Eliminating Body Checking has Been Positive; However, Female Ice Hockey Players are Still at Risk!

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Factors Associated With Concussion Rates in Youth Ice Hockey Players: Data From the Largest Longitudinal Cohort Study in Canadian Youth Ice Hockey

Eliason P, Galarneau JM, Shill I, Kolstad A, Babul S, Mrazik M, Lebrun C, Dukelow S, Schneider K, Hagel B, Emery C. Clin J Sport Med. 2023 Sep 1;33(5):497-504. doi: 10.1097/JSM.0000000000001177. Epub 2023 Jul 11. PMID: 37432327.
Full Text Freely Available

Take-Home Message

Youth ice hockey policy eliminating body checking decreases the risk of concussion; however, concussion rates are still high among female ice hockey players.

Background

Concussion injuries account for a high percentage of sport-related injuries in the Canadian youth population. Smaller studies have identified some risk factors that informed policy changes, such as eliminating body checking at certain levels and age groups. However, we need larger long-term studies to determine additional risk factors and confirm if rule changes are aiding in limiting the risk of concussion in this population.

Study Goal

The authors examined risk factors associated with concussions in >4,400 youth ice hockey players aged 11 to 17.

Methods

The authors followed 46 Canadian youth community leagues over 5 seasons (2013/14 to 2017/18). All participants completed a baseline Sport Concussion Assessment Tool (SCAT), and one person from each team collected exposure information and identified injured players. The authors evaluated the incidence of game-related concussions, game-related concussions that resulted in >10 days of time-loss, and all practice-related concussions.

Results

A total of 4,418 players were recruited to participate. Of these, 1,344 participated in more than 1 season for a combined 6,584 player-seasons. The athletes experienced 617 suspected concussions (554 game-related and 63 practice-related), of which approximately 84% were diagnosed by a physician. A higher proportion of females participating on “female-only” teams suffered a concussion (64/431; 15%) than females participating on predominately male-based teams (17/168; 10%). Additionally, relative to males, females had a higher rate of game-related concussions and concussions with >10 days of time-loss. For games, the burden of concussion was highest for under-18 players. For practices, the burden of concussion was highest for Under-13 players. Policy disallowing body checking was associated with a 46% lower rate of game-related concussions. Players with a history of concussion had a higher risk of concussion. Goalies, relative to forwards, had a lower risk of concussion during a game. Age group, year of play, and player weight were unrelated to concussion risk.

Viewpoints

The good news is that a policy prohibiting body checking lowers the risk of concussion in both games and practices. However, the authors found that females had a greater risk of a concussion during both game and practice compared to males, regardless of body checking policy. Furthermore, because concussion rates are still high in the Under-13 age group during practice, we need to find ways to reduce body checking and understand what mechanisms are leading to a higher risk of concussion during Under-13 practices. Lastly, future studies neeed to evaluate additional biomechanics, anatomical, hormonal, and psychosocial factors to identify sex-specific risk factors among youth female ice hockey players to help inform prevention strategies.

Clinical Implications

Medical professionals can continue to advocate for limiting or eliminating body checking to limit the risk of concussion in youth ice hockey leagues. More research is needed to decrease the risk for youth female ice hockey players.

Questions for Discussion

Do you talk with coaches about strategies to prevent concussions during practices?

Written by Jane McDevitt
Reviewed by Jeffrey Driban

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