Body checking in non-elite adolescent ice hockey leagues: it is never too late for policy change aiming to protect the health of adolescents

Emery, Carolyn A.; Eliason, Paul; Warriyar, Vineetha; Palacios-Derflingher, Luz; Black, Amanda M.; Krolikowski, Maciek; Spencer, Nicole; Sick, Stacy; Kozak, Stacy; Schneider, Kathryn; Babul, Shelina; Mrázik, Martin; Lebrun, Constance M.; Goulet, Claude; Macpherson, Alison; Hagel, Brent

doi:10.1136/bjsports-2020-103757

Cited by 23 publications

(33 citation statements)

References 23 publications

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“…This suggests that greater bodychecking experience does not protect adolescent ice hockey players from injury or concussion, and that the policy change to disallow bodychecking had no unintended consequences with regard to injury in subsequent years. In addition to the strong evidence showing reduced rates of injury in evaluations of the policy change, 4 , 9 , 10 our results provide further evidence in support of removing bodychecking in youth ice hockey to prevent injury. Although the effect of bodychecking experience has not been previously explored among 15- to 17-year-old players, previous research among 13- and 14-year-old players found similar rates of injury and concussion among those who had 2 years of bodychecking experience and those who had none.…”

Section: Discussionsupporting

confidence: 66%

“… 5 – 8 These policy changes have been associated with reduced rates of injury, including concussion. 4 , 9 , 10 Despite this strong evidence, some argue that gaining experience in bodychecking earlier may protect players from injuries, including concussions, when they play in the older age categories where bodychecking is allowed. 11 A previous prospective cohort study of 13- and 14-year-old players found similar rates of overall injury and concussion among those with 2 years of experience with bodychecking and those with none.…”

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confidence: 99%

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Bodychecking experience and rates of injury among ice hockey players aged 15–17 years

Eliason

Hagel

Palacios-Derflingher

et al. 2022

CMAJ

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Background: Although high rates of injury occur in youth ice hockey, disagreements exist about the risks and benefits of permitting bodychecking. We sought to evaluate associations between experience with bodychecking and rates of injury and concussion among ice hockey players aged 15–17 years. Methods: We obtained data from a prospective cohort study of ice hockey players aged 15–17 years in Alberta who played in leagues that permitted bodychecking. We collected data over 3 seasons of play (2015/16–2017/18). We compared players based on experience with bodychecking (≤ 2 v. ≥ 3 yr), estimated using local and national bodychecking policy and region of play. We used validated methodology of ice hockey injury surveillance to identify all injuries related to ice hockey games and defined concussions according to the Consensus Statement on Concussion in Sport. Results: We included 941 players who contributed to 1168 player-seasons, with 205 players participating in more than 1 season. Compared with players with 2 years or less of bodychecking experience, those with 3 or more years of experience had higher rates of all injury (adjusted incidence rate ratio [IRR] 2.55, 95% confidence interval [CI] 1.57–4.14), injury with more than 7 days of time loss (adjusted IRR 2.65, 95% CI 1.50–4.68) and concussion (adjusted IRR 2.69, 95% CI 1.34–5.42). Interpretation: Among ice hockey players aged 15–17 years who participated in leagues permitting bodychecking, more experience with bodychecking did not protect against injury. This provides further support for removing bodychecking from youth ice hockey.

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Section: Discussionsupporting

confidence: 66%

mentioning

confidence: 99%

Bodychecking experience and rates of injury among ice hockey players aged 15–17 years

Eliason

Hagel

Palacios-Derflingher

et al. 2022

CMAJ

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“…In evaluation of these policy changes, disallowing body checking in games was associated with a 50% and 64% reduction in the rate of all injury and concussion in U-13 players, respectively 14. Reduced injury rates have also been found in the non-elite U-15 and U-18 (ages 15–17 years; formerly called Midget) age categories 15 16. It is critical, however, to inform national and regional ice hockey associations regarding a greater understanding of any unintended consequences of such policy change.…”

Section: Introductionmentioning

confidence: 99%

No association found between body checking experience and injury or concussion rates in adolescent ice hockey players

et al. 2022

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ObjectivesTo compare rates of injury and concussion among U-15 (ages 13–14 years) ice hockey players playing in leagues allowing body checking, but who have a varying number of years of body checking experience.MethodsThis 5-year longitudinal cohort included U-15 ice hockey players playing in leagues where policy allowed body checking. Years of body checking experience were classified based on national/local body checking policy. All ice hockey game-related injuries were identified using a validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician. Multiple multilevel Poisson regression analysis was performed, adjusting for important covariates and a random effect at a team level (offset by game exposure hours), to estimate injury and concussion incidence rate ratios (IRRs).ResultsIn total, 1647 players participated, contributing 1842 player-seasons (195 players participating in two seasons). Relative to no body checking experience, no significant differences were found in the adjusted IRRs for game-related injury for players with 1 year (IRR=1.06; 95% CI: 0.77 to 1.45) or 2+ years (IRR=1.16; 95% CI: 0.74 to 1.84) body checking experience. Similarly, no differences were found in the rates of concussion for players with 1 year (IRR=0.92; 95% CI: 0.59 to 1.42) or 2+ years (IRR=0.69; 95% CI: 0.38 to 1.25) body checking experience.ConclusionsAmong ice hockey players aged 13–14 years participating in leagues permitting body checking, the adjusted rates of all injury and concussion were not significantly different between those that had body checking experience and those that did not. Based on these findings, no association was found between body checking experience and rates of injury or concussion specifically in adolescent ice hockey.

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“…Many of these studies were valuable for injury prevention purposes because they provided evidence for the value of raising the permitted age for bodychecking to age 13–14-year-old players, 26 but none of these had long-term data for PCS due to bodychecking. Emery et al 27 studied 15–17-year-old hockey players in bodychecking versus non-bodychecking leagues in three cities in Canada and showed a much lower incidence of concussions in non-bodychecking cities, but there was no long-term follow-up recovery data.…”

Section: Discussionmentioning

confidence: 99%

Persisting Concussion Symptoms from Bodychecking: Unrecognized Toll in Boys’ Ice Hockey

Tator

Blanchet

2022

Can. J. Neurol. Sci.

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Objectives: Youth hockey is a high-impact sport and can cause concussions with lasting effects. We hypothesized that important injury prevention information would accrue from longitudinal tracking of concussed players with persisting concussion symptoms (PCS). Methods: This case series comprised 87 consecutive concussed ice hockey players aged 10–18 including 66 males and 21 females referred to our Concussion Clinic from 1997 to 2017 and followed longitudinally by clinic visits and questionnaires. Results: PCS occurred in 70 (80.4%) of 87 concussed players and lasted 1–168 months in males and 3–26 months in females. Bodychecking was the most common concussion mechanism in 34 (39.1%) players and caused PCS in 24 (70.6%) with symptom duration 4.00 [2.75, 14.50] months (median [IQR]). The remaining 53 players had other concussion mechanisms with PCS in 86.8% (p = 0.113) with similar duration (p = 0.848). Conclusions: This is the first longitudinal study of concussion with PCS in youth hockey and showed that symptoms can last for several years. Bodychecking was the commonest mechanism of prolonged disability from concussion in boys and girls’ hockey with average PCS duration of 12.3 months but several years in some players. The injury prevention message is to raise the age of permitted bodychecking to 18 in boys’ hockey from age 13 to 14 where it is currently. In this case series, this change could have prevented the majority of the bodycheck concussions and several years of suffering from PCS and is strong evidence for raising the permitted age for bodychecking in boys’ ice hockey to age 18.

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Body checking in non-elite adolescent ice hockey leagues: it is never too late for policy change aiming to protect the health of adolescents

Cited by 23 publications

References 23 publications

Bodychecking experience and rates of injury among ice hockey players aged 15–17 years

Bodychecking experience and rates of injury among ice hockey players aged 15–17 years

No association found between body checking experience and injury or concussion rates in adolescent ice hockey players

Persisting Concussion Symptoms from Bodychecking: Unrecognized Toll in Boys’ Ice Hockey

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