Ice Hockey Injuries Research Articles

Hockey Concussion Education Project, Part 2. Microstructural white matter alterations in acutely concussed ice hockey players: a longitudinal free-water MRI study

Concussion is a common injury in ice hockey and a health problem for the general population. Traumatic axonal injury has been associated with concussions (also referred to as mild traumatic brain injuries), yet the pathological course that leads from injury to recovery or to long-term sequelae is still not known. This study investigated the longitudinal course of concussion by comparing diffusion MRI (dMRI) scans of the brains of ice hockey players before and after a concussion. The 2011-2012 Hockey Concussion Education Project followed 45 university-level ice hockey players (both male and female) during a single Canadian Interuniversity Sports season. Of these, 38 players had usable dMRI scans obtained in the preseason. During the season, 11 players suffered a concussion, and 7 of these 11 players had usable dMRI scans that were taken within 72 hours of injury. To analyze the data, the authors performed free-water imaging, which reflects an increase in specificity over other dMRI analysis methods by identifying alterations that occur in the extracellular space compared with those that occur in proximity to cellular tissue in the white matter. They used an individualized approach to identify alterations that are spatially heterogeneous, as is expected in concussions. Paired comparison of the concussed players before and after injury revealed a statistically significant (p < 0.05) common pattern of reduced free-water volume and reduced axial and radial diffusivities following elimination of free-water. These free-water-corrected measures are less affected by partial volumes containing extracellular water and are therefore more specific to processes that occur within the brain tissue. Fractional anisotropy was significantly increased, but this change was no longer significant following the free-water elimination. Concussion during ice hockey games results in microstructural alterations that are detectable using dMRI. The alterations that the authors found suggest decreased extracellular space and decreased diffusivities in white matter tissue. This finding might be explained by swelling and/or by increased cellularity of glia cells. Even though these findings in and of themselves cannot determine whether the observed microstructural alterations are related to long-term pathology or persistent symptoms, they are important nonetheless because they establish a clearer picture of how the brain responds to concussion.

Are There Differences in Ice Hockey Injuries Between Sexes?: A Systematic Review.

Background:Men’s ice hockey allows for body checking, and women’s ice hockey prohibits it. Studies have reported injury data on both sexes, but no systematic reviews have compared the injury patterns between male and female ice hockey players.Hypothesis:Men’s and women’s ice hockey would have different types of injuries, and this difference would extend across the different age groups and levels of play.Study Design:Systematic review; Level of evidence, 4.Methods:Three databases, 3 scientific journals, and selected bibliographies were searched to identify articles relevant to this study. Articles were further screened by the use of predetermined inclusion and exclusion criteria. Twenty-two studies met these criteria and were subsequently reviewed.Results:Men sustained higher rates of injuries than women at all age levels, and both sexes sustained at least twice as many injuries in games than practices. Both sexes sustained most of their injuries from player contact. Men and women in college sustained most injuries to the head and face, and women suffered from higher percentages of concussion. At all ages and levels of play, men had higher rates of upper extremity injuries (shoulder), while women were found to sustain more injuries to the lower extremity (thigh, knee).Conclusion:Although findings showed men sustaining higher rates of injuries than women, the predominant mechanism of player contact was the same. The most common locations and types of injuries in female ice hockey players are comparable to other sports played by women, and similar interventions could offer protection against injury.Clinical Relevance:Further studies that report injury data for women playing ice hockey at all levels will assist in understanding what prevention strategies should be implemented.

Youth sports & public health: framing risks of mild traumatic brain injury in american football and ice hockey.

The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates.

The epidemiology of professional ice hockey injuries: a prospective report of six NHL seasons

BackgroundThere is a paucity of literature examining injury and illness rates in men's professional ice hockey. This study aimed to determine injury and illness rates in the NHL over six...

Performance, Penalties, and Injuries in Youth Ice Hockey

Performance, Penalties, and Injuries in Youth Ice Hockey

Trends in North American Newspaper Reporting of Brain Injury in Ice Hockey

The frequency and potential long-term effects of sport-related traumatic brain injuries (TBI) make it a major public health concern. The culture within contact sports, such as ice hockey, encourages aggression that puts youth at risk of TBI such as concussion. Newspaper reports play an important role in conveying and shaping the culture around health-related behaviors. We qualitatively studied reports about sport-related TBI in four major North American newspapers over the last quarter-century. We used the grounded-theory approach to identify major themes and then did a content analysis to compare the frequency of key themes between 1998–2000 and 2009–2011. The major themes were: perceptions of brain injury, aggression, equipment, rules and regulations, and youth hockey. Across the full study period, newspaper articles from Canada and America portrayed violence and aggression that leads to TBI both as integral to hockey and as an unavoidable risk associated with playing the game. They also condemned violence in ice hockey, criticized the administrative response to TBI, and recognized the significance of TBI. In Canada, aggression was reported more often recently and there was a distinctive shift in portraying protective equipment as a solution to TBI in earlier years to a potential contributing factor to TBI later in the study period. American newspapers gave a greater attention to ‘perception of risks’ and the role of protective equipment, and discussed TBI in a broader context in the recent time period. Newspapers from both countries showed similar recent trends in regards to a need for rule changes to curb youth sport-related TBI. This study provides a rich description of the reporting around TBI in contact sport. Understanding this reporting is important for evaluating whether the dangers of sport-related TBI are being appropriately communicated by the media.

Age and Competition Level on Injuries in Female Ice Hockey

The objective of this study was to describe the number, types and locations of known injuries occurring across different age categories and levels of competition in female ice hockey within the Ontario Women's Hockey Association from 2004/05 to 2007/08. We further examined under which aforementioned factors and combination of factors an unusually high or low number of injuries was recorded. Secondary analysis of anonymized injury data was conducted. The most common known injury type was strain/sprain, followed by concussion while the most frequent injury location was head/face/mouth. Analysis of deviance indicated that a significantly higher than expected number of sprain/strain, concussion and laceration injuries were recorded compared to all other injury types. In addition, there were a higher number of injuries recorded at the AA level compared to all other levels of competition. Finally, the age categories of Peewee, Midget and Intermediate within the AA level of competition, as well as Senior/Adult within the Houseleague level of competition also recorded a significantly higher number of injuries compared to other combinations of descriptive factors. Further research with female youth is needed to better understand the high number of injuries, including concussions, reported overall.

Injury rates, types, mechanisms and risk factors in female youth ice hockey

BackgroundThe objectives of this cohort study were to examine the rate, types, mechanisms and risk factors for injury in female youth (ages 9–17) ice hockey players in the Girls Hockey...

Ocular traumatology: from military medicine to individual brilliance

In the current issue of Graefe’s, the reader will find several interesting articles related to ocular traumatology. There are two studies that have been performed using (different) national databases in the United States. One, by Armstrong et al., reviewed the National Electronic Injury Surveillance System All Injury Program to present the epidemiologic picture, during an 8-year period, of Emergency Department visits by children, defined as those under the age of 18 years. They found that the rate of eye injury was highest in the 15to 17-year-old age group, with the most frequent cause to have been struck by or against an object. The study showed that, similarly to the findings in the adult population in most countries, the majority of the injuries occur at home (66 %). One would assume that the parents or a care-taker are at home most of the time, which would point to an obvious source of prevention. The fact that in this physically very active group only 9 % of injuries occur while participating in sports is, as the authors point out, possibly due to prophylactic measures introduced many years ago—such as the face-guard in ice hockey. It is also likely that a high-profile success such as the dramatic drop in if not total elimination of serious eye injuries in ice hockey has a halo effect, and reinforces the need for prevention in other sports as well. Using the National Electronic Injury Surveillance System to identify injuries caused by consumer products (CP), the paper by Chen et al. surveys the other end of the age spectrum, injuries suffered by those 65 years and older. The youngest persons in the elderly age group (ages 65–69 years) had the highest frequency (36 %) of eye injuries, with a gradual decline toward ages 85 years and above. The authors demonstrate a well-known source of serious eye injury in the elderly population. As they wisely point out, “The furniture category of CP-related eye injuries is significant, because most of these injuries resulted from falls rather than the product itself.” Those treating large numbers of patients with severe ocular trauma rather often encounter elderly people who got injured falling in the bathtub, slipping on a rug and hitting a doorknob with their eyeball, tripping on a slippery carpet covering a stairwell etc. The significance in all of this is the great potential for prevention. Removing clutter, fixing carpets to the floor, installing anti-slippery strips in bathrooms and bathtubs are simple, inexpensive, yet very effective ways to prevent such trauma; one just has to think about taking these measures before, and not after, an accident happens. The study identified a rather unique source of injuries, the topical administration of the wrong material instead of the intended eye drops. This is again a rather obvious target for prophylaxis, especially if the application of medications can be supervised by someone. Finally, Chen et al. correctly point out that it is much easier to prevent events that are task-oriented than those that are not. A relative with the correct mindset can go a very long way in organizing the environment surrounding elderly people who are at risk. The papers by Eldaly et al. on the eye injury scene during Egypt’s 2011 Revolution, and by Boiko et al. on the casualties in Russia’s anti-terror operations in the Northern Caucasus, can by and large be categorized as military medicine. The injuries sustained are caused by weapons used with the intent to kill or maim and come in large numbers, even if the management had been done by civilian ophthalmologists in Cairo and military personnel in Russia. In Egypt, 73 % of eyes had a presenting visual acuity of worse than 3/60; upon leaving the hospital, 77 % had a vision worse than 1/60. The severity of the (open-globe) trauma sustained during the F. Kuhn (*) International Society of Ocular Trauma, 2019 Hawkcrest Dr, St. Johns, FL 32259-2971, USA e-mail: fkuhn@mindspring.com

Attitudes towards the use of mouth and face guards in Swedish ice hockey: part 2. Results

The yearly cost of sports injuries, which affects Swedish society, is estimated to 3billion SEK (460 million USD). Injuries in ice hockey represent at least 270 million SEK (42 million USD). Despite the high number of injuries, mouth and face guards are rarely used in Swedish ice hockey. The major aim of this study was to examine the attitudes of mouth and face guards in two ice hockey clubs in Sweden (one elite and one division 3 club). A second purpose was to determine why some players use mouth and face guards, while others do not. A third goal was to present a material that ice hockey clubs could use for further discussions. A phenomenographic analysis of focus groups interviews. The phenomenographic analysis of the data resulted in 12 categories. Within each category, issues, activities and engagement of the participants were described. Further, similarities and differences in the discussions between the elite club and the division 3 club were described. The following categories were found to engage the participants the most: 'Ice hockey is a high-velocity collision sport in which injuries are expected', 'Attitudes towards personal protection guards' and 'Suggested measures'. The participants were aware of the risk of playing ice hockey, but they know little about the consequences of a dental injury. Although ice hockey players wish to protect themselves, they refuse to accept just any mouth or face guard. Through the discussions about reducing dental and jaw injuries by routine use of protection devices, many reform proposals were presented that could be useful in future discussions.

Sportsmanship minimizes ice hockey injuries

Sportsmanship minimizes ice hockey injuries

Hockey-Related Emergency Department Visits After a Change in Minor Hockey Age Groups

To examine ice hockey injury rates presenting to emergency departments (EDs) in 2 separate cohorts of players before and after a policy change for age groups in minor hockey. : Retrospective cross-sectional study. Retrospective review of ice hockey injuries presenting to 2 tertiary care and 5 community care EDs in Edmonton, Alberta. Two cohorts of minor ice hockey players were constructed. The pre-age change cohort consisted of 4215 registered male hockey players. The post-age change cohort consisted of 3811 registered male hockey players. The risk of fracture, head and neck injury (intracranial and nonintracranial), and all other injuries presenting to EDs were compared between the pre-age change and post-age change cohorts. Presentation to an ED with an injury occurring in ice hockey between September 1 and April 31 for the years 1997 through 2010. Overall, significantly lower injury rates were observed in the post-age change cohort for players in the Peewee division; however, no significant differences were observed for the rate of fractures, and intracranial or nonintracranial head and neck injuries. There were no statistically significant differences observed between the pre-age change and post-age change cohorts in the Atom or Bantam divisions. Introducing body checking 1 year earlier than in a previous cohort (11 vs 12 years of age) neither significantly decreased nor increased the rate of serious ice hockey injuries occurring 2 years after the introduction of body checking. Further research is recommended to evaluate the claim that introducing body checking lowers injury rates in older divisions of hockey.

DOES BODY CHECKING POLICY TO DISALLOW BODY CHECKING REDUCE THE RISK OF INJURY AND CONCUSSION IN 11 AND 12-YEAR-OLD NON-ELITE ICE HOCKEY PLAYERS IN CANADA?

BackgroundIce hockey has high participation and injury rates in youth in Canada. Body checking (BC) is the predominant mechanism of injury. Research has informed policy change disallowing BC in non-elite...

Does Intentional or Unintentional Contact in Youth Ice Hockey Result in More Injuries?

OBJECTIVE: : To determine whether boys' ice hockey programs have higher injury rates from intentional body contact or from unintentional contact and whether allowing body checking increases the rate of injuries. DESIGN: : Cohort study over 5 seasons. Many of the participants played for more than one season. SETTING: : Youth ice hockey programs during the years 2002-2007 in Ontario, Canada. PARTICIPANTS: : The study included between 2594 and 2730 boys aged 4-18 years in each season, for a total of 13 292 player-years. ASSESSMENT OF RISK FACTORS: : Player time was estimated from the trainers' reports of the number of games and practices during the season for each team, with the assumption that all players attended practices and participated in one-third of each game. Risk factors included team age group (5 groups), level of play (house league, select, and representative [rep]), games versus practices, and whether checking was permitted. House league teams were not permitted to body check, but checking was allowed in select teams from 11 years (peewee), and rep teams from 9 years. MAIN OUTCOME MEASURES: : The main outcome measures were rates of injury in relation to unintentional contact, intentional contact, and body checking and across age group, level of play and games and practices. Injuries were reported by the team trainers using the Hockey Canada injury report form, which included a physician's statement of the diagnosis and information on the cause of injury. Intentional contact (body checks) included contact with an opposing player in games, with a team member during practices, and illegal contacts, such as cross-checking or slashing. Unintentional contacts were collisions between same-team players during games, collisions with the boards, falling on the ice, or being hit by the puck. Time missed because of injury was recorded. Injury data were checked by phone calls to 22 families and found to be reliable. An injury required missing ≥1 day of activity. MAIN RESULTS: : The total number of injuries for the 5 seasons was 247 (range per season, 40-60). Overall, unintentional collision injuries accounted for 66% (95% confidence interval [CI] 60%-72%) of injuries (house/select leagues, 69.3% and rep leagues, 60.8% of unintentional contact injuries). Greater numbers of serious injuries (concussions, contusions, sprains/strains, fractures, and dislocations) occurred in unintentional collisions than in intentional collisions (P for each category, 0.20). Including all levels of play, in comparisons with peewee (age 11-12 years), younger boys (7-10 years) had a lower rate of injuries from all causes (P ≤ 0.011) and older boys (13-18 years) tended to have a higher rate of injuries from intentional causes (P ≤ 0.058) but not unintentional causes. The rates of injuries in games increased with age and league level (top rate per 1000 hours of play, bantam rep, 10.64), but rates of injuries in practices were low and relatively stable (range, 0.00-0.82/1000 hours of play). In divisions that allowed body checking versus those that did not, RR for injuries from intentional contact was 3.95 (95% CI, 0.80-19.50), from unintentional contact, 3.27 (95% CI, 1.07-10.00), and including all injuries, 3.75 (95% CI, 1.51-9.34). CONCLUSIONS: : More injuries and more serious injuries in boys' ice hockey occurred from unintentional collisions than from intentional contact. In divisions where body checking was allowed, almost 4 times as many injuries occurred from both intentional and unintentional contacts. Language: en

Professional ice hockey injuries: a 4 years prospective study

BackgroundIce Hockey is the fastest team sport with players skating up to 60 km/h and a puck speeding up to 160 km/h. Aggressive contacts between players, rigid obstacles (boards, goalposts),...

Patients With Ice Hockey Injuries Presenting to US Emergency Departments, 1990–2006

Although the number of US ice hockey participants doubled from 1990 to 2006, no nationally representative studies have examined US ice hockey injuries among participants of all ages during this period. To describe patients with ice hockey injuries presenting to a representative sample of US emergency departments (EDs) from 1990 through 2006. Prospective injury surveillance study. The US Consumer Product Safety Commission collects data from 100 nationally representative EDs via the National Electronic Injury Surveillance System (NEISS). Individuals injured while playing ice hockey and presenting to a NEISS-affiliated ED from 1990 through 2006. Incidence and patterns of ice hockey-related injuries. From 1990 through 2006, 8228 patients with ice hockey-related injuries presented to NEISS-affiliated EDs, representing an estimated 302 368 ice hockey-related injuries sustained nationally during this time. Injuries occurred predominantly among males (93.5%). More than half of the injured were aged 9 to 14 years (28.9%) or 15 to 18 years (30.1%), and injury incidence in these age groups increased over the study period (P = .009 and P < .001, respectively). The most commonly injured body sites were the face (19.1%), wrist/hand/finger (14.1%), shoulder/upper arm (13.8%), and lower leg/ankle/foot (11.1%). Lacerations (27.0%), contusions/abrasions (23.6%), fractures (17.3%), and sprains/strains (16.9%) were the most common injuries. Falls (16.5%), contact with boards (13.6%), and contact with stick (13.0%) were the most common injury mechanisms. Compared with those aged 9 to 18 years, those aged 2 to 8 years and those older than 18 years sustained larger proportions of face (injury proportion ratio [IPR] = 2.66; 95% confidence interval [CI] = 2.29, 3.08) and mouth (IPR = 4.34; 95% CI = 2.87, 6.56) injuries. Concussions were more common among those aged 2 to 18 years (9.0%) than in those who were older than 18 years (3.7%) (IPR = 2.47; 95% CI = 1.75, 3.49). Ice hockey injury patterns vary by age and sex. Our findings indicate that many trips to the ED might be prevented by using protective equipment appropriately.

Injury in Youth Ice Hockey is Associated with Body Checking: A Review

Injury in Youth Ice Hockey is Associated with Body Checking: A Review

Allowing Body Checks Tripled Ice Hockey Injuries in Kids

Allowing Body Checks Tripled Ice Hockey Injuries in Kids

Intentional versus unintentional contact as a mechanism of injury in youth ice hockey

BackgroundYouth ice hockey injury rates and mechanisms have been described by various classification systems. Intentional versus unintentional contact was used to classify mechanisms of injuries. All injuries (n=247) in one...

A review of the prevention of head, neck and facial injuries in ice hockey

Ice hockey is one of the fastest and most physical team sports. With projectiles (pucks) travelling at over 100mph and players travelling at up to 30mph wielding sticks and skating on razor sharp blades, there is potential for significant injury. In 1961, an insurance survey reported over 100 closed head injuries, with one death. This led to research into helmets and subsequent mandatory use. Facial protection was first developed in 1972 initially for goalkeepers. By 1976 all amateur players were required to wear full facial protection.