Managing and preventing ice hockey injuries: the risk of injury cannot be eliminated but can be reduced substantially.(Cover Story)

ABSTRACT: Participation in ice hockey carries a relatively high risk of injury. Most hockey injuries are mild, but serious injuries can occur. The head, face, and eye region accounts for most injuries when players do not wear full facial protection. The risk of spinal cord injury may be increasing; preventive strategies are essential. Acute airway trauma and commotio cordis may be life-threatening. The acromioclavicular ligaments of the shoulder and the medial collateral ligament of the knee are susceptible to injury. Lower abdominal and groin pain often presents a diagnostic challenge. Foot contusions are common. Physicians who have an appreciation for the types, locations, and mechanisms of the more common injuries will be better equipped to promote safety. (J Musculoskel Med. 2005;22:37-44)

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Participation in ice hockey continues to increase worldwide. Youth programs are proliferating, and opportunities for women athletes are expanding.

Playing the game of hockey requires a unique combination of finesse, speed, and power in individual athletes, as well as a high level of teamwork. This challenging sport also carries a high risk of injury; numerous specific injury patterns can occur. The overwhelming majority of hockey injuries are mild. Most injuries involve the soft tissues: contusions, strains, ligament sprains, and lacerations. Possible serious and catastrophic injuries include concussion, cervical spine fracture, airway trauma, eye injury, commotio cordis, and neck lacerations.

The intrinsic hazards of playing ice hockey cannot be eliminated, but the risk of injury can be reduced substantially. For example, by conducting a preseason screening examination, an experienced physician who has a working knowledge of hockey injuries may identify existing injuries and uncover deficiencies. Following an injury, careful examination of a player can lead to effective diagnosis, management, and guidance about safe return to play. Recommending a sport-specific conditioning program can contribute to player safety. In this article, I describe the risk of injury in ice hockey; the types, locations, and mechanisms of the more common injuries; and management, conditioning, and preventive strategies.

INJURY RISK

Many variables influence the degree of risk of sustaining an injury during ice hockey play, including the level of participation, player position, game versus practice exposure, wearing of protective equipment, violent behavior, and personal susceptibility resulting from preexisting injury or style of play. (1) In epidemiologic research studies of the incidence of injury in players at youth, high school, and Junior A levels of play in the United States, the risk of injury in games increased dramatically at each higher level of participation (Table 1). (2-4) Injury was defined as any hockey-related ailment that occurred on the rink or player's bench that kept a player out of practice or competition for 24 hours or required medical attention, other than icing or wrapping, and all concussions; lacerations; and dental, eye, and nerve injuries.

Injuries were infrequent among the youth players. Injury risk increased dramatically as players progressed to high school and Junior A levels.

Before the 2002 season, facial lacerations that frequently resulted from a lack of mandatory protection were a major factor in the exponential injury risk increase between youth and Junior A levels.

In one study, Junior A players aged 18 years or older played wearing full protection (full cage/shield), partial protection (half-shield/visor), or …