Injuries in international ice hockey. A prospective, comparative study of injury incidence and injury types in international and Swedish elite ice hockey

In this prospective study, we have investigated incidence, nature, and mechanisms of injury in the Swedish national hockey team during 40 international games. There were 19 injuries associated with absence from practice or games, and 17 facial lacerations. The incidence of injuries associated with absence was 79.2 per 1,000 player-game hours, compared to the corresponding incidence of 78.4 found for Swedish national hockey. The incidence of facial wounds was 70.8 per 1,000 player-game hours, compared to the incidence of 21.8 for Swedish national hockey. The high incidence of facial injuries in international hockey is due to a high rate of stick contact injuries. Stricter enforcement of rules and more widespread use of visors would reduce the number of facial injuries.     

Concussion among Swedish elite ice hockey players.

OBJECTIVE: To evaluate the frequency of concussion in Swedish ice hockey and to establish a uniform grading and treatment model for concussions of different severity. METHODS: Frequency of concussion was investigated in two studies, one retrospective and one prospective. In the retrospective study, all Swedish elite ice hockey players (n = 265) were asked to answer a questionnaire on the number and treatment of previous concussions. Only concussions diagnosed by a doctor were recorded. The questionnaire was completed by 227 players (86%). In the prospective study, all injuries including concussions occurring during game and practice in the Swedish Elite League (n = 12 teams) were recorded during four years. The causes of injury, referees judgements, diagnosis, treatment, and time absent from ice hockey were registered on special cards. RESULTS: In the retrospective study, 51 out of 227 players (22%) in the Swedish Elite League reported at least one concussion. In the prospective study, 52 concussions were reported. The incidence of a concussion is at least one concussion every year/team or a yearly risk of about 5% for a player to sustain a concussion. Most concussions occurred during league play (81%). Body contact (checking or boarding) was the most common cause of concussions. The players were absent from full training and play on a mean of 6 d. CONCLUSIONS: As this injury is potentially dangerous it must be treated seriously according to a simple treatment model presented. In cases of repeated concussions during the same season, a longer period of time away from play is suggested. In players who have sustained several concussions over the years a thorough medical examination including EEG, CT/MRI, and neuropsychological tests should be performed. If any of these is pathological the player should be advised to give up ice hockey.     

Ice hockey injuries: incidence, nature and causes.

In this prospective study, we have investigated incidence of injuries of different severity, types of injury, and mechanisms of injury during ice hockey games. All twelve Swedish elite hockey teams were observed during the season 1988-1989 when a total number of 664 games were played. There was a total number of 285 injuries, of which the majority were minor (61%) and only 9% were classified as major. Seventy-four per cent of the injuries occurred during games and 26% during practice. The overall incidence of injury was 53.0 per 1000 player-game hours. Eighty-five per cent of injuries were caused by trauma and 15% by over-use. Injuries were most often localized to the head/face (39%) or the lower limb (32%). Most injuries resulted from stick contact or player contact including checking. A reduction of minor and moderate injuries should be possible by stricter enforcement of the hockey rules, and more widespread use of visors.     

Incidence, nature and causes of floorball injuries

During 1990 and 1991, 9% of all sports injuries that required emergency care at the University Hospital of Umeå were caused by floorball. Seventy-eight per cent of the injuries were minor (AIS 1) and 21% were moderate (AIS 2). Sprains of the ankle and knee joints were most frequent, constituting 30% and 11% of all injuries, respectively. Licensed players were affected in 14% of all floorball injuries, and 61% of these injuries occurred during a game. We found no difference in severity or type of injuries between licensed players and recreational players. Our data show that the number of floorball injuries is increasing and that the majority of these injuries are of minor severity.     

A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball

The purpose of this study was to examine gender differences in the incidence of anterior cruciate ligament (ACL) injuries in a population of highlevel team handball players. We also wanted to examine injury mechanisms and possible risk factors for ACL injuries, including menstrual status. The study was done prospectively during the 1993-94, 1994-95, and 1995–96 seasons. We found 28 ACL injuries, 23 among women (incidence: 0.31 ± 0.06 injuries per 1000 player hours) and 5 among men (0.06 ± 0.03 inj./1000 h; P < 0.001 vs women; risk ratio: 5.0). Of the 28 injuries, 24 occurred during competiton (0.91 ± 0.19 inj./1000 h; women: 1.60 ± 0.35 inj./1000 h; men: 0.23 ± 0.13 inj./1000 h; P ±0.001 vs. women; risk ratio: 7.0) and 4 during training (0.03 ± 0.02 inj./1000 h; P ±0.001 vs. competition; risk ratio: 29.9). Nearly all the injuries ( n = 25) occurred in noncontact situations when the players performed high-speed plant-and-cut movements which they were well accustomed to. A reliable menstrual history could be obtained in 17 of the 23 cases among females. Five of the injuries occurred in the menstrual phase, 2 in the follicular phase, 1 in the early luteal phase and 9 in the late luteal phase (chi-square_{3 d.f.}= 13.2; P ±0.01). The results suggest that there may be an increased risk of ACL injury during the week prior to or after the start of the menstrual period.     

The epidemiology of ice hockey injuries.

As part of the injury profylaxes in Denmark a questionnaire investigation was undertaken in 14 randomly chosen ice hockey teams--out of 266 players, 210 answered (79%). The injury incidence per player per 1000 hours was 4.7, i.e. 1.5 in training and 38.0 in match. Half of the injuries were localised to the head (28%) and lower extremities (27%), 19% to the upper extremities and 7% to the back. Of these 48% were contusions. Knee and elbow injuries were of longest duration. The necessity for increased shock absorption in helmets and barriers as well as built-in rotational and collateral stabilizers in the existing knee protectors for injury prophylaxis is stressed.     

Incidence and risk factors of injuries in Brazilian elite handball players: A prospective cohort study

The aim of this study was to investigate the incidence and risk factors for handball injuries in Brazilian elite handball players. Overall, 339 athletes from 21 handball teams who participated in the two main Brazilian championships were followed up during a season. In total, 312 injuries were reported by 201 athletes. The injury incidence rate during training was 3.7/1000 h, and during matches was 20.3/1000 matches. Ankle (19.4%, n = 46) and knee (13.5%, n = 32) were the body regions most affected by traumatic injuries. Shoulders (44.0%, n = 33) and knee (26.7%, n = 20) were the body regions most affected by overuse injuries. Muscle injuries (27.1%, n = 68) was the traumatic injury type most reported. Tendinopathy (91.8%, n = 56) was the overuse injury type most observed. Previous injury (OR: 2.42, CI 95%: 1.51–3.89) and an additional match per week (OR: 1.31, CI 95%: 1.05–1.62) were associated with a higher risk of overuse injury. Female athletes (OR: 1.56, CI 95%: 1.08–2.25) and an additional hour of training per week (OR: 1.09, CI 95%: 1.02–1.15) were associated with a higher risk of traumatic injury. This study showed that athletes with previous injury have shown a high risk of developing an overuse injury.     

Injuries in Dutch elite field hockey players: A prospective cohort study

This study describes the prevalence, incidence density, severity, and nature of injuries in elite field hockey players over the Dutch 2015–2016 season. Eighty players answered a baseline questionnaire and were subsequently followed up every 2 weeks to report the hours spent on training/competition and experienced injuries, which were registered using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Of the 74 players included in the analysis, 52 (70%) reported 112 injuries. Eighty‐seven injuries (78%) received medical attention, and 56 (50%) led to training/competition time‐loss. Thirty‐four injuries (30%) hampered players’ availability to train and compete. Most of the injuries (74%) were not caused by any contact. The mean prevalence of injury was 29% (95% confidence interval [CI] 3–55) for all, 9% (95% CI 0–20) for acute, and 14% (95% CI 0–36) for overuse injuries. Players sustained 3.5 (95% CI 2.5–4.5) new acute injuries per 1000 hours of training and 12.3 (95% CI 7.6–17.0) per 1000 hours of competition. The median of the severity score was 28 from 100 (25%–75% interquartile range [IQR] 16–42) for all, 35 (IQR 23–53) for acute, and 21 (IQR 16–31) for overuse injuries. On average, 1 in 4 elite field hockey players experiences an injury within a 2‐week period during the season. Although acute injuries are common, overuse injuries pose a comparable problem in elite field hockey. As injuries are a burden on players’ health and may hamper performance and availability to train and compete, prevention is of great importance.     

Evaluation of knee braces in Swedish ice hockey players.

In this retrospective investigation we have determined the rate and types of knee injuries among Swedish ice hockey players, and related these data to the use of knee braces. Thirty-seven of the originally selected 50 hockey teams (74%) of elite or first division calibre took part in the study, and 600 players answered a questionnaire. A total of 254 previous knee injuries sustained while playing hockey were reported by 243 players; tears of the medical collateral ligament (60%), meniscus (15%) or anterior cruciate ligament (12%) were the most commonly reported injuries. Prophylactic knee braces were worn by 138 (23%) of the players. Of these, 122 (88%) had earlier sustained a knee injury, and 16 had not. A total of 17 knee injuries had occurred while the players were wearing a brace. Six of these players had previously uninjured knees while 11 had repeat injury in a brace despite earlier successful rehabilitation or operation. The most common injury in braced knees was a tear of the medial collateral ligament. We conclude that the number of knee injuries is high among Swedish ice hockey players, and that the efficacy of functional knee braces to reduce knee injuries is questionable.     

A prospective study of injuries to elite Australian rugby union players

OBJECTIVES: To assess injury patterns and incidence in the Australian Wallabies rugby union players from 1994 to 2000. To compare these patterns and rates with those seen at other levels of play, and to see how they have changed since the beginning of the professional era. METHODS: Prospective data were recorded from 1994 to 2000. All injuries to Australian Wallabies rugby union players were recorded by the team doctor. An injury was defined as one that forced a player to either leave the field or miss a subsequent game. RESULTS: A total of 143 injuries were recorded from 91 matches. The overall injury rate was 69/1000 player hours of game play. The injury rates in the periods before (1994-1995) and after (1996-2000) the start of the professional era were 47/1000 player hours and 74/1000 player hours respectively. The lock was the most injured forward, and the number 10 the most injured back. Most injuries were soft tissue, closed injuries (55%), with the head being the most commonly injured region (25.1%). The phase of play responsible for most injuries was the tackle (58.7%). Injuries were more likely to occur in the second half of the game, specifically the third quarter (40%). The vast majority of injuries were acute (90%), with the remainder being either chronic or recurrent. CONCLUSIONS: Injury rate increases at higher levels of play in rugby union. Injury rates have increased in the professional era. Most injuries are now seen in the third quarter of the game, a finding that may reflect new substitution laws. There is a need for standardised collection of injury data in rugby union.     

Strength and endurance differences between elite and junior elite ice hockey players. The importance of allometric scaling

The aim of this study was to investigate differences in strength and endurance between elite and elite junior ice hockey players. Participants included 18 elite players and 21 junior elite male players (24.2 +/- 4.7 vs. 17.6 +/- 0.9 years of age, 84.2 +/- 8.1 vs. 72.3 +/- 6.0 kg body mass (p < 0.01), 179.9 +/- 6.1 vs. 179.0 +/- 7.0 cm). Absolute maximal oxygen uptake was significantly higher in elite than junior players (4.8 vs. 4.2 L x min(-1), p < 0.01), but relative expressions, including allometric scaling, eliminated the difference. Elite players lifted significantly more weight than juniors in 1 repetition maximum squats (200.0 +/- 28.9 vs. 140.3 +/- 19.5 kg, p < 0.01) and in bench press (100.8 +/- 12.8 vs. 75.3 +/- 12.8 kg, p < 0.01). Elite players also ran significantly faster in the 10 m sprint (1.80 +/- 0.07 vs. 1.88 +/- 0.08 s, p < 0.01), and had greater jumping height (27.2 +/- 3.2 vs. 20.5 +/- 3.0 cm, p < 0.01) and peak force (2336.4 +/- 219.9 vs. 2011.9 +/- 180.1 N, p < 0.01) when holding 50 extra kg. No differences were found for the 40 m sprint or for the rate of force development in jumping. This study revealed that the main differences between elite and junior ice hockey players at a high performance level seem to be in strength and body mass. The results therefore identify important factors for juniors to improve in the transition phase from junior to elite level.     

Injuries among Swedish female elite football players: a prospective population study

Injury occurrence in all 12 female elite senior football teams in premiere league was registered during 1 year. Of 269 players, 129 (48%) sustained 237 injuries. The total injury incidence was 4.6/1000 h of football. The injury incidence during practice was 2.7 and during the game time was 13.9/1000 h. The highest injury incidence during practice was to the knee (0.8/1000 h) and thigh (0.5/1000 h), and during game time was to the knee (4.4/1000 h) and head (2.2/1000 h). In total, the location for the highest injury incidence was the knee with 1.5 injuries/1000 h of football. The majority of injuries (82%) were localized to the lower extremities. Sixty-six injuries (28%) were re-occurring injuries (re-injuries). The incidence of traumatic injuries was 3.3/1000 h of football and for overuse injuries 1.3/1000 h. Overuse injuries occurred mainly during the preseason and at the beginning of the spring season. Thirty-nine percent of the injuries were slight or minor causing absence from practice or game time of less than 1 week, 39% were moderate (absence 7-28 days) and 22% were major (absence more than 28 days). The major injuries occurred often owing to trauma and were mainly to the knee.     

Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study

BACKGROUND: Numerous injuries have been attributed to playing on artificial turf. Recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term study has been conducted comparing game-related, high school football injuries between the 2 playing surfaces. HYPOTHESIS: High school athletes would not experience any difference in the incidence, causes, and severity of game-related injuries between FieldTurf and natural grass. STUDY DESIGN: Prospective cohort study. METHODS: A total of 8 high schools were evaluated over 5 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, head and knee trauma, and environmental factors. RESULTS: Findings per 10 team games indicated total injury incidence rates of 15.2 (95% confidence interval, 13.7-16.4) versus 13.9 (95% confidence interval, 11.9-15.6). Minor injury incidence rates of 12.1 (95% confidence interval, 10.5-13.6) versus 10.7 (95% confidence interval, 8.7-12.7), substantial injury incidence rates of 1.9 (95% confidence interval, 1.4-2.6) versus 1.3 (95% confidence interval, 0.8-2.1), and severe injury incidence rates of 1.1 (95% confidence interval, 0.7-1.7) versus 1.9 (95% confidence interval 1.2-2.8) were documented on FieldTurf versus natural grass, respectively. Multivariate analyses indicated significant playing surface effects by injury time loss, injury mechanism, anatomical location of injury, and type of tissue injured. Higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and injuries during higher temperatures were reported on FieldTurf. Higher incidences of 1- to 2-day time loss injuries, 22+ days time loss injuries, head and neural trauma, and ligament injuries were reported on natural grass. CONCLUSIONS: Although similarities existed between FieldTurf and natural grass over a 5-year period of competitive play, both surfaces also exhibited unique injury patterns that warrant further investigation.     

Baseline lung function, exercise-induced bronchoconstriction, and asthma-like symptoms in elite women ice hockey players

PURPOSE: Exercise-induced bronchoconstriction (EIB) is high among ice rink athletes and may be related to exercise ventilation of rink air pollutants. Impaired postchallenge expiratory flows are common for this population; however, baseline lung function and symptoms have not been fully evaluated. METHODS: We examined resting lung function and asthma-like symptoms in relation to airway hyperresponsiveness in National Team female ice hockey players (N = 43). Subjects were grouped according to observed symptoms and medical history as symptomatic ('S') or asymptomatic ('A'). Baseline and postexercise lung function was determined. RESULTS: Seventeen (39.5%) presented symptoms and 9 (21%) had EIB. Baseline FEV1, FEV1/FVC, and FEF25-75 were different between 'S' and 'A' (102 +/- 14% vs 116 +/- 12%, 77.7 +/- 7.5 vs 88.2 +/- 4.5, and 74 +/- 22% vs 118 +/- 24%, respectively; P < 0.05); FVC and PEF were not different. Ten 'S' athletes had <80% FEV1/FVC; 9 had <70% predicted FEF25-75. Six of 9 EIB+ subjects had symptoms; cough occurred in all six and was related to EIB (chi 2 = 4.23, OR = 6.5, CI = 1.1-44.1; P = 0.039). CONCLUSION: Baseline lung function is related to symptoms and precludes EIB in some rink athletes, suggesting that EIB and its development is a heterogeneous and may involve fibrotic as well as inflammatory processes. Small airway dysfunction in ice arena athletes is likely related to internal combustion pollutants emitted from ice resurfacing machines.     

Knee surgery costs in football, floor ball, European team handball and ice hockey

The purpose of this study was first, to identify the health costs of knee surgery related to different sports (football, floor ball, European team handball and ice hockey) among players at competitive level in Stockholm 1997. Information was retrieved from three different databases, one containing information on all players in different sports, another one containing information on all surgery performed at S:t Gorans Hospital, Stockholm, and a third one containing information on all surgery performed in Stockholm. The National Registration Number (NRN) was used to identify the patients. The NRN is a unique personal identifier assigned to all Swedish residents, which allows linkage between different registers and databases. In Stockholm in 1997, 6781 surgical procedures related to the knee were performed at a cost of SEK (Swedish Crowns) 39,026,657. On players in all studied sports, 762 knee surgical procedures were performed on 657 patients in Stockholm at a cost of SEK 4,884,076. At S:t Gorans Hospital, 319 knee surgical procedures were performed on 288 patients, and 293 (92%) of these were directly related to sport participation. It was also found that only 74% of anterior cruciate ligament injuries that resulted in a surgical intervention were reported to the insurance company. CONCLUSION: The average cost for knee surgery in the studied sports was low. Knee surgery costs for European team handball players were the highest compared with other sports studied.     

Incidence of injury in elite junior Rugby Union: a prospective descriptive study

The high incidence of injury in Rugby Union is well documented, particularly at elite levels of competition. This article describes the incidence and nature of all injuries sustained by elite Western Australian junior Rugby Union players during the 26 weeks up to and including the 1997 National Championship campaign. Informed consent was gained for each participant (n = 44) prior to completion of an extensive baseline questionnaire. Exposure and injury data were collected at each training session and game. The injury incidence rate over the 26 week period was 13.26/1000 player hours. Injury data were analysed by phase of play, position, severity and if occurred at games or training. The incidence of injury was significantly associated with the position played (chi2 = 67.49, p value = 0.008) and the phase of play in which the injury occurred (chi2 = 8.07, p value = 0.042). Tackling was the most dangerous phase of play (52% of injuries) and the most common site of injury was the lower limb (37%). Most injuries occurred during games (56%) and the flanker was the position most at risk of injury (12%). Further research is needed to identify the aetiology of injury at all levels of competition and to use these findings to develop effective injury prevention strategies in this sport. Position-specific risk factors should also be investigated, as should the mechanism of injury associated with tackling which is the phase of play in which significantly more injuries occur in rugby.