Does disallowing body checking in non-elite 13- to 14-year-old ice hockey leagues reduce rates of injury and concussion? A cohort study in two Canadian provinces.

OBJECTIVE: To compare rates of injury and concussion among non-elite (lowest 60% by division of play) Bantam (ages 13-14 years) ice hockey leagues that disallow body checking to non-elite Bantam leagues that allow body checking. METHODS: In this 2-year cohort study, Bantam non-elite ice hockey players were recruited from leagues where policy allowed body checking in games (Calgary/Edmonton 2014-2015, Edmonton 2015-2016) and where policy disallowed body checking (Kelowna/Vancouver 2014-2015, Calgary 2015-2016). All ice hockey game-related injuries resulting in medical attention, inability to complete a session and/or time loss from hockey were identified using valid injury surveillance methodology. Any player suspected of having concussion was referred to a study physician for diagnosis and management. RESULTS: 49 body checking (608 players) and 33 non-body checking teams (396 players) participated. There were 129 injuries (incidence rate (IR)=7.98/1000 hours) and 54 concussions (IR=3.34/1000 hours) in the body checking teams in games. After policy change, there were 31 injuries (IR=3.66/1000 hours) and 17 concussions (IR=2.01/1000 hours) in games. Policy disallowing body checking was associated with a lower rate of all injury (adjusted incidence rate ratio (IRR)=0.44; 95% CI: 0.27 to 0.74). The point estimate showed a lower rate of concussion (adjusted IRR=0.6; 95% CI: 0.31 to 1.18), but this was not statistically significant. CONCLUSION: Policy change disallowing body checking in non-elite Bantam ice hockey resulted in a 56% lower rate of injury. There is growing evidence that disallowing body checking in youth ice hockey is associated with fewer injuries.

Changes in Player Activity Profiles After the 2015 FIH Rule Changes in Elite Women's Hockey.

McMahon, GE and Kennedy, RA. Changes in player activity profiles after the 2015 FIH rule changes in elite women's hockey. J Strength Cond Res 33(11): 3114-3122, 2019-The aim of this study was to compare the player activity profiles of elite international women's hockey players before (2014) and after (2015) the 2015 the International Hockey Federation (FIH) match rule changes at team and positional levels. The match activity profiles (n = 400) of 19 female hockey players (age 23 ± 4 years, mass 63.6 ± 5.5 kg, VO2max 57 ± 6 ml·kg·min in 2014, 58 ± 6 ml·kg·min in 2015) were recorded during competitive international matches in 2014 (match n = 12) and 2015 (match n = 13) using 10-Hz global positioning system units. The practical utility of an effect was only classified as substantial when there was a >75% likelihood that the ±90% confidence interval of the effect size (ES) was equal to or greater than the small (ES ± 0.2) reference value. Mean match time decreased by over 2 minutes from 71.72 ± 1.38 to 69.40 ± 4.72 minutes. There were increases at the team level in relative substitutions (SUB), relative distance (RD), high-speed running (HSR: 3.08-5.27 m·s), and surges (S), with a fall in low-speed running (LSR: 0-3.05 m·s) between 2014 and 2015. There were no changes in the between-position differences observed from 2014 to 2015. Within positions, there were relative increases in RD for all positions, HSR and S for midfield, and in SUB and S in forwards. The 2015 FIH rule changes seem to have increased the general intensity of international women's hockey. However, the different facets of physical performance did not change uniformly across team positions. Therefore, specific modifications to conditioning practices for each position may be warranted to more accurately reflect match demands.

The Effect of the "Zero Tolerance for Head Contact" Rule Change on the Risk of Concussions in Youth Ice Hockey Players.

BACKGROUND: Ice hockey is a popular winter sport in Canada. Concussions account for the greatest proportion of all injuries in youth ice hockey. In 2011, a policy change enforcing "zero tolerance for head contact" was implemented in all leagues in Canada. PURPOSE: To determine if the risk of game-related concussions and more severe concussions (ie, resulting in >10 days of time loss) and the mechanisms of a concussion differed for Pee Wee class (ages 11-12 years) and Bantam class (ages 13-14 years) players after the 2011 "zero tolerance for head contact" policy change compared with players in similar divisions before the policy change. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The retrospective cohort included Pee Wee (most elite 70%, 2007-2008; n = 891) and Bantam (most elite 30%, 2008-2009; n = 378) players before the rule change and Pee Wee (2011-2012; n = 588) and Bantam (2011-2012; n = 242) players in the same levels of play after the policy change. Suspected concussions were identified by a team designate and referred to a sport medicine physician for diagnosis. Incidence rate ratios (IRRs) were estimated based on multiple Poisson regression analysis, controlling for clustering by team and other important covariates and offset by game-exposure hours. Incidence rates based on the mechanisms of a concussion were estimated based on univariate Poisson regression analysis. RESULTS: The risk of game-related concussions increased after the head contact rule in Pee Wee (IRR, 1.85; 95% CI, 1.20-2.86) and Bantam (IRR, 2.48; 95% CI, 1.17-5.24) players. The risk of more severe concussions increased after the head contact rule in Pee Wee (IRR, 4.12; 95% CI, 2.00-8.50) and Bantam (IRR, 7.91; 95% CI, 3.13-19.94) players. The rates of concussions due to body checking and direct head contact increased after the rule change. CONCLUSION: The "zero tolerance for head contact" policy change did not reduce the risk of game-related concussions in Pee Wee or Bantam class ice hockey players. Increased concussion awareness and education after the policy change may have contributed to the increased risk of concussions found after the policy change.

The Incidence and Types of Physical Contact Associated with Body Checking Regulation Experience in 13-14 Year Old Ice Hockey Players.

BACKGROUND: Ice hockey has one of the highest sport participation and injury rates in youth in Canada. Body checking (BC) is the predominant mechanism of injury in leagues in which it is permitted. The objectives of this study were to determine whether the incidence and types of physical contact differ for Bantam players (aged 13-14 years) who were exposed to BC at Pee Wee level (aged 11-12 years) in Calgary, Alberta versus Bantam players who were not exposed to BC at Pee Wee level in Québec City, Québec. All teams were exposed to BC at bantam level; METHODS: A cohort study was conducted in Québec City and Calgary. Sixteen games for Calgary and 15 for Québec City were randomly selected and analysed with a validated observation system to quantify five intensities of physical contact and to observe different types of physical contact such as slashing and holding; RESULTS: A total of 5610 incidences of physical contact with the trunk and 3429 other types of physical contact were observed. Very light intensity trunk contact was more frequent in Calgary (adjusted incidence RR (ARR): 1.71; 95% CI: 1.28-2.29). Holding (ARR: 1.04; 95% CI: 1.02-1.07) and slashing (ARR: 1.38; 95% CI: 1.07-1.77) were more frequent in Calgary; CONCLUSION: RESULTS suggest that players' physical contacts differ between Bantam leagues in which BC was permitted at Pee Wee level and leagues in which it was not permitted until Bantam level.

Policy change eliminating body checking in non-elite ice hockey leads to a threefold reduction in injury and concussion risk in 11- and 12-year-old players.

BACKGROUND: In ice hockey, body checking is associated with an increased risk of injury. In 2011, provincial policy change disallowed body checking in non-elite Pee Wee (ages 11-12 years) leagues. OBJECTIVE: To compare the risk of injury and concussion between non-elite Pee Wee ice hockey players in leagues where body checking is permitted (2011-12 Alberta, Canada) and leagues where policy change disallowed body checking (2011-12 Ontario, Canada). METHOD: Non-elite Pee Wee players (lower 70%) from Alberta (n=590) and Ontario (n=281) and elite Pee Wee players (upper 30%) from Alberta (n=294) and Ontario (n=166) were recruited to participate in a cohort study. Baseline information, injury and exposure data was collected using validated injury surveillance. RESULTS: Based on multiple Poisson regression analyses (adjusted for clustering by team, exposure hours, year of play, history of injury/concussion, level of play, position and body checking attitude), the incidence rate ratio (IRR) associated with policy allowing body checking was 2.97 (95% CI 1.33 to 6.61) for all game injury and 2.83 (95% CI 1.09 to 7.31) for concussion. There were no differences between provinces in concussion [IRR=1.50 (95% CI 0.84 to 2.68)] or injury risk [IRR=1.22 (95% CI 0.69 to 2.16)] in elite levels of play where both provinces allowed body checking. CONCLUSIONS: The rate of injury and concussion were threefold greater in non-elite Pee Wee ice hockey players in leagues where body checking was permitted. The rate of injury and concussion did not differ between provinces in elite levels, where body checking was allowed.

Ice Hockey Summit II: zero tolerance for head hits and fighting.

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, (2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, (4) Updates in Equipment: Their Relationship to Industry Standards, and (5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: (1) eliminate head hits from all levels of ice hockey, (2) change body checking policies, and (3) eliminate fighting in all amateur and professional hockey.

The incidence of concussion in professional and collegiate ice hockey: are we making progress? A systematic review of the literature.

BACKGROUND: The fast, random nature and characteristics of ice hockey make injury prevention a challenge as high-velocity impacts with players, sticks and boards occur and may result in a variety of injuries, including concussion. METHODS: Five online databases (January 1970 and May 2012) were systematically searched followed by a manual search of retrieved papers. RESULTS: Seventeen studies met the inclusion criteria. The heterogeneous diagnostic procedures and criteria for concussion prevented a pooling of data. When comparing the injury data of European and North American or Canadian leagues, the latter show a higher percentage of concussions in relation to the overall number of injuries (2-7% compared with 5.3-18.6%). The incidence ranged from 0.2/1000 to 6.5/1000 game-hours, 0.72/1000 to 1.81/1000 athlete-exposures and was estimated at 0.1/1000 practice-hours. DISCUSSION AND CONCLUSIONS: The included studies indicate a high incidence of concussion in professional and collegiate ice hockey. Despite all efforts there is no conclusive evidence that rule changes or other measures lead to a decrease in the actual incidence of concussions over the last few decades. This review supports the need for standardisation of the diagnostic criteria and reporting protocols for concussion to allow interstudy comparisons in the future.