The Change in Ice Hockey Injuries with Time
abstract & commentary
Synopsis: Both the severity and the incidence of injuries increased from the 1970s through the 1990s.
Source: Molsa J, et al. Injury profile in ice hockey from the 1970s through the 1990s in Finland. Am J Sports Med 2000;28:322-327.
Molsa and colleagues compare the injury rate in highly skilled Finnish ice hockey players during the three seasons between 1976 and 1979, with the injury rates of the 1988-1989 and 1992-1993 seasons. An injury was defined as "any sudden trauma during practice or games that led to examination and treatment by a physician." Injuries were compared not merely by the total number of occurrences during each season, but rather by injury rates—i.e., the ratio of the number of injuries to the number of player exposures. The injury mechanism, as well as the type, anatomic location, and severity of the injury were reported. The number of teams studied for each injury was: seven teams during the 1976-1979 seasons, five teams during the 1988-1989 season, and three teams during the 1992-1993 season. The same three-team physicians, who participated in 1992-1993, also participated in the 1988-1989 season, increasing the study’s data collection reliability.
The rate of injury for practice was low in all years studied (1.5 per 1000 player practice hours). The rate for games was much higher and increased over the three periods studied: 54 injuries per 1000 player-hours in the 1976-1979 seasons, 55 injuries per 1000 player-hours in the 1988-1989 season, and 83 injuries per 1000 player-hours in the 1992-1993 season. This last number is similar, though slightly lower, than the game injury rate in the U.S. Hockey League reported by Stuart and Smith (96 injuries per 1000 player game hours).
Checking (deliberate player contact) or collision (unintended player contact) with an opponent was a dominate injury mechanism in all the years studied with more sprains, strains, and contusions occurring in the 1988-1989 and 1992-1993 seasons than in the 1970-1979 seasons. Molsa et al feel that the increased injury rate in these highly competitive players is secondary not only to a greater amount of contact between players, but also from players having greater mass, height, strength, and speed then they did several decades ago.
Comment by Letha Y. Griffin, MD, PhD
Anyone who has attended an NHL game is probably not surprised by the findings in this study. Better body-protective pads as well as greater head and face protection is available for the players. However, some argue that increased player protective equipment has resulted in increased player aggressiveness and, hence, not a decrease but an increase in the injury rate. Of note also is the increased proportion of fractures during the 1992-1993 season attributed by Molsa et al to the use of high sticks and slashings as well as blows from the puck.
This is a well-organized, prospectively planned study comparing injury rates from the 1970s to those in the 1980s and 1990s. Reliability was enhanced by a uniform definition of injury and player exposure, and by similar data collection systems. Molsa et al conclude that an increase in body contact in recent years has led to "an alarming rate of ice injuries." Molsa et al, unfortunately, do not provide us suggestions on how to decrease this injury rate.
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