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 rates and profiles in female ice hockey players

BACKGROUND: Little data exist on injury rates and profiles in female ice hockey players. OBJECTIVE: To examine the incidence of injury in female ice hockey players and compare injury rates with those of male players. STUDY DESIGN: Prospective cohort study. METHODS: Six male and six female teams from the Canada West Universities Athletic Association were followed prospectively for one varsity season. Preseason medical history forms were completed by each player. Injury report forms and attendance records for each team session were submitted by team therapists. RESULTS: Male players reported 161 injuries, whereas female players reported 66 injuries. However, the overall injury rates for male (9.19 injuries per 1000 athlete-exposures) and female (7.77 injuries per 1000 athlete-exposures) players did not differ significantly. Ninety-six percent of injuries in female players and 79% in male players were related to contact mechanisms, even though intentional body checking is not allowed in female ice hockey. Women were more likely than men to be injured by contacting the boards or their opponent. Men sustained more severe injuries than women and missed about twice as many sessions (exposures) because of injury. Concussions were the most common injury in female players, followed by ankle sprains, adductor muscle strains, and sacroiliac dysfunction. CONCLUSION: Although the injury rate in female ice hockey players was expected to be lower than that in male players because of the lack of intentional body checking, the injury rates were found to be similar.     

Sport, age, and sex specific incidence of sports injuries in Western Australia

OBJECTIVE: To describe the trends in recreational sports injury in Perth, Western Australia. DESIGN: A prospective cohort study of sports injuries during the 1997 winter season (May to September). SETTING: Sample of Australian football, field hockey, basketball, and netball players from the Perth metropolitan area, Western Australia. METHODS: A cohort of sports participants was followed over the five month winter sports season. Before the season, participants completed a baseline questionnaire and during the season were interviewed every four weeks by telephone. RESULTS: Overall, 92% of participants (n = 1391) who completed a baseline questionnaire completed at least one follow up telephone interview. About half (51%) of the cohort sustained one or more injuries during the winter season accounting for a total of 1034 injuries. Most injuries were of moderate (58%, n = 598) or minor (40%, n = 412) severity, with only 3% (n = 24) requiring emergency department treatment or a hospital stay. The injury incidence rate was greatest for football (20.3/1000 hours of participation), similar for field hockey and basketball (15.2/1000 hours and 15.1/1000 hours respectively), and lowest for netball (12.1/1000 hours). The incidence of injury was greatest in the first four weeks of the season, and participants aged between 26 and 30 years had about a 55% greater risk of injury than those aged less than 18 years. CONCLUSIONS: This is one of the first studies to show that recreational sports are safe. Although the likelihood of injury was greatest in the first month of the season, few injuries required admission to hospital or emergency department treatment. A greater emphasis on prevention in the early part of the season should help to reduce the elevated incidence of injury found at this time.     

Injuries in youth amateur soccer and rugby players--comparison of incidence and characteristics

OBJECTIVES: In reviewing the literature on sports injuries, few studies could be found in which exposure related incidences of injury in different types of sport were compared. These studies indicated that ice hockey, handball, basketball, soccer, and rugby are popular team sports with a relatively high risk of injury. The aim of the study was to compare the characteristics and incidence of injuries in male youth amateur soccer and rugby players. METHODS: This prospective cohort study comprised an initial baseline examination to ascertain the characteristics of the players and their level of performance, and a one season observation period during which a physician visited the team weekly and documented all occurring injuries. Twelve soccer and 10 rugby school teams with male amateur players aged 14-18 years were selected for the study. 145 soccer and 123 rugby players could be followed up over one season. RESULTS: Comparison of the incidence of soccer and rugby injuries indicated that rugby union football was associated with a significantly higher rate of injury than soccer. The differences were pronounced for contact injuries, injuries of the head, neck, shoulder, and upper extremity, as well as for concussion, fractures, dislocations, and strains. Rugby players incurred 1.5 times more overuse and training injuries in relation to exposure time, and 2.7 times more match injuries than soccer players. Three rugby players but no soccer players had to stop their participation in sport because of severe injury. CONCLUSION: The incidence of injury in New Zealand school teams playing soccer or rugby union is high, probably in part because of the low ratio of hours spent in training relative to hours spent playing matches. The development and implementation of preventive interventions to reduce the rate and severity of injury is recommended.     

First-time inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury

BACKGROUND: Inversion ankle trauma is disabling, yet little is known regarding the incidence rate of first-time ankle sprains and how it is influenced by factors including sex, level of competition, and sport. HYPOTHESIS: The incidence rates of first-time ankle ligament sprains are influenced by sex, level of competition (high school vs college), and type of sports participation (basketball, soccer, lacrosse, and field hockey). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 1999 and 2003, high school and college athletes were evaluated before participation in their sports. Subjects were included in the study if they had not experienced a prior ankle or lower extremity injury and were then followed during participation in soccer, basketball, lacrosse, or field hockey to document their days of exposure to sport and injuries sustained. The relative risk associated with sex, level of competition, and sport was estimated by Cox regression. RESULTS: A total of 901 athletes had 50 680 person-days of exposure to sports, and 43 (4.8%) had an inversion injury that produced an ankle ligament sprain. Overall, the injury incidence rate was 0.85 sprains per 1000 person-days of exposure to sport. There were 0.68 and 0.97 ankle sprains per 1000 person-days of exposure to sport for the men and women, respectively. Although the risk of suffering an ankle sprain was higher for women than for men (relative risk, 1.51), the difference was not statistically significant (P = .21) and was owing to the increased risk in female basketball athletes compared to male basketball athletes (relative risk, 4.11; P = .045). Risk of injury was similar for the high school athletes in comparison to the college athletes (relative risk, 1.16). For the men, there was no difference in the risk of suffering an ankle sprain between the sports of basketball, soccer, and lacrosse, whereas for the women, the risk of suffering an ankle sprain was significantly greater during participation in basketball compared to lacrosse. CONCLUSION: In this study of first-time ankle sprains, for most sports, the incidence rate of inversion injury is less than 1 per 1000 days of exposure to sport, a value lower than previously reported. Among female athletes, ankle injury is associated with type of sport. Risk is highest for female basketball athletes, who are at significantly greater risk than male basketball athletes and female lacrosse athletes. The risk of first-time ankle injury is similar for high school and college-level athletes.     

Injuries in competitive youth bandy: an epidemiological study of a league season

PURPOSE: Bandy, with a century-long tradition in northern Europe, is a winter team-sport similar to ice hockey. To investigate the occurrence of injuries during competitive youth bandy games, injury incidence, injury types, and age-related risks were analyzed for one youth league season. METHODS: The National Athletic Injury/Illness Reporting System (NAIRS) definition of sports injury was used for the injury registration. All 416 games during the 1999-2000 season in the Swedish southeastern youth bandy league were included in the study. Primary data was collected by a questionnaire and completed by the team coaches after each game. At the end of the season, physician interviews with each team coach were performed to assure that no injuries had been missed as well as to ascertain whether there was any remaining disability. RESULTS: In total, 2.0 injuries (95% confidence interval 1.2-2.9 injuries) per 1000 player game hours were recorded. Sixty-eight percent of the injuries caused the injured player to be absent from bandy play for more than a week. Collision was the most common cause of injury (36%), and contusion was the most common injury type (41%). The injury incidence in the leagues for older players (Youth 14 -Youth 16) was slightly higher than in the leagues for the younger players (Youth 12 -Youth 13), while participation by under-aged players in games organized for older players led to an almost four-fold increase of injury risk. For severe injuries, the mean rehabilitation time away from bandy practice or competition was 27 d (range 8-56 d). CONCLUSION: The overall injury incidence during youth bandy games is low, but the injuries that occur cause extensive absences from the only four months long bandy season. From a public health perspective, bandy can be recommended for consideration when physical exercise is to be promoted among school-age children in countries with a winter climate.     

Ankle injuries in basketball: injury rate and risk factors

OBJECTIVES: To determine the rate of ankle injury and examine risk factors of ankle injuries in mainly recreational basketball players. METHODS: Injury observers sat courtside to determine the occurrence of ankle injuries in basketball. Ankle injured players and a group of non-injured basketball players completed a questionnaire. RESULTS: A total of 10 393 basketball participations were observed and 40 ankle injuries documented. A group of non-injured players formed the control group (n = 360). The rate of ankle injury was 3.85 per 1000 participations, with almost half (45.9%) missing one week or more of competition and the most common mechanism being landing (45%). Over half (56.8%) of the ankle injured basketball players did not seek professional treatment. Three risk factors for ankle injury were identified: (1) players with a history of ankle injury were almost five times more likely to sustain an ankle injury (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.95 to 12.48); (2) players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cells (OR 4.34, 95% CI 1.51 to 12.40); (3) players who did not stretch before the game were 2.6 times more likely to injure an ankle than players who did (OR 2.62, 95% CI 1.01 to 6.34). There was also a trend toward ankle tape decreasing the risk of ankle injury in players with a history of ankle injury (p = 0.06). CONCLUSIONS: Ankle injuries occurred at a rate of 3.85 per 1000 participations. The three identified risk factors, and landing, should all be considered when preventive strategies for ankle injuries in basketball are being formulated.     

Community level australian football: a profile of injuries

Identification of injuries and their risk factors is required in order to develop risk controls within the context of sports injury prevention. The Australian Football Injury Prevention Project (AFIPP) was a randomised controlled trial (RCT) examining the effects of protective equipment on injury rates in Australian Rules Football. The aim of this paper is to describe the general injury profile of community level Australian Football players over one season, as recorded during this RCT. Players were recruited from the largest community football league in Victoria, Australia, during the 2001 playing season. A total of 301 players participated (64% response rate) and all injuries occurring during training and games were recorded. The overall injury incidence rate was 12.1/1000 player hours. Bruises/soft tissue injuries made up more than a quarter of all injuries (28%) and the leg (lower leg, ankle, thigh/hamstring and knee) was the most commonly injured body region. Most injuries occurred at the beginning of the season (April-May, 53% of injuries), during competition (77%) and through body contact (49.9%). Midfielders (OR = 3.39, 95% CI: 1.13, 10.14) and players aged at least 25 years (OR = 2.15, 95% CI: 1.06, 4.34) were significantly more likely to experience an injury than other playing positions and younger players. Although the injury rate in this study was lower than that in previous studies, the results are consistent with the finding that injuries tend to occur earlier in the season and more commonly during competition. Injury prevention efforts should be particularly targeted at midfielders and older players.     

Incidence and body location of reported acute sport injuries in seven sports using a national insurance database

Sports with high numbers of athletes and acute injuries are an important target for preventive actions at a national level. Both for the health of the athlete and to reduce costs associated with injury. The aim of this study was to identify injuries where injury prevention should focus, in order to have major impact on decreasing acute injury rates at a national level. All athletes in the seven investigated sport federations (automobile sports, basketball, floorball, football (soccer), handball, ice hockey, and motor sports) were insured by the same insurance company. Using this insurance database, the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), at each body location, was calculated. Comparisons were made between sports, sex, and age. In total, there were 84 754 registered injuries during the study period (year 2006‐2013). Athletes in team sports, except in male ice hockey, had the highest risk to sustain an injury and PMI in the lower limb. Females had higher risk of injury and PMI in the lower limb compared to males, in all sports except in ice hockey. This study recommends that injury prevention at national level should particularly focus on lower limb injuries. In ice hockey and motor sports, head/neck and upper limb injuries also need attention.     

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.     

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.     

Knee injuries account for the sports-related increased risk of knee osteoarthritis

Increased risk of osteoarthritis has been found among athletes active in different kinds of sports. Knee injury is an established risk factor for knee osteoarthritis. In this population-based case-control study we investigated the risk of knee osteoarthritis with respect to sports activity and previous knee injuries. A total of 825 cases with x-ray-verified femorotibial osteoarthritis were identified at six hospitals in southern Sweden. The cases were matched (age, sex and residential area) with 825 controls from the general population. Mailed questionnaire data on sports activity for more than 1 year after the age of 16, knee injuries and confounding variables (weight, height, heredity, smoking and occupation) were collected and analyzed using logistic regression models. The response frequency was 89%. Among men knee osteoarthritis was related to soccer (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.2), ice hockey (OR 1.9, 95% CI 1.2-3.0) and tennis (OR 2.0, 95% CI 1.1-3.8) but not to track and field sports, cross-country skiing, and orienteering. After adjustment for confounding variables soccer and ice hockey remained significantly related to knee osteoarthritis, but after adjustment for knee injuries no significant relation remained. The sports-related increased risk for knee osteoarthritis was explained by knee injuries.     

Altered hip control during a standing knee-lift test is associated with increased risk of knee injuries

A few prospective studies have investigated hip and pelvic control as a risk factor for lower extremity (LE) injuries. The purpose of this study was to investigate whether deficits in hip and lumbopelvic control during standing knee-lift test are associated with increased risk of acute knee and LE injuries in youth team sports. At baseline, 258 basketball and floorball players (aged 12-21 years) participated in a standing knee-lift test using 3-dimensional motion analysis. Two trials per leg were recorded from each participant. Peak sagittal plane pelvic tilt and frontal plane pelvic drop/hike were measured. Both continuous and categorical variables were analyzed. New non-contact LE injuries, and match and training exposure, were recorded for 12 months. Seventy acute LE injuries were registered. Of these, 17 were knee injuries (eight ACL ruptures) and 35 ankle injuries. Risk factor analyses showed that increased contralateral pelvic hike was significantly associated with knee injury risk when using categorical variable (HR for high vs low group 4.07; 95% CI 1.32-12.6). Furthermore, significant association was found between high lateral pelvic hike angles and ACL injury risk in female players (HR for high vs low group 9.10; 95% CI 1.10-75.2). Poor combined sensitivity and specificity of the test was observed. In conclusion, increased contralateral pelvic hike is associated with non-contact knee injury risk among young team sport players and non-contact ACL injuries among female players. More research to determine the role of pelvic control as a risk factor for knee injuries is needed.     

Prospective study of concentric and eccentric leg muscle torques, flexibility, physical conditioning, and variation of injury rates during one season of amateur ice hockey

Twenty-three male ice hockey players in a third division amateur ice hockey team were prospectively studied during the 1987-1988 season. O2 uptake, muscle flexibility, and isokinetic concentric and eccentric leg muscle strength were measured before and after the season. All injuries were recorded by one and the same physician attending all the games: 68 injuries occurred altogether but only six of these led to absence from training or matches. O2 uptake and muscle flexibility were unchanged during the season, but a significant drop of both concentric and eccentric quadriceps and hamstring torques occurred in spite of the fact that the team played two games and trained twice per week during the entire season. No correlation between the fall in muscle strength and the injury rate was found. Although many injuries occur in ice hockey, the majority are minor ones that do not lead to absence from playing.     

Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data

Acute injuries in sport are still a problem where limited knowledge of incidence and severity in different sports at national level exists. In Sweden, 80% of the sports federations have their mandatory injury insurance for all athletes in the same insurance company and injury data are systematically kept in a national database. The aim of the study was to identify high‐risk sports with respect to incidence of acute and severe injuries in 35 sports reported to the database. The number and incidences of injuries as well as injuries leading to permanent medical impairment (PMI) were calculated during 2008–2011. Each year approximately 12 000 injuries and 1 162 660 licensed athletes were eligible for analysis. Eighty‐five percent of the injuries were reported in football, ice hockey, floorball, and handball. The highest injury incidence as well as PMI was in motorcycle, handball, skating, and ice hockey. Females had higher risk of a PMI compared with males in automobile sport, handball, floorball, and football. High‐risk sports with numerous injuries and high incidence of PMI injuries were motorcycle, handball, ice hockey, football, floorball, and automobile sports. Thus, these sports ought to be the target of preventive actions at national level.     

Self-reported psychological characteristics as risk factors for injuries in female youth football

Identifying and understanding injury risk factors are necessary to target the injury-prone athlete and develop injury prevention measurements. The influence of psychological factors on injuries in football is poorly documented. The purpose of this 8-month prospective cohort study therefore was to examine whether psychological player characteristics assessed by a self-administered questionnaire represent risk factors for injury. At baseline, female football players (14–16 years) were asked to complete a detailed questionnaire covering player history, previous injuries, perception of success and motivational climate, life stress, anxiety and coping strategies. During the 2005 season, a total of 1430 players were followed up to record injuries. A history of a previous injury [odds ratio (OR)=1.9 (1.4; 2.5), P <0.001] increased the risk of a new injury to the same region. There were significant differences in disfavor for previously injured compared with non-injured players for ego orientation ( P =0.007), perception of a performance climate ( P =0.003) and experienced stressful life events ( P <0.001). However, only high life stress ( P =0.001) and perception of a mastery climate ( P =0.03) were significant risk factors for new injuries. In conclusion, a perceived mastery climate and a high level of life stress were significant predictors for new injuries in a cohort of young female football players.     

Injury risk factors in female European football. A prospective study of 123 players during one season

The purpose of this study was to register prospectively the injuries in female soccer and to study their correlation to potential risk factors. A total of 123 senior players from eight teams of different levels were followed during one season. Isokinetic knee muscle strength at 60 and 180 degrees/s, one-leg-hop, vertical jump, square-hop, and continuous multistage fitness test (MFT) were tested at the end of the pre-season. In addition, Body Mass Index (BMI) and general joint laxity were measured. During the season, April-October, all injuries resulting in absence from one practice/game or more were registered. Forty-seven of the 123 players sustained altogether 65 injuries. The total injury rate was 14.3 per 1000 game hours and 3.7 per 1000 practice hours. The knee (26%) was the most commonly injured region followed by the foot (12%), ankle (11%), thigh (11%) and back (11%). The risk of sustaining moderate and major injuries increased in the later part of the game or practice. Significant risk factors for injuries were an increased general joint laxity (odds ratio (OR)=5.3, P<0.001), a high performance in the functional test square-hop (OR=4.3, P=0.002), and an age over 25 years (OR=3.7, P=0.01). The injury rate was not different compared to male soccer, but knee injuries were more common, which is in accordance with previous studies. None of the risk factors identified in this study is easily applicable for future intervention studies in the attempts to reduce the injury rate in female soccer.     

Active living and injury risk

The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3 657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3 363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1 000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.