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Lingering Impact

Post-concussion syndrome has cast a long shadow on the NHL's star. Brian Babineau/NHLI/Getty Images

Note: A version of this story and rankings appears in ESPN The Magazine's NHL Preview, part of the Boston Issue, on newsstands now.

Sidney Crosby was sitting in the players' lounge at Consol Energy Center following another Penguins win without him late last season. While he suffered with post-concussion syndrome, the team had adapted to life minus its captain on its way to a 106-point regular season.

After the game, Pittsburgh coach Dan Bylsma joked with Crosby about exactly how the former league MVP would fit back onto the Pens' winning front line when he was ready to return. But for the 24-year-old Crosby, who was knocked out of the lineup in early January, the real question isn't how, it's when. As Crosby's prolonged hiatus stretches into the new NHL season, his unspecified return date only begets more questions with leaguewide ramifications.

With the number of reported concussions on the rise in the NHL, the reality of post- concussion syndrome is forcing teams to adapt and move on with no guarantees of a concussed player's return -- or if he will ever be the same.

This summer, the NHL continued its efforts to address head injuries by expanding Rule 48, which previously outlawed only blindside head shots but now includes any hit where the head is targeted and is the primary point of contact. New league disciplinarian Brendan Shanahan will be charged with issuing stricter suspensions for Rule 48 violators, especially repeat offenders.

While the league works on preventive measures, it's left to the teams with recovering players to adjust to uncertain futures. Boston GM Peter Chiarelli, who has dealt with concussions to Bruins stars like Patrice Bergeron, Marc Savard and Nathan Horton, has become the reluctant expert. By winning the Stanley Cup in June, Chiarelli's Bruins proved that a team can survive concussions to even its most important players and still thrive. Ever since, the questions from his fellow general managers keep coming. He recently had a conversation with Toronto GM Brian Burke to discuss Matthew Lombardi, who might finally return to action after missing all but two games last year with a concussion. Before that, it was chats with St. Louis GM Doug Armstrong, Colorado GM Greg Sherman and, yes, Pittsburgh GM Ray Shero about Crosby.

His advice? Proceed slowly but surely. With Bergeron, the team took a measured approach. Not rushing Bergeron back from his first concussion in 2007 was a decision Chiarelli called one of the best the organization has made. But during the 2010 postseason, Chiarelli watched Savard return to the game too quickly, a tough-minded move that might have cost the player his career.

"Marc maybe had a little bit more of the old-school mentality and played through stuff he shouldn't have. It's nobody's fault that that happened," Chiarelli says. "We ask the players to have that mentality, but with concussions, you can't have it. That's the paradox."

And that's the cautionary tale for the Penguins, who are following the Bergeron blueprint when it comes to Crosby's recovery, especially after what happened to him this summer. When Crosby started to skate again and pushed himself to an exertion of 80 percent or 90 percent -- a level that might have been enough to play in the past -- some of his symptoms returned. That was enough to give Crosby pause.

"Maybe I could get by with 90 percent, maybe I couldn't," said Crosby on Sept. 7. "But I'm not going to roll the dice on that. I think it's important to get back to where I need to be."

His doctors are even more certain. Dr. Michael Collins classified Crosby's recovery as being in "reconditioning" mode. To play again, he has to get back to 100 percent, without any symptoms. It's an ongoing recovery without a set timeline, even if there are positive signs that point to Crosby being back for a good part of this season.
"I take this as a manageable injury, and I anticipate Sid returning to hockey and playing well in the future," said Collins.

But until that happens, there will be doubt.

When Crosby went down during the Winter Classic on New Year's Day, he was at the height of his game, threatening to run away with the Hart Trophy. When his season ended for good days later, he had 32 goals in 41 games.

There's now a growing fear in the hockey community that we might have seen the best of Crosby during that stretch, that post-concussion syndrome might rob fans of ever seeing him perform like that again. While he was once compared to Wayne Gretzky, Crosby is now being compared to Eric Lindros, who battled concussions until retiring at 34 years old.

It's not a fear shared by Crosby's coach.

"I've never gone there. I've never thought about those types of things," says Bylsma. "The way he competes and the way he thinks about things and the way he works at trying to get better -- that's not going to change."

But until Crosby hits the ice again, the Penguins must continue to try to find ways to win in his absence. In the process, they've gained the benefit of experiencing half a season without their captain as well as Evgeni Malkin, who was lost to a knee injury. The Pens learned to win with focused team play built around an underappreciated defense. Bylsma believes that will make Pittsburgh even more dangerous once Crosby rejoins the recovered Malkin.

And it can happen. Minnesota's Pierre-Marc Bouchard missed more than a year while recovering from a concussion and felt like his game returned by the end of last season. He anticipates the same for Crosby.

"Toward the end of the season, I felt personally that I was about where I was before," he says. "It's tough to explain. I know what I can do. By the end of the season, I was pretty close."

San Jose Sharks GM Doug Wilson gave his new defenseman, Brent Burns, a five-year contract extension this summer despite Burns' concussion history. And Burns can empathize with Crosby's recovery. He shared the same struggles with light sensitivity, fatigue and fogginess that Crosby has endured. He was also troubled by the nagging suspicion that teammates didn't truly understand how serious his injury was because there was no cast or missing teeth.

"I cringe when I hear people talk about Sidney Crosby not being the same player," Burns says. "He will be once he gets over his symptoms -- and he will get over his symptoms. I know the doctors are going to be telling him the same thing. He's going to be right back to where he was."

The entire hockey world, changed forever, waits to see if he's right.