Body Checking Not The Main Cause Of Youth Hockey Injuries

Hockey fans likely would assume that body-checking -- intentionally slamming an opponent against the boards -- causes the most injuries in youth ice hockey. But they would be wrong.  Findings from a new study, the largest and most comprehensive analysis to date of young hockey players, show that 66 percent of overall injuries were caused by accidentally hitting the boards or goal posts, colliding with teammates or being hit by a puck.

Only 34 percent of the injuries were caused by checking. Moreover, the accidental injuries were more severe than those from body checks.

These results, which appeared in June issue of the British Journal of Sports Medicine, were a surprise to many, including the researchers at the University at Buffalo who conducted the five-year study.

"There is an image of body checking as a form of violence that is condoned by the game of hockey," says Barry Willer, PhD, UB professor of psychiatry and rehabilitation sciences and senior author on the study.  "However, this study found that body checking did not account for a large proportion of injuries. Perhaps as important, body checking did not lead to a rise in intentional injuries."


The youth ice hockey program in Burlington, Ontario, Canada was the base of the study. The researchers compared injury rates overall for the three levels of competition: "house leagues," where there is no body checking; "select," in which checking is allowed at age 11 and older; and "representative," for the most skilled players, which allows checking in all divisions at age nine and above.
 
They also examined injury rates as level of competition and players' age increased, and how injury rates varied in games versus practices. The data covered 3,000 boys ages four to 18 for a total of 13,292 player years. Only injuries that kept a player off the ice for at least 24 hours were included.
Their analysis of the data shows that there were three times more accidental injuries than body-checking injuries in the house leagues -- 92 versus 30. Willer says accidents at this level of competition primarily are caused by players watching the puck instead of what's in front of them, of not playing "heads-up," which coaches try to instill at all levels.

The "select" level tallied the least injuries (28) with more than half intentional, as players first experience checking. In the most experienced league, however, 59 percent of the 96 injuries were unintentional, but the number of intentional injuries (39) was the highest of all the categories, as competition level increases.

As the researchers predicted, as the level of competition and players' age increases, so did injuries. "Game injuries were much more frequent among the highly skilled players on rep teams," says Willer. Rates during practice were low across all age groups and divisions.  Willer notes that this study doesn't answer two important questions: at what age should body checking be allowed in youth hockey, or should it be allowed at all?

"The study does suggest," says Willer, "that, regardless of whether young players are allowed to body check, unintentional contact with the board, the ice or other players are important sources of serious unintended injury. To avoid these accidents, hockey coaches must teach players to keep their heads up, rather than looking down at the puck."

Sources: University at Buffalo and Darling et al. Intentional versus unintentional contact as a mechanism of injury in youth ice hockey. British Journal of Sports Medicine, 2010

See also: Science Fair Project Leads To New Sports Concussion Test and Lifting The Fog Of Sports Concussions

Hockey, Concussions and TBI

Photo by Yong Kim/Philly.com Staff Photographer

Dan's note: I am very pleased to publish this guest post from Chelsea Travers. She is an outreach representative for CareMeridian, a subacute care facility, with locations throughout the Western United States for patients suffering from traumatic brain injury, spinal cord injury or medical complexities, such as neuromuscular or congenital anomalies.

By Chelsea Travers

Hockey is arguably one of the most physical professional sports. Hockey players are constantly getting body checked, slammed into boards, falling to the ice, slapped by a stick, hit by a dense, speeding puck or getting punched during a fight. If that isn’t bad enough, hockey players take part in one of the longest regular seasons of any sport, effectively taking on harsher pain for a longer amount of time throughout the year.    

Risk of injury couldn’t be clearer as it is common to see hockey players missing their front two teeth. With all of the injuries that can occur, one of the most dangerous is a traumatic brain injury (TBI). A TBI is a silent injury that can cause harm to the mind and body of an individual. An injury to the head or brain can alter someone’s life and can even require long-term rehabilitation and care from a skilled nursing facility. These injuries are often far too common in the sport of hockey and if not properly treated can permanently leave a hockey player's life more challenging than the game they play.

TBI is an injury that Philadelphia Flyers player Ian Laperriere knows all too well. Last month, in an NHL playoff game with the New Jersey Devils, Laperriere took a slap shot to the face that immediately caused him to bleed excessively from the wound above his eye and lose sight. Laperriere was diagnosed with a brain contusion after having a MRI a few days later. While Laperriere may have originally thought that losing sight in one of his eyes was the worst of the two injuries, in reality the bigger concern could wind up being the long-term effects of the brain injury.

Concussions may sometimes be dismissed as minor injuries because the physical nature of most sports causes them to occur regularly. However, they are still head injuries where the brain is forced to move violently within the skull, possibly changing its function permanently. When the brain moves in such a manner, it can bruise, bleed, and even tear, which can cause irreversible damage to the victim. 

For a sport like hockey this type of injury is very common and unfortunately at times ignored. Many hockey players don't take into account the possible effects of the injury. As it might not seem like a serious problem exists at first, they keep on skating as if nothing occurred. Being unaware of the injury makes it much more dangerous because a mild brain injury can turn into a life threatening injury in a very short period of time without immediate medical treatment.

Studies by the National Academy of Neuropsychology's Sports Concussion Symposium in New York have shown that since 1997, 759 NHL players have been diagnosed with a concussion. Broken down, that averages out to 76 players per season and 31 concussions per 1,000 games of hockey. That is far too frequent of an occurrence for such a serious injury. It's a frightening statistic that should send up a red flag to hockey officials that actions need to be taken to further prevent this type of injury.

The best, and sometimes only, treatment for TBI is prevention. For the National Hockey League, new rules are being considered that preserve the game but also help protect the players. Rule changes concerning blindside hits, rink size (which effects players space from each other and their proximity to walls), and stronger helmet requirements all have been considered to help curb TBI and its effects. This demonstrates that the NHL is aware of the seriousness of the injury and is taking proactive steps to help prevent it from happening.

Hockey is one of the most popular sports in North America and has millions of people participating in it every year. Unfortunately, the sport comes with the risk of a TBI.  With the right awareness of the injury and the necessary precautions in place, the game should be able to continue with players excited to lace up their skates and enjoy it. 

See also: Lifting The Fog Of Sports Concussions and Hockey Hits Are Hurting More

Why Pro Athletes Attract Trouble

From the "athletes behaving badly" department (in the past month, anyway):
•    NHL bad boy (Sean Avery) was suspended for six games for a crude remark.
•    Six NFL players were suspended for allegedly violating the league's drug policy.
•    Another NFL player (Adam "Pacman" Jones) returned to his team's roster after being suspended, again, for an off-field altercation.
•    Oh, and NFL receiver (Plaxico Burress) accidentally shot himself in a nightclub with a gun he was not licensed to carry. 

Despite the 24/7 media coverage of each of these incidents, sports fans have become accustomed to and somewhat complacent with hearing about athletes and their deviant acts.
In fact, new statistics reveal that bad behavior is clearly evident among high school athletes, particularly in high-contact sports.

It starts young
Besides the highly publicized stories, there are thousands more across the nation involving amateur athletes taking risks both on and off the field. From performance-enhancing supplements to referee/official abuse to fights, guns and recorded crimes, the image of sports as a positive influence on athletes may need a second look.

Granted, in a population of any size there will be a few bad apples. However, these actions have become so prevalent that academic researchers have created a branch of study called "deviance in sports" attached to the sports sociology tree. 

They are asking questions and challenging some assumptions about cause and effect. Is there a connection between sports participation and deviance? Does the intense competition and battle on the field shape a player's off-the-field lifestyle? Since success in sports brings attention and prestige to athletes, does the risk of losing that status cause a need to take risks to maintain their "top dog" positions?

In their new book, "Deviance and Social Control in Sport," researchers Michael Atkinson and Kevin Young emphasize the confusing environment surrounding athletes. They describe two types of deviance: wanted and unwanted.

Owners, players and fans may know that certain behaviors are literally against the rules but are at the same time appreciated as a sign of doing whatever it takes to win.  Performance-enhancing drugs are not allowed in most sports, but athletes assume they will improve their performance, which helps their team win and keeps fans happy. Fights in hockey will be, according to the rule book, penalized, but this deviance is assumed to be wanted by fans and teammates as a sign of loyalty.

However, related bad behavior can quickly turn on a player to being socially unwanted. 

Abuse of drugs that don't contribute to a win, (marijuana, cocaine, alcohol), will transform that same player into a villain with shock and outrage being reported in the media. In the Sean Avery example, a hockey player fighting to defend his teammates on the ice can then be suspended from the team and criticized by those same teammates for an off-color remark.

Real statistics
Most athletes who make it to the professional level have been involved in sports since youth. Sports sociologists and psychologists often look at the early development years of athletes to get a glimpse of patterns, social norms and influences that contribute to later behaviors.

In a recent American Sociological Review article, Derek Kreager, assistant professor of sociology at Penn State University, challenged the long-held belief that youth sports participation is exclusively beneficial to their moral character development. 

With the focus on teaching teamwork, fair play, and self esteem, sports are often cited as the antidote to delinquency. But Kreager notes that other studies have looked at the culture that surrounds high school and college athletes and identified patterns of clichés, privileges and attitudes of superiority. For some athletes, these patterns are used to justify deviant behavior.

In fact, his most recent research attempted to find a cause-and-effect link between deviant behavior and specific sports. Specifically, he asked if high-contact, physical sports like football and wrestling created athletes who were more prone to violent behavior off the field.

Using data from the National Longitudinal Study of Adolescent Health, more than 6,000 male students from across 120 schools were included. The data set included a wide collection of socioeconomic information, including school activities, risk behaviors and at-home influences. Kreager's study analyzed the effects of three team sports (football, basketball, and baseball) and two individual sports (wrestling and tennis) on the likelihood of violent off-field behavior, specifically, fighting.

To isolate the effect of each sport, the study included control groups of non-athletes and those that had a history of physical violence prior to playing sports. 

For team sports, football players were 40 percent more likely to be in a confrontation than non-athletes. In individual sports, wrestlers were in fights 45 percent more often, while tennis players were 35 percent less likely to be in an altercation. Basketball and baseball players showed no significant bias either way.

"Sports such as football, basketball, and baseball provide players with a certain status in society," Kreager said. "But football and wrestling are associated with violent behavior because both sports involve some physical domination of the opponent, which is rewarded by the fans, coaches and other players. Players are encouraged to be violent outside the sport because they are rewarded for being violent inside it."

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Hockey Hits Are Hurting More

One painful lesson every National Hockey League rookie learns is to keep your head up when skating through the neutral zone. If you don't, you will not see the 4700 joules of kinetic energy skating at you with bad intentions.

During an October 25th game, Brandon Sutter, rookie center for the Carolina Hurricanes, never saw Doug Weight, veteran center of the New York Islanders, sizing him up for a hit that resulted in a concussion and an overnight stay in the hospital.  Hockey purists will say that it was a "clean hit" and Weight was not penalized.

Six days before that incident, the Phoenix Coyotes' Kurt Sauer smashed Andrei Kostitsyn of the Montreal Canadiens into the sideboards. Kostitsyn had to be stretchered off of the ice and missed two weeks of games with his concussion. Sauer skated away unhurt and unpenalized. See video here.

Big hits have always been part of hockey, but the price paid in injuries is on the rise. According to data released last month at the National Academy of Neuropsychology's Sports Concussion Symposium in New York, 759 NHL players have been diagnosed with a concussion since 1997. For the ten seasons studied, that works out to about 76 players per season and 31 concussions per 1,000 hockey games. During the 2006-07 season, that resulted in 760 games missed by those injured players, an increase of 41% from 2005-06. Researchers have found two reasons for the jump in severity, the physics of motion and the ever-expanding hockey player.

In his book, The Physics of Hockey, Alain Haché, professor of physics at Canada's University of Moncton, aligns the concepts of energy, momentum and the force of impact to explain the power of mid-ice and board collisions.

As a player skates from a stop to full speed, his mass accelerates at an increasing velocity. The work his muscles contribute is transferred into kinetic energy which can and will be transferred or dissipated when the player stops, either through heat from the friction of his skates on the ice, or through a transfer of energy to whatever he collides with, either the boards or another player.

The formula for kinetic energy, K = (1/2)mass x velocity², represents the greater impact that a skater's speed (velocity) has on the energy produced. It is this speed that makes hockey a more dangerous sport than other contact sports, like football, where average player sizes are larger but they are moving at slower speeds (an average of 23 mph for hockey players in full stride compared to about 16 mph for an average running back in the open field).

So, when two players collide, where does all of that kinetic energy go? First, let's look at two billiard balls, with the exact same mass, shape and rigid structure. When two balls collide on the table, we can ignore the mass variable and just look at velocity. If the ball in motion hits another ball that is stationary, then the ball at rest will receive more kinetic energy from the moving ball so that the total energy is conserved. This will send the stationary ball rolling across the table while the first ball almost comes to a stop as it has transferred almost all of its stored energy.

Unfortunately, when human bodies collide, they don't just bounce off of each other. This "inelastic" collision results in the transfer of kinetic energy being absorbed by bones, tissues and organs. The player with the least stored energy will suffer the most damage from the hit, especially if that player has less "body cushion" to absorb the impact.

To calculate your own real world energy loss scenario, visit the Exploratorium's "Science of Hockey" calculator. For both Sutter and Kostitsyn, they received checks from players who outweighed them by 20 pounds and were skating faster.

The average mass and acceleration variables are also growing as today's NHL players are getting bigger and faster. In a study released in September, Art Quinney and colleagues at the University of Alberta tracked the physiological changes of a single NHL team over 26 years, representing 703 players. Not surprisingly, they found that defensemen are now taller and heavier with higher aerobic capacity while forwards were younger and faster. Goaltenders were actually smaller with less body mass but had better flexibility. However, the increase in physical size and fitness did not correspond with team success on the ice. But the checks sure hurt a lot more now. 

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