Jan 29, 2015
More Than Meets The Ice

dawncomstock-head.jpgBy Dawn Comstock

The Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital in Columbus shares its analysis of injury rates for hockey players high school-age and younger based on injury type and gender.

Icing, slap shot, power play–these terms have become standard vocabulary among U.S. hockey fans. All across the U.S., tens of thousands of youth, adolescents, and adults regularly gear up, lace up their skates, and take to the ice for the love of this exciting, fast-paced sport that encourages teamwork, athleticism, balance, and hand-eye coordination. Although these benefits are well recognized among players and coaches, many people equate ice hockey to injury, conjuring up images of fighting and violent, high-speed collisions. Understandably, many parents may be wary when their son or daughter asks to join the local team, perhaps encouraging their child to instead play a “safer” sport such as soccer or basketball.

Is ice hockey’s potential for injury a valid concern that might outweigh its positive benefits? Or are the perceived risks greater than reality?

To examine this topic, we recently completed a study looking at ice hockey injuries presented to U.S. emergency departments (ED) from 1990 to 2006. We used data from the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). The NEISS collects information from all ED visits at a sample of 100 hospitals and is able to apply statistical weights to cases in order to approximate the total number of injuries occurring across the country. The NEISS includes players of all ages and because it only includes cases from the ED, this data represents the most severe injuries.

An estimated 302,368 ice hockey-related injuries occurred nationally from 1990 to 2006. About 21,000 ice hockey-related injuries present to an ED every year. The majority of injuries (98 percent) result in the patient being treated and released.

Here is a summary of what we found:

Commonly injured body sites: • Face (19 percent) • Wrist/hand/finger (14 percent) • Shoulder/upper arm (14 percent) • Lower leg/ankle/foot (11 percent)

Common injury diagnoses: • Lacerations (27 percent) • Contusions/abrasions (24 percent) • Fractures (17 percent) • Sprains/strains (17 percent)

Common injury mechanisms: • Falling (17 percent) • Contact with boards (14 percent) • Contact with stick (13 percent)

As one might expect, because playing styles vary by age and gender, we found age- and gender-specific differences:

• Injuries among players age two to eight and >18 years old were almost three times more likely to be facial injuries and over four times more likely to be mouth injuries compared to players age nine to 18. This might reflect players aged nine to 18 being more likely to wear helmets with full-face shields because these are required during most school- and league-sanctioned competitions.

• Injuries among players age nine to 18 were 2.5 times more likely to be concussions compared to all others players. This may stem from increased physical contact, such as body checking, among players age nine to 18.

• Compared to older players, players aged two to eight were almost three times more likely to be injured following contact with the stick and 50 percent more likely to be injured by falling.

• Injuries among females were twice as likely to be concussions compared to males and twice as likely to have occurred after falling.

How can we prevent injuries?

• The best way to prevent ice hockey injuries is to wear appropriate protective equipment at all times while on the ice. This includes young children just learning to skate, adults playing a recreational pick-up game, and everyone in-between. An innocent-looking fall, wayward stick, or flying puck that glances unremarkably off protective gear can result in a game ending, expensive ED visit when such gear is missing. Furthermore, wearing this gear has not been shown to impede physical performance.

• Ice hockey leagues should consider implementing the American Academy of Pediatrics’ recommendation to raise the minimum checking age among males to 15 years old. Coaches and athletic trainers should make sure players have adequate skating skills and physical abilities prior to learning how to check.

• Ice hockey is becoming increasingly popular among females. Coaches and athletic trainers accustomed to working with males should keep in mind that females may be relatively new to the sport and should work on structuring practices that are geared and paced towards the appropriate skill level. A collaborative effort among league administrators, coaches, athletic trainers, ice hockey rinks, parents, and athletes is needed to reduce ice hockey-related injuries to their lowest possible level. Focusing on simple preventive strategies that reduce injury incidence and severity while having minimal impact on performance will help ensure that eager youth and adolescents reap maximum enjoyment and benefit from the sport.

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at [email protected].

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