Ice hockey injuries in Finland. A prospective epidemiologic study

Recognition and characteristics of concussions in the emergency department population

An anonymous survey was conducted over a 6-month period of time using consenting Emergency Department (ED) patients in an attempt to better understand concussions occurring in the ED population. Calculations were made using the respondents' history and self-reported symptoms during the previous 12 months. Five hundred twenty-two of 700 approached patients responded to the anonymous questionnaire. Of respondents, 20.1% (105/522) answered that they had experienced symptoms of a concussion after being hit in the head during the previous 12 months. Of the 105 respondents who experienced a concussion, 88.6% (93/105) did not recognize that they had suffered a concussion. There were 28.2% (147/522) of all respondents who were actively engaging in at least one activity that was considered to be at high risk for concussions. Headache was the most common symptom for both recognized and unrecognized concussions. Respondents who experienced nausea after being hit in the head were the most likely to seek some form of medical attention, followed by people who suffered a loss of consciousness. Those patients who suffered a loss of consciousness were the most likely to visit an ED. Many patients have a poor understanding of concussions and these patients may be actively participating in high-risk activities while still suffering symptoms from a concussion. Therefore, these patients may be at risk for further concussions and Second Impact Syndrome.

Cervical muscle strength measurement in two groups of elite Greco-Roman and free style wrestlers and a group of non-athletic subjects

BACKGROUND

Free style and Greco-Roman are two types of wrestling. [figure: see text]

OBJECTIVES

The aim of this study was to examine the maximal isometric strength of cervical extension (ISCE) and the maximal isometric strength of cervical flexion (ISCF) in two groups of elite wrestlers and a group of non-athletic subjects.

METHODS

Fourteen elite Greco-Roman wrestlers (aged 19-25 years), 16 elite free style wrestlers (aged 18-25 years), and 16 non-athletic subjects (aged 18-25 years) participated in this study. All wrestlers competed at international level with the Iranian national team. Maximum voluntary contractions (MVC) of cervical extensor and flexor muscles were measured using a custom made device. The ratios of ISCE to weight (ISCE/weight), ISCF to weight (ISCF/weight), and ISCF to ISCE (ISCF/ISCE) were calculated for group comparisons. Pearson product moment test was used to estimate correlation between maximal isometric strength measurements and anthropometric variables. A one way analysis of variance was computed to compare ISCE/weight, ISCF/weight, and ISCF/ISCE among groups.

RESULTS

There was significant correlation between maximum cervical extension and flexion strengths and weight in all groups (p<0.05, n = 46). The ratios of cervical muscle strengths to weight were significantly higher in wrestlers than in non-athletic subjects (p<0.00). Greco-Roman wrestlers appeared to be stronger than free style wrestlers following comparison of all ratios.

CONCLUSIONS

Neck muscle force measurements may be a useful test for athletes in combat sports like wrestling. They can be applied to identify the weakness of a group of muscles in the neck area and to devise a proper training program.

Neck injuries presenting to emergency departments in the United States from 1990 to 1999 for ice hockey, soccer, and American football

OBJECTIVE

To examine the number and rate of neck injuries in the community as a whole for ice hockey, soccer, and American football by analysing data from patients presenting to emergency departments in the United States from 1990 to 1999.

METHODS

Data compiled for the US Consumer Product Safety Commission were used to generate estimates for the total number of neck injuries and the more specific diagnoses of neck fractures, dislocations, contusions, sprains, strains, and lacerations occurring nationally from 1990 to 1999. These data were combined with yearly participation figures to generate rates of injury presenting to emergency departments for each sport.

RESULTS

There were an estimated 5038 neck injuries from ice hockey, 19,341 from soccer, and 114 706 from American football. These could be broken down as follows: 4964 contusions, sprains, or strains from ice hockey, 17,927 from soccer, and 104 483 from football; 105 neck fractures or dislocations from ice hockey, 214 from soccer, and 1588 from football; 199 neck lacerations for ice hockey, 0 for soccer, and 621 for football. The rates for total neck injuries and combined neck contusions, sprains, or strains were higher for football than for ice hockey or soccer in all years for which data were available.

CONCLUSION

The rate of neck injury in the United States was higher in football than in ice hockey or soccer in the time period studied.

American collegiate men's ice hockey: an analysis of injuries

BACKGROUND

Reported rates and types of ice hockey injuries have been variable. Ice hockey combines tremendous speeds with aggressive physical play and therefore has great inherent potential for injury.

PURPOSE

To identify rates and determinants of injury in American men's collegiate ice hockey.

STUDY DESIGN

Prospective cohort study.

METHODS

Data were collected from 8 teams in a Division I athletic conference for 1 season using an injury reporting form specific for ice hockey.

RESULTS

There were a total of 113 injuries in 23,096 athlete exposures. Sixty-five percent of injuries occurred during games, although games accounted for only 23% of all exposures. The overall injury rate was 4.9 per 1000 athlete exposures (13.8 per 1000 game athlete exposures and 2.2 per 1000 practice athlete exposures). Collision with an opponent (32.8%) or the boards (18.6%) caused more than half of all injuries. Concussion (18.6%) was the most common injury, followed by knee medial collateral ligament sprains, acromioclavicular joint injuries, and ankle sprains.

CONCLUSIONS

The risk of injury in men's collegiate ice hockey is much greater during games than during practices. Concussions are a main cause for time lost and remain an area of major concern.

Ankle syndesmosis sprains in national hockey league players

BACKGROUND

Although syndesmosis sprains are less common in sports than lateral ankle sprains, they represent a significant source of morbidity. Several studies have described the increased recovery time for these injuries in a variety of sports. No previous study has described this injury in hockey players.

HYPOTHESIS

Syndesmosis ankle sprains require a longer recovery time and are less common than lateral ankle sprains in elite hockey players.

STUDY DESIGN

Uncontrolled retrospective review.

METHODS

The medical records of the St Louis Blues (1994-2001) and Dallas Stars (1991-2001) National Hockey League teams were reviewed by the head athletic trainers. Ankle sprains were identified and divided into 2 groups: syndesmosis and lateral sprains. Player demographics, treatment, and time lost to play were recorded for each injury.

RESULTS

Fourteen players were diagnosed with syndesmosis sprains, and 5 players sustained lateral sprains during this time period. Mean time to return to play in games was 45 days (range, 6-137 days) for syndesmosis sprains versus 1.4 days (range, 0-6 days) for lateral sprains.

CONCLUSIONS

Syndesmosis sprains represent a significant injury in hockey players with an extended time lost and, unlike in other sports, are a more common injury than lateral ankle sprains.

[Pubalgia: from diagnosis to return to the sports field]

OBJECTIVES

To review reports of the diagnosis and treatment of groin pain (pubalgia) on the basis of anatomical considerations, epidemiology and pathogenicity.

METHODS

We searched the Medline database using the key words groin injury, groin pain, and symphisis syndrome for information on groin pain.

RESULTS

Despite the limitations of this study, athletic pubalgia appears to be a real diagnosis, with a long duration of symptoms and a therapeutic challenge. The pathophysiologic processes of this lower abdominal pain resulting from over use is unclear, but muscular imbalance might be involved in the pathogenicity. There is no consensus on the diagnostic criteria and the role of imaging (magnetic resonance imaging). Physicians should eliminate the diagnosis of hip and groin injuries in athletes. Specific rehabilitation should include eliminating the pain-triggering factors, increasing the limited flexibility, and strengthening the abdominal muscles and adductor muscles. The multidisciplinary team's goal is to restore function and prevent recurrence. Successful surgical repair is predictable in well-selected patients.

CONCLUSION

Further studies are required for better assessment of incidence, the natural course of groin pain, and optimal clinical evaluation in screening patients. Overall, a large prospective randomized study of athletes with groin pain would help determine optimal treatment.

Head injuries presenting to emergency departments in the United States from 1990 to 1999 for ice hockey, soccer, and football

STUDY OBJECTIVE

To examine the number and rates of head injuries occurring in the community as a whole for the team sports of ice hockey, soccer, and football by analyzing data from patients presenting to US emergency departments (EDs) from 1990 to 1999.

DESIGN

Retrospective analysis.

MAIN OUTCOME MEASURES

Data compiled for the US Consumer Product Safety Commission using the National Electronic Injury Surveillance System were used to generate estimates for the total number of head injuries, concussions, internal head injuries, and skull fractures occurring on a national level from the years 1990 to 1999. These data were combined with yearly participation figures to generate rates of injuries presenting to the ED for each sport.

RESULTS

There were an estimated 17,008 head injuries from ice hockey, 86,697 from soccer, and 204,802 from football that presented to US EDs from 1990 to 1999. The total number of concussions presenting to EDs in the United States over the same period was estimated to be 4820 from ice hockey, 21,715 from soccer, and 68,861 from football. While the rates of head injuries, concussions, and combined concussions/internal head injuries/skull fractures presenting to EDs per 10,000 players were not always statistically similar for all 3 sports in each year data were available, they were usually comparable.

CONCLUSION

While the total numbers of head injuries, concussions, and combined concussions/skull fractures/internal head injuries presenting to EDs in the United States are different for ice hockey, soccer, and football for the years studied, the yearly rates for these injuries are comparable among all 3 sports.

Injuries to the upper extremity in ice hockey: analysis of a series of 760 injuries

BACKGROUND

Injuries to the upper extremity are common in ice hockey.

PURPOSE

To investigate the mechanisms, types, and severity of upper extremity ice hockey injuries in patients in different age categories.

STUDY DESIGN

Retrospective cohort study.

METHODS

We analyzed 760 consecutive upper extremity injuries in Finnish ice hockey players reported to an insurance company during 1996.

RESULTS

The overall injury rate of upper extremity injuries was 14.8 per 1000 player-years; 70% occurred during games. Of the 861 injury types, 32% were contusions, 28% sprains or strains, and 27% fractures. Checking or other collisions with players caused 76% of the injuries to the shoulder (170 of 223), 55% of the injuries to the elbow (35 of 64), and 45% of the injuries to the distal extremity (213 of 473). Of the 561 injuries with known severity, 38% were major. The injury risk increased significantly with age, from players younger than 12 years to players 25 to 29 years of age. The injury profile among 15- to 19-year-old players was similar to that of adult players.

CONCLUSIONS

Injuries to the upper extremity are relatively serious because of the high number of shoulder injuries and fractures. The frequency of injuries increased with age. A considerable proportion of upper extremity injuries was caused by body checking.

Winter sports injuries. The 2002 Winter Olympics experience and a review of the literature

Injury patterns at the 2002 Winter Olympics were similar to those in recreational winter athletes, although injury rates were higher. The high rates of injury compared with reported rates in recreational athletes reflect the intensity of the competition and the high speeds of the athletes. In addition, rates are artificially elevated because we were not able to count the number of practice runs by each athlete, only the number of races. The highest rates of injuries resulting in positive MR imaging or plain radiographs were in snowboarders (28/1000 races), followed by alpine skiers (20/1000). In all of the winter sports, the most commonly injured joint was the knee (37 injuries), and the most common knee injury was the ACL tear. Injuries to the foot and ankle were second in frequency (15 injuries). It is interesting that three of the ankle injuries were syndesmosis sprains; this may be an underreported injury in winter sports. There were 12 injuries to the upper extremity, all but two to the shoulder. Back complaints were frequent, but only seven patients had significant imaging abnormalities found in the lumbar spine: two stress fractures of the pedicles, one acute pedicle fracture, one spondylolysis, and four disc protrusions.

Sports injury or trauma? Injuries of the competition off-road motorcyclist

A prospective analysis of the injuries of off-road competition motorcyclist at four International Six Day Enduro (ISDE) events was performed utilizing the injury severity score (ISS) and the abbreviated injury scale (AIS). Of the 1787 participants, approximately 10% received injuries that required attention from a medical response unit. The majority (85%) sustained a mild injury (mean ISS 3.9). Loss of control while jumping and striking immovable objects were important risk determinants for serious injury. Although seasoned in off-road experiences, mean 15.3 years, 54% of those injured were first year rookies to the ISDE event. Speeds were below 50 km/h in the majority of accidents (80%), and were not statistically correlated with severity. The most frequently injured anatomical regions were the extremities (57%). The most common types of injury were ligamentous (50%). Seventy-seven percent of all fractures were AIS grades 1 and 2. The most common fractures were those of the foot and ankle (36%). Multiple fractures involving different anatomical regions, or a combination of serious injuries was seen with only one rider. When compared to the injuries of the street motorcyclist, competition riders had lower AIS grades of head and limb trauma. Off-road motorcycle competition is a relatively safe sport with injury rates comparably less than those of contact sports such as American football and hockey.

The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players

BACKGROUND

Adductor strains are among the most common injuries in ice hockey. Hip adductor weakness has been identified as a strong risk factor.

HYPOTHESIS

An intervention program including muscle strengthening can reduce the incidence of adductor strains in professional ice hockey players.

STUDY DESIGN

Prospective risk factor prevention study.

METHODS

Thirty-three of 58 players from the same National Hockey League team were identified as "at risk" on the basis of preseason hip adductor strength and participated in an intervention program. The program consisted of 6 weeks of exercises aimed at functional strengthening of the adductor muscles. Injury and individual exposure data were recorded for all players.

RESULTS

There were 3 adductor strains in the 2 seasons subsequent to the intervention, compared with 11 in the previous 2 seasons (0.71 versus 3.2 per 1000 player-game exposures). All adductor strains were first-degree strains and occurred during games.

CONCLUSIONS

A therapeutic intervention of strengthening the adductor muscle group appears to be an effective method for preventing adductor strains in professional ice hockey players.

Adductor muscle strains in sport

An in-season adductor muscle strain may be debilitating for the athlete. Furthermore, an adductor strain that is treated improperly could become chronic and career threatening. Any one of the six muscles of the adductor group could be involved. The degree of injury can range from a minor strain (Grade I), where minimal playing time is lost, to a severe strain (Grade III) in which there is complete loss of muscle function. Ice hockey and soccer players seem particularly susceptible to adductor muscle strains. In professional ice hockey players throughout the world, approximately 10% of all injuries are groin strains. These injuries, which have been linked to hip muscle weakness, previous injuries to that area, preseason practice sessions and level of experience, may be preventable if such risk factors can be addressed before each season. Hip-strengthening exercises were shown to be an effective method of reducing the incidence of adductor strains in one closely followed National Hockey League ice hockey team. Despite the identification of risk factors and strengthening intervention for ice hockey players, adductor strains continue to occur throughout sport. Clinicians feel an active training programme, along with completely restoring the strength of the adductor muscle group, is the key to successful rehabilitation. Surgical intervention is available if nonoperative treatment fails for 6 months or longer. Adductor release and tenotomy was reported to have limited success in athletes.

Dental injuries in ice hockey games and training

PURPOSE

The purpose of this study was to determine the incidence, cause, and nature of maxillofacial and dental injuries in ice hockey games and training and also evaluate the use and the effect of dental or facial guards.

METHODS

Maxillofacial and dental ice hockey injuries in Finland were studied during years 1991 and 1992. Material was gathered from the insurance company that had practically all the ice hockey licenses in those years. The material consisted of 479 injured ice hockey players who suffered from 650 separate injuries. The most common dental injury was a noncomplicated crown fracture, which accounted for 43.5% of all maxillofacial or dental injuries. Of these noncomplicated crown fractures, almost 70% occurred in the games.

RESULTS

The most common cause of accidents was a blow from the ice hockey stick. The stick as a cause of injury was approximately 3 times as common in the games than in training. Only 10% of injured players wore some kind of protective guard.

CONCLUSION

A mandatory use of mouthguards and face masks or tightened rules for protection to decrease the high number of maxillofacial and dental injuries in the ice hockey games should be considered.

Concussions in hockey: there is cause for concern

PURPOSE

The purpose of the study was to document various aspects of concussion in Canadian Amateur hockey including demographics, causes, treatment, and prevention in order to guide future recommendations on how to reduce injury.

METHODS

A detailed prospective and retrospective concussion history was obtained from British Columbia Junior Hockey League players over the course of two seasons (1998-2000).

RESULTS

Higher rates of concussions occur in games versus practice, and there was an overrepresentation of forwards injured versus defensemen or goaltenders. There was between 4.63 and 5.95 concussions per 1000 player/game hours with the average age of the first hockey-related concussion in the 15th year. The greatest cause of concussion was contact with the ice and/or the boards. Fighting was not a major cause of concussion, although other illegal actions such as elbowing were.

CONCLUSIONS

The primary recommendation to reduce the number and severity of concussions is to eliminate plays where there is a demonstrable intent to injure another player. Concussions in hockey are of considerable concern; however, there is now encouraging information with respect to the treatment of these injuries.

[Influence of age and physical activity on isokinetic characteristics of hamstring and quadriceps muscles of young gymnasts and soccer players]

OBJECTIVE

The aim of this work is the assessment of age and sport influences on the isokinetic knee muscle characteristics.

SUBJECTS AND METHOD

Subjects performed a bilateral knee flexion/extension test on an isokinetic device at 60 and 180 degrees.s(-1) speed in concentric mode. The three parameters studied in this work were the Peak Torque, Average Power and hamstring/quadriceps ratio. Thirty-eight soccer players (16,6 +/- 1.4 years old) and 22 gymnasts (18 +/- 2.8 years old) were tested. The population was separated into three groups : 15 years old, 17 years old, 20 years old.

RESULTS

The isokinetic values of soccer players were significantly higher (p < 0.0001) than those of the the gymnasts. The isokinetic values of the oldest soccer players were significantly higher (0.005 < p < 0.05) for hamstrings than those of the younger soccer players. The isokinetic values of the oldest gymnasts were significantly higher (0.005 < p < 0.05) for the quadriceps than those of the younger gymnasts. There were no significant differences between dominant and non dominant limbs in soccer players.

CONCLUSION

In the present study, the muscular maturation improves the absolute strength of the older sportsmen in comparison to the younger. Soccer favor most the absolute strength of the inferior member in comparison to the gymnastics.

Effect of fatigue on knee proprioception: implications for dynamic stabilization

The high incidence of injuries that occur later during a session of sports or recreational activities suggests that fatigue may contribute to altered neuromuscular control of the lower limb and an individual's subsequent altered ability to dynamically stabilize the knee joint. One possible mechanism is a fatigue-mediated alteration in proprioception. This paper reviews experimental evidence of fatigue-induced changes in knee joint position sense and movement sense, or kinesthesia. We will discuss the possible physiological mechanisms behind these changes, including the role of joint and muscle receptors in proprioception and neuromuscular control of the knee, and the role of fatigue in changes in afferent output from muscle and joint receptors. We will then explore the implications that alteration in proprioception may have for dynamic stabilization of the knee joint.

The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players

This prospective study was conducted to determine whether hip muscle strength and flexibility play a role in the incidence of adductor and hip flexor strains in National Hockey League ice hockey team players. Hip flexion, abduction, and adduction strength were measured in 81 players before two consecutive seasons. Thirty-four players were cut, traded, or sent to the minor league before the beginning of the season. Injury and individual exposure data were recorded for the remaining 47 players. Eight players experienced 11 adductor muscle strains, and there were 4 hip flexor strains. Preseason hip adduction strength was 18% lower in the players who subsequently sustained an adductor muscle strain compared with that of uninjured players. Adduction strength was 95% of abduction strength in the uninjured players but only 78% of abduction strength in the injured players. Preseason hip adductor flexibility was not different between players who sustained adductor muscle strains and those who did not. These results indicate that preseason hip strength testing of professional ice hockey players can identify players at risk of developing adductor muscle strains. A player was 17 times more likely to sustain an adductor muscle strain if his adductor strength was less than 80% of his abductor strength.

Epidemiology of women's recreational ice hockey injuries

INTRODUCTION

Participation in ice hockey by women is increasing in many parts of North America; however, research into injuries and the patterns of injury among female players associated with this activity is limited.

PURPOSE

The purpose of this research was to examine the incidence and nature of injuries suffered by female recreational ice hockey players.

METHODS

This prospective study followed 314 female players from 33 teams in Edmonton, Canada, during the 1997-1998 hockey season. Injury and game attendance data were collected using monthly telephone interviews throughout the season. Diagnostic information for individuals who received medical treatment was solicited from the attending health professional.

RESULTS

A total of 102 players reported a total of 125 injuries for a rate 7.5 injuries/1000 player exposures. The anatomic region most often injured was the lower extremity (31.2%), and the most common diagnosis was sprain/strain (52.0%). The predominant injury mechanism was player contact, either as a result of collision with another player or a body check (40.0%). Of all injuries, 65.6% occurred during league games, 27.2% during play-off, tournament, or exhibition games, and 7.2% during practices. Although less than 1% of injuries resulted in hospitalization, 17.6% of injuries resulted in an absence from hockey of 8 or more days.

CONCLUSION

The diagnostic and anatomic distribution of injury in the women's hockey league was similar to that in leagues where full facial protection is mandatory. The observed injury rate was lower than the rates reported for male recreational and collegiate ice hockey players. Female recreational ice hockey players are at risk for injuries and further research is required to identify areas for injury prevention.

Injury profile in ice hockey from the 1970s through the 1990s in Finland

The aim of this study was to investigate the incidence, types, and mechanisms of injury in Finnish ice hockey players at the highest competition level in different decades. Several teams were observed prospectively during the seasons between 1976 and 1979, and in the 1988 to 1989 and 1992 to 1993 seasons. An injury was defined as any sudden trauma requiring examination and treatment by a physician. The inclusion criteria were the same during the entire study. A total of 641 injuries were recorded. The injury rate per game increased significantly from 54 per 1000 player-hours in the 1970s to 83 per 1000 player-hours in the 1990s. The injury profile in the 1980s and 1990s differed from that in the 1970s. Per 1000 player-years, the rate of contusions as well as of sprains or strains increased significantly with each decade. Checking and unintentional collision with an opponent were common mechanisms of injury throughout the study, and the rate of injury by these mechanisms has continually increased. In conclusion, we suggest that there has been an increase in rough body contact between players, causing an alarming increase in the rate of ice hockey injuries.

Professional roller hockey injuries

OBJECTIVE

To study the incidence and types of injuries sustained by professional roller hockey players in practices and games, and to compare these statistics with those from ice hockey.

DESIGN

This injury survey used a strict definition of injury, standardized reporting strategies, and diagnosis by a team physician as standards by which to analyze the characteristics of roller hockey injuries.

SETTING

The injuries were recorded after the players had been examined by a team physician at the game or practice site or in the physician's office.

PARTICIPANTS

During three seasons for one roller hockey team and one season for another team, an average of 22 players per team participated in the study. Due to personnel changes, the team rosters were modified between seasons. Each player injury was included in the study. An injury was defined as any physical impairment caused during a practice or game that eliminated the player from that practice or game or the next day's practice session or contest, or any physical ailment that necessitated a physical examination by the team physicians.

MAIN OUTCOME MEASURE

Injury data were categorized and injury rates were calculated.

RESULTS

122 injuries were recorded during four professional roller hockey seasons, resulting in an overall participation injury rate of 14.4 per 1,000 player hours. The game injury rate was 304.9 per 1,000 player hours. The players were 105.1 times more likely to be injured during a game than during practice. Preseason practices produced 4.5 times more injuries than regular season practices. In comparison, sample data from the only other published study of roller hockey injuries and from several studies of ice hockey have indicated game injury rates of 139.0 (roller hockey), 119.0, 96.1, 78.4, 78.8, and 66.0 per 1,000 player hours, respectively.

CONCLUSION

Results of this study demonstrate that roller hockey produces a higher rate of both contact and noncontact injuries than ice hockey; this contradicts the findings of the only other published research study on injuries in roller versus ice hockey. This increased incidence of injury may be due in part to the differences in surfaces, and can prove hazardous to even the recreational roller hockey player or in-line skater.

The incidence of ankle sprains in soccer

This study investigated the relationship between exposure time and ankle sprains in soccer. Forty-one teams (639 players) from four male senior soccer divisions at different levels of skill (divisions I-VI) were followed prospectively for 1 year. The exposure to soccer and the number of injuries per player were higher in higher divisions, but the injury incidence, percentage of ankle injuries and incidence of ankle injuries were the same at different levels of skill. Of all injuries 17 to 20% were ankle sprains and the incidence varied between 1.7 to 2.0 ankle injuries per 1,000 hours of exposure. Since players with previous ankle problems run an increased risk of reinjury we suggest that these players receive preventive advice.