Ice Hockey Injuries

Ice hockey is one of the most popular team sports in many parts of the country. It is a fast-paced game that combines players of many sizes together on the rink with high skating speeds and fast, furious action.

Hockey is known as a hard-hitting, collision sport. Players risk injury from high-impact collisions with each other, the rigid boards that mark the boundary of the playing surface, and the goal posts. Impact with a skate blade, long sticks, and pucks traveling more than 100 MPH also add to the risk.

What causes most injuries?
Studies show that most hockey injuries occur during games rather than practices. It is estimated that direct trauma (a sudden forceful injury) accounts for 80% of all injuries. Most of these injuries are caused by player contact (checking and collision), falls, and contact with a puck, high stick, and occasionally, a skate blade.

The most common injuries
Lacerations (cuts) to the head, scalp, and face are the most frequent types of injury. However, the use of helmets and face shields has markedly reduced the incidence of injuries to the face and head.

Yet, there has been an increase in neck and spine injuries in the past decade. Some players may adopt a false sense of security, believing that they are not susceptible to injury when wearing protective equipment. Usually, however, that's when injuries occur-when you least expect them.

The knee is another frequently injured site, with sprains to the medial collateral and capsular ligaments being common (Fig. 1). Cruciate ligament tears are less common in hockey and seen more in turf sports, such as football and soccer.

Players can injure their shoulders as well. Acromioclavicular, or AC, joint separation (separated shoulder) is a common injury that occurs both with checking to the boards and falls onto the ice (Fig. 2).

Other arm injuries include shoulder dislocations, gamekeeper's thumb (tear of the ulnar collateral ligament) (Fig. 3), and fractures of the hand and wrist.

A unique aspect of hockey is that gloves normally protect the hands from injury, but when fighting occurs and the protective gloves are removed, the hands become exposed to injury. These injuries include fractures, torn tendons, or even bite wounds from striking an opposing player's teeth.

It has been estimated that as many as one-third of injuries are caused by foul play. Many have observed a need for increased vigilance in this area, particularly at the adolescent and high school levels. Establishment and enforcement of effective rules have lead to fewer injuries.

Education on the ice
Education regarding equipment usage, as well as teaching players to avoid the "head down" or "spearing" postures of the neck, should remind players that helmets do not make them invincible. And, as in any sport, proper coaching and effective training and conditioning can serve to further reduce injury.

Todd A. Schmidt, M.D.
Atlanta, Georgia