It’s the most gruesome distinction in hockey: Only one player has ever died from injuries directly suffered in an NHL game.

When Bill Masterton’s limp body collapsed to the ice on Jan. 15, 1968, the Minnesota North Stars centre appeared to be the victim of an innocuous hit. Thirty hours later, he was dead in hospital.

Today his story is nearly forgotten, but for an annual NHL award that bears his name. It honours perseverance and dedication to hockey.

The irony is that perseverance probably killed Bill Masterton.

What happened in the days leading up to that fatal moment in Minneapolis, when Masterton played his 38th and final NHL game, has been largely a mystery.

But a Star investigation has uncovered evidence that an earlier, untreated concussion was likely responsible for Masterton’s death at the age of 29.

That injury was compounded by the age-old hockey code that preaches shake-it-off-and-get-back-out-there resilience in the face of pain, serious injury, even brain trauma.

“I’ve never said this to anyone before,” said Wren Blair, Masterton’s coach and general manager, now 85. “I’ve never thought that it had anything to do with that hit. I think he had a (pre-existing) cerebral brain hemorrhage.”

Those closest to Masterton concur he was suffering from a brain injury before he stepped on to the ice that night, as does a medical expert who reviewed an autopsy report obtained by the Star.

Minnesota goalie Cesare Maniago’s wife, Mavis, had a clear view of Masterton’s fall from her seat in the stands. She, too, believes something else was wrong with Masterton that night, something that explains why the routine bodycheck left him unconscious even before he hit the ice.

“I saw Bill’s head after he was just checked from behind and it just looked like his eyes were in the back of his head,” she said. “I thought he was out then and just went fast right down.”

While much in hockey has changed since Masterton died, one thing hasn’t: Playing hurt is a sacred principle.

A ritual unfolded every Saturday evening in the small Masterton home in Winnipeg’s East Kildonan neighbourhood: brothers Bill and Bob took a bath, slipped into pajamas and sat together in front of a tiny electric fireplace while listening to Foster Hewitt on the radio.

“We spent a lot of time dreaming,” said Bob. “But my brother was the worker and he had the ethic that you need to make the NHL.”

He didn’t just work on the ice. He was a rarity in the way he prepared for a life outside the game. He starred at the University of Denver from 1957-61, helping the Pioneers win three national collegiate titles and earning tournament MVP honours his senior year. More importantly, he earned a degree.

Masterton left pro hockey after two seasons when it appeared he’d never make the NHL. He pursued a master’s degree in business engineering, eventually joining technology giant Honeywell, where he worked on the financial end of the Apollo project. He settled in Minneapolis with his high school sweetheart, Carol, and they adopted two children, Scott and Sally.

In 1967, Masterton’s nearly forgotten hope of playing in the NHL re-emerged with the league’s expansion from six to 12 teams. The Montreal Canadiens, which owned his rights, traded them to Minnesota. Blair, in charge of the North Stars, came calling.

Bob Masterton remembers his brother telling him about the NHL offer over dinner. “I looked at him and said, ‘What are you going to do?’ because he was just starting a young family,” said Bob. “It was kind of one of those things where I asked the question but I knew what he was going to do. It was always in the back of his mind.”

The season started with promise: Masterton scored the first goal in North Stars history. But 37 games later, in the days leading up to the hit that would kill him, there were signs all was not right.

The night before the fatal game against Oakland, Masterton was at Maniago’s house with his family — Scott was 3 and Sally, 1 — helping the genial goaltender celebrate his 29th birthday with teammates.

In a quiet moment, Masterton made a rare admission to Maniago: He was struggling with the effects of a head check into the glass during a recent game.

“He had been complaining of headaches,” said Maniago. “He’d got hit and even that night he said ‘Gee, I’ve really been getting these migraines and they’ve been with me for about a week.’”

In several games prior to the tragedy, Blair had also noticed something strange.

“I’d said to our trainer, ‘Do you ever look at Billy when the game’s on?’” Blair recalled. “His face is blood red, almost purple. (The trainer) said, ‘Yeah, I notice that too.’ I said, ‘I wonder if we could have him checked. There’s something wrong.’”

Masterton, who was always quick to dismiss concerns, was never sent to a doctor.

“I’m fine,” he’d say, the mantra of a thousand hockey players.

Carl Johnson, assistant general manager of Minnesota’s farm team in Memphis, said he was told Masterton had blacked out while on line rushes during practice.

Former Edmonton Oilers coach John Muckler, who coached the North Stars’ farm club in Memphis that season, said he saw signs of trouble with Masterton in training camp.

“I really believe he was injured before the fatal blow. I know that in our training camp he got hit hard a couple of times. And he got hit a few games very hard at the NHL level. His aggressiveness got him.”

Masterton wasn’t big. But he played as though he was, said Muckler.

“He wasn’t the most talented guy in the world but he really wanted to play. . . . He wanted it badly. I’ve never seen a person work so hard. He’d never show when he got hurt. He never laid down.”

When he suffered the final hit of his career, Masterton was making his patented move — crossing the opposing blueline and cutting to one side before passing the puck to a teammate.

Oakland defencemen Larry Cahan and Ron Harris moved in to check Masterton, who wound up falling on the back of his head. One account holds that Masterton regained consciousness for a few moments and repeated the words, “Never again, never again,” before closing his eyes for the final time.

After reviewing the document, Dr. Charles Tator, a Toronto neurosurgeon and concussion expert, believes Masterton suffered “second impact syndrome,” a rare occurrence where a second concussion happens on the heels of a first concussion that never healed, causing rapid and severe brain swelling.

“We know the second hit can be fatal. The usual story is just as has unfolded here, that they can even talk a bit after that final hit and then they lapse into a coma,” Tator said. “There is evidence of massive brain swelling . . . that is out of proportion to the blow that he got. My interpretation is that the seeds of this catastrophic injury were sown days before.”

What makes hockey players hide their injuries and re-enter games knowing the next hit could spell ruin?

Fear, plain and simple, said Mike Walton, a Maple Leafs rookie when Masterton died.

“Injury wasn’t really of any importance in the sense that you didn’t want to lose your job and if you couldn’t play, obviously they had to fill their roster,” said Walton, now a real estate agent in Toronto. “It was a dictatorship. They had total control.”

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While knowledge of concussions has increased dramatically since Masterton died, the warrior-like mindset of professional hockey players is everlasting, he said.

“It goes on today, there’s no question about it. The general public doesn’t understand the adrenaline, the passion, the dedication the players have to get out there and perform.”

Throughout his college career, right through to his training camp in Memphis, Masterton wore a helmet, a rarity in an age when head protection was dismissed by players and management alike. It disappeared during his 38-game career as an NHLer.

“I’ve always thought of this after, that when he complained (of headaches) at least he could have put on a helmet for a couple of days,” said teammate Wayne Connolly. “But it was frowned on, really.”

Only Andre Boudrias had the temerity to challenge it on Minnesota. He was traded the following season to Chicago.

“We were not allowed to wear helmets,” said J.P. Parise. “You would get traded if you did. It was a no-no in no uncertain terms. You were a yellow belly if you wore a helmet.”

Bill’s son Scott Masterton, now 46 with four children of his own, also believes that his father’s fate was sealed long before the night when the final blow was dealt.

“My mother, before she died, talked about it. He was having some headaches. My feeling is that he may have gotten a minor concussion playing or practising on some other day . . . and when he got hit the second time, he had that head whip and when that happens, you can go unconscious in that split second before you fall.”

He speaks with the authority of an athlete accustomed to putting his body at risk.

As a 29-year-old professional U.S. kickboxing champion, the younger Masterton’s career ended with a slip and fall in the ring against the then British champion on the very date — Jan. 15th — of his father’s death, also at the age of 29.

Their professional athletic careers may have ended with eerie similarity exactly 25 years apart. But from that moment forward, the echoes of his father’s life stopped. With a blown knee and broken bones, Scott stepped away from his sport.

“I knew it was time to stop.”

Philadelphia forward Ian Laperriere is one of three final nominees for this year’s Masterton Trophy — despite not playing a single game in 2010-11 as he deals with post-concussion syndrome.

Like Masterton, Laperriere earned an unlikely place in the pros with grit. Twice last season, Laperriere took slapshots in the face. Still, he returned to play following lost teeth, hundreds of stitches and even the discovery of a spot on his brain visible on a CAT scan.

Laperriere’s brain was bleeding. But four neurologists cleared him to play after the spot disappeared.

“People said I was crazy, but I’m like, ‘They brought me here to show the young guys the right way,’” said the 37-year-old Laperriere, who had signed with Philly before the 2009-10 season.

His playing style has endeared him to hockey fans. Nowhere was that more apparent than during a standing ovation for Laperriere during Game 3 of the Eastern Conference semifinals against Boston last year. The scoreboard showed a video of Laperriere getting nailed in face with a puck in the opening series against New Jersey, blood pouring from a gash over his right eye.

As dramatic music replaced a play-by-play call of the incident, the video moved backwards in slow motion until just before Laperriere’s face absorbed the slapshot. The question flashed up on the big screen: “What if Ian didn’t believe in sacrifice?”

Laperriere acknowledged his career may be over, though he can’t bring himself to retire. He admits he lied to team doctors about his post-concussion issues in order to return for a shot at the Stanley Cup.

“If I had a slim chance to play, I’m going to play.”

That’s a philosophy that Scott Masterton views with the ambivalence of both a former competitive athlete and a man left fatherless at the age of 3.

He sees both nobility and short-sightedness in the demands placed on hockey’s most devoted players. He understands how passion and perseverance can deliver both glory and death.

“The idea that you persevere goes back to time immemorial. It’s a badge of honour,” he said. “It’s also the mindset that will shorten their lives and destroy their bodies. Men are the way men are.”

The Bill Masterton Memorial Trophy, for perseverance, sportsmanship and dedication to hockey, will be awarded June 22.