.

He climbed onto a stationary bike two weeks ago, but pedaling brought back the headaches that have plagued him since Chicago’s Gary Suter cross-checked him into hockey oblivion Feb. 1 and caused the fourth concussion of his career.

“Basically, now my season is trying to get myself back to normal,” Kariya said.

“What’s the worst part? It would take an hour to tell you. Everything’s been bad.

“The last two months, I couldn’t tell you what I did. It’s not so much my memory is bad, but I haven’t done anything. I’m someone who’s really active. . . . I miss playing and I miss the guys, but I can’t even ride the bike. That’s been very tough.”

This should have been a spectacular season for Kariya, who was a first-team all-star last season with 99 points and was runner-up for the NHL’s most-valuable-player award. But, 22 games after he ended a contract dispute, his season was halted by an illegal hit to the jaw that plunged him into the dark, unpredictable world of head injuries.

“I thought I’d be playing the next game,” he said. “I thought I was feeling pretty good after that. Now, I look back and I realize how bad I was feeling. You forget how good it normally feels like.”

This should have been a spectacular season for Eric Lindros too. The Philadelphia Flyers’ captain had 28 goals and 67 points in 59 games before Pittsburgh’s Darius Kasparaitis leveled him with a hard but clean hit, which gave him a concussion and rendered him unable to sleep or eat.

Lindros, who is scheduled to resume play Monday, is sadly familiar with the consequences of concussions. His younger brother, Brett, a 1994 first-round draft pick of the New York Islanders, retired two years ago at 20 because of the cumulative effects of concussions his family believes did not fully heal before he returned to the ice.

“The more we research this, the more we realize how vulnerable Brett was when he played,” said Carl Lindros, father of Eric and Brett. “We can’t say, ‘Too bad he’s not playing.’ We’ve got to be glad he’s cooking. In his last game, if Brett had been confronted by a heavy-duty impact like the one Eric took from Darius Kasparaitis, he could be a vegetable.”

Center Rob Niedermayer flailed through the season, yet the Florida Panthers didn’t link his woes to his concussions--he apparently had three--until March. He then was ordered to rest.

Vancouver defenseman Mattias Ohlund’s impressive rookie season was interrupted March 26, when Buffalo’s Michael Peca caught him with an elbow and knocked him cold. Ohlund returned Thursday after sitting out two weeks.

And in a case as celebrated as Kariya’s, New York Ranger center Pat LaFontaine’s remarkable comeback from a severe concussion ended March 16, when he suffered another--his sixth. The impact of teammate Mike Keane’s shoulder hitting LaFontaine’s head triggered headaches and lethargy, symptoms similar to those of his previous injury. And he might have run out out of comebacks. He has been contemplating retirement.

Defenseman Jim Johnson of Phoenix, Toronto winger Nick Kypreos, King center Nathan LaFayette and prospect Pavel Rosa, Duck winger Jeremy Stevenson and veteran Islander defenseman Dennis Vaske probably wouldn’t have had great seasons, but they’ll never know. They have all missed significant playing time because of post-concussion syndrome, which is more menacing for its mysterious nature and potential consequences than its frequency.

“It’s becoming a serious problem,” said King General Manager Dave Taylor, whose career ended in 1994 after the last in a series of concussions left him with headaches and dizziness for six months. “Every team in the league probably has two or three guys who have gone out of the lineup because of a concussion over the course of the year. That’s a big number.”

Said Stevenson, who was elbowed in an exhibition game and was out for more than a month: “It’s not just the stars. It’s regular guys like me, who are trying to make it in the NHL. It affects everyone.”

According to statistics compiled through Sunday for the NHL by Med Sports Systems of Iowa City, Iowa, clubs had reported 64 concussions that cost players 238 games this season. That’s comparable to last season’s 63 concussions and 117 games lost, and the 69 concussions and 217 games lost in 1995-96. It doesn’t seem alarming, given the number of hits and falls in an average game.

“Concussions, for us as a league, are not a statistically significant injury compared to knees and shoulders,” said Brian Burke, the NHL’s director of hockey operations. “The problem is that [it’s] only in the last couple of seasons they’re being properly diagnosed and treated. [When he played] you went back to the bench, threw up, and went back out there. It happened to me a half-dozen times in college and the AHL. Now doctors diagnose it.

“I don’t sense we have an epidemic. Some of the concussions were clean hits, like the one on Eric Lindros. This is a contact game and people are going to get banged up.”

True. But broken bones heal and torn ligaments can be repaired. The brain is less forgiving. Doctors say repeated concussions make victims susceptible to more concussions and possibly increase the risk of Alzheimer’s disease.

“The public perception that this is happening to a lot of people might be a little media-driven, but I think it’s worth paying that price in order to get more care and better knowledge,” said Chip Burke, team physician for the Pittsburgh Penguins and director of the NHL’s concussion study program. “When you see these players in the locker room, struggling to regain their functions, it’s something you won’t soon forget.”

Concussions happen when the brain, jarred by an impact, strikes the inside of the skull. Damage to neurons and nerve fibers causes dizziness, blurred vision, memory loss--the worse the concussion, the more acute the amnesia--and confusion. In severe concussions, victims lose consciousness. Recovery varies, depending on severity, personality and the area of the brain affected.

“We all lose brain cells as we age,” said Craig Milhouse, the Ducks’ team doctor. “A brain injury like this . . . damages neurons, and when you lose neurons, they don’t repair themselves. They’re one of the few organs in the body that don’t. There is so little known about how long it takes the brain to repair itself on microscopic levels. You can take CAT scans or MRI and be normal. That tells you anatomy, not function.”

Concerned by the incidence of concussions, the NHL this season undertook its first thorough study of head injuries. More than 900 players were given baseline neurological exams during training camp to measure their reaction time, coordination and other functions. Those tests are used for comparison after players suffer head injuries.

Also this season, the NHL and the NHL Players’ Assn. agreed that players under 25 joining the league must wear helmets that meet the Canadian Standards Assn.’s requirements for durability of the shell and the liner’s absorption of force. Older players were allowed to keep sub-standard helmets. And many players reduce the effectiveness of CSA-approved helmets by removing padding or loosening the chin straps.

“We should probably do a better job on helmets,” said Taylor, whose final concussion occurred after he collided with teammate Warren Rychel and struck his head on the ice after his helmet popped off. “Nobody would think of going out with poor shin pads, but some guys don’t protect their heads as well. I’ve always been a fan of the more protection, the better.”

Yet, Chip Burke doesn’t see better helmets as the only answer.

“We’re just not sure helmets have a significant contributory role in either causing or preventing concussions,” he said. “As far as certified helmets, what are CSA standards? Who even says that makes a safe helmet? They drop a rock on a helmet--what does that have to do with what a player will face in a hockey game?”

He also questions the value of mouth guards--universally worn by boxers--until more data is available. Milhouse, King physician Michael Mellman and Carl Lindros endorse them, citing studies that show mouth guards distribute the force of blows to the jaw. The mouth guard separates the upper and lower jaws and prevents the force of a blow from being transmitted from the lower jaw to the base of the brain, where it can disrupt nerve impulses or blood flow.

“The obvious protection is to put players in a suit of armor, but you can’t,” Mellman said. “All of us who care for players are concerned that protection isn’t as good as it needs to be. The problem with [mouth guards] is, the thicker the mouth guard is, the more uncomfortable it is for a player. So you have a player who’s uncomfortable and he modifies it by cutting it down, which makes it less effective.

“The equipment our players use is a compromise. We have to allow them comfort in performing, but we also have to protect them.”

Even if the number of concussions is not great, the costs are immense in human terms--pain, fear, and interrupted lives.

Johnson, 35, was punched in the jaw Nov. 6. He felt woozy but played two more games and scored a goal Nov. 11.

“He looked up at the clock and couldn’t see it and he took himself out of the game,” Phoenix Coyote General Manager Bobby Smith said. “He’s absolutely unable to compete. . . . He can get on a bike for a few minutes, but not more.”

Johnson, who for weeks couldn’t walk to his mailbox without becoming exhausted, probably will retire.

Rosa, 20, led the Quebec Major Junior Hockey League in scoring last season. He was expected to compete for a job with the Kings, but a concussion in an exhibition game limited him to one minor league game until March 27. His injury wasn’t obvious, but it was severe. Doctors determined when he was hit in the chin and his head snapped back, his brain also experienced rotational forces such as boxers endure, increasing the damage.

King Coach Larry Robinson didn’t know the extent when he initially dismissed it as Rosa “getting his bell rung.” That was the mentality when Robinson played. He recalls hitting his head on the ice while trying to break up a fight and waking up on the trainer’s table with no idea how he got there.

“They never checked me for a concussion,” he said. “If I have a twitch once in a while, maybe that’s why.”

But Robinson knows head injuries aren’t funny.

“Players now are so much bigger and stronger and the game is played with so much more speed,” he said. “There’s no give to the boards anymore. You hit the boards and it’s solid. There’s a jarring effect when there’s a big impact and that twisting.

“From the coach’s point of view, you want your player back as soon as he can get there. As the league stands now, there’s so much money involved. You get a guy making a couple of million dollars a year and you’re losing him, right away you get the insurance companies involved. Yes, I’d like to have that player back, but when you’re dealing with somebody’s life you tend to hold back.”

Theories vary on why concussions seem more serious now.

In 1971, the average NHL player was 5 feet 11 and weighed 184.2 pounds. His 1997-98 counterpart is 6-1, 200.2 pounds, and is probably in better shape, thanks to improved training methods.

“It’s the law of physics: A larger object moving at greater speed will exert greater force, ergo more potential for injury,” Chip Burke said.

High-tech equipment is also thought to be a factor.

“Guys didn’t used to hit each other as hard because they weren’t protected,” Brian Burke said. “Now, you can go full-tilt because you know the other guy is well protected.”

It has also been suggested that players don’t respect each other as much as in previous generations and are more inclined to hit recklessly. Mighty Duck winger Teemu Selanne cited that theory after Dallas defenseman Craig Ludwig left his feet to hit Selanne in the head and into the boards March 13. Selanne was lucky to emerge unhurt and Brian Burke suspended Ludwig for two games.

Phoenix’s Smith never gave the disrespect theory much weight, having heard it when he broke into the NHL in 1978, but he has changed his mind.

“I think there’s a little truth to it when I see the vicious way guys try to hit each other,” he said. “They’re not trying to separate people from the puck, or gain body position or put their body between another player and the puck. They’re trying to hurt someone.”

Smith deemed Ludwig’s suspension appropriate but called Suter’s hit on Kariya “vicious.”

Said Taylor, “There’s always been headhunters in the league and I think it’s a very dirty play, especially when a player is along the boards and has the puck and maybe has his head down. He has no protection against an elbow or a shove to the back, which drives his head into the glass. A deliberate blow to the head is a very dirty play.”

Robinson, a Hall of Fame defenseman, sees “more guys in vulnerable positions and more guys taking advantage of that. . . . It was almost an unwritten rule, if a guy was in a vulnerable position you didn’t cross-check him in the back of the neck or whatever.”

Kariya said the NHL could reduce such hits by imposing severe sanctions. As proof, he cited the league’s elimination of bench-clearing brawls through mandating heavy fines and suspensions.

“[Instead] they’ve given guys two-game suspensions, which are nice holidays and a chance to rest some injuries,” Kariya said. “If the league doesn’t come down on players who are intentionally trying to injure other players and the players can’t [retaliate] because of the instigator penalty, you’re going to get what’s happening--a lot of injured players.”

Carl Lindros advocates educating players about head injuries, issuing major penalties for elbows to the head and using extreme caution before allowing players to return after concussions.

“We weren’t all that concerned when Eric had his concussion because we learned from Brett,” he said. “A minor concussion, when it’s properly cared for, is minor. You have to listen to your body. You can’t play through these.”

In the meantime, Kariya sits and ponders his future. He was fitted for a special helmet and is considering a mouth guard, but he knows those things can’t make him invulnerable. He asked Milhouse if one more concussion might end his career, and Milhouse had no answer.

“I said, ‘Honestly, Paul, I do not know. Nobody knows how many concussions are too many for one person. We do know the threshold drops from one concussion to the next,’ ” Milhouse said.

Taylor, Brett Lindros and Michel Goulet had too many. Perhaps Vaske, Johnson and LaFontaine have too. Kariya hopes he has not reached that point.

“I’m not going to make a decision . . . until I get more tests,” Kariya said. “I still have to feel normal and see where I’m at going forward. . . . At some point I have to make a decision on that. Right now, you don’t want to make decisions when you’re not feeling normal.”

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How Concussion Occurs Concussion occurs when the body is hit hard enough for the brain, which floats in fluid, to jolt against the inner skull. It bounces back against the opposite side and continues until momentum stops. Concussions generally divide into five levels, ranging from 0 to 4. Characteristics of the levels: *

0: Headache and difficulty concentrating 1: Victim may appear stunned or dazed with no loss of consciousness (LOC); sensory disorientation for less than a minute 2: Headache, disorientation of more than a minute; no LOC 3: Victim loses consciousness for less than a minute but is not comatose 4: Headache, disorientation, LOC for more than a minute Source: Galen Health Care