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Contact Injuries in Minor Hockey: A Review of the CHIRPP Database for the 1998/1999 Hockey Season 6th World Conference: Injury Prevention and Control: Montréal, 2002 CHIRPP is 10 Years Old – Congratulations
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Contact Injuries in Minor Hockey: A Review of the CHIRPP Database for the 1998/1999 Hockey SeasonSteven McFaull, M.Sc. Hockey has been referred to as a game played with clubs (hockey sticks), knives (skates), and bullets (pucks)1. Indeed, sticks are often used as ‘weapons’ and during shooting can reach angular velocities of up to 40 radians/second. Skate blades have the potential to sever nerves, tendons and blood vessels in unprotected areas. Pucks can have impact forces exceeding 5,500 newtons and, given the small surface area of impact, the injury potential is high. Yet despite the increased potential for injury related to these ‘tools’ of hockey, by far the most common serious injury circumstance in minor hockey (10-17 years of age, males) is player contact (both intentional and unintentional)2.
Age divisions are a popular point of discussion in minor hockey associations across Canada. Part of the concern is that because player contact makes up a large portion of major injuries in minor hockey (76.5%; Bernard et al.2), body size, speed and strength are important factors; consequently, large discrepancies in player size may increase the risk of serious injuries. The problem is amplified at the Pee Wee and Bantam levels because boys are reaching their peak height and weight velocities during these years3,4. Bernard et al.2 performed an interesting study with Canadian Bantam level players. Members of 12 teams in five leagues in the Quebec and Outaouais regions (1987/1988 and 1988/1989 seasons) were measured for various anthropometric (body size) and biomechanical parameters. Players in competitive leagues are grouped in accordance to skill level as ‘AA’ (highly skilled) and ‘CC’ (less skilled). Body checking is allowed in both ‘AA’ and ‘CC’ leagues. Although some statistically significant (p < 0.001) differences were found between ‘AA’ and ‘CC’ players, the largest disparities were found among the ‘CC’ players. There was a 32-month range in age, a 47.7-kg range in body mass, a 41-cm height difference, a 2.3-m/s range in skating speed and a 357% difference in force of impact (as measured by a simulated body check using a force plate). Given the importance of mass and velocity in the physics of collisions5, player size is a concern. The size range for 10-17-year-old males is wide (see Figure 1)6, a fact that is easily observable in the many hockey arenas across Canada. This size differential creates the potential for serious injury; however, the chances of a collision between a 5th and a 95th percentile player is low and, in fact, the distribution of competitive minor hockey players by size may not be normal.
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CHIRPP data: Methods and analysis The CHIRPP database contained 3,165 records related to ice hockey in the 1998/1999 season (July 1/1998 to June 30/1999). Almost half (49%) of these were contact injuries (through collisions with other players, the boards, goal posts, skates, sticks and pucks) involving males playing organized minor hockey. The following analysis deals with these records. The cases were classified into minor hockey age groups based on the Canadian
Hockey Association3 (CHA) guidelines (see Table
1). This table also includes the classification system used in the United
States for comparison. The four groupings in minor hockey are Atom (10-11
years), Pee Wee (12-13 years), Bantam (14-15 years) and Midget (16-17 years).
Although the divisions catch most of the intended two-year age blocks, it
is not exclusive. For example, in Pee Wee, 1.3% of the cases were fourth quartile
(born in October, November or December) 11-year-olds and 5.1% were first and
second quartile 14-year-olds. |
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Circumstances Table 2 details the circumstances by age division. In
Atom hockey, which usually does not involve body checking, fully one-quarter
of the injuries are the result of unintentional collisions between players
and 16.8% from collisions with the boards (no other player involved) — about
twice the level of that in the other three divisions. This higher proportion
may partially be the result of younger players still developing their skating
ability and ‘hockey sense’. Bantam players are often the focus of study in
the hockey injury literature. In the current data set, Bantam-aged players
showed the largest number (101.7) of cases per 1,000 injuries of all types
in ‘Bantam-aged’ children in the 1998/1999 ‘season’. For the 1988/1989 season,
Bernard et al.2 found that 38.4% and 53.1% of all minor and major
injuries, respectively, were the result of receiving a body check. In the
CHIRPP analysis body checks received, both legal and illegal, resulted in
60.6% of all Bantam contact injuries. In 35 cases (2.3%) a goaltender was
involved. In 15 instances the injury was the result of an unintentional collision
with another player; contact with the stick, puck or a skate accounted for
19 of the 35 cases; and in one instance the circumstances were unknown. |
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Types of injuries Overall, upper extremity injuries represented almost half (46.6%) of all
injuries (Table 3.). This proportion is similar to that
for other organized sports (41.6%) and for all CHIRPP injuries (43.5%). Collarbone
fractures are common in contact hockey, representing almost one-third of upper
extremity fractures in this data set. Most (83.8%) of the collarbone fractures
occurred in the Pee Wee and Bantam divisions, and of these, 45.9% were the
result of being checked into the boards legally. Compared to other organized
sports and the overall database, lower extremity injuries are less frequent
and trunk/spine injuries are more frequent. Part of the reason that the lower
extremity injury frequency is reduced may be due to the fact that in this
study we did not look at over-exertion injuries, which are quite common in
hockey, especially in the groin/inner thigh area. |
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Admissions to hospital In the CHIRPP database, in general, those injured in organized sports have
a lower percentage of being admitted to hospital compared with the overall
database. Table 4 shows the percentages of admitted patients
by age division for ice hockey, other organized sports and all CHIRPP records
for the 1998/1999 ‘season’. Overall, ice hockey has a higher percentage of
admissions than other organized sports but less than the overall CHIRPP database.
One factor to keep in mind is that different sports have varying practice
to game injury rates. Hockey tends to have a significantly higher game injury
rate than the rate for practices, probably due to the increased intensity
of game situations. In one American study7 the injury rate per
1000 athlete-exposures for games was almost seven times that of practices
(16.2 vs 2.4). In the CHIRPP database, organized ice hockey includes both
games and practices and it is usually not possible to separate the two unless
the word “PRACTICE” is in the description (only 1.7% of the cases in the CHIRPP
data set included this word in the description). Thus, the admission proportion
may also be different in the two situations. |
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Intervention Ice hockey is an inherently aggressive sport and, in males over the age
of about 12-13 years, this element can never be totally eliminated. Injury
control efforts usually require a multi-pronged approach, which is best illustrated
using a form of the Haddon conceptual model (Table 5).
The various cells of the Haddon Matrix include key issues regarding ice hockey
safety, some of which are discussed briefly below. |
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Protective equipment is, of course, essential for a game like hockey even without body checking. Indeed, individuals playing organized recreational (no body checking) hockey often wear equipment that is too small and/or old. For instance, if shoulder pads are too small, the hard plastic caps, which are supposed to be on the lateral aspect of the deltoid, will be positioned on top. If the player collides into the boards, the pads will not be in the proper position to absorb the energy of the impact and, consequently, the player is at increased risk for a collarbone fracture. Similarly, shorts, which are too small, will not provide enough kidney protection. Also, the padding of old equipment may have lost some of its energy-absorbing capacity; in particular, helmets have a finite longetivity (typically 3-5 years according to manufacturers). Organized minor hockey leagues enforce protective equipment use well, but coaches and parents should make sure equipment is properly fitted, especially in growing boys in Pee Wee and Bantam-age divisions. Although there has been wide publicity and acceptance of helmets and face shields, neck guards have not received as much attention, except in the case of goaltenders. These devices have the potential to protect against traumatic injuries, such as skate lacerations and puck or stick impacts. Skates Properly fitting skates with good ankle support are protective against potential injury events due to less frequent falling and increased control. Strength training and conditioning Stronger muscles have the ability to protect the joints and enhance the body’s ability to tolerate impacts. The literature on this topic is sparse, however. One study8 did find an apparent protective effect significant enough to warrant further investigation. Overall conditioning can help to prevent fatigue-related injuries and in the rehabilitation of existing injuries. Trainers and coaches must be cautious, however, since a large amount of exercise, particularly anaerobic activities, (in addition to the hockey games and practices) has the potential to place the athlete in an overtrained state9 thereby, possibly, having the unintended consequences of putting the player at increased risk for injury. Body checking There are two main types of body checks: checking into the boards and open ice checks. In both cases there are legal and illegal versions. It is not clear whether illegal checks produce more severe injuries than legal checks. In the current CHIRPP database, in the case of checking into the boards, the illegal version (i.e. checked from behind) resulted in 6.3% of players being admitted to hospital versus 3.8% for legal checks into the boards. However, overall injuries resulting from legal body checks accounted for 45.7% of all injuries while those resulting from illegal checks accounted for 7.8% with no major differences in the nature of injury profile or percentage of admitted patients. Thus, by virtue of their numbers, most of the injuries are the result of legal body checks. According to the CHA, body checking is generally allowed from Pee Wee and up, but in recreational leagues, body checking is not allowed at any level. The association has a pilot project currently underway that is testing checking in Atom hockey. The problem may not be an issue in Atom divisions since the smaller size and lower skating speeds would make the checks less forceful. Age classification Even if rules were strictly enforced to eliminate illegal checks, injuries would still result from legal checks and unintentional collisions. Thus, age classification is very important. As discussed previously, age divisions are a hot topic among hockey associations, coaches and parents. At a recent meeting (September 2000), the CHA’s member branches agreed on age-related recommendations (not yet final): the Midget category would encompass a three-year age-block (15-17 years) and the other categories would all move back by one year. This is the same as the U.S. system (Table 1) except that the cut-off date is still December 31 versus the mid-year cut-off date for the U.S. Some branches of the CHA already divide their Bantam and Midget leagues into minor (first year) and major (second year) players in an effort to reduce size and skill discrepancies. Air quality inside ice hockey rinks Although not discussed often in the injury literature, exposure to pollutants in the enclosed ice hockey rink is a public health issue10. The operation of fuel-powered ice resurfacing equipment over the course of a 14 to 18-hour operating day can lead to the buildup of elevated concentrations of carbon monoxide (CO) and nitrogen dioxide (NO2). The levels finally reached depend upon the maintenance of the equipment and the ventilation system in the building. These exposures can lead to acute respiratory illness and, occasionally, toxicity. CO can also cause decreased alertness and reduced visual acuity in otherwise healthy individuals, which could potentially lead to subsequent injury events. All rink occupants (i.e. staff, spectators, players) are exposed but players are at increased risk due to their high breathing rates. Conclusion The CHIRPP data and other studies indicate that body contact is the predominant mechanism of injury for males playing organized minor hockey. Further epidemiologic research should focus on the detailed circumstances of such injuries and the effectiveness of various control measures.
1. Sim FH, Chao EY. Injury potential in modern ice hockey. Am J Sports Med 1978; 6(6):378-84. 2. Bernard D, Trudel P, Marcotte G, Boileau R. The incidence, types, and circumstances of injuries to ice hockey players at the Bantam level (14 to 15 years old). In: Castaldi CR, Bishop PJ, Hoerner EF, eds. Safety in ice hockey: second volume. ASTM STP 1212. Philadelphia: American Society for Testing and Materials, 1993:44-55. 3. Canadian Hockey Association (CHA), www.canadianhockey.ca. 4. Haywood KM. Life span motor development. 2nd ed. Illinois: Human Kinetics Publishers, 1993. 5. Meriam JL, Kraige LG, eds. Engineering mechanics, Vol 2: dynamics. New York: John Wiley and Sons, 1987. 6. Hamill PVV, Drizd PA, Johnson CL, Reed RB, Roche AF. National Center for Health Statistics (NCHS) growth curves for children, birth to eighteen years. Washington, DC: U.S. Government Printing Office, 1977. 7. Dick RW. Injuries in collegiate ice hockey. In: Castaldi CR, Bishop PJ, Hoerner EF, eds. Safety in ice hockey: second volume. ASTM STP 1212. Philadelphia: American Society for Testing and Materials, 1993:21-30. 8. Gilder KA, Grogan J. Prevention of ice hockey injuries by strength and conditioning. In: Castaldi CR, Bishop PJ, Hoerner EF, eds. Safety in ice hockey: second volume. ASTM STP 1212, Philadelphia: American Society for Testing and Materials, 1993:56-68. 9. Kreider R., Fry A., O’Toole M, eds., Overtraining in sport. Illinois: Human Kinetics Publishers, 1998. 10. Brauer M, Spengler JD, Lee K., Yanagisawa Y. Air pollutant exposures inside ice hockey rinks: exposure assessment and reduction strategies. In: Castaldi CR, Bishop PJ, Hoerner EF, eds. Safety in ice hockey: second volume. ASTM STP 1212. Philadelphia: American Society for Testing and Materials, 1993:142-156.
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Last Updated: 2001-02-16 |  |
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Age
classification and body size
Protective
equipment