Why hasn’t USA Hockey mandated neck guards after Adam Johnson’s death? Its chief medical officer explains

In the wake of former NHL player Adam Johnson’s death from an injury suffered during a game in England in late October, many expected that USA Hockey would mandate the use of neck guards. Instead, on Friday, the organization that governs organized ice hockey in the United States issued a statement reiterating a “recommendation” to wear neck protection but did not change its policy.

Why?

It’s not for lack of understanding of the gravity of the situation, Dr. Michael Stuart, USA Hockey’s chief medical officer and chair of its Safety and Protective Equipment Committee (SPEC), emphasized to The Athletic this week in explaining the decision and what needs to come next from the organization’s perspective.

Stuart is also a member of the International Ice Hockey Federation (IIHF) medical committee and the vice chairman of orthopedic surgery at the Mayo Clinic in Rochester, Minn. And this isn’t only professional for him; it’s personal. He’s the father of a daughter who played NCAA Division I hockey and three sons who played in the NHL, including one who suffered a neck laceration when he was a freshman at Colorado College in 1998.

“I was at the game, and since that day, I realized that there is clearly a risk of skate blade lacerations to the uncovered and unprotected areas of a hockey player’s body,” Stuart said. “This has been near and dear to my heart for many, many years.”

But two decades later, and even after Johnson’s death and the death of a 10th grader in Connecticut last year also because of a skate cut to the neck, USA Hockey still only “recommends that all players wear a neck laceration protector, choosing a design that covers as much of the neck area as possible.”

A memorial to Adam Johnson at his home in Hibbing, Minn. (Michael Russo / The Athletic)

Meanwhile, countries such as Canada, Sweden and Finland, and even some USA Hockey affiliates, have previously made that protection mandatory. Hockey Canada’s rulebook states that wearing a neck guard certified by the Bureau de Normalisation du Quebec (BNQ), the organization that created the country’s standard for the guards, “is required for players registered in minor and female hockey.” Other amateur, junior and professional leagues have changed their rules to require neck protection since Johnson’s death.

So what is USA Hockey waiting for?

Stuart said the critical point is that the organization wants to mandate neck protection that meets a higher standard than what’s currently available at a mass scale.

The International Organization of Standardization (ISO) published a standard for neck laceration protectors in 2017, but to this point, no one has ever asked for that standard to be certified. The neck laceration products on the market today are not certified by the Hockey Equipment Certification Council (HECC), which certifies other pieces of vital protective gear like helmets.

The ISO has been developing a new standard, which Stuart said is supposed to be released soon.

“That’s what we’ve been waiting for,” he said.

USA Hockey may have issued a release saying it will continue to only recommend neck guards, but Stuart said there is an ongoing conversation about neck laceration protection and proposed rule changes. The HECC is working on a process by which it’d certify products, too. This may still lead to a requirement that players must wear neck guards that are certified by HECC.

“I think USA Hockey and other federations throughout the world are looking for improved materials and designs so that hopefully the requirement or mandate is effective and enforceable,” Stuart said. “We take this very, very seriously. We’re very saddened for the families and the teammates and the community that had to witness this.

“But suffice it to say that this provides, I think, an opportunity for improved safety. Even though USA Hockey has recommended a neck laceration protector for many years for all players, and we’ve also recommended coverage in undergarment sleeves and socks, it needs to go further.

“We’ve done it with helmets. We’ve done it with facial protection. I am very optimistic that this will happen.”

In a meeting that was scheduled before Johnson’s death, the HECC convened Wednesday in Washington, D.C., and discussed the topic.

“It may be coming,” Ryan Miosek, who is general counsel to the HECC, told The Athletic on Wednesday. “In fact, I think it is based on the meeting we had today. I think that’s probably the reasonable expectation, but I can’t say for any certainty that it’s going to be in a month, a year, whenever.

“HECC is prepared that if someone were to ask us to certify a neck laceration guard, we understand that would be something that would come down to us and we would say to those entities that require that, ‘OK, what standard are we going to test to?’ That’s a conversation that’s started.”

Still, that it’s a conversation that’s not further along will frustrate many. There are several reasons for the delay, Stuart said, among them market interest, quality, product safety and cost.

Stuart, who has done his own research on neck laceration protectors at Mayo Clinic under the sponsorship of USA Hockey and with funding from the USA Hockey Foundation, has worked with small companies on prototypes.

“We’ve tried, but in the past there was not a whole lot of interest, to be honest, by the consumer or the manufacturer,” he said. “The question is, ‘Why would you research and manufacture a product if nobody is going to buy it?’ That’s where the challenges lie.”

That may change now with tragedy in the news and concerned parents wanting their children to have the right equipment.

“I think with these devices now selling off the shelves, that should be some very important motivation to come up with the best possible product in a competitive market that does satisfy the highest standard and is certified,” Stuart said.

But there’s a Catch-22. Quality comes at a cost. Will the consumer pay it?

“We’re hoping they use the best cut-resistant material out there, but that is very expensive, so it might be difficult to sell,” Stuart said. “For me, it comes down to materials, design, affordability and the proper sizes. For example, there’s a lot of different lengths of necks, and just like people wear different size skates, you’re going to need different-sized neck laceration protectors.

“So yes, there is merit in wearing a neck laceration protector. However, we have to do a better job of finding the most effective, cut-resistant, affordable material.”

T.J. Oshie is one of several NHL players trying out neck guards recently. (John McDonnell / The Washington Post via Getty Images)

In the meantime, why would USA Hockey be opposed to mandating a neck laceration protector, even an uncertified one, if it offers some benefit?

“You can say something is better than nothing, and I would agree with that,” Stuart said. “However, if you’re wearing the wraparound collar-type of device that may not be very cut-resistant or is not covering the majority of your neck, the skate blade can come in contact with an area that’s uncovered.

“In addition, we’ve shown in our research that when these protectors become wet or washed and then dried, they shrink. We know they all become saturated with sweat, and because of the weight of the sweat, they’re going to slide down farther (on the neck). That doesn’t mean they may not provide some benefit, but we have to do a better job. We’re not going to rest with ‘whatever you wear is fine.’”

USA Hockey once conducted research in which it determined that current neck protectors did not eliminate the risk of lacerations. In the study, 27 percent of players who sustained a neck laceration were wearing a neck guard at the time of the injury.

“That doesn’t mean you shouldn’t wear one,” Stuart said. “But what we concluded was we need to do a better job of constructing a device.”

Again, to Stuart, the goal for USA Hockey should be to mandate equipment that definitively can prevent potential injuries. Otherwise, he said, “What exactly are you mandating? That’s an ineffective rule.”

In fact, he added, some protectors could even lead to potential injuries.

“Some people have speculated, and this is not proven, that wearing certain types of these devices could actually deflect the skate blade off the collar, into the unprotected area, and actually cause a more severe injury,” Stuart said. “That doesn’t mean it happens, or it’s going to happen, but it’s a valid observation.”

Another concern he raised is that certain neck laceration protectors could affect neck movement, which could cause sight issues for players.

“We did a study looking at high school hockey players wearing them, and we measured their cervical spine range of motion,” Stuart said. “We were able to document that it limits side-bending and rotation of the neck. So there’s some concern that restricting neck motion could have consequences, too, if you can’t turn to see and anticipate a collision or things like that.”

Those are the findings that have been discussed in previous USA Hockey deliberations on a neck guard mandate.

“That doesn’t mean that the currently available devices are not effective,” Stuart said. “Some are probably more effective than others, and there’s a possibility that some could actually be detrimental.”

Stuart said that he is prepared to recommend to both USA Hockey and the IIHF that neck guards are mandated when he believes there’s one that’s truly effective and is HECC certified.

“I can only give my personal opinion,” he said. “We don’t legislate, but the boards of those organizations highly value our opinions and counsel. Having said that, it’s my own personal opinion that I have voiced that that would be our next step.”

A spokesperson for USA Hockey said its board leans heavily on its experts’ opinions, so passage could be likely at that point. But while meetings will continue, it does not appear imminent.

Hockey Canada, reached by The Athletic on Wednesday, did not say whether it has plans to update its own BNQ certification process, only pointing to its current policy and adding, “We are reviewing whether to expand the scope of who must wear neck protection to include other participants.”

Stuart, however, hopes there’s progress on the way.

“Despite these horrible tragedies, this is an impetus for change and the change is going to make a big difference,” Stuart said. “The time is now to act in a variety of different ways. Yes, maybe with legislation, but it goes further than that. In order to be effective, we need to go many steps further than just saying, ‘You have to wear something.’ Let’s all work together as a hockey family to make a difference.”

(Top photo: Chris Tanouye / Getty Images)