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By Janet Zimmerman, Ph.D. in public health and youth hockey parent
In a state championship game, a player suffered a head injury when an opponent pushed the player’s feet out
from under her during a fast breakaway, sending her flying up in the air. The player fell flat on her back and hit
her head hard on the ice as she landed. The player showed signs of having a concussion. The game had to be
stopped, the parents were called from the stands, and she had to be led off the ice. This player is 10 years old.
At a recent playoff game, a player, whose coach calls out to the team, “Get physical!”, pushed an opposing
player into the boards with a force sufficient to crack the player’s helmet, knock her down, stop the game, and
cause her to suffer headaches and nausea throughout the night. The player, age 11, wasn’t near the puck at the
time she was pushed, and there was no call by the referees on the play.
These injuries occurred in girl’s hockey, where
aggressive body contact isn’t allowed. One would
hope that instances such as these are rarities, but
as anyone who spends time in amateur hockey
knows, they are not. An increasing body of
evidence paints an alarming picture of injuries
sustained by youth ice hockey players. Much of
the recent work in this area has been conducted
in Canada. Although the styles of play may
differ between U.S. and Canadian youth hockey
players, the basic rules of the game are the same.
Studies such as the following send out a word of
warning to us all:
- A recent study in British Columbia found
that among 440 players age 15-20, 63% of
them had suffered at least one head injury,
and 111 of them actually lost consciousness
at some point in their career while playing
minor hockey. The leading cause of
concussion, whether or not the player lost
consciousness, was a player’s head striking
the boards, including the end glass. A $1.3
million study is underway at Simon Fraser
University in British Columbia to explore
concussions and mild head injuries in youth
hockey players and the impact of these
injuries on the lives of children and youth.
- The incidence of concussions in hockey is
on the rise: whereas concussions accounted
for 4% of reported injuries in hockey in
1996 in the U.S., the percentage increased
to 17% in 2001. The actual frequency of
concussions is likely to be much higher,
given that these figures include only
reported cases.
- In a comprehensive study of violence in
youth hockey, 44% of 212 youth hockey
players surveyed indicated that they had
been injured from rough play (e.g., fighting,
high sticking, checking from behind),
sustaining injuries ranging from concussions
and neck injuries, to slashed wrists and
ankles. Sixteen percent indicated that they wanted to stop playing hockey or get off the
ice because the game got too rough. Seventeen
percent indicated their parents have
urged them to leave hockey because of
rough play.
Clearly, some level of injury is inevitable, as
hockey is a fast-paced, nonstop action contact
sport and mistakes are made. But injury that
results from dangerous and illegal plays can be
avoided by establishing a climate in which all
players, coaches, parents, and referees agree to
strictly support the rules of the game rather than
to tolerate (and sometimes even encourage) rule
violations. What follows is a range of approaches
discussed in the field and in the sports medicine
literature for making hockey safer for kids to play.
Some strategies are easier to implement than
others. The payoff of making progress on any of
them, though, would be enormous if our kids
could play the sport they love so well with a
reduced likelihood that they will be injured as
a result.
Referees/ Referee Associations
Achieve greater consistency in enforcing the
rules. Increasing the consistency of rule enforcement
among referees is perhaps one of the most
vexing but important challenges in reducing
injurious plays and increasing safety in youth ice
hockey. It clearly is extremely difficult for two
referees to see all plays on the ice and to make
precise judgments given the split second timing
under which decisions need to be made. As any
hockey parent or coach knows, referees do not
penalize all rule violations. In a study of emergency
room visits among youth aged 7-18 for
injuries related to ice hockey, for example,
penalties were assigned on only 3 (4%) of the
85 plays that caused them to be injured. Injured
players judged 40% of these plays to be illegal,
and 85% of these “illegal” plays to be “injury
potential” infractions, as identified by USA Hockey. USA Hockey recommends that all
violations with an injury potential be penalized:
examples include boarding, charging, checking
from behind, cross-checking, elbow/kneeing, high
sticking, roughing, and slashing, among others.
Without consistent penalties for breaking the rules,
the rules lose their meaning and players are freer to
break them.
Several approaches can be pursued for improving
the consistency of officiating and increasing the
likelihood that all dangerous plays will be penalized:
- Tighten certification requirement to demand
more stringent testing on rule interpretation
and enforcement before certification or
re-certification is granted.
- Enhance continuing training requirements
aimed at reducing variations in officiating,
especially for dangerous plays and rule violations
against players who do not have
the puck.
- Significantly increase oversight and monitoring
of referees’ performance (e.g., videotape
games to enable expert panels to review
problem areas and to devise corrective actions;
have unannounced monitoring of referees’
performance during games by expert judges;
make detailed feedback/complaint forms more
readily available in all rinks)
- Increase accountability of referees and severity
of consequences for persistent problems with
performance.
- Require that higher-level referees officiate
younger as well as older youth games.
Amateur Hockey Associations
Set safety in youth ice hockey as a high priority
- Establish state and local level task forces to
devise strategies for improving safety in youth
hockey. Develop and promote the ideas
behind the Fair Play System, in which strong
incentives (points are added in the standings)
are provided to reward individual players and
teams who have few penalties, and strong
disincentives (points are deducted in the
standings) are established to discourage
penalties. Strengthen consequences for failing
to follow code of conduct agreements that
typically are part of Fair Play programs.
- Vigorously promote the integration of the
Heads Up program into daily practices. Heads
Up is designed to prevent serious head and
spinal injuries by teaching players and coaches
about how injuries happen and providing
techniques to avoid injuries.
- Encourage the STOP program to be adopted
by all teams. This program is designed to
improve fair play and reduce the likelihood
that players will check from behind, a
dangerous play that can lead to spinal injury.
- Require more vigorous continuing education
for coaches on the prevention and management
of injurious plays.
Explore possible rule revisions to protect youth from serious injury
- Increase the severity of penalties for violations
with significant potential to injure, whether
intentional or not and whether a player was
injured or not (e.g., make more liberal use of
suspensions not only from the current game
but from the subsequent game or games;
require the offending team to pay for a third
high-level referee at the next game, whether
home or away).
- Adopt more stringent suspension provisions
for injury potential plays; establish a limit
beyond which a player would be banned
from playing.
- Reassign to a different age level extreme
variations in children by weight and size
(make it impossible for a 70 lb. 12 year old to
play against a 140 lb. 12 year old, for example).
- Track frequency of injury potential penalties
by team; include upper limits on what is
allowed for coach re-certification or coach
selection by local hockey associations.
- Alongside win/loss records, post the comparative
frequency of major rule violations by
teams and players on the hockey association’s
website; this not only would help inform
decisions to recertify or select a coach, but in
parents’ and players’ decisions to join a team.
will be injured as
a result.”
Help players, coaches, parents, referees become informed
- Develop educational videotapes that demonstrate
precisely what is and is not allowed
within the parameters of each rule. Recruit
celebrity hockey players, coaches, and sports
broadcasters to star in the videos.
- Develop videotapes and other educational
materials on preventing, assessing and
managing common injuries of hockey. In a
recent study, fewer than _ of injured hockey
players recalled receiving instruction on
injury prevention.
- Require players, parents, coaches, and
referees to watch the above videotapes at the
start of the season.
- Closely track research on safety in hockey;
inform others of findings; work closely with
the research communities to support efforts in
injury prevention.
Retain prohibition of checking in non-checking leagues
- Proponents of changing the rules to allow
checking in non-checking leagues argue that
players will be less inclined to be reckless or
resort to violent plays if they are taught how
to give and receive check and are allowed to
check legally. This argument gives insufficient
attention to the sizable body of evidence
that checking—both illegal and
legal—increase the likelihood of injury,
including serious injury. A safer strategy
would be to work toward reducing illegal
plays through other approaches described in
this paper, rather than through promoting the
expansion of checking.
- The American Academy of Pediatrics and
others have recommended that all checking
be banned among youth age 15 and under.
The evidence and rationale underlying this
recommendation warrant serious consideration
by all participants in amateur hockey.
Coaches
Incorporate safety issues into daily practices
- Train players to defend themselves against
dangerous plays, even in non-checking
leagues.
- Check the safety of players’ equipment;
notify parents if there are opportunities for
improvement.
- Teach players about the limitations of
equipment in preventing injury.
- Increase practice-to-games ratio to increase
training and conditioning time.
- Advise players and parents of off-ice conditioning
exercises, including neck strengthening
and flexibility exercises.
Establish no tolerance for injurious plays or disrespect
- Provide strong disincentives (e.g, reduced ice
time, probation) for engaging in dangerous
illegal plays.
- Refrain from putting players with a history of
injury potential penalties in the game toward
the end of a period or the end of the game,
when violence and injuries are more common.
- Clarify to players and parents that any form
of disrespect toward opposing team or
officials on or off the ice will not be tolerated.
- Clarify that all complaints about a referee,
another coach, parents or players should
come to you, rather than through any direct
or indirect confrontation.
Emphasize skill develop; reduce the pressure of winning
- Measure success based on progress in the
team’s technical and strategic skills and the
level of contentment, excitement, and
respect among the players.
- Routinely acknowledge excellent plays and
areas of progress.
Parents
Do what you can to keep your child safe
- Provide children with the highest quality equipment possible.
- Make sure players are properly hydrated, rested, and conditioned prior to games.
- Keep players conditioned during theoff-season.
- Remain informed about safety issues.
Players and Parents
Keeping winning in perspective
- Be resolved never to let the pressure to win overpower having fun and maintaining a respectfulness toward other players and officials.
- Resolve never to resort to violence or aggressive behavior.
Researchers, Foundations
There are striking gaps in our knowledge of the
prevalence, causes, prevention, and management
of injuries in youth ice hockey. Giving the
growing number of youth who play ice hockey in
the United States, the need for additional
research is increasingly urgent.
Conduct ongoing and more rigorous analyses of equipment and rink safety
- Conduct more rigorous helmet impact tests to identify superior design in preventing concussions.
- Design superior chest protection against sudden impact.
- Investigate optimal board design to reduce the severity of impact.
- Continue to devise improved strategies for rink air quality.
Track and analyze injury patterns
- Improve and expand systems for tracking and
reporting injuries (e.g., revise score sheets to
document types of penalties and frequency of
injury; survey parents at the end of the season
to document occurrence and management of
injuries among players).
- Endorse efforts to separate ice hockey from
field, roller, and other forms of hockey in
existing data tracking systems (e.g., isolate
admissions to the emergency room for injuries
specific to ice hockey, for example).
- Conduct detailed subgroup analyses to
identify variations in frequency, types, and
site of injury by a range of predictive or
explanatory variables related to individual
players (e.g., age, gender, body size).
- Build on our existing base of knowledge of
injury patterns according to game-related
variables (player position, whether game vs.
practice, season vs. tournament, game period
and point of play in game).
- Investigate at greater length the frequency
and nature of injury in checking vs. nonchecking
leagues.
Evaluate interventions to reduce injury and barriers to implementation
- Evaluate the effectiveness of and attitudes
toward initiatives designed to reduce injury in
youth hockey.
- Evaluate the adequacy of certification
requirements and continuing education
programs for coaches and referees relative to
injury prevention, assessment and management.
- Examine strategies for overcoming political
and other obstacles to implementing or
expanding safety programs.
Investigate knowledge and attitudes of players, parents, coaches, referees
- Investigate variations in players’ attitudes
about risk-taking and willingness to engage
in dangerous plays; investigate attitudes or
parents, coaches, referees toward violence
in youth ice hockey; make use of existing
survey tools—e.g., “Eliminating Violence
in Hockey,” by Bernie Pascall.
- Determine gaps in coaches’ and referees’
knowledge and understanding of injury
prevention, assessment, and management.
Encourage the development of position papers
- Make greater use of position papers to
stimulate discussion and extend the reach
of scientific findings to the diverse participants
in youth ice hockey.
So what do we conclude from all of this?
It should be clear that there is no shortage of
possibilities for improving safety in youth ice
hockey. Routine reminders by referees before
games of the types of plays that will not be
tolerated, increased practice time spent training
players on injury prevention — any number of
incremental approaches can play a part in
making hockey a safer sport for kids to play.
The good news is that if we all make the effort,
children and youth can indulge in the sport
they love with a lower risk of injury.
The intense excitement of hockey depends on
keeping our kids in top form in the game, rather
than on the sidelines recovering from a tough
blow. Too much is at stake by not taking some
measure of action.
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